Annual report of the Department of Public Health / Union of South Africa.

  • South Africa. Department of Health.
Date:
[1944]
Catalogue details

Licence: Public Domain Mark

Credit: Annual report of the Department of Public Health / Union of South Africa. Source: Wellcome Collection.

    12/26 (page 10)
    Additional quinine runners were appointed and over a million tablets of quinine were diverted to the epidemic area for the use of both Europeans and Natives. Supplies of the drug were made readily avail¬ able at suitable points throughout the area. The small staff and short¬ age of equipment made it impossible to control Anopheles gambiae breeding over this vast terrain. In addition to the Natives in the reserves the Europeans and their Native farm labourers also suffered heavily. The death rate is impossible to assess with any degree of accuracy but from such information as is available it appears to have been low. It seems that many of the deaths which did occur were unnecessary as they were due to Native prejudice against proper medical treatment rather than to any lack of availability of quinine. In the other malaria areas the incidence of the disease was no greater than that which occurs in a normal season in spite of the fact that flooded areas close to the rivers provided ideal breeding grounds for Anopheles gambiae. As in the past the local authorities in the Transvaal malaria areas have employed staff trained by the Department and their results in the control of malaria have been very satisfactory. The control of the disease on the Letaba Citrus Estates, which are situated in a highly endemic malarious area, has again been very successful. During each of the last eight years classes of instruction have been held for various groups at the Department’s Malaria Research Station at Tzaneen or at other suitable points in the malarious- areas of the Transvaal. These classes have provided instruction for doctors taking post-graduate courses for the Diploma in Public Health and the Diploma in Tropical Medicine and Hygiene of the Witwatersrand University, for health inspectors, European teachers and nurses, railway health fore men and, the largest group of all, Native school teachers. The total number of persons who have attended these classss is 823, made up as follows :— Doctors attending Diploma in Public Health or Diploma in Tropical Medicine and Hygiene course —. 45 Health inspectors attending tropical hygiene course. 40 European school teachers’, nurses’ and health inspectors’ course. 233 Railway health foremen’s course. 55 Native school teachers’ course. 450 823 During the year under review five such courses were held for different groups of Europeans ahd three for Native school teachers. Most of these courses extended over a full working week. The teaching is of great importance as it enables knowledge of the disease jfo be spread throughout the malarious districts. Teachers, both European and Native, are able to impart knowledge of the prevention and control of the disease to thousands of children living in our malarious areas while the more technical knowledge acquired by doctors, nurses, health inspectors and health foremen is very valuable. Propaganda among the general public is carried out by the showing of the Department’s malaria film. This, however is unfortunately only possible in urban areas where projectors are available as the necessary equipment for showing the film in the rural areas is lacking. Natal and Zululand. Climatic conditions during the year under review were generally favourable for the control of malaria. The incidence of the disease was comparatively low and was restricted to isolated cases, the majority of which occurred in the coastal and inland valleys of Northern Zululand. The difficulty of obtaining mosquito gauze suitable for coastal con¬ ditions and the scarcity of suitable types of insecticide spray pumps are becoming more pronounced. These factors unfortunately provided convenient excuses for the less conscientious, where cases occurred as a result of obvious ineffective application of control measures. The most seriously affected Area in this respect was the Umfolosi flats, where, on account of local conditions, malaria control largely depends on effective mosquitoproofing and systematic insecticidal spraying of dwellings. The highest incidence of malaria in the Native areas was in the Nongoma district. This is attributed to two factors, firstly the numerous Natives returning to this district from inland farms, and secondly the employment of susceptible Natives from the bighveld on game destruc¬ tion in connection with the prevention of ngana in the malarious valleys in the eatern parts of the district. The influx of susceptible Natives from farms to the Northern Zululand reserves, particularly in Nongoma and Mahlabatini districts, during the last few years, has greatly increased the difficulty of control. The healthy fever-free sections of these districts are already over-crowded, with the result that new-comers are obliged to settle in the less populous malarious sections. Control of malaria in the Native areas would be simplified by the grouping of kraals on selected and relatively healthy sites, a policy which has been recommended in respect of those Natives obliged to return from farms to the Native areas. The system of control in European and Native areas of this Province has remained practically the same during the past ten years and may be summarised as follows :— (i) Close observation over all known or potential vector breeding places throughout the year. (ii) Anti-larval control of all breeding places by weekly application of oil during the malaria season, spring to autumn, and fort¬ nightly application of oil during the winter months. (iii) Systematic spraying of dwellings from once to thrice weekly depending on adult infestation and ability to exercise effective anti-larval control. (iv) Early diagnosis by blood slide, if possible, of all suspected cases and immediate eradication of mosquitoes from dwellings in which infection has been contracted. (v) The elimination of permanent breeding grounds where possible by drainage, fencing, or planting with eucalyptus trees as a means of lowering the water table. Uniformity and co-ordination of control in contiguous local authority and malaria committee areas comprising the organisation is effectec through the departmental inspectors. The low incidence of malaria over the past few years is conducive to apathy in some quarters and tc counteract this tendency and maintain the efficiency of the organisation is the Department’s primary concern. While the publication of weekly bulletins and the circularising to all units of lists showing the localities from which vectors have been identified serves a useful purpose, persona contact between the Department and malaria committees is essential The harmonious functioning of the control organisation is in no smali measure due to these personal contacts and the opportunity which they afford to discuss difficulties which arise from time to time. Control of pyrethrum. In October, 1943, the control of pyrethrum products was delegated to this Department under the Deputy Chief Health Officer in Durban. In view of the fact that the campaign against adult malaria-carrying mosquitoes depended almost entirely on adequate supplies of pyrethrum being available in the malarious areas of the Union, it was decided tc restrict supplies of pyrethrum products to such areas. Supplies were issued on permit to magistrates and local authorities and to dealers in the northern Transvaal, South-West Africa, Zululand and the coastal areas of Natal. Dealers were required to give an undertaking to the controller that the stocks of pyrethrum supplied to them would be used solely foa combating malaria. As a result of this system adequate supplies of pyrethrum products were ensured in all malarious areas. Extract from Annual Report of Deputy Chief Health Officer {Railways). “ Malaria control continued to be one of the major undertakings on the Natal, Eastern Transvaal and South West Africa Systems and for this reason took precedence over other health activities during the summer months . . . Seasonal Measures. (i) Transvaal.—Early spring rains, together with favourable climatic conditions, favoured the breeding of malarial vectors. During Decem¬ ber it was necessary to intensify control measures . . . This contributed materially towards minimising malaria incidence . . . (ii) Natal.—Good results were again obtained in this province, prima¬ rily due to the close network of organisations which exist in the control belt, in contrast with the Transvaal, where, due to the small population in relation to the vast territory, it is possible to control only'small areas. Climatic conditions generally did not favour the propagation of the malarial mosquito. North of Empangeni, however, particularly at Hluhluwe, Heatonville, Eteza and Candover, breeding due to favourable meteorological conditions, was very active, and this necessitated the intensification of control measures . . . Train find Bus Spraying.—This aspect again received very close attention. As in the past, all passenger trains operating in or through malarious areas were regularly sprayed either by bedding staff or Health staff . . . The spraying of Road Motor buses was also given close attention by the drivers of the vehicles. Essential Services Protection Corps Posts.—The Administration again undertook anti-malaria work on behalf of the Defence Department at the various Essential Services Protection Corps posts, between Waterval Boven and Komatipoort. The cost was borne by the Defence Depart¬ ment. The results obtained were satisfactory. Co-operative Measures.—Close co-operation with other Government departments, local authorities, malaria committees and private bodies, both in the Union and in South West Africa, as mentioned in previous reports, was maintained with good results. Excellent co-operation exists between the Administration and the Union Health Department. That Department has contributed largely towards the success, of the Administration’s anti-malaria measures . . .” 9. Plague. The majority of outbreaks of plague occurred in the major hyperen¬ demic areas, viz. in the northern Orange Free State, in the Glen Grey and St. Marks districts on the Transkei border and in the Uitenhage district near Port Elizabeth. In all twenty seven outbreaks were reported with 62 cases and 39 deaths. Thirteen outbreaks took place in the Kopjes area of the Vredefort district in the northern Orange Free State. Plague had a firm hold in the domestic rodents over an area of about one hundred square miles to the north of Kopjes. Farmers within the area collaborated in a drive to stamp out rodents systematically. The Department lent out cyanogas pumps and issued cyanogas dust at cost to successive groups of farmers throughout the area and super¬ vised gassing operations. The response was excellent; farmers are now regularly gassing their premises and considerable progress in ratproofing farm buildings is being made. A similar drive was organised in the Passie area on the Kroonstad-Bothaville border where domestic rodents were dying of plague over a wide area. There were no human cases. The localised epizootics of plague in gerbilles discovered in July 1943 on the farm Zuurbekom, 17 miles to the southwest of Johannesburg and on the boundaries of Johannesburg, Alberton and Germiston came to an end in September without much further spread partly as a result of a natural decline but mainly as a result of the intensive anti-rodent measures put into operation not only in the infected areas but throughout the length of the Reef. All local authorities, together with the rodent staff of the South African Railways and Harbours and this Department co-operated in a comprehensive drive against gerbilles and domestic rodents which was relaxed in most areas only six months after no further infection was found. The routine examination of domestic rats from Johannesburg and othei areas by the pooled bone marrow technique revealed the presence of virulent P. pestis in apparently healthy rats in July 1943 and June 1944 within the Johannesburg municipal area but no evidence of an epizootic even on a small scale could be discovered. No satisfactory explanation of this occurrence can yet be given.