Dr Dina Coertzen

Limpopo, South Africa | Malaria disproportionately burdens sub-Saharan Africa. The region contributes up to 97% of the global 154 million malaria cases, 95% of these being reported in the most vulnerable of populations, children under the age of 5 and pregnant women. In June 2024, the World Economic Forum published a report stating that if current antimalarial elimination goals, set at reducing malaria by 90% by 2030, are reached, Africa's annual GDP would increase by $126 billion.

Despite decades of malaria control strategies, progress towards malaria elimination and eradication targets has reversed. This setback is due to a resurgence in malaria transmission, as evidenced by a reported increase of 5 million cases, from 149 million in 2022 to 154 million in 2023. This creates an immense need for community-based malaria transmission surveillance to enhance our understanding of malaria transmission dynamics and to develop novel antimalarial therapies that block the continuous onward transmission of the parasite responsible for causing malaria. This directly contributes towards malaria elimination strategies. However, to bridge the gap between science and societal needs, transdisciplinary partnerships and research approaches need to be established.

To successfully implement novel transmission-blocking strategies, she says we must first be able to survey and understand the dynamics of parasite transmission within endemic communities. Malaria parasites, of which Plasmodium falciparum is the most lethal and prevalent in sub-Saharan Africa, are transmitted between humans by Anopheles mosquitoes. Rapid asexual parasite proliferation cycles in red blood cells lead to disease pathology. Current antimalarial therapeutics target these. However, to ensure their continuous transmission through subsequent mosquito blood meals, a subset of asexual parasites phenotypically differentiates into sexual, non-replicative and non-pathogenic gametocyte forms. Gametocytes can persist in the human circulatory system at submicroscopic levels for up to 14 days after antimalarial drug treatment and for up to 55 days in untreated individuals. Currently, antimalarial treatment strategies do not target gametocytes.

South Africa contributes less than 10% of sub-Saharan Africa's malaria cases. The rural Vhembe district in Limpopo province remains one of the country's last transmission hotspots. Despite bordering high-transmission countries, Mozambique and Zimbabwe, investigations into the genetic diversity within this circulating parasite reservoir showed that endemic cases are mediated through local rather than cross-border transmitted parasite populations. The lack of efficient and robust gametocyte detection and surveillance techniques hampers malaria elimination efforts, particularly in pre-elimination, low-transmission settings, such as South Africa.

Detection of gametocyte prevalence will inform transmission dynamics within this setting, guiding the implementation of policies and strategies to prevent disease transmission. Dr Coertzen aims to develop a sensitive yet robust gametocyte detection protocol that can be used to monitor gametocyte populations in febrile and non-febrile patients in malaria-endemic communities. Furthermore, data collection from a low-transmission setting will establish a geospatial representation of the transmissible gametocyte reservoirs endemic to the malaria-endemic Vhembe district.

The overall goal is to contribute to the implementation of sustainable and effective malaria control and elimination strategies. Completing this project will lead to the establishment of a collaborative transdisciplinary research excellence platform between researchers within the UP Institute for Sustainable Malaria Control (ISMC). Dr Coertzen aims to translate her findings and informed strategies to the international research community and key stakeholders in the global arena, guiding policy implementation in other malaria-endemic countries.

Dr Dina Coertzen is a lecturer in the Department of Biochemistry, Genetics, Faculty of Natural and Agricultural Sciences at the University of Pretoria (UP), South Africa. She obtained her PhD in Biochemistry at UP, which was upgraded from an MSc. She utilises her expertise in malaria parasite biology to inform structural and phenotypic-based approaches to antimalarial drug discovery, with a particular interest in blocking malaria transmission. In her current position, she forms part of the flagship transdisciplinary malaria research institute, UP Institute for Sustainable Malaria Control, where she aims to develop a novel technique to detect and survey the transmissible forms of malaria parasites. She has obtained independent national and international (Medicines for Malaria Venture grand challenges) funding. She has authored and co-authored 26 original research publications in leading international journals within her field, as well as given 40 presentations at national and international conferences, including 15 plenary talks and four invited talks.