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. 2015 Sep;15(9):1017-1023.
doi: 10.1016/S1473-3099(15)00061-4. Epub 2015 Jun 23.

Effect of the Ebola-virus-disease Epidemic on Malaria Case Management in Guinea, 2014: A Cross-Sectional Survey of Health Facilities

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Free PMC article

Effect of the Ebola-virus-disease Epidemic on Malaria Case Management in Guinea, 2014: A Cross-Sectional Survey of Health Facilities

Mateusz M Plucinski et al. Lancet Infect Dis. .
Free PMC article

Abstract

Background: The ongoing west Africa Ebola-virus-disease epidemic has disrupted the entire health-care system in affected countries. Because of the overlap of symptoms of Ebola virus disease and malaria, the care delivery of malaria is particularly sensitive to the indirect effects of the current Ebola-virus-disease epidemic. We therefore characterise malaria case management in the context of the Ebola-virus-disease epidemic and document the effect of the Ebola-virus-disease epidemic on malaria case management.

Methods: We did a cross-sectional survey of public health facilities in Guinea in December, 2014. We selected the four prefectures most affected by Ebola virus disease and selected four randomly from prefectures without any reported cases of the disease. 60 health facilities were sampled in Ebola-affected and 60 in Ebola-unaffected prefectures. Study teams abstracted malaria case management indicators from registers for January to November for 2013 and 2014 and interviewed health-care workers. Nationwide weekly surveillance data for suspect malaria cases reported between 2011 and 2014 were analysed independently. Data for malaria indicators in 2014 were compared with previous years.

Findings: We noted substantial reductions in all-cause outpatient visits (by 23 103 [11%] of 214 899), cases of fever (by 20249 [15%] of 131 330), and patients treated with oral (by 22 655 [24%] of 94 785) and injectable (by 5219 [30%] of 17 684) antimalarial drugs in surveyed health facilities. In Ebola-affected prefectures, 73 of 98 interviewed community health workers were operational (74%, 95% CI 65-83) and 35 of 73 were actively treating malaria cases (48%, 36-60) compared with 106 of 112 (95%, 89-98) and 102 of 106 (96%, 91-99), respectively, in Ebola-unaffected prefectures. Nationwide, the Ebola-virus-disease epidemic was estimated to have resulted in 74 000 (71 000-77 000) fewer malaria cases seen at health facilities in 2014.

Interpretation: The reduction in the delivery of malaria care because of the Ebola-virus-disease epidemic threatens malaria control in Guinea. Untreated and inappropriately treated malaria cases lead to excess malaria mortality and more fever cases in the community, impeding the Ebola-virus-disease response.

Funding: Global Fund to Fight AIDS, Tuberculosis and Malaria, and President's Malaria Initiative.

Figures

Figure 1
Figure 1
Comparison of the total monthly number of all-cause outpatient visits (A), cases of fever (B), patients treated with oral antimalarial drugs (C), and patients treated with injectable antimalarial drugs for severe malaria (D) recorded in registers in selected health facilities in Guinea for January to November in 2013 and 2014
Figure 2
Figure 2
Suspect malaria cases per week for all prefectures in Guinea from January, 2011, to December, 2014 Dots represent the suspect malaria cases, reported through telephone-based weekly surveillance system, and the lines indicate the locally weighted scatterplot smoothing fit.

Comment in

  • Malaria kills more than Ebola virus disease.
    Pagnoni F, Bosman A. Pagnoni F, et al. Lancet Infect Dis. 2015 Sep;15(9):988-989. doi: 10.1016/S1473-3099(15)00075-4. Epub 2015 Jun 23. Lancet Infect Dis. 2015. PMID: 26116185 Free PMC article. No abstract available.

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