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In Guinea, the Ebola epidemic disrupted healthcare services, including those for malaria, which is highly endemic and accounts for >30% of visits to public health facilities. To document the epidemic's effect on malaria case management in that country, investigators conducted cross-sectional surveys, interviews, and analysis of malaria indicators for 2011 through 2014, sampling 60 health facilities in Ebola-affected and 60 in Ebola-unaffected prefectures.
In 2014, all-cause outpatient visits, cases of fever, and patients treated for malaria (oral and injectable drugs) were all decreased compared with 2013. The reductions, which were greatest for malaria patients treated with injectable drugs, coincided with the Ebola epidemic and also involved Ebola-unaffected areas. Sixty-nine percent of healthcare workers in Ebola-unaffected areas reported decreased attendance at health facilities vs. 97% in Ebola-affected areas. Explanations included fears of healthcare workers, of contracting Ebola during care, and of being sent to an Ebola treatment center. In Ebola-affected prefectures, 30% of healthcare workers reported using malaria rapid diagnostic tests compared with 70% earlier. Presumptive treatment with artemisinin-based combination therapy rose slightly — to 11% from 9%. Based on historical reports, an estimated 74,000 suspected malaria cases in Guinea went untreated in 2014; excess malaria deaths likely exceeded those from Ebola virus during this period.
Plucinski MM et al. Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: A cross-sectional survey of health facilities. Lancet Infect Dis 2015 Jun 23; [e-pub]. (http://dx.doi.org/10.1016/S1473-3099(15)00061-4)
Pagnoni F and Bosman A.Malaria kills more than Ebola virus disease. Lancet Infect Dis 2015 Jun 23; [e-pub]. (http://dx.doi.org/10.1016/S1473-3099(15)00075-4)
Comment
This report describes consequences of the Ebola epidemic on management of one disease: malaria. Other consequences include interruption of immunization and maternal and child health delivery services. The authors and editorialists note that untreated malaria can result in fever episodes that are managed as suspected Ebola virus disease. WHO guidelines for malaria prevention and control in Ebola-affected regions (e.g., mass treatment for malaria to reduce the number of febrile patients), issued in November 2014, were adopted in Guinea the following month — after completion of this study. The effects of the Ebola epidemic cannot be measured by Ebola deaths alone.