Guinea: up to 62% of malaria cases ‘overlooked during Ebola epidemic’

24 Jun

Rising numbers of malaria deaths in Guinea have “greatly exceeded” the total number of deaths caused by Ebola, a new report finds, which suggests that the Ebola epidemic may have led to 74,000 extra untreated cases of malaria in the country.

Around 74,000 fewer malaria cases than were expected were treated at Guinea’s health facilities in 2014 – a fall of 62%, in comparison with the years before the Ebola epidemic.

The report, published in The Lancet Infectious Diseases, is the first systematic analysis of the use of outpatient health care in a country affected by the Ebola epidemic.

The researchers conducted a cross-sectional survey of 60 public health facilities in the areas of Guinea most affected by Ebola. They found that around 74,000 fewer malaria cases than were expected were treated at Guinea’s health facilities in 2014 – a fall of 62%, in comparison with the years before the Ebola epidemic.

The consequence of this fall in treatment, write the authors, is that the number of deaths caused by malaria will exceed the total number of Ebola deaths. The number of deaths from malaria this year in Guinea was reported to be 2,444 as of June 14th, 2015.

The authors of the report say the main problem is that the early symptoms of malaria and Ebola are so similar – they both manifest in fever, headaches and body aches.

“Malaria is one of the main causes of fever and health facilities visits in Guinea,” explains lead author Dr. Mateusz Plucinski from the Centers for Disease Control and Prevention (CDC), “but our data suggest that since the start of the Ebola epidemic people with fevers have avoided clinics for fear of contracting Ebola or being sent to an Ebola treatment center.”

The report also reveals that outpatient visits among the surveyed health facilities fell by 11%, while outpatient attendance fell by 42% in the most Ebola-affected areas.

Decreases in malaria treatment correlated most strongly with third wave of Ebola epidemic

Before and after the Ebola crisis, the number of patients receiving oral drugs for malaria fell by 24%, with an accompanying drop of 30% for prescription of injectable malaria treatments.

Among the districts of Guinea most badly affected by the third wave of the epidemic in August 2014, decreases in malaria treatment were even greater. However, even districts that were unaffected by Ebola saw significant reductions in the number of patients who received treatments for malaria.

In terms of active health workers, before the Ebola epidemic hit Guinea, 98% of health workers in the country were actively working. However, this figure fell to just 74% after Ebola, with the percentage of health workers actively treating malaria cases falling to 48% after Ebola. By contrast, during the same period, there was an increase from 63% to 96% in health care workers treating malaria cases in Ebola-free districts of Guinea.

These regions unaffected by Ebola also saw an increase from 78% to 95% in the proportion of operational community health workers.

Dr. Plucinski comments:

“Untreated malaria cases lead to rising malaria death rates and more cases of fever in the community. This puts extra pressure on an already overburdened health system owing to a greater number of suspected Ebola cases requiring triage and isolation at treatment centers. Malaria control efforts and care delivery must be kept on track during an Ebola epidemic so that progress made in malaria control is not jeopardized and Ebola outbreak response is not impeded.”

In December 2014, Medical News Today reported on a warning from the World Health Organization (WHO) that the “fragile” gains in controlling malaria were in danger of being jeopardized in the response to the Ebola crisis.

Written by David McNamee