Abstract
This study aimed to measure the effects of Ebola outbreak on antenatal care attendance and malaria management in pregnant women in Guinea. A retrospective cross-sectional study was conducted in two rural malaria-endemic health districts: on the epicentre of the West African Ebola outbreak (Guéckédou) and the other spared by Ebola (Koubia). Data were compared over similar periods of high malaria transmission before, during and after the Ebola outbreak. There were substantial declines in antenatal care visits in Guéckédou, from a monthly average number of 7,208 before the outbreak to 3,151 (57% decrease) during and 2,843 visits (61% decrease) after it while this indicator increased across the same periods in Koubia. In Guéckédou, the number of SP first doses provided dropped from 2,566 before the outbreak to 1,263 (51% decrease) during and 1,010 (61% decrease) after the Ebola outbreak (P < 0.001) while in Koubia, the decline was by 13% and 24% during and after the outbreak from an average number of 499 doses before it (P < 0.001). Fever cases increased by 43% and 38% during and after the outbreak respectively in Guéckédou and by 28% during and 11% after the outbreak in Koubia. Untreated malaria cases represented 11% and 12% of confirmed malaria cases during and after the outbreak respectively compared to 3% before it in Guéckédou, while in Koubia no untreated case was seen across these periods. There is need to uphold malaria services during future outbreaks.
Highlights
Malaria is among the five top killers in Africa where it claimed nearly 105,574 lives in 2016 [1, 2]
Study variables were extracted from the monthly malaria reports at district level; they included the numbers of: antenatal care (ANC) visits, doses of intermittent preventive treatment (IPT), fever cases, suspected malaria cases, cases tested for malaria and outcomes, malaria cases treated
We found significant declines in ANC visits and the use of IPT in pregnant women in the Ebola affected district (Guéckédou) compared to the unaffected one (Koubia)
Summary
Malaria is among the five top killers in Africa where it claimed nearly 105,574 lives in 2016 [1, 2]. Its management in pregnant women has been a national health priority [4]. The World Health Organization (WHO) guideline recommends, for pregnant women, the use of Sulfadoxine-pyrimethamine (SP) as an intermittent preventive treatment (IPT) provided during antenatal care (ANC) visits [5]. In case of uncomplicated malaria in the second and third trimester, Artemisinin-based combination therapy (ACT) is recommended, while quinine is given at any gestational age for severe malaria [5]. Health indicators in 2012 showed a need for further efforts in prevention and management of malaria among pregnant women in Guinea. In 2013, a new national malaria control strategy recommended the administration of 3 to 4 doses of SP as IPT instead of 2 doses [6]. Access to malaria health services and long-lasting insecticidal nets (LLINs) were improved through the training and deployment of community health workers (CHWs) in remote areas [6]
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