Abstract
SummaryBackgroundThe ongoing Ebola epidemic in parts of west Africa largely overwhelmed health-care systems in 2014, making adequate care for malaria impossible and threatening the gains in malaria control achieved over the past decade. We quantified this additional indirect burden of Ebola virus disease.MethodsWe estimated the number of cases and deaths from malaria in Guinea, Liberia, and Sierra Leone from Demographic and Health Surveys data for malaria prevalence and coverage of malaria interventions before the Ebola outbreak. We then removed the effect of treatment and hospital care to estimate additional cases and deaths from malaria caused by reduced health-care capacity and potential disruption of delivery of insecticide-treated bednets. We modelled the potential effect of emergency mass drug administration in affected areas on malaria cases and health-care demand.FindingsIf malaria care ceased as a result of the Ebola epidemic, untreated cases of malaria would have increased by 45% (95% credible interval 43–49) in Guinea, 88% (83–93) in Sierra Leone, and 140% (135–147) in Liberia in 2014. This increase is equivalent to 3·5 million (95% credible interval 2·6 million to 4·9 million) additional untreated cases, with 10 900 (5700–21 400) additional malaria-attributable deaths. Mass drug administration and distribution of insecticide-treated bednets timed to coincide with the 2015 malaria transmission season could largely mitigate the effect of Ebola virus disease on malaria.InterpretationThese findings suggest that untreated malaria cases as a result of reduced health-care capacity probably contributed substantially to the morbidity caused by the Ebola crisis. Mass drug administration can be an effective means to mitigate this burden and reduce the number of non-Ebola fever cases within health systems.FundingUK Medical Research Council, UK Department for International Development, Bill & Melinda Gates Foundation.
Highlights
Since the Ebola outbreak in Guinea was first reported to WHO on March 23, 2014, the virus has spread to nine countries, leading to 25 826 cases and 10 704 deaths by April 12, 2015.1 Sustained transmission of the virus is occurring in three countries in west Africa: Guinea, Liberia, and Sierra Leone.2 The high case fatality ratio of the disease, coupled with high transmission to health-care professionals and low specificity of early symptoms of Ebola virus disease, has placed extraordinary strain on health systems in these countries
Interpretation—These findings suggest that untreated malaria cases as a result of reduced health-care capacity probably contributed substantially to the morbidity caused by the Ebola crisis
With the exception of some urban centres such as Conakry in Guinea, malaria is hyperendemic in almost all areas where Ebola virus transmission is sustained, with population-based estimates of parasite prevalence in children younger than 5 years of 43·9% in Guinea, 27·8% in Liberia, and 42·9% in Sierra Leone
Summary
Since the Ebola outbreak in Guinea was first reported to WHO on March 23, 2014, the virus has spread to nine countries, leading to 25 826 cases and 10 704 deaths by April 12, 2015.1 Sustained transmission of the virus is occurring in three countries in west Africa: Guinea, Liberia, and Sierra Leone. The high case fatality ratio of the disease, coupled with high transmission to health-care professionals and low specificity of early symptoms of Ebola virus disease, has placed extraordinary strain on health systems in these countries. Since the Ebola outbreak in Guinea was first reported to WHO on March 23, 2014, the virus has spread to nine countries, leading to 25 826 cases and 10 704 deaths by April 12, 2015.1 Sustained transmission of the virus is occurring in three countries in west Africa: Guinea, Liberia, and Sierra Leone.. The high case fatality ratio of the disease, coupled with high transmission to health-care professionals and low specificity of early symptoms of Ebola virus disease, has placed extraordinary strain on health systems in these countries. Few patients have access to health-care facilities, with many facilities closed. In those still open, fear of the disease has decreased outpatient attendance to as low as 10%.3. The near cessation of malaria control could lead to a resurgence in malaria cases and deaths, reversing progress made over the past decade. An increase in malaria prevalence will increase the number of people who have fever-like symptoms, further complicating the identification and treatment of people with Ebola virus disease
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