Abstract
BackgroundThe COVID-19 pandemic has resulted in unprecedented challenges to health systems worldwide, including the control of non-COVID-19 diseases. Malaria cases and deaths may increase due to the direct and indirect effects of the pandemic in malaria-endemic countries, particularly in sub-Saharan Africa (SSA). This scoping review aims to summarize information on public health-relevant effects of the COVID-19 pandemic on the malaria situation in SSA.MethodsReview of publications and manuscripts on preprint servers, in peer-reviewed journals and in grey literature documents from 1 December, 2019 to 9 June, 2021. A structured search was conducted on different databases using predefined eligibility criteria for the selection of articles.ResultsA total of 51 papers have been included in the analysis. Modelling papers have predicted a significant increase in malaria cases and malaria deaths in SSA due to the effects of the COVID-19 pandemic. Many papers provided potential explanations for expected COVID-19 effects on the malaria burden; these ranged from relevant diagnostical and clinical aspects to reduced access to health care services, impaired availability of curative and preventive commodities and medications, and effects on malaria prevention campaigns. Compared to previous years, fewer country reports provided data on the actual number of malaria cases and deaths in 2020, with mixed results. While highly endemic countries reported evidence of decreased malaria cases in health facilities, low endemic countries reported overall higher numbers of malaria cases and deaths in 2020.ConclusionsThe findings from this review provide evidence for a significant but diverse impact of the COVID-19 pandemic on malaria in SSA. There is the need to further investigate the public health consequences of the COVID-19 pandemic on the malaria burden.Protocol registered on Open Science Framework: https://doi.org/10.17605/OSF.IO/STQ9D
Highlights
The COVID-19 pandemic has resulted in unprecedented challenges to health systems worldwide, including the control of non-COVID-19 diseases
Considering primarily a reduced access to effective anti-malarial treatment and reduced insecticide-treated mosquito net (ITN) distribution, Weiss et al predicted in their worst-case scenario (75% fewer anti-malarial drugs and ITNs) and for the year 2020 that in sub-Saharan Africa (SSA) countries, malaria cases would increase by 22% and malaria deaths by 99%; the lower access to anti-malarial treatment had a larger effect than reduced ITN distribution [21]
These estimates mirror those by the World Health Organization (WHO), but the authors described the effects of nine different scenarios compared to the effects of three scenarios by Weiss et al [22]
Summary
The COVID-19 pandemic has resulted in unprecedented challenges to health systems worldwide, including the control of non-COVID-19 diseases. By 14 June, 2021, there were some 3.6 million COVID-19 cases and 89,000 deaths reported from the entire continent, and most of these were from its northern and southern regions [8, 9] Potential explanations for such a situation are incomplete data due to much lower testing capacities, a significantly younger population, overall lower population mobility, crossreactive immunity or immunomodulation due to high prevalence of other infectious agents, and effects of public health responses [5, 7, 10]. First findings from SARSCoV-2 seroprevalence surveys support the evidence for significant under-reporting and for a predominance of asymptomatic and mild cases [11, 12] It appears that the second epidemic wave has hit the African continent more severely than the first one, possibly explained by the emergence of more transmissible SARSCoV-2 variants [7, 13]
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