Date Published: February 28, 2018
Publisher: Public Library of Science
Author(s): Delphin Kolie, Bienvenu S. Camara, Alexandre Delamou, Abdoul H. Béavogui, Veerle Hermans, Jeffrey K. Edwards, Guido Benedetti, Claude P. Muller, Johan van Griensven, Rony Zachariah, Luzia Helena Carvalho.
The 2014–15 Ebola outbreak in West Africa was disruptive for the general health services in the affected countries. This study assessed the impact of the outbreak on the reported number and management of malaria in children under-five in rural Guinea.
A retrospective cross-sectional study was conducted in nineteen health centres in two rural, malaria-endemic health districts, one at the epicentre of the outbreak (Guéckédou) and one (Koubia) spared by Ebola. Routine surveillance data at health facility level were compared over similar periods of high malaria transmission in both districts before, during and after the outbreak.
There were significant declines in the number of visits during the Ebola outbreak (3,700) in Guéckédou compared to before (4,616) and after it (4,195), while this trend remained more stable within the three periods for Koubia. Differences were nonetheless significant in both districts (p<0.001). In 2014, during the peak of the outbreak, the overall number of malaria cases treated exceeded the number of confirmed malaria cases in Guéckédou. There were decreases in antimalarial treatment provision in August and November 2014. In contrast, during 2015 and 2016, the proportion of malaria positive cases and those treated were closely aligned. During the peak of the Ebola outbreak, there was a significant decrease in oral antimalarial drug administration, which corresponded to an increase in injectable antimalarial treatments. Stock-outs in rapid diagnostic tests were evident and prolonged in Guéckédou during the outbreak, while more limited in Koubia. The Ebola outbreak of 2014–15 in Guinea had a significant impact on the admission and management of malaria in children under-five. This study identifies potential challenges in the delivery of care for those at highest risk for malaria mortality during an Ebola outbreak and the need to improve preparedness strategies pre-Ebola and health systems recovery post-Ebola.
Children in Africa are frequently exposed to malaria, with one child dying of malaria every two minutes. In 2015, the African continent carried 66% (292,000/438,000) of the global under-five malaria-attributable deaths. In 2014, Guinea, a country with a high malaria burden, was at the epicentre of the West-African Ebola outbreak, which lasted until 2015 and was declared an international public health emergency [1–3]. The sustained nature of the Ebola outbreak jeopardized the health system in Guinea and its neighbouring afflicted countries, Sierra-Leone and Liberia. In these countries, many health facilities were shut down due to the lack of protective measures for health workers, Ebola-related death of health workers and the overall fear of contracting Ebola. Declines in maternal, paediatric and malaria related consultations and attrition from HIV/AIDS care have been reported in Guinea and Sierra Leone [4–10].
The monthly trends of visits and malaria suspect cases among under-five children at the health centres of Guéckédou and Koubia are shown in Fig 1(A). There were significant declines in the number of visits during the Ebola outbreak in Guéckédou compared to before and after it, while this trend remained more stable within the three periods for Koubia. The reported monthly median number of visits in Guéckédou was 4,616 before the outbreak (2013), then had the greatest decline in patient visits during September-November 2014 with a median number of visits of 3,298 per month (a median number of visits of 3,700 per month in 2014). Afterwards, there was a progressive increase in the number of visits in reaching a peak of 5,317 in November 2016 (a median number of visits of 4,195 per month in 2016). There were significant differences in the proportions of malaria suspect cases among under-five children attending the health centres across the study period, see Table 1, p<0.001. To our knowledge, this is the first study to describe and compare malaria burden and case management in children under-five, between an Ebola affected and non-affected district, in Guinea before, during and after the Ebola outbreak of 2014–15. Our findings show that in the Ebola-affected district of Guéckédou, there was a decrease in total clinical visits, malaria testing, reported malaria cases and increase in unconfirmed malaria case treatment during the Ebola outbreak. Additionally, there were more frequent RDT supply stock-outs. In contrast, there was a limited decline in under-five related health services attendance and stock-outs in the Ebola non-affected district (Koubia). The Ebola outbreak of 2014–15 in Guinea likely had a significant impact on the diagnosis and management of malaria in children under-five. Total clinical visits and reported malaria confirmed cases were decreased in an Ebola-affected health district when compared to a non-affected. This study identifies potential challenges in the delivery of care for those at highest risk for malaria mortality during an Ebola outbreak and the need to improve preparedness strategies going forward. Source: http://doi.org/10.1371/journal.pone.0192798