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A microscopic image of the malaria-carrying Anopheles
mosquito. Photograph: Tim Flach/Getty Images
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Experts say urgent action is needed to treat people with
symptoms of deadly disease who have avoided visiting health clinics during
epidemic.
Tens of thousands of
malaria cases went untreated in Guinea last year as people
with symptoms shunned health clinics for fear of being sent into isolation at
Ebola treatment centres, according to authoritative research.
A major paper from
infectious diseases experts said 74,000 fewer people were diagnosed and offered
malaria treatment than would have been expected. The research was based on a
survey of public health facilities in December 2014 and interviews with
healthcare workers.
The Guardian UK reports:
The paper says far more
people will have died from malaria in 2014 than Ebola, which had killed
2,444 people by 15 June of this year.
Urgent action was
required to get malaria treatment to those who needed it, say the paper’s
authors from the Centers for Disease Control and Prevention, Atlanta, and the
President’s Malaria Initiative in the Lancet’s
Infectious Diseases journal.
“The two major avenues for
delivering life-saving medicine to patients with malaria – public health
facilities and community health workers – have been substantially compromised
by the Ebola virus-disease epidemic,” they write. “Efforts to reinforce malaria
care delivery in Guinea should be focused on reconnecting healthcare workers
and health facilities with the communities they serve and whose trust they need
to regain.”
In the areas of Guinea
hit worst by Ebola, the numbers of people seeking treatment at outpatient
clinics dropped by up to 42% and the numbers seeking care for suspected malaria
were down by 69%, according to the first systematic survey from one of the
three countries affected by the epidemic.
Fewer oral malaria drugs
were given (down 24%) and fewer injectables (down 30%) than the previous year.
In districts affected by Ebola the numbers of community health workers actively
working also dropped from 98% before Ebola to 74%, while those treating malaria
dropped to less than half (48%).
“One problem is that the early symptoms of
malaria (fever, headache, and body aches) mimic those of Ebola virus disease,”
said the lead author, Dr Mateusz Plucinski. “Malaria is one of the main causes
of fever and health facilities visits in Guinea, 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 centre.”
But, he added, untreated
malaria cases will have led to more malaria in the villages and increased the
numbers eventually arriving at clinics with fever who could be suffering from
either malaria or Ebola. “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 centres. 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,” he said.
New guidelines from the
World Health Organization recommend giving malaria drugs to everyone with a
fever during an Ebola outbreak and handing out drugs that families can take to
stave off a bout of the disease. Dr Franco Pagnoni, of the WHO, says in a
comment piece in the journal that while this will help, it is important to
return to business as usual.
“To restore the credibility
of health service delivery in the population, it is important that
Ebola-virus-disease-specific activities in the communities, such as contract
tracing and safe burials, are accompanied by the delivery of standard health
services, such as distribution of long-lasting impregnated nets, vaccination,
or community case management of child diseases with specific no-touch
approaches appropriate to the context of the epidemic,” he writes.
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