Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities

Summary Background The ongoing west Africa Ebola-virus-disease epidemic has disrupted the entire health-care system in affected countries. Because of the overlap of symptoms of Ebola virusdisease and malaria, the care delivery of malariais particularly sensitive to the indirect effects of the current Ebola-virus-disease epidemic. We therefore characterise malariacase management in the context of the Ebola-virus-disease epidemic and document the effect of the Ebola-virus-disease epidemic on malariacase management. Methods We did a cross-sectional survey of public health facilitiesin Guinea in December, 2014. We selected the four prefectures most affected by Ebola virusdisease and selected four randomly from prefectures without any reported cases of the disease. 60 health facilitieswere sampled in Ebola-affected and 60 in Ebola-unaffected prefectures. Study teams abstracted malariacase management indicators from registers for January to November for 2013 and 2014 and interviewed health-care workers. Nationwide weekly surveillance data for suspect malariacases reported between 2011 and 2014 were analysed independently. Data for malariaindicators in 2014 were compared with previous years. Findings We noted substantial reductions in all-cause outpatient visits (by 23 103 [11%] of 214 899), cases of fever (by 20249 [15%] of 131 330), and patients treated with oral (by 22 655 [24%] of 94 785) and injectable (by 5219 [30%] of 17 684) antimalarial drugs in surveyed health facilities. In Ebola-affected prefectures, 73 of 98 interviewed community health workers were operational (74%, 95% CI 65–83) and 35 of 73 were actively treating malariacases (48%, 36–60) compared with 106 of 112 (95%, 89–98) and 102 of 106 (96%, 91–99), respectively, in Ebola-unaffected prefectures. Nationwide, the Ebola-virus-disease epidemic was estimated to have resulted in 74 000 (71 000–77 000) fewer malariacases seen at health facilitiesin 2014. Interpretation The reduction in the delivery of malariacare because of the Ebola-virus-disease epidemic threatens malariacontrol in Guinea. Untreated and inappropriately treated malariacases lead to excess malariamortality and more fever cases in the community, impeding the Ebola-virus-disease response. FundingGlobal Fundto Fight AIDS, Tuberculosis and Malaria, and President's MalariaInitiative.