3.5M additional cases of malaria untreated due to Ebola in 2014

There were 3.5 million extra cases of malaria, which were untreated in the year 2014.

According to new modelling research, as many as 10900 extra malaria deaths may have occurred last year due to the disruption of healthcare services in the three countries in west Africa currently experiencing widespread Ebola virus outbreaks (Guinea, Sierra Leone, and Liberia), with a further 3900 deaths resulting from the interruption of insecticide treated net (ITN) delivery.

These new estimates of malaria deaths that would have been prevented by health systems when functioning normally, suggest that the west African Ebola outbreak could have resulted in comparable number of malaria deaths as those due to Ebola itself (8981 by Feb 1, 2015). However, the findings also indicate that implementing mass drug administration (MDA) and ITN campaigns to coincide with the 2015 malaria transmission season in May/June could largely mitigate the impact of Ebola on malaria.

Lead author Dr Patrick Walker explained that the ongoing Ebola epidemic in parts of west Africa largely overwhelmed already fragile healthcare systems in 2014 making adequate care for malaria impossible and threatening to jeopardise progress made in malaria control and elimination over the past decade.

The worst case scenario, assuming that the Ebola epidemic led to a complete end to malaria care, shows that the number of untreated malaria cases could have increased by 45 percent (1.6 million) in Guinea, 88 percent (1.3 million) in Sierra Leone, and 140 percent (0.52 million) in Liberia in 2014 (figure 2). Around half (48 percent) of these cases are expected to occur in children under 5. What is more, lapses in ITN delivery could have led to another 0.84 million malaria cases in 2014.

The new estimates also suggest that an absence of clinic and hospital care would have increased malaria deaths by 35 percent (5600 deaths) in Guinea, 50 percent (3900) in Sierra Leone, and 62 percent (1500) in Liberia in 2014 (figure 1D). Moreover, the authors estimate that in 2015, pre-Ebola levels of healthcare provision would be responsible for preventing 15600 malaria deaths highlighting the urgent need to support health system recovery.

Their projections suggest that emergency MDA campaigns (assuming 70 percent coverage) can be a highly effective method to reduce further malaria mortality and the burden of non-Ebola fever cases upon still fragile health systems in 2015.

The study is published in The Lancet Infectious Diseases journal.