What impact is coronavirus having on malaria services?

Dear Doc,

What impact did the Covid-19 pandemic have on the ability of malaria-endemic countries to provide malaria preventive services and treatments? And what impact did this have on cases and deaths?

Ann

Dear Ann

With the global attention being fixed on the ongoing Covid-19 pandemic, other diseases seem to have gotten a back seat, including malaria, one of the biggest killers in sub-Saharan Africa. 

With every surge in cases, health care services have been stretched and other effects like restriction of movement and the economic downturn have made access to care a real challenge. 

In anticipation of this, the World Health Organization (WHO) released a publication in April 2020, “Tailoring malaria interventions in the Covid-19 response”. In it, ministries of health and other actors are encouraged to maintain malaria services as part of the essential package of care and not to neglect any of the preventive strategies and case management. There was also a recommendation on exceptional measures to control malaria, including mass drug administration or presumptive treatment. According to World Malaria Report from WHO, there were an estimated 227 million malaria cases worldwide in 2019, 94 per cent of which were in Africa, and 558,000 deaths, while in 2020, the estimated number of cases was 241 million and 627,000 deaths. 
About 95 per cent of the infections and 96 per cent of the deaths were in Africa, with 80 per cent of the deaths being among children below five years. 

The upsurge in cases and deaths is mostly due to disruption of preventive and case management services due to Covid-19. There was a 12 per cent rise in malaria deaths in the WHO Africa region, highlighting the impact of even moderate service disruption for at-risk populations. There was also a reduction in malaria testing and distribution of treatment.

On a positive note, at the time when Covid-19 struck, after about 30 years of research, a malaria vaccine had just been piloted (in 2019) in Kenya, Ghana and Malawi, specifically in malaria endemic zones. The pilot continued through the pandemic, with prevention of four out of 10 malaria infections, and about 30 per cent reduction in hospitalisations from severe illness.

The vaccine is part of the arsenal of strategies used in prevention, including use of insecticide-treated nets, use of effective antimalarials, environmental management, intermittent preventive therapy in pregnancy and seasonal chemoprevention – giving antimalarial drugs to children under five during the malaria season.

I am 21-years-old and in college. I have been experiencing severe headaches for years and dizzy spells. I have visited hospitals but I’m always told that it is either malaria or typhoid and after a few days, the cycle begins again. I cannot concentrate in class since during the day I feel so tired and sleepy. The same happens when I try to read. Reading makes me have strong headaches. Please help me
College student

Dear college student,
Recurrent headaches and dizzy spells require proper evaluation to establish the cause. 

You need to visit a proper hospital because it seems where you have been going, you have most likely been misdiagnosed. 

There are many possible causes of headache and dizziness beyond malaria and typhoid, and these two are randomly blamed for almost all symptoms, without proper diagnosis being made. 

It is advisable for you to be evaluated by a physician and relevant tests, including blood tests, possibly a CT scan or an MRI of the brain, and you also need an eye check-up. The issue of poor concentration and falling asleep in class is most likely a separate issue. Sleeping in class or while studying is a very common problem for people of all ages. Studying is a lot of mental work which utilises a lot of the energy available in the body. Typically, the brain uses up about 20 per cent of the available energy, and when your brain is very “busy”, you use up more, which means there is less energy available for the rest of the body, leading to feeling fatigued. In addition, level of interest, study patterns, study environment, diet, hydration status, availability of distractions, stress, burnout, sleep habits and physical illness can also contribute to sleeping while studying. It might simply be boredom, poor ventilation of the classrooms leading to too much heat, or the delicate balance between digestion (gut brain) and any brain work. 

In case it is more severe than this, for example, you have poor concentration and you drift off in other environments like at home, in social circumstances, or when carrying out some work, then you might need to have screening done for attention deficit disorder. If you suspect that you may have a physical or mental health concern,  visit a health professional for evaluation and management.

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