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Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis.
Weiss, Daniel J; Bertozzi-Villa, Amelia; Rumisha, Susan F; Amratia, Punam; Arambepola, Rohan; Battle, Katherine E; Cameron, Ewan; Chestnutt, Elisabeth; Gibson, Harry S; Harris, Joseph; Keddie, Suzanne; Millar, Justin J; Rozier, Jennifer; Symons, Tasmin L; Vargas-Ruiz, Camilo; Hay, Simon I; Smith, David L; Alonso, Pedro L; Noor, Abdisalan M; Bhatt, Samir; Gething, Peter W.
  • Weiss DJ; Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia; Curtin University, Perth, WA, Australia; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Bertozzi-Villa A; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Institute for Disease Modeling, Bellevue, WA, USA.
  • Rumisha SF; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Medical Research, Dar es Salaam, Tanzania.
  • Amratia P; Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia.
  • Arambepola R; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Battle KE; Institute for Disease Modeling, Bellevue, WA, USA.
  • Cameron E; Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia; Curtin University, Perth, WA, Australia.
  • Chestnutt E; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Gibson HS; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Harris J; Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia.
  • Keddie S; Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia.
  • Millar JJ; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Rozier J; Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia.
  • Symons TL; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Vargas-Ruiz C; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Hay SI; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
  • Smith DL; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
  • Alonso PL; Global Malaria Programme, World Health Organization, Geneva, Switzerland.
  • Noor AM; Global Malaria Programme, World Health Organization, Geneva, Switzerland.
  • Bhatt S; Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  • Gething PW; Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia; Curtin University, Perth, WA, Australia. Electronic address: peter.gething@telethonkids.org.au.
Lancet Infect Dis ; 21(1): 59-69, 2021 01.
Article in English | MEDLINE | ID: covidwho-1059565
ABSTRACT

BACKGROUND:

Substantial progress has been made in reducing the burden of malaria in Africa since 2000, but those gains could be jeopardised if the COVID-19 pandemic affects the availability of key malaria control interventions. The aim of this study was to evaluate plausible effects on malaria incidence and mortality under different levels of disruption to malaria control.

METHODS:

Using an established set of spatiotemporal Bayesian geostatistical models, we generated geospatial estimates across malaria-endemic African countries of the clinical case incidence and mortality of malaria, incorporating an updated database of parasite rate surveys, insecticide-treated net (ITN) coverage, and effective treatment rates. We established a baseline estimate for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis for nine hypothetical scenarios in which effective treatment with an antimalarial drug and distribution of ITNs (both through routine channels and mass campaigns) were reduced to varying extents.

FINDINGS:

We estimated 215·2 (95% uncertainty interval 143·7-311·6) million cases and 386·4 (307·8-497·8) thousand deaths across malaria-endemic African countries in 2020 in our baseline scenario of undisrupted intervention coverage. With greater reductions in access to effective antimalarial drug treatment, our model predicted increasing numbers of cases and deaths 224·1 (148·7-326·8) million cases and 487·9 (385·3-634·6) thousand deaths with a 25% reduction in antimalarial drug coverage; 233·1 (153·7-342·5) million cases and 597·4 (468·0-784·4) thousand deaths with a 50% reduction; and 242·3 (158·7-358·8) million cases and 715·2 (556·4-947·9) thousand deaths with a 75% reduction. Halting planned 2020 ITN mass distribution campaigns and reducing routine ITN distributions by 25%-75% also increased malaria burden to a total of 230·5 (151·6-343·3) million cases and 411·7 (322·8-545·5) thousand deaths with a 25% reduction; 232·8 (152·3-345·9) million cases and 415·5 (324·3-549·4) thousand deaths with a 50% reduction; and 234·0 (152·9-348·4) million cases and 417·6 (325·5-553·1) thousand deaths with a 75% reduction. When ITN coverage and antimalarial drug coverage were synchronously reduced, malaria burden increased to 240·5 (156·5-358·2) million cases and 520·9 (404·1-691·9) thousand deaths with a 25% reduction; 251·0 (162·2-377·0) million cases and 640·2 (492·0-856·7) thousand deaths with a 50% reduction; and 261·6 (167·7-396·8) million cases and 768·6 (586·1-1038·7) thousand deaths with a 75% reduction.

INTERPRETATION:

Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19.

FUNDING:

Bill and Melinda Gates Foundation; Channel 7 Telethon Trust, Western Australia.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 / Malaria Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Africa Language: English Journal: Lancet Infect Dis Journal subject: Communicable Diseases Year: 2021 Document Type: Article Affiliation country: S1473-3099(20)30700-3

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 / Malaria Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Africa Language: English Journal: Lancet Infect Dis Journal subject: Communicable Diseases Year: 2021 Document Type: Article Affiliation country: S1473-3099(20)30700-3