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Impact of COVID-19 on routine malaria indicators in rural Uganda: an interrupted time series analysis.
Namuganga, Jane F; Briggs, Jessica; Roh, Michelle E; Okiring, Jaffer; Kisambira, Yasin; Sserwanga, Asadu; Kapisi, James A; Arinaitwe, Emmanuel; Ebong, Chris; Ssewanyana, Isaac; Maiteki-Ssebuguzi, Catherine; Kamya, Moses R; Staedke, Sarah G; Dorsey, Grant; Nankabirwa, Joaniter I.
  • Namuganga JF; Infectious Diseases Research Collaboration, Kampala, Uganda. jnamuganga@idrc-uganda.org.
  • Briggs J; Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
  • Roh ME; Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.
  • Okiring J; Infectious Diseases Research Collaboration, Kampala, Uganda.
  • Kisambira Y; Infectious Diseases Research Collaboration, Kampala, Uganda.
  • Sserwanga A; Infectious Diseases Research Collaboration, Kampala, Uganda.
  • Kapisi JA; Infectious Diseases Research Collaboration, Kampala, Uganda.
  • Arinaitwe E; Infectious Diseases Research Collaboration, Kampala, Uganda.
  • Ebong C; Infectious Diseases Research Collaboration, Kampala, Uganda.
  • Ssewanyana I; Infectious Diseases Research Collaboration, Kampala, Uganda.
  • Maiteki-Ssebuguzi C; National Malaria Control Division, Ministry of Health, Kampala, Uganda.
  • Kamya MR; Infectious Diseases Research Collaboration, Kampala, Uganda.
  • Staedke SG; Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda.
  • Dorsey G; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
  • Nankabirwa JI; Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Malar J ; 20(1): 475, 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1635854
ABSTRACT

BACKGROUND:

In March 2020, the government of Uganda implemented a strict lockdown policy in response to the COVID-19 pandemic. Interrupted time series analysis (ITSA) was performed to assess whether major changes in outpatient attendance, malaria burden, and case management occurred after the onset of the COVID-19 epidemic in rural Uganda.

METHODS:

Individual level data from all outpatient visits collected from April 2017 to March 2021 at 17 facilities were analysed. Outcomes included total outpatient visits, malaria cases, non-malarial visits, proportion of patients with suspected malaria, proportion of patients tested using rapid diagnostic tests (RDTs), and proportion of malaria cases prescribed artemether-lumefantrine (AL). Poisson regression with generalized estimating equations and fractional regression was used to model count and proportion outcomes, respectively. Pre-COVID trends (April 2017-March 2020) were used to predict the'expected' trend in the absence of COVID-19 introduction. Effects of COVID-19 were estimated over two six-month COVID-19 time periods (April 2020-September 2020 and October 2020-March 2021) by dividing observed values by expected values, and expressed as ratios.

RESULTS:

A total of 1,442,737 outpatient visits were recorded. Malaria was suspected in 55.3% of visits and 98.8% of these had a malaria diagnostic test performed. ITSA showed no differences between observed and expected total outpatient visits, malaria cases, non-malarial visits, or proportion of visits with suspected malaria after COVID-19 onset. However, in the second six months of the COVID-19 time period, there was a smaller mean proportion of patients tested with RDTs compared to expected (relative prevalence ratio (RPR) = 0.87, CI (0.78-0.97)) and a smaller mean proportion of malaria cases prescribed AL (RPR = 0.94, CI (0.90-0.99)).

CONCLUSIONS:

In the first year after the COVID-19 pandemic arrived in Uganda, there were no major effects on malaria disease burden and indicators of case management at these 17 rural health facilities, except for a modest decrease in the proportion of RDTs used for malaria diagnosis and the mean proportion of malaria cases prescribed AL in the second half of the COVID-19 pandemic year. Continued surveillance will be essential to monitor for changes in trends in malaria indicators so that Uganda can quickly and flexibly respond to challenges imposed by COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ambulatory Care / COVID-19 / Malaria Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Africa Language: English Journal: Malar J Journal subject: Tropical Medicine Year: 2021 Document Type: Article Affiliation country: S12936-021-04018-0

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ambulatory Care / COVID-19 / Malaria Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Africa Language: English Journal: Malar J Journal subject: Tropical Medicine Year: 2021 Document Type: Article Affiliation country: S12936-021-04018-0