Effects of the COVID-19 pandemic on general health and malaria control in Ghana: A qualitative study with mothers and health care professionals (preprint)

ABSTRACT

Background COVID-19 has severely impacted health systems and the management of non-COVID-19 diseases, including malaria, globally. The pandemic has hit sub-Saharan Africa less than expected; even considering large underreporting, the direct COVID-19 burden was minor compared to the Global North. However, the indirect effects of the pandemic, for example, on socio-economic inequality and health care systems, may have been more disruptive. Following a quantitative analysis of routine surveillance data of 2020 compared to 2015 to 2019 from northern Ghana, which showed significant reductions in overall outpatient department visits and malaria cases, this qualitative study aims to provide further explanations to those quantitative findings.Methods In the Northern Region of Ghana, 72 participants, consisting of 18 health care professionals (HCP) and 54 mothers of children under the age of five, were recruited in urban and rural districts. Data were collected using focus group discussions with women that were pregnant during the first phase of the pandemic, women that had already under five children by then, and through key informant interviews with HCP.Results Three main themes occurred. The first theme - general effects of the pandemic - includes impacts on finances, food security, health service provision as well as education and hygiene. Many women lost their jobs, which increased their dependance on males, children had to drop out of school, and families had to develop strategies to cope with food shortages and considering migration. HCPs had problems to reach the communities, suffered stigmatization and were often barely protected against the virus. The second theme - effects of the pandemic on health seeking - includes fear of infection, lack of COVID-19 testing capacities, changed behavior of HCPs, and reduced access to clinics and treatment due to reduced opening hours as well as patients’ and HCPs’ fear of getting infected with COVID-19. The third theme – effects of the pandemic on malaria – includes disruptions of malaria preventive measures and reduced access to and acceptance of chemoprophylaxis as the side effects mimic COVID-19 symptoms. Clinical discrimination between malaria and COVID-19 symptoms was difficult and HCPs observed increases in severe malaria cases in health facilities due to late reporting.Conclusion The COVID-19 pandemic has had large collateral impacts on mothers, children and HCPs. In addition to overall negative effects on families and communities, access to and quality of health services was severely impaired, including serious implications for malaria prevention and treatment.