Ebola has been blamed for a surge in untreated malaria cases in west Africa, according to a study that suggests the latest epidemic may have led to more deaths from malaria than the total caused by the Ebola virus.
Published in The Lancet Infectious Diseases journal, the research exposed the indirect effects of the Ebola epidemic in Guinea: a severely disrupted health-care system and a compromised National Malaria Control Program.
The US researchers surveyed 60 facilities in Ebola-affected regions of Guinea and 60 in areas unaffected by the virus. Study teams reviewed malaria case management indicators from registers for January to November in 2013 and 2014 and interviewed health-care workers, comparing the data with previous years.
They found around 74,000 fewer malaria cases than expected were seen at health facilities in the country in 2014 compared with pre-Ebola years.
Lead author Dr Mateusz Plucinski from the Malaria Branch of the US Centers for Disease Control and Prevention, said the consequences for those infected with malaria could be severe.
“In a setting like Guinea, people with malaria are very likely to either receive no care or inappropriate care if they do not go to health facilities. As a result, they are at much higher risk of dying from malaria,” he said.
“Our study and a recent modelling analysis suggest that the number of excess malaria deaths in Guinea are likely substantially larger than number of deaths from Ebola virus disease.”
Malaria is usually the main cause of visits to health facilities in Guinea, accounting for more than 30% of visits to health facilities. However, during Ebola epidemic the number of people presenting with fever at outpatient clinics fell dramatically across the health facilities – dropping by nearly 42% in certain age groups and worst affected areas. This was in contrast to presentations in areas not affected by Ebola, which showed no marked difference.
Dr Ricardo Ataide from the Burnet Institute said the results weren’t surprising.
“People are afraid to go to the hospital, not just because they don’t want to get in contact with Ebola but because they don’t want people thinking they have Ebola.”
The researchers thought the overlapping symptoms of the two diseases, such as high fever and headaches, prevented those infected with malaria from seeking treatment for fear of being sent to an Ebola treatment centre.
Dr Ataide, who was not involved in the study, also noted that the diagnosis of other diseases – such as tuberculosis – would likely have suffered during the Ebola focused wave of health care.
“Ebola is something that comes in a very determined period of time. So what happens is that people think, ‘ok we need to put all our efforts into reducing this now and then we’ll go back to doing the malaria work’,” he said.
“The problem is that the number of people affected by malaria is much higher than the number affected by Ebola. But Ebola attracts much more media attention so local governments are pressured to do much more and donors start throwing a lot of money at them. You basically throw a curtain over everything else.”
Professor of Pediatric Infectious Diseases at the University of Sydney Dr David Isaacs has dubbed government led responses to epidemics like Ebola as “pandemic paranoia”.
“One has to be a little bit careful to overreacting to public health problems, mostly infectious diseases,” Dr Isaacs said. “If you spend huge amounts of money on one particular thing, it’s an opportunity cost. And then you may spend less on other things – and so you have to prioritise.”
The researchers conclude the Ebola outbreak could have similarly threatened the health-care system in other affected countries.
“The underlying factors – closed health facilities, an atmosphere of fear in the community and mistrust of the public health sector – have also been consistently reported in Sierra Leone and Liberia. It is thus likely that Sierra Leone and Liberia have been affected in a similar way,” Dr Plucinski said.
It’s important to note, however, that the study did not determine whether there was a larger number of malaria deaths during the study period.
“This is not telling us that malaria went up. This is telling us that the capacity to detect malaria came down,” said Dr Ataide.