In Sierra Leone, malaria spiked during Ebola. Will it happen again during Covid-19?

As far as diseases go, malaria is the biggest killer on the African continent — although, thanks to impressive continent-wide interventions, it is not as lethal as it used to be. Between 2000 and 2015, the number of malaria cases in Africa declined by 42%, according to the World Health Organisation, and the number of malaria deaths dropped by two-thirds.

This impressive progress is under threat because of another disease — Covid-19. As African countries scramble to respond to the pandemic, there is a risk that they neglect the continuous public health measures necessary to reduce cases of malaria.

It has happened before. Sierra Leone is among the countries most affected by malaria, and the disease is an ever present part of daily life. Stories of its social and economic effects are heard in every part of the country: families lose loved ones, students miss exams, footballers sit out key games and farmers are unable to work. It is the reason for nearly 40% of hospital consultations.

When the first case of Ebola was recorded in Sierra Leone, on May 24 2014, it had a devastating effect on the country’s healthcare system. Among the 3 589 Ebola-related deaths were at least 221 healthcare workers, an enormous loss in a country where there is, on average, just one nurse per 10 000 people. At the same time, poor communications and distrust of the government means that people became increasingly reluctant to go to hospital — after all, that is where almost all of the Ebola victims would go to die.

During this time, there was a surge in deaths attributed to malaria. Deaths that, in normal circumstances, should and would have been prevented. The same was true of deaths attributed to HIV and tuberculosis.

A study in the Emerging Infectious Diseases journal found that there was a 50% reduction in access to healthcare services during the 2014-2016 Ebola outbreak in the three most affected countries: Guinea, Liberia and Sierra Leone. It estimated that this increased death counts from malaria, HIV and tuberculosis by an additional 6 269 people in Guinea, 1 535 people in Liberia and 2 819 people in Sierra Leone.

These statistics should provide a stark reminder to policymakers today. Even while governments fight to contain the coronavirus, they cannot neglect the treatment of other diseases such as malaria. Doing so would reverse all the gains achieved over the past decade in controlling the disease.

As of April 13, there were 10 confirmed cases of Covid-19 in Sierra Leone, according to the World Health Organisation. Neighbours Guinea and Liberia have 250 and 50 cases respectively. Even before Sierra Leone’s first case was recorded on March 30, the country had 370 test kits available and had identified the rapid deployment isolation treatment facility in Freetown as the main treatment centre for the coronavirus. It has activated a public health emergency operations centre and developed a Covid-19 preparedness plan, which includes strengthening surveillance and improving case management.

The World Bank has approved a $7.5-million grant to help Sierra Leone respond to the pandemic.

What is missing in the government’s planning is to take into account the knock-on effect of another public health crisis on diseases such as malaria. We need to make sure that even as we confront one public health threat, we do not let another get out of control.

Abdul S Brima is a journalist from Sierra Leone who has covered public health extensively. He is a Media Fellow of Germany’s Konrad Adenauer Stiftung

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