Impact of the COVID-19 pandemic on malaria cases in health facilities in northern Ghana: a retrospective analysis of routine surveillance data

Abstract

Background The COVID-19 pandemic and its collateral damage severely impact health systems globally and risk to worsen the malaria situation in endemic countries. Malaria is a leading cause of morbidity and mortality in Ghana. This study aims to describe the potential effects of the COVID-19 pandemic on malaria cases observed in health facilities in the Northern Region of Ghana. Methods Monthly routine data from the District Health Information Management System II (DHIMS2) of the Northern Region of Ghana were analysed. Overall outpatient department visits (OPD) and malaria case rates from the years 2015–2019 were compared to the corresponding data of the year 2020. Results Compared to the corresponding periods of the years 2015–2019, overall visits and malaria cases in paediatric and adult OPDs in northern Ghana decreased in March and April 2020, when major movement and social restrictions were implemented in response to the pandemic. Cases slightly rebounded afterwards in 2020, but stayed below the average of the previous years. Malaria data from inpatient departments showed a similar but more pronounced trend when compared to OPDs. In pregnant women, however, malaria cases in OPDs increased after the first COVID-19 wave. Conclusions The findings from this study show that the COVID-19 pandemic affects the malaria burden in health facilities of northern Ghana, with declines in inpatient and outpatient rates except for pregnant women. They may have experienced reduced access to insecticide-treated nets and intermittent preventive malaria treatment in pregnancy, resulting in subsequent higher malaria morbidity. Further data, particularly from community-based studies and ideally complemented by qualitative research, are needed to fully determine the impact of the pandemic on the malaria situation in Africa.

Impact of COVID-19 on outcomes of childhood severe malaria: A comparative of study pre-COVID-19 and COVID-19 periods

“…[16] In contrast, a study in Ghana that compared similar periods observed a reduction in the cases of malaria among under-ve. [14] In Rwanda, a study that also compared similar periods like this current study did observe any change in the cases of severe malaria. [15] It is worthy of note that the site of this present study falls under the malaria endemic zone in Nigeria, with high seasonal variability.…”

“…For instance, a retrospective study in northern Ghana that compared pre-COVID-19 and COVID-19 periods showed a decline in malaria cases at health facilities. [14] A similar study in the malaria endemic part of Rwanda found no change in the overall rate of uncomplicated malaria with a reduction in the proportion of severe malaria cases at the health facilities. [15] In Zimbabwe, when compared with the pre-COVID-19 period, COVID-19 was associated surge in malaria cases and deaths.…”

Sustaining surveillance as an intervention during the COVID-19 pandemic in Cabo Verde and implications for malaria elimination

“…The ongoing COVID-19 pandemic may also impact the probability that a patient is tested if they seek care for their illness (e.g., malaria, HIV, Tuberculosis, other infectious and chronic diseases). Factors that may influence the likelihood of testing include symptom presentation, prevalence of the illness, availability of testing or treatment supplies, the ability of the health facility to manage COVID-19 as well as other common diseases, amongst others ( 9 , 10 ). A study in Rwanda found that there was a reduction in malaria testing at health facilities during the pandemic but increases in community-based testing ( 11 ).…”

Assessment of health staff’s proficiency and quality of key malaria indicators in rural district of Ghana

“…Malaria parasite prevalence among children aged 6–59 months in the 2011 report indicated a regional variation from as low as 4% in the Greater Accra region to as high as 51% in the Upper West region [ 21 ]. Malaria remains the number one cause of OPD attendance and the first among the top ten diseases in Ghana [ 22 ]. The National Malaria Control Program (NMCP) in collaboration with the Upper West Regional Health Directorate (RHD) and Sissala East Municipal Health Directorate (MHD) continue to implement interventions across the municipality aimed at controlling the burden of the disease within the municipality, region and Ghana as a whole.…”

“…The National Malaria Control Program (NMCP) in collaboration with the Upper West Regional Health Directorate (RHD) and Sissala East Municipal Health Directorate (MHD) continue to implement interventions across the municipality aimed at controlling the burden of the disease within the municipality, region and Ghana as a whole. These interventions include Long-lasting insecticidal nets (LLIN) distribution, In-door Residual Spraying and Seasonal Malaria Chemoprevention (SMC) among others [ 22 ].…”