News

The malaria-carrying mosquito is not in lockdown: the importance of malaria prevention continuing

Summary

Recent modelling by the World Health Organisation (WHO) warns that the number of malaria deaths in sub-Saharan Africa in 2020 could double in comparison to 2018 if malaria prevention activities are reduced or delayed by COVID-19.

Detail

The report estimates that in the worst case scenario the number of deaths would reach 769,000, which is equivalent to the mortality level seen 20 years ago. This scenario would arise if COVID-19 were to stop LLIN campaigns and routine LLIN distributions, limit access to effective treatment for malaria and reduce the availability of antimalarial drugs. The model assumes that other forms of malaria prevention would continue (i.e. indoor residual spraying and seasonal malaria chemoprevention), which is not necessarily the case.

There are 27 countries in sub-Saharan Africa planning to carry out LLIN campaigns this year. Together, these countries account for 85% of total malaria cases and deaths in the region. If the campaigns do not take place, the WHO estimates that:

“…malaria cases and deaths will increase by up to 10%, even if access to effective malaria treatment is maintained at current level. It is estimated that there would be between 5 and 17 million additional cases… and up to 30 000 lives would be lost to malaria compared to the 2018 baseline. About 70% of these additional deaths would be of children under the age of 5.”

Furthermore, it is possible that treatment will be affected by the pandemic. Individuals may avoid visiting health centres for malaria diagnoses and treatments for fear of catching the virus, and overstretched health facilities may be unable to provide effective treatment.

AMF is funding nets for LLIN campaigns in four countries in 2020: DRC (13.1m) nets, Uganda (11.6m nets), Togo (3.5m nets) and PNG (1.1m nets).

Currently, all countries are following WHO guidance and intend to continue their net campaigns, and are working on strategies and operational adjustments that will enable nets to be distributed where they are needed while minimising the risk of spreading coronavirus.

Africa registered a 43% jump in reported COVID-19 cases between April 16th and 23rd.

We continue to work with our partners to ensure nets are distributed and the worst impacts laid out in the WHO report are avoided.

Coronavirus (COVID-19) and continuity of AMF operations - Update 22 Apr 2020

Since our previous update, the eight countries where AMF is working have all implemented COVID-19 measures. These are affecting our programmes in different ways and more detail is provided below.

We are in regular contact with our partners to receive updates and discuss adjustments to plans. This is particularly important for the four countries in which we have 2020 net distributions planned – DRC , Uganda, Togo and PNG. We continue to support the strong guidance from WHO to maintain malaria prevention activities. Halting or delaying net distributions could well result in a spike in malaria cases and deaths that exceeds the potential harm caused by COVID-19. It is of course vital that all measures are taken to ensure the safety of the health workers that carry out distributions and we are discussing with our in-country partners the changes needed to our normal procedures.

The Alliance for Malaria Prevention (AMP) has recently published guidelines for carrying out distributions in COVID-19 affected countries. To reduce the chance of transmission, training will be carried out remotely and distribution sites that attract crowds will be avoided. The registration process – the door to door visits where each household is surveyed to understand the net need – is likely to be simplified. These changes will mean that net need is not known as accurately as in a normal distribution and it is therefore likely that an increased number of nets will be required to reach similar and acceptable levels of coverage. Other factors that are likely to increase net need include: the recommendation that those suffering from COVID-19 self-isolate and sleep separately; nets that have been used for COVID-19 sufferers may be rejected afterwards for fear of infection.

Many tools are available for tracking COVID-19, but we have been using this one to follow the cases in the countries in which we’re working. This graphic also shows a visualisation of the propagation of COVID-19 through the continent of Africa.

Impact on AMF’s programmes

Distributions

DRC – Going ahead as planned (with COVID-19 related operational adjustments)
The distribution in Sud Ubangi province is going ahead and is due to begin on May 5th. It will be a door to door distribution (as always planned) and not a ‘fixed site distribution’ where people would gather to receive nets. The PNLP has confirmed to us that PPE equipment will be available to all health workers and we will be monitoring closely the delivery and availability of this protective equipment. As current measures prohibit travel from Kinshasa to the provinces, the normal national staff from the NMCP and our distribution partner will not be present in the province. Risk mitigation measures have been taken and AMF has increased its independent monitoring presence in Sud Ubangi with our independent monitor RHA. Distribution in Haut Katanga is still due to go ahead, and discussions are ongoing as to how to reorganise the distribution which was originally planned as a fixed site distribution.

Uganda – Temporary delay
2020 distribution campaign on hold until current lockdown ends. Last week the 14 day lockdown was extended until May 5th. Currently, this is a 6 weeks delay to the net distribution.

Togo – Currently going ahead as planned
Discussions are continuing to establish what operational changes may be needed for the 2020 distribution. Currently the country is not in full lockdown, but a curfew and social distancing measures are in place.

PNG – Going ahead as planned (with COVID-19 related operational adjustments)
Social distancing measures are in place but distributions are continuing as they have been deemed an essential activity by the government.

Post-distribution monitoring

Guinea – Going ahead as planned (with COVID-19 related operational adjustments)
The final PDM at 9 months is going ahead this week with the following measures taken in line with government advice: 4 people per vehicle, 2 masks per day for all workers, alcohol solution, regular hand washing, social distancing, hygiene measures and temperature checks on leaving Conakry. We will continue to monitor closely the situation.

AMF’s PDM activities have been delayed in some countries as follows:

Ghana – Temporary delay
There is a 2-month delay to PDMs due to lockdown. The situation will be reviewed in 10 days when the current lockdown period ends, although high COVID-19 cases may mean that there is an extension.

Malawi – Temporary delay
There is a 2 month delay to PDMs due to COVID-19 measures. A three-week lockdown began last Saturday but has since been overruled by the high court.

Zambia – Temporary delay
PDMs have been suspended due to measures taken by the government. The country is not a full lockdown and options for continuing monitoring work are being explored.