In April, research based on a broad-ranging computer model, suggested an additional 11,000 deaths from malaria may have occurred in the three West African countries hit by the Ebola epidemic. A new study led by the US Centers for Disease Control and Prevention (CDC) has now revealed that untreated malaria in Guinea surged as a result of the Ebola scare and has probably caused far more deaths than the dreaded hemorrhagic fever itself. The study suggested that around 74,000 likely cases of malaria were not treated. Experts said, "Tens of thousands shunned seeking help for malaria, fearing infection from people with Ebola or confinement if they showed feverish symptoms."
Researchers led by Mateusz Plucinski from the US CDC analyzed figures from 120 clinics in December 2014, when the Ebola outbreak in Guinea was at its peak. 60 clinics were in prefectures that had been most affected by Ebola and the 60 others in places where the disease had not been reported. The research team compared this with data for attendance at these clinics in 2013 and malaria incidence from 2011 and 2014.
The researchers found that the number of outpatient visits in December fell by 11% and the tally of patients receiving malaria treatment fell by 24% for oral drugs and by 30% for injectable drugs. The falls were far greater in the Ebola-affected areas. Out-patient attendance there plummeted by 42% in certain age groups, and the number of treated malaria cases dropped by as much as 69%. Even districts which had not recorded a single case of Ebola saw substantial declines in reported malaria cases and treatment. The study found that malaria facilities were also badly affected by staff shortages.
Previous investigations into uncomplicated malaria have found that around three to 30% of untreated cases progress to severe malaria, depending mainly on the age of the patient. Of these cases, between 45 and 73% will die.
Plucinski said, "It is difficult to put an exact figure on the number of excess malaria deaths. However, our study and a recently modelling analysis suggest that the number of excess malaria deaths in Guinea are likely substantially larger than number of deaths from Ebola virus disease. One problem is that the early symptoms of malaria such as fever, headache and body aches mimic those of Ebola. Our data suggest that since the start of the Ebola epidemic, people with fevers have avoided clinics for fear of contracting Ebola or being sent to an Ebola treatment center. Malaria control efforts and care delivery must be kept on track during an Ebola epidemic so that progress is not jeopardized and Ebola outbreak response is not impeded. Evidence from Sierra Leone and Liberia suggests it is very likely they too were devastatingly affected."