Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis.
Open accessAbstract
BACKGROUND: Substantial progress has been made in reducing the burden of malaria in Africa since 2000, but those gains could be jeopardised if the COVID-19 pandemic affects the availability of key malaria control interventions. The aim of this study was to evaluate plausible effects on malaria incidence and mortality under different levels of disruption to malaria control. METHODS: Using an established set of spatiotemporal Bayesian geostatistical models, we generated geospatial estimates across malaria-endemic African countries of the clinical case incidence and mortality of malaria, incorporating an updated database of parasite rate surveys, insecticide-treated net (ITN) coverage, and effective treatment rates. We established a baseline estimate for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis for nine hypothetical scenarios in which effective treatment with an antimalarial drug and distribution of ITNs (both through routine channels and mass campaigns) were reduced to varying extents. FINDINGS: We estimated 215·2 (95% uncertainty interval 143·7-311·6) million cases and 386·4 (307·8-497·8) thousand deaths across malaria-endemic African countries in 2020 in our baseline scenario of undisrupted intervention coverage. With greater reductions in access to effective antimalarial drug treatment, our model predicted increasing numbers of cases and deaths: 224·1 (148·7-326·8) million cases and 487·9 (385·3-634·6) thousand deaths with a 25% reduction in antimalarial drug coverage; 233·1 (153·7-342·5) million cases and 597·4 (468·0-784·4) thousand deaths with a 50% reduction; and 242·3 (158·7-358·8) million cases and 715·2 (556·4-947·9) thousand deaths with a 75% reduction. Halting planned 2020 ITN mass distribution campaigns and reducing routine ITN distributions by 25%-75% also increased malaria burden to a total of 230·5 (151·6-343·3) million cases and 411·7 (322·8-545·5) thousand deaths with a 25% reduction; 232·8 (152·3-345·9) million cases and 415·5 (324·3-549·4) thousand deaths with a 50% reduction; and 234·0 (152·9-348·4) million cases and 417·6 (325·5-553·1) thousand deaths with a 75% reduction. When ITN coverage and antimalarial drug coverage were synchronously reduced, malaria burden increased to 240·5 (156·5-358·2) million cases and 520·9 (404·1-691·9) thousand deaths with a 25% reduction; 251·0 (162·2-377·0) million cases and 640·2 (492·0-856·7) thousand deaths with a 50% reduction; and 261·6 (167·7-396·8) million cases and 768·6 (586·1-1038·7) thousand deaths with a 75% reduction. INTERPRETATION: Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19. FUNDING: Bill and Melinda Gates Foundation; Channel 7 Telethon Trust, Western Australia.
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In resource constrained low- and middle-income countries, including Ghana, the COVID-19 pandemic has the potential to undermine targeted malaria control efforts because of overlapping symptoms and diversion of limited public health resources from malaria control to COVID-19 response.
“In resource constrained low- and middle-income countries, including Ghana, the COVID-19 pandemic has the potential to undermine targeted malaria control efforts based on our findings because of overlapping symptoms, and because of diversion of limited public health resources from malaria control to COVID-19 response [60,61,62].”
From A Bayesian Spatio-Temporal Analysis of Malaria in the Greater Accra Region of Ghana from 2015 to 2019 (2021) · cites this paper as [62]
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Experimental — accuracy not yet measuredThe Covid-19 pandemic has disrupted malaria control programmes and health systems in general and malaria prevalence and cases greatly increased in 2020.
“The Covid-19 pandemic has disrupted malaria control programmes and health systems in general and malaria prevalence and cases greatly increased in 2020 [40, 41].”
From Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000 (2022) · cites this paper as [41]
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- Authors
- Weiss, D. J., Bertozzi-Villa, A., Rumisha, S. F., Amratia, P., Arambepola, R., Battle, K. E., Cameron, E., Chestnutt, E., Gibson, H. S., Harris, J., Keddie, S., Millar, J. J., Rozier, J., Symons, T. L., Vargas-Ruiz, C., Hay, S. I., Smith, D. L., Alonso, P. L., Noor, A. M., Bhatt, S., & Gething, P. W.
- Affiliations
- The Kids Research Institute Australia (AU)
- University of Oxford (GB)
- Institute for Disease Modeling (US)
- University of Washington (US)
- World Health Organization (CH)
- Imperial College London (GB)
- Corresponding author
- Gething, Peter W
- ORCID
- Weiss, Daniel J
- Bertozzi-Villa, Amelia
- Rumisha, Susan F
- Amratia, Punam
- Arambepola, Rohan
- Battle, Katherine E
- Cameron, Ewan
- Chestnutt, Elisabeth
- Gibson, Harry S
- Keddie, Suzanne
- Millar, Justin J
- Rozier, Jennifer
- Symons, Tasmin L
- Hay, Simon I
- Smith, David L
- Alonso, Pedro L
- Noor, Abdisalan M
- Bhatt, Samir
- Gething, Peter W
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 21
- Issue
- 1
- Pages
- 59-69
- ISSN
- 1473-3099 (ISSN-L)
- PMC
- PMC7505634
- OpenAlex
- W3087003139
- Cited by
- 236
- References
- 24
- Citations by year
- 2026: 12 · 2025: 25 · 2024: 35 · 2023: 35 · 2022: 68 · 2021: 55 · 2020: 6
- FWCI
- 30.75
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Infectious Diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Bill and Melinda Gates Foundation (OPP1152978)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- COVID-19 pandemic, malaria burden, malaria incidence, malaria mortality, malaria control interventions, insecticide-treated nets, antimalarial drug treatment, treatment coverage, mass distribution campaigns, healthcare disruption, scenario analysis, health system resilience, health system preparedness
- MeSH terms
- COVID-19, SARS-CoV-2, Africa, Antimalarials, Bayes Theorem, Humans, Malaria, Morbidity, Models, Statistical, Incidence, Insecticide-Treated Bednets
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