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Knockdown and recovery of malaria diagnosis and treatment in Liberia during and after the 2014 Ebola outbreak
Objective: To describe the consequences of the Ebola outbreak on Liberia's National Malaria Programme and its post-Ebola recovery.
Design: A retrospective cross-sectional study using routine countrywide programme data.
Results: Malaria caseloads decreased by 47% during the Ebola outbreak and by 11% after, compared to the pre-Ebola period. In those counties most affected by Ebola, a caseload reduction of >20% was sustained for 12 consecutive months, while this lasted for only 4 consecutive months in the counties least affected by Ebola. Linear regression of monthly proportions of confirmed malaria cases—as a proxy indicator of programme performance—over the pre- and post-Ebola periods indicated that the malaria programme could require 26 months after the end of the acute phase of the Ebola outbreak to recover to pre-Ebola levels.
Conclusions: The differential persistence of reduced caseloads in the least- and most-affected counties, all of which experienced similar emergency measures, suggest that factors other than Ebola-related security measures played a key role in the programme's reduced performance. Clear guidance on when to abandon the emergency measures after an outbreak may be needed to ensure faster recovery of malaria programme performance.
Keywords: artemisinin-based combination therapy; malaria diagnosis; malaria treatment; operational research; rapid diagnostic test
Document Type: Research Article
Affiliations: 1: Ministry of Health, Monrovia, Liberia 2: Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia 3: Médecins Sans Frontières-Operational Centre Brussels, Brussels, Belgium 4: Institute of Medicine, University of Chester, Chester, UK 5: International Union Against Tuberculosis and Lung Disease, South East Asia Office, New Delhi, India 6: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, International Union Against Tuberculosis and Lung Disease, Paris, France
Publication date: 21 June 2017
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