Impact of the COVID-19 pandemic on the malaria burden in northern Ghana: Analysis of routine surveillance data

Introduction: 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 analyze routine surveillance data to assess possible effects on the malaria burden in the first year of the COVID-19 pandemic 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 analyzed. Overall outpatient department visits and malaria incidence rates from the years 2015 to 2019 were compared to the corresponding data of the year 2020. Results: Compared to the corresponding periods of the years 2015 to 2019, overall visits and malaria incidence in pediatric and adult outpatient departments in northern Ghana decreased in March and April 2020, when major movement and social restrictions were implemented in response to the pandemic. Incidence slightly rebounded afterwards in 2020 but stayed below the average of the previous years. Data from inpatient departments showed a similar but more pronounced trend when compared to outpatient departments. In pregnant women, however, malaria incidence in outpatient departments increased after the first COVID-19 wave. Discussion: The findings from this study show that the COVID-19 pandemic affects the malaria burden in health facilities of Ghana, with declines in in- and outpatient rates. Pregnant women may experience reduced access to intermittent preventive malaria treatment and insecticide treated nets, resulting in subsequent higher malaria morbidity. Further data from other African countries, particularly on community-based studies, are needed to fully determine the impact of the pandemic on the malaria situation.

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Impact of The COVID-19 Pandemic on the Malaria Burden in Northern Ghana: Analysis of Routine Surveillance Data

10.21203/rs.3.rs-1123015/v1 ◽

2021 ◽

Author(s):

Anna-Katharina Heuschen ◽

Alhassan Abdul-Mumin ◽

Martin Nyaaba Adokiya ◽

Guangyu Lu ◽

Albrecht Jahn ◽

...

Keyword(s):

Pregnant Women ◽

Malaria Incidence ◽

Information Management System ◽

Northern Region ◽

Surveillance Data ◽

Northern Ghana ◽

Malaria Burden ◽

Routine Surveillance ◽

Outpatient Departments ◽

The Impact

Abstract Introduction: 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 analyze routine surveillance data to assess possible effects on the malaria burden in the first year of the COVID-19 pandemic 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 analyzed. Overall outpatient department visits and malaria incidence rates from the years 2015 to 2019 were compared to the corresponding data of the year 2020. Results: Compared to the corresponding periods of the years 2015 to 2019, overall visits and malaria incidence in pediatric and adult outpatient departments in northern Ghana decreased in March and April 2020, when major movement and social restrictions were implemented in response to the pandemic. Incidence slightly rebounded afterwards in 2020 but stayed below the average of the previous years. Data from inpatient departments showed a similar but more pronounced trend when compared to outpatient departments. In pregnant women, however, malaria incidence in outpatient departments increased after the first COVID-19 wave. Discussion: The findings from this study show that the COVID-19 pandemic affects the malaria burden in health facilities of Ghana, with declines in in- and outpatient rates. Pregnant women may experience reduced access to intermittent preventive malaria treatment and insecticide treated nets, resulting in subsequent higher malaria morbidity. Further data from other African countries, particularly on community-based studies, are needed to fully determine the impact of the pandemic on the malaria situation.

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The malaria burden of Amerindian groups of three Venezuelan states: a descriptive study based on programmatic data

Malaria Journal ◽

10.1186/s12936-021-03819-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Juan C. Gabaldón-Figueira ◽

Carlos Chaccour ◽

Jorge Moreno ◽

Maria Villegas ◽

Leopoldo Villegas

Keyword(s):

Risk Factors ◽

Plasmodium Falciparum ◽

Malaria Incidence ◽

Hot Spot ◽

Public Health Problem ◽

Epidemiological Data ◽

Descriptive Study ◽

Malaria Burden ◽

Indigenous Groups ◽

The Impact

Abstract Background Fifty-three percent of all cases of malaria in the Americas in 2019 came from Venezuela, where the epidemic is heavily focused south of the Orinoco river, and where most of the country’s Amerindian groups live. Although the disease is known to represent a significant public health problem among these populations, little epidemiological data exists on the subject. This study aims to provide information on malaria incidence, geospatial clustering, and risk factors associated to Plasmodium falciparum infection among these groups. Methods This is a descriptive study based on the analysis of published and unpublished programmatic data collected by Venezuelan health authorities and non-government organizations between 2014 and 2018. The Annual Parasite Index among indigenous groups (API-i) in municipalities of three states (Amazonas, Bolivar, and Sucre) were calculated and compared using the Kruskal Wallis test, risk factors for Plasmodium falciparum infection were identified via binomial logistic regression and maps were constructed to identify clusters of malaria cases among indigenous patients via Moran’s I and Getis-Ord’s hot spot analysis. Results 116,097 cases of malaria in Amerindian groups were registered during the study period. An increasing trend was observed between 2014 and 2016 but reverted in 2018. Malaria incidence remains higher than in 2014 and hot spots were identified in the three states, although more importantly in the south of Bolivar. Most cases (73.3%) were caused by Plasmodium vivax, but the Hoti, Yanomami, and Eñepa indigenous groups presented higher odds for infection with Plasmodium falciparum. Conclusion Malaria cases among Amerindian populations increased between 2014 and 2018 and seem to have a different geographic distribution than those among the general population. These findings suggest that tailored interventions will be necessary to curb the impact of malaria transmission in these groups.

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The impact of stopping and starting indoor residual spraying on malaria burden in 14 districts of Uganda

10.21203/rs.3.rs-126095/v1 ◽

2020 ◽

Author(s):

Jane Namuganga ◽

Adrienne Epstein ◽

Joaniter Nankabirwa ◽

Arthur Mpimbaza ◽

Moses Kiggundu ◽

...

Keyword(s):

Malaria Incidence ◽

Critical Role ◽

Scale Up ◽

Indoor Residual Spraying ◽

Fold Increase ◽

Bed Nets ◽

Malaria Burden ◽

Vector Control Intervention ◽

Using Data ◽

The Impact

Abstract The scale-up of malaria control efforts has led to marked reductions in malaria burden over the past twenty years, but progress has slowed. Implementation of indoor residual spraying (IRS) of insecticide, a proven vector control intervention, has been limited and difficult to sustain partly because questions remain on its added impact over widely accepted interventions such as bed nets. Using data from 14 enhanced surveillance health facilities in Uganda, a country with high bet net coverage yet high malaria burden, we estimate the impact of starting and stopping IRS. We show that stopping IRS resulted in a 5-fold increase in malaria incidence within 10 months, but reinstating IRS led to an over 5-fold decrease within 8 months. In areas where IRS was initiated and sustained, malaria incidence dropped by 85% after year 4. IRS could play a critical role in achieving global malaria targets, particularly in areas where progress has stalled.

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Determinants of dietary diversity and its relationship with the nutritional status of pregnant women

Journal of Nutritional Science ◽

10.1017/jns.2021.6 ◽

2021 ◽

Vol 10 ◽

Author(s):

Mahama Saaka ◽

Sofo Mutaru ◽

Shaibu Mohammed Osman

Keyword(s):

Nutritional Status ◽

Food Insecurity ◽

Pregnant Women ◽

Dietary Diversity ◽

Household Wealth ◽

Northern Region ◽

Urban Setting ◽

Northern Ghana ◽

Cross Sectional Survey ◽

Cross Sectional

Abstract There is little information regarding factors that determine dietary diversity among pregnant women in Ghana. The present study, therefore, sought to assess the independent predictors of dietary diversity and its relationship with nutritional status of pregnant women in the Northern Region of Ghana. The present study was an analytical cross-sectional survey involving 423 pregnant women in different stages of gestation. The 24-h dietary recall method was used to assess minimum dietary diversity for women (MDD-W), and nutritional status was assessed using mid-upper arm circumference (MUAC) measurements. Binary logistic regression was performed to assess the association between maternal dietary diversity and maternal thinness and a P value of <0⋅05 was considered statistically significant. Of the 423 women, 79⋅9 % (95 % CI 76⋅1, 83⋅7) met the MDD-W and the prevalence of undernutrition among the pregnant women was 26⋅0 %. The analysis showed that women of low household wealth index were 48 % less likely (AOR 0⋅52, CI 0⋅31, 0⋅88) of meeting the MDD-W, whereas women from households of poor food insecurity were 88 % less likely (AOR 0⋅12, CI 0⋅05, 0⋅27) of achieving the MDD-W. Women of low household size were three times more likely of meeting the MDD-W (AOR 3⋅07, CI 1⋅13, 8⋅39). MDD-W was not associated with maternal underweight during pregnancy. In conclusion, the results of the present study showed that food insecurity and not low MDD-W, associated with mothers’ thinness (underweight) during pregnancy in peri-urban setting of Northern Ghana.

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Accounting for regional transmission variability and the impact of malaria control interventions in Ghana: A population level mathematical modelling approach.

10.21203/rs.2.22332/v1 ◽

2020 ◽

Author(s):

Timothy Awine ◽

Sheetal P Silal

Keyword(s):

Malaria Control ◽

Malaria Incidence ◽

Protective Efficacy ◽

Indoor Residual Spraying ◽

Information Management System ◽

Control Measures ◽

Bed Nets ◽

Model Parameters ◽

Insecticide Treated Bed Nets ◽

The Impact

Abstract Background Assessing the effectiveness of malaria control measures in Ghana will require taking transmission dynamics of the disease into account given the influence of climate variability in the region of interest. The impact of preventative interventions on malaria incidence and the prospects of meeting program timelines in Ghana have been investigated using mathematical models based on regionally diverse climatic zones. Methods An ordinary non-linear differential equation model with its associated rate parameters was developed incorporating the transitions between various disease compartments for three ecological zones in Ghana. Model parameters were estimated using data captured on the District Health Information Management System in Ghana from 2008 to 2017.The impact of insecticide treated bed nets and indoor residual spraying on the incidence of malaria were simulated at various levels of coverage and protective effectiveness in each ecological zone. To fit the model, Approximate Bayesian Computational sampling approach was adopted. Results Increasing the coverage levels of both long lasting insecticide treated bed nets or indoor residual spraying activities without a corresponding increase in their proper use or patronage does not impact highly on averting predicted incidence of malaria in Ghana. Improving on the protective efficacy of long lasting insecticide treated bed nets through proper usage could lead to substantial reductions in the predicted incidence of malaria. Similar results were obtained with indoor residual spraying across all zones. Conclusions Projected goals set in the National Strategic plan for malaria control 2014-2020 as well as WHO targets for malaria pre-elimination by 2030 are only likely be achieved if a substantial improvement in treated bed net usage is achieved coupled with targeted deployment of indoor residual spraying with high efficacy.

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The impact of stopping and starting indoor residual spraying on malaria burden in Uganda

Nature Communications ◽

10.1038/s41467-021-22896-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Jane F. Namuganga ◽

Adrienne Epstein ◽

Joaniter I. Nankabirwa ◽

Arthur Mpimbaza ◽

Moses Kiggundu ◽

...

Keyword(s):

Malaria Incidence ◽

Critical Role ◽

Scale Up ◽

Indoor Residual Spraying ◽

Fold Increase ◽

Bed Nets ◽

Malaria Burden ◽

Vector Control Intervention ◽

Using Data ◽

The Impact

AbstractThe scale-up of malaria control efforts has led to marked reductions in malaria burden over the past twenty years, but progress has slowed. Implementation of indoor residual spraying (IRS) of insecticide, a proven vector control intervention, has been limited and difficult to sustain partly because questions remain on its added impact over widely accepted interventions such as bed nets. Using data from 14 enhanced surveillance health facilities in Uganda, a country with high bed net coverage yet high malaria burden, we estimate the impact of starting and stopping IRS on changes in malaria incidence. We show that stopping IRS was associated with a 5-fold increase in malaria incidence within 10 months, but reinstating IRS was associated with an over 5-fold decrease within 8 months. In areas where IRS was initiated and sustained, malaria incidence dropped by 85% after year 4. IRS could play a critical role in achieving global malaria targets, particularly in areas where progress has stalled.

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Accounting for regional transmission variability and the impact of malaria control interventions in Ghana: A population level mathematical modelling approach.

10.21203/rs.2.22332/v2 ◽

2020 ◽

Author(s):

Timothy Awine ◽

Sheetal P Silal

Keyword(s):

Malaria Control ◽

Malaria Incidence ◽

Protective Efficacy ◽

Indoor Residual Spraying ◽

Information Management System ◽

Control Measures ◽

Bed Nets ◽

Model Parameters ◽

Insecticide Treated Bed Nets ◽

The Impact

Abstract Background Assessing the effectiveness of malaria control measures in Ghana will require taking transmission dynamics of the disease into account given the influence of climate variability in the region of interest. The impact of preventative interventions on malaria incidence and the prospects of meeting program timelines in Ghana were investigated using mathematical models based on regionally diverse climatic zones. Methods An ordinary non-linear differential equation models with their associated rate parameters were developed incorporating the transitions between various disease compartments for three ecological zones in Ghana. Models were fitted using data from the District Health Information Management System in Ghana from 2008 to 2017 and historical intervention coverage levels. To calibrate the models, Approximate Bayesian Computational sampling approach with a distance based rejection criteria was adopted. A leave-one-out approach was used to validate model parameters and the most sensitive evaluated using a multivariate regression sensitivity analysis. The impact of insecticide treated bed nets and their usage and indoor residual spraying as well as their protective efficacy on the incidence of malaria were simulated at various levels of coverage and protective effectiveness in each ecological zone to investigate the prospects of achieving goals of the malaria control strategy for 2014-2020. Results Increasing the coverage levels of both long lasting insecticide treated bed nets and indoor residual spraying activities without a corresponding increase in their recommended usage does not impact highly on averting predicted incidence of malaria. Improving upon the protective efficacy of long lasting insecticide treated bed nets through proper usage could lead to substantial reductions in the predicted incidence of malaria. Similar results were obtained with indoor residual spraying across all zones.Conclusions Projected goals set in the national strategic plan for malaria control 2014-2020 as well as WHO targets for malaria pre-elimination by 2030 are only likely to be achieved if a substantial improvement in treated bed net usage is achieved coupled with targeted deployment of indoor residual spraying with high community acceptability and efficacy. Key words: model, malaria, interventions, long lasting insecticide bednets, indoor residual spraying

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Zika Pregnancy Surveillance: Transforming Data into Educational and Clinical Tools

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v11i1.9693 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Kara Polen ◽

Titilope Oduyebo ◽

Jazmyn Moore ◽

Sascha Ellinton ◽

Regina Simeone ◽

...

Keyword(s):

Public Health ◽

Pregnant Women ◽

Surveillance System ◽

Healthcare Providers ◽

Surveillance Data ◽

Clinical Settings ◽

Educational Materials ◽

The Us ◽

Clinical Tools ◽

The Impact

ObjectiveTo describe how Zika virus (Zika) surveillance data informs and improves testing guidance, clinical evaluation and management of pregnant women and infants with possible Zika infectionIntroductionLittle was known about the maternal and fetal/infant effects of Zika infection before the 2015 outbreak in the Americas, which made it challenging for public health practitioners and clinicians to care for pregnant women and infants exposed to Zika. In 2016, CDC implemented a rapid surveillance system, the US Zika Pregnancy and Infant Registry, to collect information about the impact of Zika infection during pregnancy and inform the CDC response and clinical guidance. In partnership with state, tribal, local, and territorial health departments, CDC disseminated information from this surveillance system, which served as the foundation for educational materials and clinical tools for healthcare providers.MethodsThroughout the Zika response, CDC worked closely with health officers, epidemiologists, and clinical partners to seek expert input on the interpretation of emerging data and the evaluation and management of these vulnerable populations. In response to requests from clinical and public health partners, CDC created targeted educational materials and tools to facilitate the implementation of clinical guidance. These materials equipped healthcare providers with the information needed to care for pregnant women and infants with Zika infection. Examples of products developed included: 1) screening tools to identify pregnant women for whom testing is indicated; 2) an interactive web tool to assist with implementation and interpretation of Zika testing guidance (Pregnancy and Zika Testing Widget); 3) patient counseling scripts; and 4) videos to explain critical clinical concepts (e.g., measurement of infant head circumference). These tools were informally pre-tested with the target audiences prior to dissemination, specifically to assess usefulness in clinical settings. CDC disseminated these tools through the CDC website and through comprehensive outreach (e.g., webinars, calls, email alerts) to various audiences. Additionally, several professional organizations incorporated these tools into regular communication with their membership.ResultsThe US Zika Pregnancy and Infant Registry is currently monitoring infants from approximately 7,300 pregnancies in the US states and territories with laboratory evidence of Zika. Surveillance data provided valuable information, including clues toward the pattern of defects and other neurologic disabilities associated with congenital Zika infection, estimates of the risks associated with congenital infection, and timeframes of greatest risk during pregnancy, to help clinicians counsel pregnant patients with potential Zika exposure. CDC used these data to inform their clinical tools, particularly in pretest counseling materials and educational factsheets for healthcare providers to use with pregnant women with potential Zika exposure.After informal testing among healthcare providers, the tools received positive feedback regarding usefulness and applicability in clinical settings. Collectively, CDC’s Zika clinical tools were downloaded more than 300,000 times from CDC’s website. The Pregnancy and Zika Testing Widget was accessed and followed to an endpoint (e.g., Zika testing recommended) more than 17,000 times, with more than 75% of users self-identifying as clinicians.ConclusionsRapid implementation of Zika surveillance captured evolving data about the impact of Zika on pregnant women and their infants. These data informed the development of clinical tools for healthcare providers caring for and counseling patients with Zika exposure. These tools ensured pregnant women and infants were adequately monitored during the Zika outbreak. Health education materials and clinical tools based on surveillance data should be considered in future emergency responses, particularly when knowledge is rapidly evolving.ReferencesCDC Zika Pregnancy Website: https://www.cdc.gov/pregnancy/zika/materials/index.html

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