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

  1. Anna-Katharina Heuschen
  2. Alhassan Abdul-Mumin
  3. Martin Nyaaba Adokiya
  4. Guangyu Lu
  5. Albrecht Jahn
  6. Oliver Razum
  7. Volker Winkler
  8. Olaf Müller

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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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  1. ScreenIT

    SciScore for 10.1101/2021.11.29.21266976: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableThe data allowed analyzing children under five years and pregnant women separately using the fraction of the under-five population (14% of the population) and the fraction of women between 15 and 45 years (23% of the population) as estimates of the respective population denominators (26).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analysis: The data have been processed with Microsoft Excel Version 16.52 and analyzed with Stata IC Version 16 (Statacorp, College Station, TX, USA).
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    Statacorp
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has strengths and limitations. A strength of the study is that the data represent a whole year of follow-up into the pandemic, which provides a more comprehensive picture of the effects compared to the previous studies with much shorter study periods. Limitations are that the surveillance system itself may have been affected by the pandemic, with a bias in the reported numbers. Moreover, it is not clear if the quality of surveillance data is fully comparable during the five years observed. Finally, much more people with malaria symptoms may have switched to self-medication during the pandemic, which may also have an albeit unknown effect on the malaria figures. In conclusion, this study shows that the COVID-19 pandemic has been accompanied by a reduced malaria incidence in northern Ghana’s health facilities. Further data from other African countries and in particular data from community-based studies are needed to fully judge the impact of the pandemic on the global malaria situation.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.11.29.21266976v1 on medRxiv