Impact of COVID-19 on Malaria Elimination: Juxtaposing Indoor Residual Spraying and Mobile Phones in Buhera Rural District, Zimbabwe

Abstract

BackgroundGlobally, malaria remains one of the leading health problems decimating population in Africa with an estimated 228 million cases of malaria and 405 000 deaths occurred worldwide in 2018. In Zimbabwe, like other sub-Saharan countries, is fighting both elusive malaria and COVID-19 that continues to overwhelm the already overburdened healthcare system. Zimbabwean rural healthcare centres including Buhera district experience dire impact of malaria and COVID-19 pandemic. Therefore, the study presents the impact of COVID-19 on malaria control measures and reflects on indoor residual spraying (IRS) activities pre and post the outbreak of COVID-19 while introspecting milestones and challenges encountered when executing IRS activities; and opportunities to integrate mobile technologies into malaria elimination.MethodsA retrospective study of malaria cases and IRS reports was carried out. Malaria cases per each health centre from 2015-2020 were collected from DHIS in Buhera rural district.ResultsThe study shows that the overall IRS acceptance rate in 2015, 2016, 2017, 2018 and 2019 was 100%, 58.5%, 66.6%, 52.8% and 83.3%, respectively. The absolute rooms sprayed in 2017 are 2.55% above those sprayed in 2016 but are 8.46% below those sprayed in 2015. The coverage failed to reach impact levels in most of the wards due but not lack of resources, limited to inadequate community sensitization, and competing programmes which were running concurrently with IRS. Also, the study revealed that malaria confirmed cases increased tremendously in 2020 as compared to the previous years, particularly from 2015-2019 because of delayed IRS coverage, COVID-19 restrictions, heavy rains, differed and inconsistent social and behaviour change communication, lack of community engagement, delayed procurement of equipment and lack of funding among others. ConclusionsThe study revealed that moving from malaria prevention to elimination is possible in low malaria incidence areas in Buhera rural district. However, new challenges including cyclones and COVID-19, disrupts of movements of medical equipment, delayed IRS activities, social and behaviour change communication and IEC campaigns and mandatory national lockdowns. It is therefore imperative to integrate mobile phones into malaria control strategies during COVID-19 pandemic to strengthen awareness campaigns while maintaining COVID-19 regulations.

Public health relevant consequences of the COVID-19 pandemic on malaria in sub-Saharan Africa: A scoping review

“…On the other hand, the increased usage of these drugs for COVID-19 prevention and treatment in some malaria endemic countries might have reduced malaria (25). A frequent off-label use of artemisinin-based drugs may also increase the likelihood of emerging drug resistance and thus threatens the most important of the remaining effective antimalarials (47)(48)(49)(50).…”

“…The largest effects may occur if the COVID-19 transmission peaks and the planned malaria campaigns overlap (21,23,53,55). About three quarters of malaria-affected countries reported disruptions of malaria services and programs (17,32,48,50,53,(56)(57)(58). (48,50,57).…”

“…About three quarters of malaria-affected countries reported disruptions of malaria services and programs (17,32,48,50,53,(56)(57)(58). (48,50,57).…”

“…The COVID-19 pandemic in SSA endangers access to health care services due to several factors. Direct factors include restricted services and closures of health facilities because of reduced health care worker (HCW) capacity due to lack of personal protective equipment (PPE), stigmatization, fear of getting infected, or absence due to COVID-19 quarantine, disease or death (27,32,50,51). Delayed treatment results in prolonged gametocyte carriage and additional opportunities for transmission.…”

“…Disrupted ITN programs will lead to increased malaria transmission as 80% of the nets are distributed through mass campaigns (22,48,53,55). IRS campaigns face many challenges as they require direct household contact (33,50,57).…”