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.

Malaria, HIV and TB in Zimbabwe: Epidemiology, Disease Control Challenges and Interventions

“…The Covid-19 pandemic has undermined this progress (Mbunge et al, 2021b). One study finds that there was a higher than expected increase in malaria cases and deaths from January-June 2020, compared to January-June 2017-2019, which resulted in an excess of over 30,000 malaria cases and 75 malaria deaths (see Figures 2 and 3) (Gavi et al, 2021).…”

“…Challenges: Continued sensitisation of vulnerable communities through IEC programmes are needed in rural districts to enhance uptake of malaria interventions (Mbunge et al, 2021b). Failure to book or late booking of antenatal care (ANC) appointments, which include information and counselling sessions on malaria and HIV, have resulted in delayed or limited education in disease prevention and treatment for pregnant women and their partners (Chimwaza et al, 2021).…”

“…Interventions: Social and behaviour change communication (SBCC) is a key malaria control strategy in Zimbabwe, aiming to counter IRS refusal, for example. However, the effectiveness of these SBCC interventions is not yet known (Mbunge et al, 2021b). Studies have shown peer education groups to be effective in increasing uptake of HIV services among AGYW; yet, few have assessed their efficacy in Zimbabwe (Oberth et al, 2021).…”

“…Covid-19 mitigation measures, such as travel restrictions, border closures, curfews, lockdowns, and social distancing, have affected the delivery and utilisation of essential health services (see Figure 17) (Gavi et al, 2021;Heuschen et al, 2021;Mbunge et al, 2021b;Thekkur et al, 2021). Health facilities have also been closed due to lack of staff and inadequate PPE; and of the ones that remain open, only a few patients were allowed in at a time, resulting in long waiting queues outside, which may have deterred patients (Heuschen et al, 2021;Thekkur et al, 2021).…”

“…The largest effect of Covid-19 related disruption of HIV, TB, and malaria services is projected to result from interruption of ART, decline in TB case detection, and interruption of IRS and LLIN distribution campaigns, respectively (Amimo et al, 2020). The suspension of IRS and LLIN distribution, shortages of malaria commodities, and reduced demand for health services have hindered the continued delivery of malaria services (Gavi et al, 2021;Mbunge et al, 2021b). A recent modelling analysis by the WHO predicted a >20% rise in malaria morbidity and >50% mortality in sub-Saharan Africa during the Covid-19 pandemic as a result of a 75% reduction in routine malaria control measures and shortage of anti-malarial drugs (Zawawi et al, 2020).…”