title: Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities.
abstract: BACKGROUND
  The ongoing west Africa Ebola-virus-disease epidemic has disrupted the entire health-care system in affected countries. Because of the overlap of symptoms of Ebola virus disease and malaria, the care delivery of malaria is particularly sensitive to the indirect effects of the current Ebola-virus-disease epidemic. We therefore characterise malaria case management in the context of the Ebola-virus-disease epidemic and document the effect of the Ebola-virus-disease epidemic on malaria case management.
  
  
  METHODS
  We did a cross-sectional survey of public health facilities in Guinea in December, 2014. We selected the four prefectures most affected by Ebola virus disease and selected four randomly from prefectures without any reported cases of the disease. 60 health facilities were sampled in Ebola-affected and 60 in Ebola-unaffected prefectures. Study teams abstracted malaria case management indicators from registers for January to November for 2013 and 2014 and interviewed health-care workers. Nationwide weekly surveillance data for suspect malaria cases reported between 2011 and 2014 were analysed independently. Data for malaria indicators in 2014 were compared with previous years.
  
  
  RESULTS
  We noted substantial reductions in all-cause outpatient visits (by 23 103 [11%] of 214 899), cases of fever (by 20249 [15%] of 131 330), and patients treated with oral (by 22 655 [24%] of 94 785) and injectable (by 5219 [30%] of 17 684) antimalarial drugs in surveyed health facilities. In Ebola-affected prefectures, 73 of 98 interviewed community health workers were operational (74%, 95% CI 65-83) and 35 of 73 were actively treating malaria cases (48%, 36-60) compared with 106 of 112 (95%, 89-98) and 102 of 106 (96%, 91-99), respectively, in Ebola-unaffected prefectures. Nationwide, the Ebola-virus-disease epidemic was estimated to have resulted in 74 000 (71 000-77 000) fewer malaria cases seen at health facilities in 2014.
  
  
  CONCLUSIONS
  The reduction in the delivery of malaria care because of the Ebola-virus-disease epidemic threatens malaria control in Guinea. Untreated and inappropriately treated malaria cases lead to excess malaria mortality and more fever cases in the community, impeding the Ebola-virus-disease response.
  
  
  BACKGROUND
  Global Fund to Fight AIDS, Tuberculosis and Malaria, and President's Malaria Initiative.
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA. Electronic address: mplucinski@cdc.gov.
authors.forename: Mateusz M
authors.initials: MM
authors.lastname: Plucinski
authors.affiliation: National Malaria Control Programme, Ministry of Health, Conakry, Guinea.
authors.forename: Timothée
authors.initials: T
authors.lastname: Guilavogui
authors.affiliation: Mafèrinyah Rural Health Research Center, Mafèrinyah, Guinea.
authors.forename: Sidibe
authors.initials: S
authors.lastname: Sidikiba
authors.affiliation: National Malaria Control Programme, Ministry of Health, Conakry, Guinea.
authors.forename: Nouman
authors.initials: N
authors.lastname: Diakité
authors.affiliation: National Malaria Control Programme, Ministry of Health, Conakry, Guinea.
authors.forename: Souleymane
authors.initials: S
authors.lastname: Diakité
authors.affiliation: National Malaria Control Programme, Ministry of Health, Conakry, Guinea.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Dioubaté
authors.affiliation: Catholic Relief Services, Conakry, Guinea.
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Bah
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Hennessee
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Butts
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Halsey
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: McElroy
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: S Patrick
authors.initials: SP
authors.lastname: Kachur
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA.
authors.forename: Jamila
authors.initials: J
authors.lastname: Aboulhab
authors.affiliation: Division of Prevention and Disease Control, Ministry of Health, Conakry, Guinea.
authors.forename: Richard
authors.initials: R
authors.lastname: James
authors.affiliation: National Malaria Control Programme, Ministry of Health, Conakry, Guinea.
authors.forename: Moussa
authors.initials: M
authors.lastname: Keita
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D058872:Epidemics; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000469:parasitology; D016701:Guinea / Q000453:epidemiology; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008288:Malaria / Q000150:complications / Q000188:drug therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000962:Antimalarials