Malaria in the time of Ebola: Alleviating health system impacts during crises

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True ClaycombeCropThe following is a guest post by True Claycombe, Policy Manager, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria

Friends of the Global Fight against AIDS, Tuberculosis and Malaria welcomed malaria expert Dr. Susie Nasr for a recent webinar to discuss malaria and the Global Fund’s role during the Ebola outbreak in West Africa. Dr. Nasr is the Disease Advisor for Malaria at the Global Fund and a public health specialist and clinician with more than 10 years of field experience in both government and non-governmental sectors across Africa and Asia. In order to understand the important intersection of malaria, Ebola and health systems, Dr. Nasr walked us through the steps that the Global Fund took in both Sierra Leone and Liberia last year.

Why is it even relevant to discuss Malaria and Ebola at the same time?

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Dr. Susie Nasr

Malaria and Ebola are completely different infections caused by entirely different beasts (Ebola is thought to be transmitted by bats and the malaria virus is carried by mosquitoes), but their symptoms are similar. Warning signs for both diseases include fever, headache, weakness, joint and muscle pain, and fatigue. Both Liberia and Sierra Leone have a high burden of malaria, with both countries reporting more than 100 cases per 1,000 people in 2014. To date, there have been 11,861 confirmed cases of Ebola in both countries. Additionally, both countries have weak health systems due to years of conflict, a lack of adequate health facilities and qualified health workers, and alarmingly high mortality rates among mothers and children under 5.

Prior to the Ebola crisis in West Africa, a fever was automatically assumed to be malaria; however, the Ebola crisis resulted in people jumping to the conclusion that every fever was Ebola. Thus, people were either flooding the Ebola facilities or were too scared to seek any kind of treatment. As a result, cases of malaria – also deadly if untreated – were going undiagnosed. Furthermore, prevention strategies and treatment for these two diseases are radically different, making it critically important to separate malaria cases from Ebola in order for both diseases to be diagnosed and treated correctly.

So what did the Global Fund do?

Because the Global Fund’s focus is primarily on the three diseases (HIV/AIDS, tuberculosis and malaria), they put their efforts into malaria to help ease the burden on the health systems. Immediately, the Global Fund took action and disseminated the WHO guidelines on temporary malaria control to Ministries of Health and National Malaria Control Programs and redirected funds to support these guidelines. Next, in Liberia the Global Fund launched a national insecticide-treated net campaign to help protect against malaria. In Sierra Leone, a national net campaign was launched pre-Ebola, thus the Global Fund’s actions here involved the undertaking of a mass drug administration (known as MDA)  program, which provided malaria treatment to provinces with confirmed Ebola cases. The idea behind these two efforts was that they would indirectly target Ebola by removing the malaria burden on the health system and help to mitigate the confusion surrounding similar symptoms. The Global Fund will produce a report on the effectiveness of their response to Ebola next year.

Dr. Nasr ended the webinar with a brief discussion on how the Global Fund created an Emergency Fund to allow some increased flexibility to deal with emergency situations like the Ebola crisis. While both countries are now Ebola-free, there is still a lot of work the Global Fund, its partners in the global health community and the countries themselves must do to ensure their health systems are ready for similar epidemics in the future.

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