Anti-Malaria Recommendations for Sub-Saharan Africa During the COVID-19 Pandemic

Abstract

Because of COVID-19, the vulnerable healthcare systems of many African countries have faced additional burdens. As governments divert resources towards COVID-19 efforts, researchers and international organizations have voiced concerns on how the pandemic would affect malaria incidence, especially in malaria-endemic regions. In this study, we searched relevant keywords on PubMed to systematically review the existing literature on malaria recommendations and malaria outcomes during COVID-19. Special attention was brought to the malaria recommendations in Nigeria, The Democratic Republic of Congo, and South Africa, as these three countries vary in malaria and COVID-19 incidence. We included 20 relevant publications that highlight the importance of chemoprevention, vector control, and rapid diagnostics in decreasing malaria incidence in the context of COVID-19. We also examined how malaria recommendations vary among the three countries of interest. We found that while both insecticide-treated nets and antimalarials are essential to preventing additional malaria cases, continuous supply of antimalarials is especially important in preventing hundreds of thousands of additional malaria deaths. Certain countries like South Africa still use chloroquine against Plasmodium vivax. Unwarranted use of chloroquine against COVID-19 not only increases chloroquine resistance but decreases supplies available against P. vivax. To encourage community safety and compliance, additional protection is recommended for indoor-residual spraying delivery teams and seasonal malaria chemoprevention campaign community health workers. Finally, mass drug administrations are recommended only for urban regions with low malaria endemicity, and malaria rapid diagnostic tests should be used together with COVID-19 diagnostics. Continued funding and government efforts are required to implement these recommendations and prevent additional malaria drug resistance, cases, and deaths during the COVID-19 pandemic.