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.
