ArticleMalaria journal2025
Malaria healthcare service utilization before, during, and 1 year into the COVID-19 pandemic in 20 sub-Saharan African countries using Generalized Estimating Equation.
Article in Malaria journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe onset of the COVID-19 pandemic disrupted healthcare delivery including malaria healthcare services in sub-Saharan Africa. There is limited research exploring impact of COVID-19 on malaria healthcare utilization. This study explores the trends in disruption of malaria service utilization across 20 sub-Saharan African countries before, at the initial onset, and 1 year into the COVID-19 pandemic.
methodsLongitudinal study was conducted using secondary data from the 'Premise Malaria COVID-19 Health Services Disruption Survey 2020 and 2021 from 20 malaria endemic African countries'. The study population consisted of individuals aged 16 years and above from the general population across 20 malaria-endemic African countries. The outcome variable for this study was malaria healthcare service utilization, comprising three specific measures: being tested for malaria, visiting a healthcare provider for malaria symptoms and receiving treatment for malaria symptoms at three distinct time periods. Data was extract and analysed using STATA version 18. A Generalized Estimating Equation (GEE) approach was used in the statistical analysis.
resultsA total of 4726 participants were included in this study. Before to, during, and 1 year into the COVID-19 pandemic, 71.77%, 72.26%, and 59.12% of participants were tested for malaria, respectively. Also, 80.61%, 79.71%, and 1.25% of participants visited healthcare providers for malaria symptoms before, at the initial onset, and 1 year into the COVID-19 pandemic, respectively. Additionally, 97.97%, 96.30%, and 15.23% of participants received treatment for malaria symptoms before, at the initial onset, and 1 year into the COVID-19 pandemic, respectively. 1 year after the onset of the COVID-19 pandemic, people were 45% less likely to be tested for malaria, (AOR = 0.55, 95% CI 0.48, 0.63), 99.7% less likely to visit healthcare providers for malaria symptoms (AOR = 0.003, 95% CI 0.002, 0.005), 99.6% less likely to receive treatment for malaria symptoms (AOR = 0.004, 95% CI 0.002, 0.006).
conclusionThis study demonstrates a significant decline in malaria healthcare service utilization 1 year into the COVID-19 pandemic across 20 sub-Saharan African countries. Individuals were markedly less likely to be tested, visit healthcare providers, or receive treatment for malaria symptoms compared to pre-pandemic levels. These findings emphasize the urgent need for resilient health systems and sustained malaria services during global health emergencies to prevent setbacks in malaria control and elimination efforts.
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