Ethiopia: Towards Consolidating Malaria, Covid-19 Mitigation Endeavors

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Even if it is not yet clear whether malaria infection presents an additional risk factor for becoming infected with COVID-19 or the severity of the infection, researchers do agree that there are several reasons to be concerned about malaria within the current context of the COVID-19 pandemic.

Malaria is ranked at the top of hospital based admissions, outpatient visits and mortality in Ethiopia. This life-threatening epidemic leaves more than 50 million people at risk of contracting the disease. It affects four to five million people in Ethiopia every year. Some studies indicate that it kills a staggering number of children every day-a child every two minutes globally. The National Malaria Elimination Roadmap of Ethiopia has been developed with the aim of helping to further reduce the human suffering due to malaria and eliminate the disease from the country. In the past decade, the government of Ethiopia is said to have given a high priority to the prevention and control of malaria.

The World Health Organization (WHO) indicates that 68 percent of Ethiopian population lives in malaria-prone areas and are, therefore, at risk of contracting the epidemic. Some other studies say, Malaria is a scourge across 75% of the country. In Ethiopia, altitude and climate (rainfall and temperature) are the most important determinants of malaria transmission. Transmission is seasonal and largely unstable in character. The major transmission of malaria follows the June to September rains and occurs between Septembers to December; while the minor transmission season occurs between from April to May; following the February to March rains.

Now that the heavy summer rain is ending and winter has already commenced, seasonal outbreak of malaria is likely to occur during the coming four months in many parts of the country. Therefore, the next three months are opportune moment for the spread of the vector-borne epidemic in most lowlands and highland fringe areas between 1,500 and 2,500 meter; which are affected by frequent epidemics of the country.

What makes this year's scenario different from previous cases is the outbreak of coronavirus all across the globe including Ethiopia. With COVID-19 spreading all across the country and the number of daily new positive cases escalating every day, the overall health intervention strategies devised earlier by the Ministry of Health to mitigate major epidemics like Malaria, TB, among others, will definitely be challenged.

Earlier in April 2020, WHO urged countries to move fast and distribute malaria prevention and treatment tools at this stage of the COVID-19 outbreak in sub-Saharan Africa, and to do their utmost to safely maintain these essential malaria control services. Under such premises, I do believe that Ethiopia had already responded accordingly.

With over 1,000 new positive cases of COVID-19 being registered every day in the country, the only way to protect the diseases is to stay safe and healthy from contracting virus itself and other diseases. Other diseases like TB, Malaria, Diabetics, inter alia, might end up to be aggravating factors for the damage caused by COVID-19. This is predominantly because the fatality rate of COVID-19 depends on the prevalence of other diseases. The lesser the prevalence of associated diseases on a person, the higher the chance of surviving COVID-19 would be.

As the COVID-19 pandemic continues to accelerate and challenge even the most advanced health systems across the world, countries are urged to keep up the fight against malaria, a disease that puts half the world's population at risk and kills a child every two minutes. Ethiopia should prepare itself in this regard.

In this regard, this year's attempts to curtail malaria outbreak is expected to be daunting; creating additional burden along with the effort being exerted to control COVID-19.The ongoing COVID-19 pandemic places an extra burden on health systems worldwide, and especially in countries with fragile health systems like Ethiopia. Reports say, many countries, particularly in sub-Saharan Africa; which accounts for more than 90% of global malaria cases and deaths, are facing a double challenge of protecting their citizens against existing threats to public health, like malaria and emerging ones like COVID-19.

This calls for acceleration of mass vector control campaigns, while ensuring their deployment in ways that protect health workers and communities against potential COVID-19 transmission.

According to the International Journal of Infectious Diseases, COVID-19 currently imposes an additional burden to the already overstretched, resource strapped health services which are grappling to bring under control the high burden of existing infectious and non-infectious diseases, including TB, HIV, and malaria. Proactive screening for COVID-19 is ongoing in high malaria endemic African countries.

It is known that the case of COVID-19 is deemed 'confirmed' based on a positive laboratory test result for SARS-Cov-2 virus infection regardless of symptoms. Health care workers and community members alike are faced with an important challenge of quickly identifying symptoms and taking appropriate steps for laboratory investigation in line with the case definition based on surveillance or clinical characterization.

The bottom line is, the effort to control malaria outbreak should be harmonized with the ongoing national COVID-19 mitigating endeavors; considering the fact that there are always limitations of resources in individual actions. Malaria screening activities, for instance, may be handled along with COVID-19 screening test. But most importantly, it is required to exert maximum effort to minimize the impact of malaria outbreak in the earlier periods through drying marshy lands and spraying chemicals as usual, to ban propagation of the vector.

Earlier experiences show that malaria outbreak is, by and large, unstoppable; though its impact has been significantly reduced following the various intervention mechanisms undertaken so far. Ministry of Health, I presume, has already devised an exceptional intervention plan this year; along with its comprehensive strategic malaria mitigation endeavors due to the outbreak of COVID-19 globally. As the number of COVID-19 positive cases so far is currently much lower in rural areas, where malaria outbreak is relatively higher, the effort of consolidating efforts in mitigating the epidemic and the pandemic would not be that much complicated. It rather helps proper utilization of trained professionals and other resources which is vital to Ethiopia; where trained health professionals are not galore.

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