The Ebola epidemic in West Africa is having devastating consequences. To the direct effects of the epidemic—over 23,000 cases and more than 9000 deaths according to the World Health Organisation—we must add its economic and social effects and collateral effects on healthcare systems and health. While none of these effects have yet been quantified, they are expected to be enormous.
In Sierra Leone, malaria is one of the three leading causes of death among children under five In Sierra Leone, the country with the most reported cases of Ebola, malaria is one of the three leading causes of death among children under five and also one of the leading causes of death among adults, according to the indicator survey published by the country’s National Malaria Control Programme. After almost a year during which most of the scant health care resources in Sierra Leone have been focused on dealing with the Ebola epidemic, it would be surprising if this state of affairs had not deteriorated further.
In response to this situation—and and with the dual objective of minimizing deaths from malaria and reducing the number of patients with fever who might be suspected of having Ebola and be referred to the already overwhelmed healthcare facilities—MSF offered to work with Sierra Leone’s Ministry of Health to undertake a mass distribution of antimalarials (MDA). The province chosen for the intervention was the Western Area, the most populous in the country and one of the areas most affected by the Ebola epidemic.
In December 2014 and January 2015, during the peak malaria season and in the midst of the Ebola epidemic, over 1.5 million children and adults in the Western Area received two courses of treatment with the antimalarial drug artesunate amodiaquine (ASAQ).
Following three weeks of preparation and training and an informative publicity campaign that made use of radio, television and leaflets, more than 5000 health workers trained by MSF visited every house in all the districts of the province to distribute the antimalarial drugs, explain to families how to take the medicine, and monitor its administration.
The mass distribution involved huge challenges, including the need to prepare for a large-scale intervention in record time. But the preliminary results have been positive, indicating that 88% of the population was covered in the first round and 100% in the second, and that most of the population (89%) supported the campaign. None of the health workers contracted Ebola and no serious side effects to treatment were reported.
we have proved that it is possible to organise this type of intervention on a mass scale even in complex situations, such as an Ebola epidemic We recognise that, working with other actors, the next step is to carry out a more thorough analysis of the impact of MDA on malaria in the region and to study in what contexts (with or without Ebola) this impact is greater so that the intervention can be repeated. We are also aware that the field staff have proved that it is possible to organise this type of intervention on a mass scale even in complex situations, such as an Ebola epidemic. Since the evidence indicates that strategies such as MDA can reduce malaria transmission, we believe that this mass intervention may have helped to prevent part of the population from contracting malaria and perhaps from dying as a result. While carrying out an in-depth analysis of MDA, we are continuing to work on the challenges that remain, namely, reducing the number of cases of Ebola to zero and ensuring that, as the epidemic continues, the population does not succumb to other diseases that continue to affect people not only in times of Ebola.
Bosman A, Ringwald. P. (2014) Proposal for an Evidence Review Group on MDA, MSAT & FSAT. Geneva: World Health Organisation.
World Health Organisation Ebola Situation Report. Accessed 20-02-2015. Available at http://apps.who.int/ebola/en/ebola-situation-report/situation-reports/ebola-situation-report-18-february-2015
National Malaria Control Programme, Statistics Sierra Leone, University of Sierra Leone, Catholic Relief Services, (2013). Malaria Indicator Survey. Freetown, Sierra Leone: NMCP, Statistics Sierra Leone, CRS, ICF International.
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