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. 2021 Dec 20;20(1):475.
doi: 10.1186/s12936-021-04018-0.

Impact of COVID-19 on routine malaria indicators in rural Uganda: an interrupted time series analysis

Jane F Namuganga  1 , Jessica Briggs  2 , Michelle E Roh  3 , Jaffer Okiring  4 , Yasin Kisambira  4 , Asadu Sserwanga  4 , James A Kapisi  4 , Emmanuel Arinaitwe  4 , Chris Ebong  4 , Isaac Ssewanyana  4 , Catherine Maiteki-Ssebuguzi  5 , Moses R Kamya  4   6 , Sarah G Staedke  7 , Grant Dorsey  2 , Joaniter I Nankabirwa  4   6
Affiliations

Impact of COVID-19 on routine malaria indicators in rural Uganda: an interrupted time series analysis

Jane F Namuganga et al. Malar J. .

Abstract

Background: In March 2020, the government of Uganda implemented a strict lockdown policy in response to the COVID-19 pandemic. Interrupted time series analysis (ITSA) was performed to assess whether major changes in outpatient attendance, malaria burden, and case management occurred after the onset of the COVID-19 epidemic in rural Uganda.

Methods: Individual level data from all outpatient visits collected from April 2017 to March 2021 at 17 facilities were analysed. Outcomes included total outpatient visits, malaria cases, non-malarial visits, proportion of patients with suspected malaria, proportion of patients tested using rapid diagnostic tests (RDTs), and proportion of malaria cases prescribed artemether-lumefantrine (AL). Poisson regression with generalized estimating equations and fractional regression was used to model count and proportion outcomes, respectively. Pre-COVID trends (April 2017-March 2020) were used to predict the'expected' trend in the absence of COVID-19 introduction. Effects of COVID-19 were estimated over two six-month COVID-19 time periods (April 2020-September 2020 and October 2020-March 2021) by dividing observed values by expected values, and expressed as ratios.

Results: A total of 1,442,737 outpatient visits were recorded. Malaria was suspected in 55.3% of visits and 98.8% of these had a malaria diagnostic test performed. ITSA showed no differences between observed and expected total outpatient visits, malaria cases, non-malarial visits, or proportion of visits with suspected malaria after COVID-19 onset. However, in the second six months of the COVID-19 time period, there was a smaller mean proportion of patients tested with RDTs compared to expected (relative prevalence ratio (RPR) = 0.87, CI (0.78-0.97)) and a smaller mean proportion of malaria cases prescribed AL (RPR = 0.94, CI (0.90-0.99)).

Conclusions: In the first year after the COVID-19 pandemic arrived in Uganda, there were no major effects on malaria disease burden and indicators of case management at these 17 rural health facilities, except for a modest decrease in the proportion of RDTs used for malaria diagnosis and the mean proportion of malaria cases prescribed AL in the second half of the COVID-19 pandemic year. Continued surveillance will be essential to monitor for changes in trends in malaria indicators so that Uganda can quickly and flexibly respond to challenges imposed by COVID-19.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Map of Uganda with the 17 Malaria Reference Centres included in the analysis
Fig. 2
Fig. 2
Timeline of malaria interventions and COVID-19 epidemic in Uganda
Fig. 3
Fig. 3
Observed and expected A total number of visits, B non-malaria visits, C visits where malaria was diagnosed, D mean proportion of suspected malaria cases, and E mean proportion of patients tested using RDT by month, and F mean proportion of malaria cases prescribed artemether-lumefantrine. The grey ribbon represents the bootstrapped 95% confidence interval of the model. Vertical red line represents the start of the COVID-19 time-period on 1 April 2020. Vertical black dashed line represents the 6-month midpoint of the COVID-19 time period (1 October, 2020)
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