Impact of the second and third COVID-19 waves on out patient malaria indicators and case management guidelines at selected sites with varying malaria transmission intensities in Uganda.

Abstract

Background: COVID-19 has imposed negative impacts on the fight against malaria in many malaria endemic countries. We aimed to assess the impact of the second and third COVID-19 waves on outpatient malaria indicators and adherence to malaria case management practices at selected sites of varying malaria transmission intensities in Uganda.

Methods: A time trend ecological study was conducted using existing data at three public health facilities including: 1) Lumino HC III; 2) Walukuba HC IV; 3) Kasambya HCIII. Records of all patients who reported to the outpatient departments of the selected facilities between January 2019 and February 2022 were retrieved and extracted. Using pre-COVID 19 trends (January 2019-February 2020), interrupted time series analysis was used to predict the expected trends for the study outcomes during the 2nd (March 2021-October 2021) and 3rd (November 2021-February 2022) COVID-19 waves.

Results: The observed average outpatient department attendance during the 2nd COVID-19 wave was significantly lower compared to what was expected (3916 vs 4888; incidence rate ratio(IRR)= 0.80 [0.67-0.93]). There were no differences between the observed versus expected proportion of suspected malaria cases (34.87% vs 34.93%; relative percent ratio(RPR) =0.99[0.93-1.06]). The observed overall test positivity rate was lower than what was expected/predicted (35.57% vs 45.39%; RPR=0.78 [0.72-0.85]). The observed OPD attendance in the third wave had similar trends to what was seen in the 2nd wave. The observed proportion of suspected malaria cases in the third wave had similar trends to what was seen in the 2nd wave. The observed overall TPR in the 3rd wave had similar trends to what was seen in the 2nd wave. There were no differences in observed versus expected proportion of tested malaria and confirmed cases prescribed AL in both waves.