Continuity of malaria-related care services during the COVID-19 pandemic in Guinea and Sierra Leone

Introduction The COVID-19 pandemic disrupted health services in many countries across the globe, including in low-income countries. Following efforts to strengthen the health systems in Guinea and Sierra Leone after the Ebola outbreak in 2014, this study aimed to explore the resilience of the health system in these countries, focusing on malaria-related services. Methods We used data collected through medical record reviews (MRRs) of pregnant women or patients under the age of five (U5) from medical registers at public health facilities in Guinea and Sierra Leone in 2022, referring to the years 2018, 2020, and 2021. A multi-stage sampling approach was employed to select health facilities, and Bayesian hierarchical models were used to analyze changes in fever complaints, malaria testing, and treatment. Results Data from over 12,000 paper-based medical records in Guinea and Sierra Leone were analyzed. Our findings revealed no significant decline in the proportion of patients with fever presenting at public health facilities during the pandemic. Additionally, there were no overall disruptions in malaria testing and treatment. Instead, recorded service provisions remained stable or increased in 2020 and 2021 compared to pre-pandemic levels of 2018. Conclusions These findings show that health systems in Guinea and Sierra Leone demonstrated considerable resilience for malaria-related services during the COVID-19 pandemic. The continuity of such services may be related to lessons and strategies learned during the Ebola response and further financial investments in health system strengthening, factors such as the swift mobilization of resources and community engagement strategies. It is important that these systems continue to build their robustness, adaptability and resilience and also learn the new lessons from the COVID-19 pandemic on the maintenance of essential services during health crises.