Malaria together with COVID challenge Burundi

In Burundi, malaria has become a major public health problem. An outbreak with the potential to become an epidemic has killed almost as many people as the Ebola outbreak in the neighboring Democratic Republic of Congo. The burden has been worsened by the government's failure to declare a national emergency, additional breeding places as a result of floods, and the prevalence of multi-drug resistant malaria. These problems are challenging, but not new, given the concurrent COVID-19 epidemic, economic ramifications, and overlap of symptoms between the two diseases.

Spraying initiatives have been conducted out by organizations like as Médecins Sans Frontières, and the government is actively limiting attempts to combat the epidemic. However, in order to better endure difficulties, preventative measures such as improving technical capability and epidemiological surveillance must be improved.

• Malaria is prevalent in Sub-Saharan Africa, with the majority of cases and deaths occurring there.

• Malaria poses a serious threat to Africa's public health and economic development.

• Malaria is one of the leading causes of child mortality worldwide, killing over one million children each year in Africa.

• Malaria can affect intellectual growth as well as diminish productivity at work and school.

Malaria is an illness caused by Plasmodium that is transmitted by mosquito bites from infected female Anopheles mosquitos. Plasmodium falciparum and Plasmodium vivax are the two most deadly species. Malaria is the leading cause of mortality in Africa, accounting for more than 90% of the 400,000 fatalities recorded each year. Burundi, a tiny nation in East Africa, is particularly hard hit, with an incidence of Plasmodium Falciparum of over 85%, the existence of multi-drug resistance forms in all malaria-endemic zones, and high risk throughout the year.

Burundi, which has a population of 12 million people, reported 8,571,897 malaria cases in early January 2020, with 3170 fatalities (CFR 0.04 percent), a 93 percent rise in both cases and deaths over 2018 and surpassing the outbreak in 2017 . Malaria is common in April to May and November to December, but there was no typical drop beyond May 2019, creating an exceptional hazard to the healthcare system. From January 1 through October 20, 2019, there were 7,233,138 malaria cases registered, including 2691 fatalities. In the week ending December 22, 2019, 152,960 cases were reported, including 63 fatalities . Despite the fact that over 6 million people were afflicted with malaria in 2019, the death toll was equivalent to Ebola, and the declaration of a national emergency was delayed due to imminent elections 6., 7.

A total of 1.2 million new cases of malaria has been reported as of March 22, 2020 . Flooding and vector-borne illnesses are linked because of a rise in breeding places, as well as rates of survival, reproduction, and juvenile development . Reduced competence of preventative measures, as well as a vulnerable population with low levels of resistance and poor nutrition, have been cited as contributing factors by the United Nations Office for the Coordination of Humanitarian Affairs and other experts .

With the arrival of the coronavirus disease 2019 (COVID-19) in 2020, malaria became a secondary concern. Despite this, the symptoms of malaria and COVID-19 are similar, including fever, chills, headache, sweating, vomiting, and body throbs. This is a source of worry for health care professionals who are attempting to diagnose the condition in individuals who display these symptoms. 6. and 11. According to the World Health Organization, the infection rate of COVID-19 in the younger population, as well as a symptomatic rate of over 80% in Sub-Saharan Africa, is a cause for worry, posing additional problems to the health-care system .

Furthermore, the significant rise in workload, understaffing in critical Care Units, and a lack of resources exacerbate the situation in many African nations fighting COVID-19, notably Burundi, which is also dealing with a malaria pandemic . The lack of both manpower and resources creates an ideal climate for COVID-19 to spread. As a result, COVID-19 has been shown to have a detrimental impact on the operations of epidemic motion and other infectious illnesses in different regions of the world 13., 14., 15., and 16.

Furthermore, due to COVID-19, Burundi entered a recession in 2020, with a 3.3 percent drop in gross domestic product. COVID-19 mostly harmed industry, with a 4.5 percent drop in output and services. The value of the investments has also dropped by about 3%. A dramatic spike in prices occurred from a decline in agricultural productivity and the increased cost of imported items. As a result of these occurrences, inflation is expected to rise by 8.5 percentage points to 7.6% in 2020. These economic ramifications exacerbate difficulties in the country's healthcare system, which is already underfunded. However, humanitarian and government measures have been undertaken to control the malaria outbreak. Spraying has been shown to be the most effective method for reducing malaria cases, with an 80 percent reduction in prior years <2>.

Malaria prevention programs are being carried out in the Kinyin hills by Médecins Sans Frontières teams, who are riding and spraying individual homes to prevent the spread of the disease. Collaboration with local officials, community members, and education have all contributed to the viability of this strategy. Furthermore, with the assistance of the Burundi government, the United Nations Development Programme (UNDP), and the Global Fund, 6.8 million nets have been distributed. The national health crisis center, which now contains 200 cellphones and computers, has become the country's COVID-19 response headquarters. UNDP is also funding the creation of an app to track COVID-19 cases and is collaborating with the Global Fund to improve COVID-19 testing capacity, which is currently at 200 per day.

The COVID-19 and malaria syndemic is a significant concern that demands immediate attention from healthcare professionals, policymakers, and the general public. The closeness of early COVID-19 symptoms to those of malaria in areas where the disease is endemic, such as Burundi, may make identification challenging, needing laboratory investigations. Furthermore, untreated and misdiagnosed malaria and COVID-19 cases contribute to increased mortality, putting a greater strain on the healthcare system and economy. As a result, healthcare personnel are advised to do thorough diagnostic laboratory testing rather than relying primarily on reason when diagnosing a patient. For individuals with symptoms that imply malaria and COVID-19, two screening tests should be performed. Second, understaffing, a lack of resources, and inadequate health-care capability may all increase frontline employees' mental health, and the consequences of burnout may have an influence on patient care.

Another important proposal is that Burundi's epidemiological surveillance be strengthened. To improve case monitoring and documentation, as well as readiness, inter-communication within the national healthcare system should be improved. As a result, policymakers are recommended to increase public awareness campaigns on the need of social distancing and COVID-19 prevention, as well as the need to improve malaria prevention efforts by the general public, with a special focus on mental health services for frontline workers.