“My network has a lot of holes,” said Rose, dressed in a t-shirt that said “never stop,” as she pointed to the bedroom in the old, rundown building in the Gulu district where she lives. “All nets have holes.”
Rose has just recovered from malaria, which also infected the two-year-old grandchild she cares for.
She is unemployed and goes into debt to pay for the 25,000 Ugandan shillings (US $ 6.80) medication needed to treat herself and the toddler whose life she feared.
“It was really awful,” she said, watching him play with a stick on the floor.
World Health Organization (WHO) data shows that around 405,000 people died of malaria in 2018, with 94% of those deaths occurring in sub-Saharan Africa. More than two thirds of the victims were under five years old.
The WHO warned in April that the number of annual malaria deaths in sub-Saharan Africa could almost double this year to 769,000 due to the coronavirus pandemic – a figure last seen 20 years ago.
The spread of COVID-19 has impacted access to anti-malarial drugs as people wary of seeing a doctor and the distribution of insecticide-treated mosquito nets.
It would not be the first time an outbreak of another disease has led to an increase in malaria infections.
In North Kivu Province, Democratic Republic of the Congo, there was an eight-fold increase in malaria cases following the 2018 Ebola outbreak as the focus of medical efforts shifted.
Many countries are aware of the risks and are campaigning to reduce the number. They are concerned about losing the profits made in recent years to meet a globally agreed United Nations target to eradicate malaria by 2030.
This year, for the first time since 2017, Uganda is planning a nationwide program to distribute mosquito nets with around 27 million nets to be distributed to 43 million people.
Beware of doctors
The sales teams are up and running, wearing protective clothing and receiving support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Against Malaria Foundation and USAID.
“Mosquitoes are not locked, they are still free. Why COVID-19 survive and die of malaria?” said Jimmy Opigo, program manager in the Ugandan Ministry of Health’s national malaria control program.
“The distribution of the mosquito net is one of the most important means of fighting malaria. We do this every three years because mosquito nets, the long-lasting insecticide-treated mosquito nets, last three years.”
Uganda cut the prevalence of malaria from 42% in 2009 to around 9.2% in 2018, and Opigo said it was critical that routine public health interventions continue despite the pandemic.
“Malaria in particular can have a resurgence and an epidemic if you don’t react. A reversal and loss of all profits,” he told the Thomson Reuters Foundation.
However, while efforts are being made to distribute bed nets, some healthcare workers fear that the government-distributed nets will be slow to arrive.
“We have some of the worst rates of malaria in the world,” said Nicolas Laing, co-founder of One Day Health, which operates remote health centers in northern Uganda.
Laing raises money to buy 5,000 nets for fear that the government will be late.
“The malaria season in Gulu is between April and October and we will get our nets in October or November,” said Laing.
“It’s absolutely debilitating … you have all these kids and adults who are anemic. They have a lot less energy than they should.”
Across Africa, where there are now more than 600,000 confirmed COVID-19 cases, health workers fear the pandemic is preventing people from seeing doctors.
“There is a general reluctance to go to a health facility because patients and parents of patients fear infection,” said Fabio Biolchini, director of a Medecins Sans Frontieres (MSF) hospital in the Eastern Province of Sierra Leone.
Biolchini said they saw only a third of the number of patients who came around this time last year, with parents only bringing sick children “as a last resort.”
Instead, MSF is now running contact programs, including mobile clinics, where Biolchini said they have seen “many, many” cases of malaria.
Keziah L Malm, program manager for the National Malaria Program in Ghana, said malaria is a major public health concern.
“It affects every aspect of people’s health, social and economic life,” Malm said.
Ghana reported its first COVID-19 case in March and now has more than 23,800 confirmed cases – one of the highest numbers on the continent.
Meanwhile, the intake for malaria has decreased.
“People prefer to stay at home and buy over-the-counter drugs and only go to hospitals when all other attempts at self-medication have failed,” Malm said.
Ocen David, a 19-year-old refugee from South Sudan, is recovering from malaria in the Palabek refugee settlement in northern Uganda.
“This time the mosquitoes are too many. We get malaria every day,” said David, who has lived in the settlement of around 53,000 people since it was founded in 2017.
Ocan Robert, chairman of the Refugee Welfare Council, said the nets were last distributed in 2018. More were promised but delayed by the pandemic, he said.
At one of Palabek’s health clinics, staff said they were overwhelmed and did not have the resources needed to fight COVID-19, such as soap and masks or room for social distancing, with around 100 refugees waiting outside for appointments.
Clinical director Adong Nancy said many of the patients had malaria or anemia while others had a scabies outbreak.
Last month, one person in the clinic died of malaria, others died in the hospital after experiencing advanced symptoms.
Even before the coronavirus pandemic, Nancy said, employees were struggling with the level of the disease. “Most of them are (too) late,” she said.
This story is part of a series supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria.