Here’s how Ebola erodes overall health in West Africa

As the news about Ebola gets worse, it’s easy to lose sight of the long list of other deadly diseases that wreak havoc in Guinea, Liberia, and Sierra Leone.

The health systems in these poor countries are overwhelmed by this outbreak and the progress that’s been made in fighting these diseases, or in improving services like maternal and child care, is under threat. High-quality, timely data are urgently needed to understand how the Ebola epidemic is affecting other health issues in these three nations.

For example, writing for Nature, Erika Check Hayden reported that Ebola has brought malaria control work to a halt in Guinea, Liberia, and Sierra Leone, according to Acting Executive Director of Roll Back Malaria Thomas Teuscher. Fear of contracting the virus is keeping sick people and health workers away from clinics, and mobs angered by the government’s response to the outbreak have blocked the distribution of malaria drugs.

Over the last decade, all three of these countries had made impressive strides in reducing malaria deaths. According to the Global Burden of Disease 2013 Study, malaria deaths had been decreasing at a rapid pace in Guinea, Liberia, and Sierra Leone (see screen grabs below) since peaking in the mid-2000s. These declines were a marked contrast to the period 1990 to 2000 when malaria deaths were rising.

Malaria deaths in Guinea, 1990-2013

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Note: The shading around the line represents the uncertainty interval, which is the range of possible estimates of deaths in a given year. To access the visualization tool online, visit http://ihmeuw.org/2bb1 and select your country of choice.Source:Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.”

Malaria deaths in Liberia, 1990-2013

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Note: The shading around the line represents the uncertainty interval, which is the range of possible estimates of deaths in a given year. To access the visualization tool online, visit http://ihmeuw.org/2bb1 and select your country of choice.Source:Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.”

Malaria deaths in Sierra Leone, 1990-2013

EbolaGBD3

Note: The shading around the line represents the uncertainty interval, which is the range of possible estimates of deaths in a given year. To access the visualization tool online, visit http://ihmeuw.org/2bb1 and select your country of choice.Source:Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.”

Relative to its West African neighbors, Liberia’s malaria death rates were on the lower end of the spectrum and were similar to rates seen in Côte d’Ivoire. Guinea’s and Liberia’s malaria death rates were on the higher end of the spectrum, but were still not as high as rates in Guinea Bissau, Mali, and Burkina Faso.

Malaria death rates in West Africa, 2013

EbolaGBDmap

Note: To access the visualization tool online, visit http://ihmeuw.org/2bb3.Source:Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.”

The Nature article highlighted the difficulty of tracking malaria deaths in these three countries in real time. Out of the three countries, Guinea reports malaria cases to WHO, but these data only capture infected individuals who seek care at clinics. In a recent Huffington Post article, WHO Director General Margaret Chan said “…systems for monitoring health statistics, not good to begin with, have now broken down completely.”

Once cause of death and disease burden estimates for 2014 are published as part of the annual update to the GBD study in 2015, it will be important to evaluate how they have changed in the wake of the Ebola outbreak.

Reports from Liberia, Guinea, and Sierra Leone demonstrate how the fate of individuals suffering diseases other than Ebola may be closely tied to the Ebola outbreak itself. Malaria is just one example. You can use IHME’s Millennium Development Goal (MDG) data visualization tool to see how much headway these countries have made in tackling MDGs 4, 5, and 6 through 2013 (see screen grab). Health experts’ concerns underscore just how easily the progress these countries have made in reducing preventable deaths could be reversed.

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About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.