The Epidemiology and Diseases Control Division (EDCD) has updated its Guideline for Malaria Program During COVID-19.

Malaria and COVID-19

The similarities between the malaria illness and COVID-19 illness (fever, headache, body aches and weakness) possess
a challenge in case finding and testing. Malaria can coexist with many other infections. Consequently, confirming malaria
infection with a diagnostic test does not rule out the possibility that the patient might also be suffering from COVID-19;
similarly, testing positive for COVID-19 does not mean that the individual does not also have malaria infection. The table
below highlights the similarities and differences in clinical presentation of both illnesses.

Rationale for updating the Interim Malaria Guidelines

An assessment of COVID -19 pandemic on malaria program suggests a significant impact on malaria diagnosis,
treatment, and continuing malaria services. There was around 40 lo mean reduction in malaria testing during the 10
months period between Apr 2O20 -Jan202landthe testing percentage reduction was more pronounced during
the peak malaria season with around 23 % reduction in May 2020 to over TLYo reduction in August 2020 as compared
to the same months last year. Case based investigations and foci investigations and response and distribution of long lasting insecticidal nets (LLINs) had to be rescheduled.
The “catch-up plan” was also conducted in the high-risk districts to mitigate the low testing at the health facility and
for the early detection of malaria cases at the community.
Building on the experience and the lessons learnt during the first wave of COVID -19 pandemi cin 2O20, an updated
interim Malaria Guidelines is prepared to mitigate the impacts on malaria diagnosis, treatment, and continuing malaria
services while maintaining safe environment for patients, clients and staff, especially in the current context of lock down
and COVID-19 pandemic.

Key priorities areas of focus during the COVID-19 pandemic

Malaria Case Surveillance

• Local Body and SMCs identify hot spots ( active foci) and potential hot spots due to influx of returnees from malaria endemic country, or across the border due to COVID-19 pandemic.
• The focal person of the local HF & the local body, and SMCs will closely monitor the situation in the identified wards by keeping in mobile contact with the FCHVs of the ward.
• FCHVs in coordination with local leaders will advocate for early health care seeking behaviors and monitor treatment adherence.
• National Malaria Program (NMP) will conduct monthly virtual meeting with provincial team to review the status of malaria situation, critical issues and continuing services.
• NMP, Provincial and local level health authority will monitor any unusual changes in malaria incidence,timeliness of reporting from health facilities, testing and treatment for malaria and trends in febrile illness and hospitalization.

Communication, community engagement and advocacy

• Deliver and support good public health practices among communities, households and individuals,
• The use of social networking platforms, e.g., SMS messages, virtual meeting should be prioritized and explored.
• Highlight the policy makers at all level why the malaria needs special attention. The malaria is at the historically low level with target of elimination by 2025. Scale back of malaria interventions or failure to mitigate the impact of COVID-19 on the malaria program could offset the progress that the country has achieved.

Malaria commodities

• Availability of malaria commodities (RDT, drugs, logistics) needs to be ensured at all levels.
• EDCD will also supply malaria RDTs to the all the quarantine and holding centers for malaria testing of the suspected cases.

Coordination
Technical and administrative collaboration are key to providing quality malaria service especially during the covid19 pandemic. Following activities will be prioritized:

• Central Malaria coordination team meeting every 2 weeks to discuss the current situation.
• Recommend weekly meetings at provincial and local level to discuss the malaria services.
• Technical supervision, monitoring and capacity building program should be conducted when possible following national/local rule and maintaining standard COVID-19 precaution and prevention.
• EDCD focal point for malaria to be notified of any issues in malaria at the earliest.

Related readings

• National Malaria Treatment Protocol 2019, Nepal – EDCD
• National Malaria Surveillance Guidelines 2019, Nepal
• Epidemiological Trend of Malaria in Nepal (2012/13-2017/18)
• El Salvador certified as malaria-free by WHO
• WHO Guidelines for Malaria (Consolidated Guidelines for Malaria)
• Malaria Risk Areas Micro-stratification 2020
• World Malaria Report 2020
• Tailoring malaria interventions in the COVID-19 response
• World Malaria Day 2020: “Zero malaria starts with me”
• WHO urges countries to ensure the continuity of malaria services in the context of the COVID-19 pandemic
• World Health Organization’s World malaria report 2019
• Malaria eradication within a generation: ambitious, achievable, and necessary
• Algeria and Argentina certified malaria-free by WHO
• Malaria vaccine pilot launched in Malawi
• Malaria Micro Stratification Report 2018
• The World Malaria Report 2018