Assessing the impact of COVID‑19 response on malaria control and malaria burden in rural Tanzania
The World Health Organization has warned that deaths from malaria could double across sub-Saharan Africa this year if malaria control programs are disrupted by COVID-19. Currently, 94% of all malaria deaths occur in sub-Saharan Africa, with children and pregnant women amongst the most vulnerable groups. Given recent estimates that predict a return to mortality levels last seen 20 years ago, it is critical that countries can maintain the delivery of insecticide-treated nets and access to antimalarial medicines in the face of the COVID‑19 pandemic. To better understand the COVID‑19 response in Tanzania and its impacts on malaria control and burden, we will collect information on COVID‑19 and malaria prevention practices, malaria care-seeking behaviours and health system impacts in a rural district where a large-scale malaria vector control trial is underway. Data will be collected using a mixed methods approach through (1) repeated cross-sectional surveys with 4200 households in January 2020, July 2020 and January 2021, (2) focus group discussions with women and men in randomly selected communities, and (3) key informant interviews with multiple health systems stakeholders. We will apply a sex and gender based analysis plus (SGBA+) approach to identify vulnerable population sub-groups. We will conduct spatial and trend analyses of survey data and thematic analysis of qualitative data to characterize individual and health systems level responses to COVID‑19 and estimate gaps in malaria intervention coverage. We will use simulation models to estimate the potential impacts of changes in malaria control on the burden of malaria disease and death using the ‘OpenMalaria’ simulator of malaria epidemiology and control. Our results will inform strategies to tailor malaria control strategies in the context of COVID‑19 in Tanzania to ultimately prevent a resurgence in malaria cases and deaths while ensuring effective pandemic response.