Guinea

Malaria is endemic throughout Guinea, and the country is among the 17 highest burden malaria countries in the world (1.8% of all global malaria cases, and 1.6% of global malaria deaths in 2020 [1]). It accounts for 4% of malaria cases in West Africa.[1] 

The country has made important progress in malaria control and prevention, substantially reducing malaria prevalence in children under five years of age, annual malaria incidence, and in-patient deaths. Between 2020 and 2021, the case burden for malaria fell by 1% (from 334 to 331 per 1000 of the population at risk), while deaths decreased  by 7.4% (from 0.75 to 0.70 per 1000 of the population at risk. [1] 

These gains were driven by the rapid scale-up of malaria prevention and control interventions, led by the country’s National Malaria Control Programme (NMCP) and supported by the US President’s Malaria Initiative (PMI) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

There are two areas in Guinea where malaria is endemic (MICS 2016): a moderate transmission area, which covers five regions of the country and 63 % of the general population, and a low transmission area, which covers three regions, including the capital Conakry and 37 % of the population. [2] 

The major vector of malaria is Anopheles gambiaes sensu lato, which is found throughout the country, with its density peaking in the rainy season, from June to October. The dominant plasmodium species is Plasmodium falciparum, at 96.5 %; P. malariae and P. ovale represent 3.3 % and 0.13 %, respectively. [2] 

The percentage of malaria infections in children under 5 years and pregnant women between 2017 and 2019 were 37.3 % and 3.9 %, respectively. [2] According to routine NMCP data, the, compared with overall malaria morbidity. According to the 2018 DHS, 30 % of children under 5 years are stunted and 9 % are acutely malnourished, while 46 % of women of childbearing age are anaemic. [2] 

Furthermore, people who face difficulties in accessing health services are groups at increased risk of malaria. These include mobile populations and people who live in isolated areas or a long way from health care facilities. These groups include populations living in the mining areas of Kankan and Faranah, and the communities who live around the coastal areas. [2] 

Case management 

In collaboration with partners, NMCP revised the national guidelines for the fight against malaria in the context of COVID-19. This revised tool will serve as a reference document to guide the interventions of the implementing actors as well as the beneficiaries. The differential diagnosis between malaria and coronavirus disease is a major concern for providers because of the similarity of signs (e.g., fever, headache, muscle aches, etc.). Consequently, any patient received in health facilities or at the community level must be considered as both a suspected COVID-19 and a suspected malaria case.[3] 

Artemisinin-based combination therapies (ACTs) were introduced into national policy in 2005. The guidelines are to treat any case of severe malaria with artemisinin derivatives or parenteral quinine salts. As soon as the oral route is possible, the treatment should be done with ACTs. The management of severe malaria must be carried out in health facilities with capacities for adequate treatment. Any case of severe malaria in pregnant women should be treated with parenteral quinine during the first trimester of pregnancy, and artemisinin derivatives or parenteral quinine salts in the second and third trimesters. [3] 

All cases of severe malaria seen in a health facility without adequate management capacity should benefit from specific pre-transfer management with artemisinin derivatives intramuscularly or as a rectal capsule before being referred. Children between six months and six years of age seen at the community level (RECOs trained on malaria) should benefit from specific pre-transfer management with rectal artesunate before being referred to the nearest health facility. 

Prevention of malaria 

Between 2012 and 2016, there were significant improvements in the use of insecticide-treated nets (ITNs) by vulnerable populations. The use by children under five years increased from 26% to 68% and use by pregnant women from 28% to 70%. [3] However, a dramatic decline in use was observed between 2016 and 2018 – household ownership fell from 84% to 44%, and the use by vulnerable populations returned to 2012 levels.[3] 

A nationwide ITN distribution mass campaign was implemented in 2019. The Against Malaria Foundation (AMF) supported this campaign by donating 5 million ITNs, which were distributed in 20 of the 38 districts in Guinea. A post-distribution evaluation, carried out 18 months after the 2019 campaign, showed that on average 85 percent of ITNs distributed were present in households.[3] 

Guinea began implementing seasonal malaria chemoprevention (SMC) in 2015 in six health prefectures in the northern part of the country, representing a total population of 2.2 million. [3] The number of prefectures has gradually been expanded and SMC is currently implemented in 13 districts found to be meeting the criteria for the implementation of SMC (chosen by the NMCP). The SMC activities in eight of the prefectures are supported by PMI, while the other 5 are supported by the Global Fund. [3] 

SMC implementation in Guinea comprises four cycles of the distribution of  sulfadoxine-pyrimethamine and amodiaquine (SPAQ) to all children 3–59 months old. Each cycle of distribution lasts between four and five days and is done on a monthly basis between July and October, representing the highest transmission period in the area. [3]. Recently, a pilot program, testing one additional cycle of SMC started in one of the districts. This implies starting the season earlier in June based on the rain falls and incidence peak data and the additional impact on malaria indicators is been explored. 

Malaria in pregnancy 

Guinea’s national strategic plan has a 2023 target of at least 60% of pregnant women receiving at least three doses of sulfadoxine-pyrimethamine (SP) doses of intermittent preventive treatment in pregnancy (IPTp)3 to prevent malaria throughout their pregnancy. [3] 

Progress has been made towards this target: the percentage of women who received two or more doses of IPTp during their last pregnancy in the last two years increased from 49% to 62% between 2016–18, while those who received three or more doses increased from 30–36% in the same period. [3] 

The national strategy states that all cases of severe malaria in pregnant women should be treated with parenteral quinine during the first trimester of pregnancy, and intramuscular injection of artemisinin derivatives or parenteral quinine from the second trimester onward. The strategy follows WHO guidance regarding pregnant women who are HIV-positive. [3] Of note, the treatment guidelines for WHO also recommends using Inj AS also during the 1st trimester of pregnancy.