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This mixed-methods study examined malaria burden in four indigenous communities in the Peruvian Amazon during the COVID-19 pandemic, finding that PCR-confirmed malaria prevalence increased from 17.6% in 2021 to 26.09% in 2022. The pandemic disrupted malaria control activities including diagnosis, treatment availability, and community surveillance, while communities reported fear-driven behavioral changes such as temporary migration and increased reliance on traditional herbal medicine. Previous malaria infection and chills were identified as factors associated with current infection.
Why it matters
The findings demonstrate how health emergencies like COVID-19 can severely disrupt malaria control programs in remote, vulnerable populations, potentially reversing years of progress. Understanding these disruptions is critical for designing resilient health systems that can maintain essential services during future crises, particularly in hard-to-reach indigenous communities with limited healthcare access.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background The COVID-19 pandemic was associated with reported disruptions to healthcare delivery and malaria control activities in remote, malaria-endemic indigenous communities with limited access to healthcare. Remote indigenous communities in the Peruvian Amazon may have been especially vulnerable due to interruptions in malaria surveillance, diagnosis, and treatment. We investigated the impact of the COVID-19 pandemic on malaria burden, healthcare access, and community perceptions in hard-to-reach indigenous communities in the Amazonas region of Peru. In malaria-endemic regions, these lessons are particularly important because future health emergencies may similarly affect surveillance, diagnosis, prevention, and treatment activities, potentially reversing gains achieved through malaria control programs. Methods A convergent parallel mixed-methods study was conducted in 2021 and 2022 across four indigenous communities in the Rio Santiago district, Amazonas region, Peru. Quantitative data were collected through cross-sectional malaria surveys, and qualitative data were obtained through semi-structured interviews with inhabitants, community health workers, and local health personnel. Malaria infections were detected by microscopy and confirmed by PCR. Factors associated with the occurrence of malaria infection were studied based on a generalized estimating equation (GEE) approach applied to clustered binary outcome data and accounting for repeated observations within participants across study years. Qualitative data were analyzed thematically, and both components were integrated using the Pillar Integration Process framework. Results A total of 514 participants were included. PCR-based malaria prevalence was 17.6% in 2021 and 26.09% in 2022. P. falciparum prevalence was particularly high in the Alianza Progreso community (2021: 24.19%, 2022: 16.16%) compared to the other studied communities. Previous malaria infection and chills were associated with PCR-confirmed malaria infection. Qualitative findings indicated that COVID-19-related disruptions affected malaria control activities by interrupting diagnosis and treatment availability, reducing community follow-up, and prioritizing COVID-19 response activities over malaria control. Participants also described fear of COVID-19, temporary migration to farm areas, and reliance on herbal medicine during the pandemic. Conclusions The COVID-19 pandemic may have contributed to exacerbated pre-existing challenges to malaria control in remote indigenous communities in the Peruvian Amazon. Strengthening malaria surveillance, ensuring continuity of diagnosis and treatment, and improving healthcare access in geographically isolated communities will be critical to supporting malaria elimination efforts in Peru.