Setting: The malaria-endemic country of Liberia, before,
during and after the 2014 Ebola outbreak.
Objective: To describe the consequences of the Ebola
outbreak on Liberia’s National Malaria Programme and its
post-Ebola recovery.
Design: A retrospective cross-sectional study using routine
countrywide programme data.
Results: Malaria caseloads decreased by 47% during the
Ebola outbreak and by 11% after, compared to the
pre-Ebola period. In those counties most affected by Ebola,
a caseload reduction of 20% was sustained for 12
consecutive months, while this lasted for only 4 consecutive
months in the counties least affected by Ebola. Linear
regression of monthly proportions of confirmed malaria
cases—as a proxy indicator of programme performance—over
the pre- and post-Ebola periods indicated
that the malaria programme could require 26 months after
the end of the acute phase of the Ebola outbreak to
recover to pre-Ebola levels.
Conclusions: The differential persistence of reduced
caseloads in the least- and most-affected counties, all of
which experienced similar emergency measures, suggest
that factors other than Ebola-related security measures
played a key role in the programme’s reduced performance.
Clear guidance on when to abandon the emergency
measures after an outbreak may be needed to ensure
faster recovery of malaria programme performance.