The COVID-19 pandemic has caused significant disruptions to health systems worldwide, particularly in low- and middle-income countries with fragile infrastructures and limited resources. In sub-Saharan Africa, where communicable diseases such as HIV, malaria, tuberculosis (TB), and vaccine-preventable illnesses remain prevalent, these disruptions threaten to reverse years of progress in disease control and prevention. Measures implemented to contain the pandemic, including lockdowns, curfews, and the reallocation of healthcare resources, have reduced access to routine health services, delayed diagnoses, and altered health-seeking behaviours, leading to potential increases in morbidity and mortality.
Evidence from multiple African countries demonstrates the pandemic’s indirect effects on essential health services. In South Africa, HIV testing and initiation of antiretroviral therapy (ART) were significantly affected during lockdowns, though ART provision was largely maintained. Kenya experienced declines in outpatient consultations and antenatal care visits, while Ghana saw disruptions in TB case notifications and HIV testing. Conversely, some countries such as Togo reported relative stability in HIV, malaria, and TB services. Despite these observations, real-world data on such disruptions remain scarce for Guinea, where previous epidemics, including Ebola, have already strained the health system.
In Guinea, COVID-19 has caused 38,210 infections and 455 deaths. Understanding the pandemic’s impact on essential services—including HIV, TB, malaria, and childhood immunisation—is crucial for epidemic preparedness and recovery planning. To assess this, the study employed an uncontrolled interrupted time series analysis using nationally collected surveillance data from January 2018 to December 2022. Data were extracted from Guinea’s DHIS 2 system, covering over 3,000 primary health facilities and multiple hospitals, and validated by a multidisciplinary team including epidemiologists and program stakeholders.
The analysis focused on nine key indicators: infant HIV testing at six weeks, pentavalent and BCG vaccination coverage, confirmed malaria cases, malaria treatment and hospitalisations, TB case notifications, positive TB microscopy results, and TB treatment success rates. Poisson segmented regression models were applied to estimate the immediate and trend effects of COVID-19, adjusting for seasonality and potential outliers to ensure robust results. Statistical significance was considered at p<0.05.
Between 2018 and 2022, Guinea recorded over 2.2 million infants receiving BCG, more than 2 million completing pentavalent vaccination, and over 9.5 million confirmed malaria cases, with the majority treated appropriately. TB cases totaled 83,811, with treatment success rates ranging from 75% to 92%, while 6,310 infants born to HIV-positive mothers received HIV testing at six weeks. During the pandemic, service indicators varied, with malaria services largely maintained but substantial disruptions observed in TB detection, infant HIV diagnosis, and childhood vaccination coverage.
The study demonstrates that the COVID-19 pandemic had significant and heterogeneous effects on essential health services in Guinea. While some services like malaria management were relatively preserved, critical areas such as TB case detection, HIV testing for infants, and routine immunisations were negatively impacted. These findings highlight the urgent need for investments in health system resilience, strategies to maintain continuity of care during public health emergencies, and targeted recovery interventions for the most affected services.
