Ebola: the hidden toll

During the past decade, renewed commitment from donors, ministries of health, and international agencies has led to the scale-up of malaria interventions across sub-Saharan Africa, with a corresponding reduction in child malaria mortality of 50%.2 The continuous delivery of those life-saving interventions--prompt effective treatment, routine distribution of insecticide-treated bednets, indoor residual spraying, and intermittent preventive treatment of malaria in pregnancy--depends on a reliable, functioning health-care system. An effort in Sierra Leone resulted in successful mass drug administration for more than 2 million people.3 Until service delivery systems are restored, these extraordinary measures, delivered after careful planning and with due attention to safety, are warranted. Because quality routine surveillance data are not available, it is primarily through modelling that the broader indirect health effects of the Ebola epidemic (in this case malaria) can be understood.