In addition to overall negative effects on families and communities, access to and quality of health services was severely impaired, including serious implications on malaria. The COVID-19 pandemic has had large collateral impacts on mothers, children and HCPs. Clinical discrimination between malaria and COVID-19 symptoms was difficult and HCPs observed increases in severe malaria cases in health facilities due to late reporting. The third theme-effects on malaria-includes disruptions of malaria preventive measures. The second theme-effects on health-seeking-includes fear of infection, lack of COVID-19 testing capacities, and reduced access to clinics and treatment. HCPs had problems reaching the communities, suffered stigmatisation and were often barely protected against the virus. Many women lost their jobs, which increased their dependance on males, children had to drop out of school, and families had to cope with food shortages and were considering migration. The first theme-general effects of the pandemic-includes impacts on finances, food security, health service provision as well as education and hygiene. Data were collected using focus group discussions with mothers and through key informant interviews with HCPs. In the Northern Region of Ghana, 72 participants, consisting of 18 health care professionals (HCPs) and 54 mothers of children under the age of five, were recruited in urban and rural districts. Following a quantitative analysis from northern Ghana, which showed significant reductions in overall outpatient department visits and malaria cases during the first year of COVID-19, this qualitative study aims to provide further explanations to those quantitative findings. on socio-economic inequality and health care systems, may have been more disruptive. However, the indirect effects of the pandemic, e.g. The pandemic has hit sub-Saharan Africa less than expected even considering large underreporting, the direct COVID-19 burden was minor compared to the Global North. COVID-19 has severely impacted health systems and the management of non-COVID-19 diseases, including malaria, globally.
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