Tens of thousands of malaria cases went untreated in Guinea last year as people with symptoms shunned health clinics for fear of being sent into isolation at Ebola treatment centres, according to authoritative research.

A major paper from infectious diseases experts said 74,000 fewer people were diagnosed and offered malaria treatment than would have been expected. The research was based on a survey of public health facilities in December 2014 and interviews with healthcare workers.

The paper says far more people will have died from malaria in 2014 than Ebola, which had killed 2,444 people by 15 June of this year.

Urgent action was required to get malaria treatment to those who needed it, say the paper’s authors from the Centers for Disease Control and Prevention, Atlanta, and the President’s Malaria Initiative in the Lancet’s Infectious Diseases journal.

“The two major avenues for delivering life-saving medicine to patients with malaria – public health facilities and community health workers – have been substantially compromised by the Ebola virus-disease epidemic,” they write. “Efforts to reinforce malaria care delivery in Guinea should be focused on reconnecting healthcare workers and health facilities with the communities they serve and whose trust they need to regain.”

In the areas of Guinea hit worst by Ebola, the numbers of people seeking treatment at outpatient clinics dropped by up to 42% and the numbers seeking care for suspected malaria were down by 69%, according to the first systematic survey from one of the three countries affected by the epidemic.

Fewer oral malaria drugs were given (down 24%) and fewer injectables (down 30%) than the previous year. In districts affected by Ebola the numbers of community health workers actively working also dropped from 98% before Ebola to 74%, while those treating malaria dropped to less than half (48%).

“One problem is that the early symptoms of malaria (fever, headache, and body aches) mimic those of Ebola virus disease,” said the lead author, Dr Mateusz Plucinski. “Malaria is one of the main causes of fever and health facilities visits in Guinea, but our data suggest that since the start of the Ebola epidemic people with fevers have avoided clinics for fear of contracting Ebola or being sent to an Ebola treatment centre.”

But, he added, untreated malaria cases will have led to more malaria in the villages and increased the numbers eventually arriving at clinics with fever who could be suffering from either malaria or Ebola. “This puts extra pressure on an already overburdened health system owing to a greater number of suspected Ebola cases requiring triage and isolation at treatment centres. Malaria control efforts and care delivery must be kept on track during an Ebola epidemic so that progress made in malaria control is not jeopardised and Ebola outbreak response is not impeded,” he said.

New guidelines from the World Health Organisation recommend giving malaria drugs to everyone with a fever during an Ebola outbreak and handing out drugs that families can take to stave off a bout of the disease. Dr Franco Pagnoni, of the WHO, says in a comment piece in the journal that while this will help, it is important to return to business as usual.

“To restore the credibility of health service delivery in the population, it is important that Ebola-virus-disease-specific activities in the communities, such as contract tracing and safe burials, are accompanied by the delivery of standard health services, such as distribution of long-lasting impregnated nets, vaccination, or community case management of child diseases with specific no-touch approaches appropriate to the context of the epidemic,” he writes.