Prevalence and associated risk factors of malaria among adults in East Shewa Zone of Oromia Regional State, Ethiopia: a cross-sectional study

Asymptomatic malaria and predictors among migrant farmworkers East Shewa zone Oromia Ethiopia

Asymptomatic malaria can impact existing malaria control and elimination efforts around the world, particularly in Africa, where the majority of malaria cases and death occurs. This is a cross-sectional study aimed to determine the prevalence and predictors of asymptomatic malaria among migrant farmworkers from June to July 2020 in the Upper Awash Agro-industry, East Shewa zone, Oromia Regional State, Ethiopia. A total of 254 migrant farmworkers without signs and symptoms of malaria were enrolled. Data on socio-demographic characteristics and malaria prevention practices were obtained through a structured questionnaire. Venous blood samples were collected and diagnosed using microscopy, rapid diagnostic tests, and polymerase chain reaction (PCR). Data were coded, entered, and analyzed using SPSS version-21 statistical software. Multivariable logistic regression was used to assess associated factors. A p < 0.05 was considered statistically significant. The overall prevalence of asymptomatic malaria among farmworkers in this study was 5.1% [95% CI 1.6, 6.7]. The proportions of Plasmodium falciparum was 90.0% (9/10) while it was 10.0% (1/10) for Plasmodium vivax. Out of the microscopy and/or RDT-confirmed malaria cases, (n = 9; 100%) were confirmed to be P. falciparum by nested PCR, while (n = 3/122; 2.46%) were found to be P. falciparum among 50% negative cases with the microscopy and/or RDT. The gametocyte stage was detected in 40% of microscopically positive cases out of which 44.4% belongs to P. falciparum. Home area/origin of migrant laborers [AOR = 6.08, (95% CI 1.08, 34.66)], family history of malaria [AOR = 8.15, (95% CI 1.43, 46.44)], and outdoor sleeping [AOR = 10.14, (95% CI 1.15, 89.14)] were significantly associated with asymptomatic malaria. In conclusion, asymptomatic malaria was detected among farmworkers in the study area and it was significantly associated with outdoor sleeping, home area, and family history of malaria. Prevention tools and control strategies, particularly focusing on migrant farmworkers, should be considered to support the ongoing malaria control and elimination effort in Ethiopia.

Malaria Prevalence and Risk Factors in Outpatients at Teda Health Center, Northwest Ethiopia: A Cross-Sectional Study

Background

Despite extensive efforts and achievements made in prevention and control, malaria is still a public health problem in Ethiopia. Currently, the case number has been climbing, even changing the epidemiology to the previously low-burden reporting locations. Therefore, our study is aimed at assessing malaria prevalence and associated risk factors in outpatients, Northwest Ethiopia.

Methods

A facility-based cross-sectional study was conducted among 318 malaria-suspected outpatients from October 22 to December 15, 2022, at Teda Health Center, Northwest Ethiopia. Sociodemographic characteristics and malaria risk factors were assessed by a face-to-face interview using a pretested questionnaire. Plasmodium parasites were detected by using microscopy on a blood film stained with 10% and 3% Giemsa stain. The data were analyzed using Statistical Package for Social Sciences software version 25, and statistical significance was reported at a p value < 0.05.

Results

Of the 318 study participants, 124 (39.0%; 95%CI = 33.6% - 44.6%) tested positive for Plasmodium infection. Plasmodium vivax, P. falciparum, and mixed infections were identified in 71 (57.3%), 47 (37.9%), and 6 (4.8%), respectively, among positive study participants. Individuals above the age of 15 (AOR = 2.704, 95% CI 1.370-5.336) were more likely to be infected with Plasmodium than under-five-year-old individuals. Rural residents (AOR = 2.56, 95% CI 1.281-5.098), those who sleep or work outside at night (AOR = 1.99, 95% CI 1.020-3.875), and individuals who did not use long-lasting insecticide-treated net (AOR = 3.26, 95% CI 1.633-6.499) and had a family member with a history of malaria (AOR = 2.902, 95%CI = 1.671 - 5.041) had higher odds of acquiring Plasmodium infection than their counterparts.

Conclusion

In our study area, malaria was a major health problem, with P. vivax being the dominant species. Multiple environmental and behavioural factors were associated with the infection acquisition. Therefore, urgent holistic intervention is required.

Magnitude of malaria and associated factors among febrile adults in Siraro District Public Health facilities, West Arsi Zone, Oromia, Ethiopia 2022: a facility-based cross-sectional study

BACKGROUND

Despite significant efforts made to control malaria in Ethiopia, the disease remains one of the top public health problems in the country. Baseline malaria prevalence and associated factor at high malaria area is important to guide malaria control interventions, there was paucity of information regarding the study area. Therefore, the aim of this study was to determine prevalence of malaria and associated factors among febrile adults in Siraro district health facilities, West Arsi Zone, Oromia, Ethiopia.

METHODS

Institution-based cross-sectional study was conducted among 317 febrile adult patients at Siraro district health facilities. Structured pre-tested questionnaires were used to collect data. Epi-data version 3.1 and SPSS version 23 were used for data entry and analysis respectively. In order to identify factors associated with malaria infection bivariable and multivariable binary logistic regression analysis was employed, The Adjusted Odds Ratio (AOR) with a 95% confidence interval (CI) and p-value of < 0.05 was computed to show the strength of the association.

RESULTS

The overall prevalence of malaria at the study area was 130 (41.0%) [(95% CI 35.3-46.7)]. Occupation (being farmer) [(AOR = 6.05; 95% CI 1.38, 26.49)], having poor knowledge on malaria transmission [(AOR = 2.95 95%; CI 1.48-5.88)], house with wood wall [(AOR = 2.71; 95% CI 1.34-5.49)], and number of windows (≥ 3) in the house [(AOR = 6.82; 95% CI 1.05, 44.40)] were identified to be significantly associated with magnitude of malaria in the study area.

CONCLUSION

The prevalence of malaria at the study area was high as compared with the national wide figures. Being farmer, having poor knowledge on malaria transmission, and housing condition (house with wood wall and houses with three and above windows) were found to be significantly associated with malaria infection in the study area. Therefore, there has to be an emphasis on addressing the factors by providing sustainable health education for the communities to improve their housing condition and knowledge of community on the way of malaria prevention.

Symptomatic and asymptomatic malaria prevalence and its determinant factors in pastoral communities of Waghemira Zone, Northeast Ethiopia: A community-based cross-sectional study

Background and Aims

Malaria elimination programs have also encountered numerous challenges, such as widespread asymptomatic carriers in endemic areas, which should be taken into account in malaria-control programs for effective transmission interruption. The purpose of this research was to determine the prevalence of symptomatic and asymptomatic malaria infections and associated factors, in pastoral communities.

Methods

A community-based cross-sectional study was conducted among selected districts in the Waghemra Zone, Northeast Ethiopia, from September to December 2022. A structured questionnaire was employed to collect sociodemographic data and associated risk factors. Plasmodium species were detected using light microscopy and a rapid diagnostic test. Data entry and analysis were carried out using SPSS version 26 software. The association between dependent and independent variables was explored by using multivariable logistic regression analyses. A statistically significant association was declared at a p-value of <0.05.

Results

The overall prevalence of malaria was 21.2% (134/633), with the predominant Plasmodium falciparum infections accounting for 67.8% (87/134). Among asymptomatic participants, 7.5% (34/451) and 10.2% (46/451) were diagnosed by rapid diagnostic test and light microscopy, respectively. On the other hand, the prevalence of symptomatic malaria was 44.5% (81/182) and 48.4% (88/182) as diagnosed by rapid diagnostic test and light microscopy, respectively. The presence of stagnant water near the houses, the utilization of insecticide-treated mosquito nets, the number of insecticide-treated mosquito nets, and outdoor stays at night were all positively linked with the prevalence of malaria.

Conclusions

The overall prevalence estimate for symptomatic and asymptomatic malaria was high. Malaria is still a public health problem in the study area. Malaria infection was associated with the presence of stagnant water near the houses, the utilization of insecticide-treated mosquito nets, the number of insecticide-treated mosquito nets, and outdoor stays at night. Improved access to all malaria interventions is needed to interrupt the transmission at the community level.

A Retrospective Study on the Burden of Malaria in Northeastern Ethiopia from 2015 to 2020: Implications for Pandemic Preparedness

Background

Regardless of various prevention and control strategies, malaria continues to be a significant public health problem in Ethiopia. As there are few studies on malaria trend analysis in Northeastern Ethiopia, it hinders the evaluation of ongoing and prioritization of new malaria intervention strategies, particularly during the period of pandemics. Therefore, the present study investigated the trend of malaria prevalence in Northeastern Ethiopia from 2015 to 2020.

Methods

An institution-based retrospective study was employed to assess the trend of malaria prevalence over a 6-year period (2015-2020) in three districts (Jile tumuga, Aruma fursi, and Dawachefa) of Northeastern Ethiopia. Data were extracted from clinical records of malaria cases by trained medical laboratory technologists. The associations between the prevalence of malaria and independent variables (age group, malaria transmission season, and districts) were assessed using chi-square test. P-values with a cut-off point of 0.05 were used to determine statistically significant associations.

Results

In our study area, a total of 212,952 malaria suspected patients were diagnosed over the 6 years. Of these, 33,005 (15.5%) were confirmed malaria cases. The identified Plasmodium species were Plasmodium falciparum and P. vivax, accounting for 66.4% and 33.6%, respectively. These with the age of >15 years old were the most affected (41.9%). The highest numbers of malaria cases (34.6%) were recorded during spring season (September to November). The prevalence of Plasmodium species showed a significant association with age (X²=9.7; p=0.002), districts (X²=13.5; p<0.001), and malaria transmission season (X²=16.5; p<0.001).

Conclusion

In our study area, P. falciparum is the dominant species. We noted that malaria remains a public health concern and fluctuates throughout the years. Therefore, national, regional, zonal, and district health bureaus should strengthen the ongoing and devise appropriate prevention and control strategies even during the period of pandemics.

Malaria among under-five children in Ethiopia: a systematic review and meta-analysis

Background

Globally, malaria is among the leading cause of under-five mortality and morbidity. Despite various malaria elimination strategies being implemented in the last decades, malaria remains a major public health concern, particularly in tropical and sub-tropical regions. Furthermore, there have been limited and inconclusive studies in Ethiopia to generate information for action towards malaria in under-five children. Additionally, there is a considerable disparity between the results of the existing studies. Therefore, the pooled estimate from this study will provide a more conclusive result to take evidence-based interventional measures against under-five malaria.

Methods

The protocol of this review is registered at PROSPERO with registration number CRD42020157886. All appropriate databases and grey literature were searched to find relevant articles. Studies reporting the prevalence or risk factors of malaria among under-five children were included. The quality of each study was assessed using the Newcastle–Ottawa Quality Assessment Scale (NOS). Data was extracted using Microsoft Excel 2016 and analysis was done using STATA 16.0 statistical software. The pooled prevalence and its associated factors of malaria were determined using a random effect model. Heterogeneity between studies was assessed using the Cochrane Q-test statistics and I² test. Furthermore, publication bias was checked by the visual inspection of the funnel plot and using Egger’s and Begg’s statistical tests.

Results

Twelve studies with 34,842 under-five children were included. The pooled prevalence of under-five malaria was 22.03% (95% CI 12.25%, 31.80%). Lack of insecticide-treated mosquito net utilization (AOR: 5.67, 95% CI 3.6, 7.74), poor knowledge of child caretakers towards malaria transmission (AOR: 2.79, 95% CI 1.70, 3.89), and living near mosquito breeding sites (AOR: 5.05, 95% CI 2.92, 7.19) were risk factors of under-five malaria.

Conclusion

More than one in five children aged under five years were infected with malaria. This suggests the rate of under-five malaria is far off the 2030 national malaria elimination programme of Ethiopia. The Government should strengthen malaria control strategies such as disseminating insecticide-treated mosquito nets (ITNs), advocating the utilization of ITNs, and raising community awareness regarding malaria transmission.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04370-9.

Prevalence of malaria and its risk factors in Lake Tana and surrounding areas, northwest Ethiopia

Background

In Ethiopia, malaria is a major concern to the health, and socio-economic development of the country because of its occurrence at the peak agricultural activities. Factors such as environmental, human host, parasite, and vector determine malaria transmission. Therefore, the present study was conducted to determine the prevalence and associated factors of malaria among febrile patients who visited selected health centres.

Methods

Institutional-based cross-sectional study was conducted between October 2020 to July 2021 in eight selected health centres located in Lake Tana and its surrounding areas. A simple random sampling technique was used to select febrile patients. Thick and thin blood films were prepared and processed according to the WHO guidelines. Socio-demographic and malaria risk factors were collected from study participants who could read and write using a self-administered questionnaire, whereas face-to-face interview was used to collect information from those participants who could not write and read. The strength of association between risk factors and malaria was assessed using univariate and multivariate logistic regression models.

Results

Of the total (531) febrile patients, 75.3% were malaria negative and 24.7% (overall prevalence) were malaria confirmed cases. Most of the infections were caused by Plasmodium falciparum (72.5%) followed by Plasmodium vivax (23.7%) and mixed-species (3.8%). The highest prevalence was recorded in Kidist Hana (51.5%) followed by Robit (34.8%), Gorgora (30.3%), and Wusha Tiris (25%) health centres. In terms of months, the highest prevalence (37.5%) was detected in October whereas the lowest (14%) was in March. Logistic regression analysis revealed that gender (p = 0.023), educational level (p = 0.025), study month (p = 0.036), presence of eave in the house (p = 0.002) and wall openings (p = 0.041), not using bed nets (p = 0.001), sleeping in the same house with cattle (p = 0.031) and the distance between mosquito-breeding site and living house (p = 0.020) were explanatory risk factors significantly associated with malaria among studied participants.

Conclusions

In this study, we confirmed that the occurrence of malaria prevalence was high and continued against the Ethiopian malaria elimination plan of 2021–2025. Therefore, to meet the goals of this plan, the current prevention and control efforts should be stepped up even better in the coming years.

The Occurrence and Distribution of Plasmodium Species in Woyn Wuha Health Center, Ethiopia

Plasmodium species is an important causative agent of malaria in the world including Ethiopia, and the majority of people were at risk of infection. The study's general objective was to determine the occurrence and distribution of Plasmodium species in the study area through microscopic examination of blood films. A cross-sectional study was carried out in the study sites from September 2016 to February 2017. Out of 512 participants, 32 (6.25%) were malaria positive. Of these, 17 (53.12%, 95% CI: 0.358, 0.704) were P. vivax, 12 (37.5%, 95% CI: 0.207, 0.543) P. falciparum, and 3 (9.375%, 95% CI: -0.007, 0.195) mixed out of the total positive case. The occurrence of parasites was greater in rural villages (59.375%) than in urban villages (40.625%) but not significant (χ² = 1.2917, df = 1, p = 0.2557). More males were infected compared to females but not significant (χ² = 0.0005665, df = 1, p = 0.981). The monthly distribution of Plasmodium species was higher in September and October but there was no significant variation in each month (χ² = 10.142, p = 0.4281). Due to the high occurrence of Plasmodium vivax in the study area, the result contrasts with the national figure of the Plasmodium species report. The result of the current study may be useful to those individuals who work in Plasmodium species control and prevention program.

Assessment of malaria prevalence in Boset District, East Shawa Zone, Oromia Regional State, Ethiopia: a retrospective study

Objective

In this study, we aimed to assess the epidemiological profile and associated risk factors of malaria in Boset District using clinical records from the Boset District Health Office Central Surveillance Unit, East Shawa Zone, Oromia, Ethiopia.

Methods

This health facility-based retrospective cross-sectional study included clinical malaria data for 5 years (2016–2020) recorded at all public and private health facilities in the district.

Results

The present study revealed an overall malaria slide positivity rate of 12.4% (21,059/169,986), ranging from 23.3% to 5.3% during 2016–2020 in Boset District. Malaria cases were recorded in all age groups, but individuals aged 15 years and above accounted for a higher (56.2%) average proportion of malaria cases. Concerning the relative proportion of malaria parasite species, Plasmodium falciparum was slightly predominant (58%) over P. vivax (42%).

Conclusion

The present study revealed a declining trend in malaria cases over the 5-year study period in Boset District. Scaling up the available malaria prevention strategies and control measures is recommended to achieve malaria pre-elimination.

Vivax malaria in Duffy-negative patients shows invariably low asexual parasitaemia: implication towards malaria control in Ethiopia

BACKGROUND

The increase in detections of Plasmodium vivax infection in Duffy-negative individuals in Africa has challenged the dogma establishing the unique P. vivax Duffy Binding Protein-Duffy antigen receptor for chemokines (PvDBP-DARC) pathway used by P. vivax merozoites to invade reticulocytes. Information on the impact of Duffy antigen polymorphisms on the epidemiology of P. vivax malaria remains elusive. The objective of this study was to determine the distribution of asexual parasitaemia of P. vivax according to the Duffy antigen polymorphisms in Ethiopia.

METHODS

DNA was extracted from dried blood spots (DBS) collected from prospectively recruited 138 P. vivax-infected patients from health centres. The identification and estimation of P. vivax asexual parasitaemia were performed by microscopic examination and quantitative real-time polymerase chain reaction (PCR). Duffy genotyping was conducted by DNA sequencing in a total of 138 P.vivax infected samples.

RESULTS

The proportion of Duffy-negatives (FY*BES/FY*BES) in P. vivax infected patients was 2.9% (4/138). Duffy genotype FY*B/FY*BES (48.6%) was the most common, followed by FY*A/FY*BES genotype (25.4%). In one patient, the FY*02 W.01/FY*02 N.01 genotype conferring a weak expression of the Fyb antigen was observed. All P.vivax infected Duffy-negative patients showed low asexual parasitaemia (≤ 110 parasites/µL). The median P. vivax parasitaemia in Duffy-negative patients (53 parasites/µL) was significantly lower than those found in homozygous and heterozygous individuals (P < 0.0001).

CONCLUSION

Plasmodium vivax in Duffy-negative patients shows invariably low asexual parasitaemia. This finding suggests that the pathway used by P. vivax to invade Duffy-negative reticulocytes is much less efficient than that used in Duffy-positives. Moreover, the low asexual parasitaemia observed in Duffy-negative individuals could constitute an 'undetected silent reservoir', thus likely delaying the elimination of vivax malaria in Ethiopia.

Malaria prevalence and risk factors among patients visiting Mizan Tepi University Teaching Hospital, Southwest Ethiopia

Background

Ethiopia is among sub-Saharan African countries with a high number of malaria cases each year, with most of the landmass favoring the breeding of the vectors. There have been extensive efforts to control and prevent the transmission of malaria, which is part of the country’s prevention-based health policy.

Objective

This study aimed to determine malaria prevalence and associated risk factors among patients visiting Mizan-Tepi University Teaching Hospital (MTUTH).

Materials and methods

A cross-sectional study was conducted from September to December 2021 among patients visiting MTUTH, Southwest Ethiopia. A pretested structured questionnaire was used to collect sociodemographic data, and a capillary blood sample was collected after obtaining written informed consent from the study participants. The data were entered into Epi-data manager (v4.0.2.101) and analyzed with SPSS version 25.0, with a P-value of < 0.05 set as a significance.

Results

A total of 439 patients participated, of which 20.7% (91) were positive for malaria parasites, with a higher prevalence observed among the age group interval of 25–34 years (5.5%). Inadequate access to insecticide-treated bed net (ITN) 23.9% (105) and a low level of ITN usage 20.5% (90) were recorded. Patients living in areas of stagnant water were more likely to get infected with the malaria parasite (AOR = 16.191, 95% CI: 9.137, 28.692) compared to those who live away from stagnant water, and individuals living in houses not sprayed with insecticides were more susceptible to malaria infection (AOR = 0.215, 95% CI: 0.128, 0.360).

Conclusion

The overall malaria prevalence in this study was 20.7% (91), which proves that malaria remains a major threat to the communities in the study area, with Plasmodium falciparum contributing to most of the cases. Improving the habits of ITN usage and indoor residual spray through health education may help to reduce the impact of malaria in the study area.

High asymptomatic malaria among seasonal migrant workers departing to home from malaria endemic areas in northwest Ethiopia

Background

In Ethiopia, thousands of seasonal migrant workers travel from non-malaria or mild malaria transmission areas to malaria-endemic areas for seasonal farm activities. Most of these migrants stay in the farm areas for land preparation, plowing, planting, weeding, and harvesting for a specific period and return to their living areas. However, there is limited evidence of how seasonal migrant workers contribute to the transmission of malaria to new or less malaria transmission areas.

Methods

A cross-sectional study was conducted at the departure phase of seasonal migrant workers in the Metema district from September 2018 to October 2019. A total of 1208 seasonal migrant workers were interviewed during their departure from farm sites to their homes. The face-to-face interviews were performed using a pretested structured questionnaire. Moreover, blood samples were collected from each study participant for microscopic malaria parasite examination. The data were fitted with the logistic regression model to estimate the predictors of malaria transmission.

Results

At departure to home, the prevalence of malaria among seasonal migrant workers was 17.5% (15.6–19.45%). Approximately 71.80% (177/212) of the cases were Plasmodium falciparum, and 28.20% (35/212) were Plasmodium vivax. Most seasonal migrant workers 934 (77.4%) were from rural residences and highlanders 660 (55%). Most 661 (55.4%) of the migrants visited two and more farm sites during their stay at development corridors for harvesting activities. Approximately 116 (54.7%) asymptomatic malaria cases returned to the Dembia 46 (21.7%), Chilaga 46 (19.8%) and Metema 28 (13.2%) districts.

Conclusion

In this study, asymptomatic malaria remains high among seasonal migrant workers departing to home from malaria endemic areas. This may fuel a resurgence of malaria transmission in the high lands and cause challenges to the country's malaria prevention and elimination efforts. Hence, tailored interventions for seasonal migrant workers could be in place to enhance malaria control and elimination in Ethiopia, such as asymptomatic malaria test and treat positive cases at departure and transit, and integration between malaria officers at their origin and departure for further follow-up to decrease any risk of spread at the origin.

The prevalence of symptomatic and asymptomatic malaria and its associated factors in Debre Elias district communities, Northwest Ethiopia

BACKGROUND

Malaria is a major cause of morbidity and mortality worldwide. According to the World Health Organization 2021 malaria report, it is considered to be endemic in 85 countries and territories. Malaria elimination programmes have also faced many challenges, such as widespread asymptomatic carriers in endemic regions, and they should be considered in malaria-control programmes in endemic areas for successful transmission interruption. This study aimed to assess the prevalence of symptomatic and asymptomatic malaria infections, and associated factors in Debre Elias district communities, Northwest Ethiopia from May to Jun 2018.

METHODS

A community-based cross-sectional study was conducted among selected kebeles in Debre Elias district, Amhara region, North-western Ethiopia. Multi-stage sampling technique was carried out to select representative households. A total of 440 randomly selected households were included, of which one individual per household was sampled for laboratory examination. Malaria prevalence was determined by light microscopy of stained blood films and using CareStart™ Malaria HRP2/pLDH (Pf/Pv) Combo rapid diagnostic test (RDT). A structured questionnaire was employed to collect socio-demographic data and associated risk factors. Data entry and analysis were carried out using Epi data 3.1 and SPSS version 23 software, respectively. The association between dependent and independent variables was explored by using bivariate and multivariate logistic regression analyses. Statistically significant association was declared at P-value of < 0.05.

RESULTS

A total of 440 (333 asymptomatic and 107 symptomatic) individuals were included in this study. The overall prevalence of malaria was 5% with the majority (59.1%) of infections caused by Plasmodium falciparum. Among asymptomatic participants, 4.8% (n = 16, 95% CI = 2.6-7.3) and 4.2% (n = 14, 95% CI = 2.1-6.5) were diagnosed and confirmed by RDT and light microscopy respectively. Similarly, the prevalence of malaria among 107 symptomatic individuals was 7.5% (n = 8, 95% CI = 2.8-12.6) by either RDT or light microscopy. Utilization of insecticide-treated net (ITN), availability of ITN, house with eave, previous history of malaria infection, and family history of malaria infection were significantly associated with malaria infection (P < 0.05).

CONCLUSION

In this study, the prevalence of asymptomatic and symptomatic malaria was moderate. Screening of both symptomatic and asymptomatic malaria in the community is very important to scale up intervention programmes.

Prevalence of Malaria and Associated Risk Factors among the Community of Mizan-Aman Town and Its Catchment Area in Southwest Ethiopia

Background

Ethiopia is a Sub-Saharan African country with a high annual malaria case count, owing to the majority of the country's geography favoring vector rearing. As part of the country's prevention-based health policy, substantial efforts have been made to control and prevent malaria transmission. The objective of this study was to determine the prevalence of malaria and the associated factors in the community of Mizan-Aman and its catchment.

Materials and Methods

From September to October 2021, a community-based cross-sectional survey was undertaken among the communities of Mizan-Aman town and its catchment area in Southwest Ethiopia. A pretested structured questionnaire was used to collect sociodemographic data, as well as a capillary blood sample from each study participant. Epi-data manager (v4.0.2.101) was used to enter the data and analyzed by SPSS version 25.0. A statistical significance was set at a P value of <0.05.

Result

The study comprised a total of 412 people, of which 87 (21.1%) tested positive for malaria parasites, with a greater prevalence reported among those aged 25 to 34 years (5.8%). Individuals who lived near stagnant water were more likely to become infected with the malaria parasite (AOR = 8.996, 95% CI: 5.087-15.908) compared to those who lived further away, in warm climates, and those who did not use insecticide-treated bed nets were more susceptible to malaria parasite infection (AOR = 4.647, 95% CI: 1.257-17.184) compared to those who did use ITN and With (AOR = 0.466, 95% CI: 0.218-0.996 and AOR = 0.352, 95% CI: 0.206-0.604); participants with a history of antimalarial medication appear to have a protective function against malaria infection, respectively.

Conclusion

The overall malaria prevalence in this study was 87 (21.1%), demonstrating that malaria remains a significant concern to the populations in the study area, with Plasmodium falciparum accounting for the vast majority of cases.

Prevalence and Associated Factors of Malaria Infection among Outpatients Visiting Shewa Robit Health Center, Northcentral Ethiopia

Introduction

Malaria infection is a serious health problem killing millions in tropical developing countries including Ethiopia. The present study focused on assessing malaria prevalence and identification of determinants in Shewa Robit, northcentral Ethiopia.

Methods

A cross-sectional study was conducted among 422 participants who visited Shewa Robit Health Center between 01/10/2017 and 30/04/2018, using a simple random sampling. Sociodemographic characteristics were recorded using a pre-tested semi-structured questionnaire and infection was confirmed by microscopic examination. Data were analyzed using the Statistical Program for Social Sciences (SPSS) version 20 and p < 0.05 was used to indicate the level of significance.

Results

Eighty-one (19.0%) microscopically confirmed malaria cases were recorded, P.vivax was the most frequently detected species (n = 58; 71.6%). Interestingly, 73.2% (n = 309) of the participant did not utilize LLINs due to the fear of toxicity (37.4%, n = 158), misconception (21.6%, n = 91), and shortage (14.2%, n = 60). The data showed age, gender, marital status, family size, usage of LLINs and application of IRS, proximity to mosquito breeding sites and less robust and porous walls were the determinants of the infection in the study area.

Conclusion

The prevalence of malaria in the study population was high and P. vivax being the most common causative agent. Environmental and behavioral factors related to LLIN are the potential determinants of malaria. Continued public health interventions, targeting proper utilization of bed nets, drainage of stagnant water, and improved public awareness about reducing the risk of insect bites have the potential to minimize the infection.

Prevalence of Malaria and Associated Factors among Malaria-Suspected Patients Attending Hamusit Health Center, Northwest Ethiopia: A Cross-Sectional Study

Background

Malaria is one of the major public health problems in developing countries like Ethiopia. Despite efforts to reduce the mortality and morbidity, the disease is still a prominent health problem in Ethiopia. This study, therefore, was undertaken to assess the prevalence of malaria and associated factors among symptomatic patients in Northwest Ethiopia.

Methods

A facility based cross-sectional study was conducted from February to March 2020 among 210 febrile patients attending Hamusit Health Center, Northwest Ethiopia. A structured questionnaire was used to collect data on sociodemographic characteristics and factors perceived to be associated with Plasmodium infection. Questionnaire data was collected through face to face interview. Thin and thick blood films were prepared from capillary blood buffy coat samples. Data were analyzed using Statistical Package for Social Sciences Software version 20.

Results

Out of 210 malaria-suspected participants, 61 (29.0%) were confirmed to be infected by Plasmodium species. Plasmodium falciparum and P. vivax monoinfections were detected in 41 (19.5%) and 10 (4.8%) participants, respectively. Mixed infection was detected in 10 (4.8%) participants. Female participants (AOR = 2.261; 95% CI: 1.118-4.571; P = 0.023) and those having family members with history of malaria (AOR =2.261; 95% CI: 1.264-5.340; P = 0.009) had higher odds of acquiring Plasmodium infection as compared to their counterparts. Using insecticide-treated bed net and draining stagnant water were the most commonly mentioned malaria prevention measures reported by 71.9% and 8.1% of the respondents, respectively.

Conclusion

Malaria contributes significantly for febrile illnesses in the study area. Therefore, community mobilization should be strengthen in order to improve implementation of malaria control activities and, hence, reducing the prevalence.

Plasmodium falciparum Clinical Isolates Reveal Analogous Circulation of 3D7 and FC27 Allelic Variants and Multiplicity of Infection in Urban and Rural Settings: The Case of Adama and Its Surroundings, Oromia, Ethiopia

Background

Despite significant progress achieved globally in reducing malaria burden, still it is one of the major public health and economic problems in Ethiopia. Investigation of the local genetic polymorphism of P. falciparum, the most virulent and predominant malaria parasite primarily targeted in malaria control and elimination program, is paramount to assess intensity of parasite transmission. Analysis of the block 3 region of the msp-2 gene of P. falciparum provides strong molecular evidence to evaluate the real picture of malaria epidemiology to fine-tune the ongoing control and elimination programs in the region. Thus, this study was aimed at examining the status of such polymorphic gene and its implications in Adama and its surroundings.

Methods

148 isolates from patients with uncomplicated falciparum malaria were collected in the study from September 2019 to August 2020. Tween® 20 and the Chelex method were employed for parasite DNA extraction. msp-2 allelic families were genotyped by using nested polymerase chain reaction targeting its 3D7 and FC27 allelic variants followed by gel electrophoresis for fragment analysis.

Results

Seventeen different polymorphic forms of msp-2 allelic fragments were detected in the study area. Moreover, 47 (31.8%) and 41(27.7%) were detected for 3D7 and FC27 allelic families, respectively. Furthermore, the multiclonal allele type accounted for 60 (40.5%). The mean MOI was 1.4, and the heterogeneity index (He) is 0.49 indicating nearly intermediate malaria transmission in the study area.

Conclusions

The study revealed nearly intermediate genetic diversity and mean MOI of P. falciparum in the study area, demanding further scale up of the ongoing control and elimination efforts.

Malaria prevalence, knowledge and associated factors among household heads in Maygaba town, Ethiopia

Malaria remains a leading public health issue in Ethiopia, despite wide use of insecticide-treated mosquito nets (ITNs). Consistent use of ITNs reduces malaria transmission by 90%. However, coverage and proper use of ITNs are the major challenge for most rural settings of Ethiopia. We assessed the prevalence of malaria, ITNs use and associated factors among household heads in Maygaba town, northwest Ethiopia. A cross-sectional study was carried out among 403 households using a structured questionnaire. Blood samples were collected from household heads and examined for malaria parasites by microscopy. Chi-square test and logistic regression were used to check the association between the dependent and independent variables. Of the 403 blood samples, 19 (4.7%) had malaria parasites (12 cases of Plasmodium falciparum and 7 cases of Plasmodium vivax). Majority of the respondents were aware of the cause, communicability, preventability and curability of the disease. ITNs use was identified as the main malaria prevention method. About 64% (257) of the respondents owned ITNs, of which, 66.9% (172) consistently slept under the nets during the peak malaria season. Majority of the respondents (83.6%) had positive attitude towards the benefit of sleeping under ITNs. Educational status and livelihood of the respondents had statistically significant (p < 0.05) association with malaria knowledge. Malaria infection was significantly (p < 0.05) higher among household heads aged 18-30 years (AOR = 5.982; 95% CI = 1.715-20.863). Moderate prevalence rate and acceptable ITNs ownership was detected among the community of Maygaba town. However, a considerable proportion had misconceptions about the use of ITNs. A comprehensive malaria control measures and health education about the use of ITNs should be in place for effective prevention and control of malaria in the locality.

Five-Year Trend Analysis of Malaria Cases in East Shawa Zone, Ethiopia

BACKGROUND

Malaria is an infectious disease caused by Plasmodium parasites. Of the five human malaria parasites Plasmodium falciparum and Plasmodium vivax are the two co-endemic predominant and widely distributed species in Ethiopia, with major public health importance. Even though enormous effort has been made countrywide to reduce the disease burden little was reported about trends of malaria transmission in the several localities of malarious areas like East Shawa Zone, Ethiopia. Thus, the present study was aimed at assessing fiveyear (2016-2020) trends of malaria transmission at Adama, Boset and Lume districts of East Shawa Zone of Oromia Regional State, Ethiopia.

METHODS

Retrospective data was extracted from the central surveillance database of East Shawa Zone Health Office. The data collected was analyzed from September 2020 to December 2020 to examine trends of malaria epidemiology in three malarious districts in the Zone.

RESULTS

The results of the present study showed a remarkable decrease in slide positivity rate (SPR) from 16.3 to 1.4% from 2016 to 2018 in the areas. However, a recent slight increase of malaria SPR was observed. On the other hand, as age increases more male individuals were infected with malaria compared to female of similar age groups. Falciparum, vivax and mixed malaria infection accounted for 53%, 41% and 6% respectively.

CONCLUSIONS

Even though, an overall reduction of malaria incidence was revealed in the study areas, an increase in malaria SPR was observed in 2019 and 2020. Such inconsistency in reduction of malaria cases in the study area demands due attention of health planners.

Prevalence of Malaria and Associated Knowledge, Attitude, and Practice among Suspected Patients in Bahir Dar Zuria District, Northwest Ethiopia

BACKGROUND

Control and prevention activities have brought substantial decline of malaria incidence in the last two decades in Ethiopia. However, lack of local data on the disease transmission and community knowledge, attitude, and practice about malaria are thought to reverse the trend of malaria in certain areas. Therefore, assessment of the prevalence and community awareness towards malaria plays pivotal role for the success of malaria control and prevention.

OBJECTIVE

To assess malaria prevalence and knowledge, attitude, and practice about malaria among febrile patients in Bahir Dar Zuria district, Northwest Ethiopia.

METHODS

A facility based crosssectional study was conducted from January to March 2020 among 149 febrile patients attending selected health centers in Bahir Dar Zuria district. Data about knowledge, attitude, and practice about malaria were collected using semistructured questionnaire. Blood sample from each participant was tested for Plasmodium species through malaria rapid diagnostic tests and blood film microscopy. Data were analyzed using statistical software for social sciences version 20.

RESULTS

Among 149 participants, 22 (14.8%) were positive for Plasmodium infection at least by one diagnostic methods. Prevalence of P. falciparum and P. vivax was 3.4% and 10.1%, respectively, while that of mixed infection was 1.3%. From the total study participants, 29.5% have good knowledge, 77.2% have positive attitude, and 34.9% have good practice towards malaria. Statistically significant associations were observed on knowledge with age group (X 2 = 10.377, P = 0.035), educational level (X 2 = 15.075, P = 0.001), family size (X 2 = 7.601, P = 0.022), attitude level and practice level. Participants with family size < 5 were 6.841 (95% CI: 2.570-18.206, P ≤ 0.001) times more likely to have negative attitude as compared to those with family size ≥ 5.

CONCLUSIONS

Prevalence of malaria in the study area was relatively high. Study participants had encouraging attitude; however, their knowledge and practice towards malaria were poor. Therefore, the existing malaria control activities should be supplemented with continuous health educations, aware the community, and ensure participation in the control and prevention activities.

Malaria prevalence and associated risk factors in Dembiya district, North-western Ethiopia

Background

Ethiopia embarked on combating malaria with an aim to eliminate malaria from low transmission districts by 2030. A continuous monitoring of malaria prevalence in areas under elimination settings is important to evaluate the status of malaria transmission and the effectiveness of the currently existing malaria intervention strategies. The aim of this study was to assess the prevalence of malaria and associated risk factors in selected areas of Dembiya district.

Methods

A cross-sectional parasitological and retrospective survey was conducted in the two localities of Dembiya District, selected based on their long standing history of implementing malaria prevention and elimination strategies. Thin and thick blood smears collected from 735 randomly selected individuals between October and December, 2018 were microscopically examined for malaria parasites. Six years (2012–2017) retrospective malaria data was collected from the medical records of the health centres. Structured questionnaires were prepared to collect information about the socio-economic data of the population. Logistic regression analysis was used to determine a key risk factor explaining the prevalence of malaria. The data were analysed using SPSS version 20 and p ≤ 0.05 were considered statistically significant.

Results

The 6-year retrospective malaria prevalence trend indicates an overall malaria prevalence of 22.4%, out of which Plasmodium falciparum was the dominant species. From a total of 735 slides examined for the presence of malaria parasites, 3.5% (n = 26) were positive for malaria parasites, in which P. falciparum was more prevalent (n = 17; 2.3%), Plasmodium vivax (n = 5; 0.7%), and mixed infections (n = 4; 0.5%). Males were 2.6 times more likely to be infected with malaria than females (AOR = 2.6; 95% CI 1.0, 6.4), and individuals with frequent outdoor activity were 16.4 times more vulnerable than individuals with limited outdoor activities (AOR = 16.4, 95% CI 1.8, 147.9). Furthermore, awareness about malaria transmission was significantly associated with the prevalence of malaria.

Conclusions

Malaria is still a public health problem in Dembiya district irrespective of the past and existing vector control interventions. Therefore, the authorities should work on designing alternative intervention strategies targeting outdoor malaria transmission and improving community awareness about malaria transmission and control methods in the study area. For this, continuous monitoring of vectors’ susceptibility, density, and behaviour is very important in such areas.

Malaria Infection is High at Transit and Destination Phases Among Seasonal Migrant Workers in Development Corridors of Northwest Ethiopia: A Repeated Cross-Sectional Study

Purpose

Malaria is a leading public health problem in Ethiopia. Every year, thousands of seasonal farm workers travel to farm corridors in Northwest Ethiopia and fall at risk of malaria infection. However, the magnitude of malaria infection and risk factors during harvest time were not well identified. This study aimed at estimating the prevalence and risk factors of malaria infection among seasonal migrant workers in Northwest Ethiopia.

Methods

A repeated cross-sectional study was conducted at transit and destination phases in Metema district from September 15, 2018 to October 30, 2019. Data were collected using a structured questionnaire. A capillary blood sample was collected to examine infection with malaria parasite using a microscope. A multivariate logistic regression technique was used to determine risk factors.

Results

The malaria prevalence at transit and destination phases among migrant workers was 13.5% (95% CI: 12.07–14.93%) and 18.7% (95% CI: 16.40–21.02%), respectively. The combined prevalence was 16.1% (95% CI: 14.67–17.63%). The odds of malaria infection among migrant workers at the destination phase was 1.5 (OR=1.5, 95% CI 1.167–1.846) times higher compared to the transit phase. Education (AOR=8.198; 95% CI: 4.318–15.564), knowledge of antimalarial drugs (AOR=2.4; 95% CI: 1.43–3.95), and use of long-lasting insecticidal nets (AOR=5.0; 95% CI: 3.34–4.43) were significantly associated with malaria infection at migration phases.

Conclusion

This study showed that the burden of malaria among seasonal migrant workers was high at transit and destination phases. Malaria prevalence was higher at the destination phase compared to the transit phase. A tailored malaria prevention intervention is needed including awareness creation, screening, treatment, repellent, and prophylaxis at both phases to reduce malaria infections.

Prevalence of Malaria among Adults in Ethiopia: A Systematic Review and Meta-Analysis

Background

Malaria is one of the leading causes of mortality and morbidity in tropical and subtropical regions. The bulk of the global malaria burden is in sub-Saharan African countries, including Ethiopia. Malaria adversely affects the health of the peoples as well as the economic development of many developing countries including Ethiopia.

Methods

This review article was reported according to PRISMA guidelines. Related published articles were searched from online public databases, such as PubMed, Google Scholar, and ScienceDirect. The search approach used to retrieve related articles were "prevalence," "malaria," "adults," and "Ethiopia." The quality of articles was assessed using Joana Brigg's Institute (JBI) critical appraisal checklist. The meta-analysis was computed using STATA version 14. The pooled prevalence estimates with 95% confidence interval were analyzed using a random-effect model, and the possible source of heterogeneity across studies was indicated through subgroup analysis, inverse of variance (I ²), and time series analysis. The presence of publication bias was evaluated using funnel plots and Egger's regression test.

Results

Out of 144 studies collected, only eight full-text articles were screened and included in the final quantitative meta-analysis. The pooled prevalence of malaria among adults in Ethiopia was 13.61%. Subgroup analysis based on types of malaria cases showed that the prevalence of malaria among symptomatic and asymptomatic adults was 15.34% and 11.99%, respectively. Similarly, regional subgroup analysis showed that the highest malaria prevalence was recorded in Southern Nations, Nationalities, and Peoples' Region (SNNPR) (16.17%) followed by Oromia Regional State (13.11%) and Amhara Regional State (12.41%). Discussion and Conclusion. The current systematic review and meta-analysis showed that the pooled prevalence of malaria among adults was found to be greater than the general population and nearly equal to pregnant women. Therefore, the current prevention and control measures, which are related to both vectors and parasites, should be strengthened.

Prevalence and association of malaria with ABO blood group and hemoglobin level in individuals visiting Mekaneeyesus Primary Hospital, Estie District, northwest Ethiopia: a cross-sectional study

Malaria is a serious and sometimes fatal mosquito-borne disease caused by protozoan parasite of the genus Plasmodium. ABO blood group antigens represent polymorphic traits inherited among individuals and populations. Differences in blood group antigen expression can increase or decrease host susceptibility to many infections. This study was undertaken to determine the prevalence of malaria and its possible association with ABO blood group and hemoglobin level among individuals attending Mekaneeyesus Primary Hospital, Estie District, northwestern Ethiopia. Sociodemographic variables and relevant data were collected from 390 randomly selected individuals through structured questionnaire. Then, thick and thin smears were prepared from finger pricked blood samples, stained, and examined microscopically for detection and identification of malaria parasites. ABO blood group and hemoglobin levels of the same subjects were also determined. The data generated were analyzed for descriptive and logistic regression models. Variables with p value < 0.05 in multivariable logistic regression were considered explanatory variables. The overall prevalence of malaria was 8.5%; Plasmodium vivax (5.6%) was the most predominant, followed by P. falciparum (2.3%), and mixed infection of the two species (0.5%). In our study, being male (AOR = 3.48), under-five years of age (AOR = 72.84), rural residence (AOR = 2.64), and failing to use bed net (AOR =4.65) were significantly associated with the risk of malaria. Most (14.6%) of malaria-positive cases were among individuals with blood group "A," while the least numbers of cases were among subjects with blood group "O." Individuals with blood group "A" were about four times at risk of malaria as compared to individuals with blood group "O" (AOR= 3.74). The prevalence of anemia was 23.1% and significantly associated with malaria (p<0.05). Prevalence of malaria in this study is still higher compared to some of previous reports from Ethiopia. Thus, there is a need to intensify effort in malaria prevention among potentially at risk segments of population, including males, rural residents, and under-five children, and promotion of ITNs use in the community. Supplementation of iron-rich diet for iron-deficient anemia people is needed. Further in-depth investigation is also necessary to clearly establish the role that ABO blood group plays in malaria.

In vivo anti-malarial activity of the hydroalcoholic extract of rhizomes of Kniphofia foliosa and its constituents

BACKGROUND

Kniphofia foliosa is a flamboyant robust perennial herb which has dense clumps and tick upright rhizomes with leaves at the base. In Ethiopia, it has several vernacular names including Abelbila, Ashenda, Amelmela, Yeznjero Ageda, Shemetmetie and Yezinjero Ageda. The plant is endemic to Ethiopian highlands, where its rhizomes are traditionally used for the treatment of malaria, abdominal cramps and wound healing. In the present study, the 80% methanol extract of K. foliosa rhizomes and its constituents are tested against Plasmodium berghei in mice.

METHODS

Isolation was carried out using column and preparative thin layer chromatography (PTLC). The chemical structures of the compounds were elucidated by spectroscopic methods (ESI-MS, 1D and 2D-NMR). Peters' 4-day suppressive test against P. berghei in mice was utilized for in vivo anti-malarial evaluation of the test substances.

RESULTS

Two compounds, namely knipholone and dianellin were isolated from the 80% methanolic extract of K. foliosa rhizomes, and characterized. The hydroalcoholic extract (400 mg/kg) and knipholone (200 mg/kg) showed the highest activity with chemosuppression values of 61.52 and 60.16%, respectively. From the dose-response plot, the median effective (ED₅₀) doses of knipholone and dianellin were determined to be 81.25 and 92.31 mg/kg, respectively. Molecular docking study revealed that knipholone had a strong binding affinity to Plasmodium falciparum l-lactate dehydrogenase (pfLDH) target.

CONCLUSION

Results of the current study support the traditional use of the plant for the treatment of malaria.

Prevalence and Risk Factors of Asymptomatic Plasmodium Infection in Gondar Zuria District, Northwest Ethiopia

Background

Malaria is one of the major public health problems worldwide. In Ethiopia, an increase in malaria incidence may be attributed to the presence of community-wide asymptomatic Plasmodium infection. This study aims to assess asymptomatic Plasmodium infection and associated factors in Gondar Zuria district, Northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted in Gondar Zuria district from May to June 2019. Angacha and Hamsafeg villages were randomly selected from Tachtseda and Hamsafeg kebeles, respectively. Fifty-three (53) households were selected using systematic random sampling to recruit a total of 251 study participants. Sociodemographic data were collected using structured questionnaires. Thin and thick blood films were prepared and examined for evidence of parasites. Data were entered and analyzed using SPSS version 23. The association between dependent (asymptomatic Plasmodium infection) and independent (sex, age group, family size and previous history of malaria) variables was explored using bivariate and multivariate logistic regression. Statistically significant association was declared at a P-value of <0.05.

Results

A total of 251 individuals were tested, of whom 53.4% were females and 33.5% were above the age of 30 years. The prevalence of asymptomatic Plasmodium infection was 12%. The highest prevalence of malaria was observed in females (6.4%) and among the age group 15–29 years (4.4%). The majority (70%) of study participants had <500 parasites/μL of blood. A high parasitemia level (ie ≥1000 parasites/μL of blood) was observed in the age group 15–29 years. Age group, bed net usage and previous history of malaria were significantly associated with asymptomatic Plasmodium infection (P<0.05).

Conclusion

Asymptomatic Plasmodium infection remains an important public health problem in the study area. Further studies using more sensitive diagnostic methods are required to scale up the eradication and control program of malaria.

Determinants of malaria among under-five children in Ethiopia: Bayesian multilevel analysis

BACKGROUND

In Ethiopia, malaria is one of the public health problems, and it is still among the ten top leading causes of morbidity and mortality among under-five children. However, the studies conducted in the country have been inconclusive and inconsistent. Thus, this study aimed to assess factors associated with malaria among under-five children in Ethiopia.

METHODS

We retrieved secondary data from the malaria indicator survey data collected from September 30 to December 10, 2015, in Ethiopia. A total of 8301 under-five-year-old children who had microscopy test results were included in the study. Bayesian multilevel logistic regression models were fitted and Markov chain Monte Carlo simulation was used to estimate the model parameters using Gibbs sampling. Adjusted Odd Ratio with 95% credible interval in the multivariable model was used to select variables that have a significant association with malaria.

RESULTS

In this study, sleeping under the insecticide-treated bed nets during bed time (ITN) [AOR 0.58,95% CI, 0.31-0.97)], having 2 and more ITN for the household [AOR 0.43, (95% CI, 0.17-0.88)], have radio [AOR 0.41, (95% CI, 0.19-0.78)], have television [AOR 0.19, (95% CI, 0.01-0.89)] and altitude [AOR 0.05, (95% CI, 0.01-0.13)] were the predictors of malaria among under-five children.

CONCLUSIONS

The study revealed that sleeping under ITN, having two and more ITN for the household, altitude, availability of radio, and television were the predictors of malaria among under-five children in Ethiopia. Thus, the government should strengthen the availability and utilization of ITN to halt under-five mortality due to malaria.

Capture and Detection of Plasmodium vivax Lactate Dehydrogenase in a Bead-Based Multiplex Immunoassay

Laboratory detection of malaria antigens has proved valuable for research and epidemiological purposes. We recently developed a bead-based multiplex antigen assay for pan-Plasmodium and Plasmodium falciparum targets. Here, we report integration of a Plasmodium vivax-specific target to this multiplex panel: P. vivax lactate dehydrogenase (PvLDH). Within the multiplex panel, assay signal for purified PvLDH antigen titrated into the single-digit picogram range. Against a panel of polymerase chain reaction (PCR)-confirmed samples from acute P. vivax infections (n = 36), sensitivity was 91.7% in using PvLDH detection for identifying the presence of parasites. Specificity against a panel of persons with no Plasmodium infection (n = 44) was 100%, and specificity against a panel of PCR-confirmed P. falciparum, Plasmodium malariae, or Plasmodium ovale infections (n = 164) was 90.2%. Addition of this PvLDH capture and detection system into the multiplex antigen panel will now allow for sensitive screening for species identification of both P. falciparum and P. vivax in the laboratory.

Variation of preventive practices and its association with malaria infection in eastern Indonesia: Findings from community-based survey

BACKGROUND

Geographical variation may likely influence the effectiveness of prevention efforts for malaria across Indonesia, in addition to factors at the individual level, household level, and contextual factors. This study aimed to describe preventive practices at individual and a household levels applied by rural communities in five provinces in eastern Indonesia and its association with the incidence of malaria among adult (≥15 years) populations.

METHODS

This study analyzed a subset of data of nationally representative community-based survey 2018 Riset Kesehatan Dasar (Riskesdas). Data for socio-demographic (age, gender, education and occupation) and preventive behaviors (use of mosquito bed nets while slept, insecticide-treated mosquito nets (ITNs), mosquito repellent, mosquito electric rackets, mosquito coil/electric anti-mosquito mats, and mosquito window screen) were collected. Data were analyzed using bivariate and multivariable logistic regression model.

RESULTS

Total of 56,159 respondents (n = 23,070 households) living in rural areas in Maluku (n = 8044), North Maluku (n = 7356), East Nusa Tenggara (n = 23,254), West Papua (n = 5759) and Papua (n = 11,746) were included in the study. In the multivariable models, using a bed net while slept likely reduced the odds of self-reported malaria among Maluku participants. Reduced odds ratios of self-reported malaria were identified in those participants who used ITNs (North Maluku, ENT, Papua), repellent (Maluku, West Papua, Papua), anti-mosquito racket (ENT), coil (Maluku, North Maluku, Papua) and window screen (West Papua, Papua).

CONCLUSION

Our study concluded that the protective effects of preventive practices were varied among localities, suggesting the need for specific intervention programs.

Prevalence and Associated Factors of Malaria among Febrile Children in Afar Region, Ethiopia: A Health Facility Based Study

Background

Malaria is a major public health problem in Sub-Saharan Africa including Ethiopia and it affects children under five and pregnant mothers. Theprevalence of malaria is not well studied though the burden is expected to be high in low lands of Afar region.Therefore, this study attempts to assess the prevalence and associated factors of malaria among under five children in the pastoral community.

Methods

Cross-sectional study design was employed from April 15^th to 15^th May 2018 on a sample of 484 under-five children who visited the randomly selected health facilities of Dubti district, Afar region.The study participants were recruited randomly with the basic assumption that their arrival at health facilities is random. The main outcome variable was parasitological confirmed malaria among under five children and it was measured using either microscopy blood film examination. Binary logistic regression model was done to measure the association between confirmed malaria infection and its predictors. Independent variables with p-value less than 0.25 in the bivariate analysis were entered into multivariable logistic regression analysis model. Statistical significance level was declared at p-value less than 0.05.

Results

The prevalence of malaria among febrile under-five children was 64% (95% CI 59.5%–68.4%). Of these, more than half (66.5%) and one-fifth (22. 2%) of the cases were caused by p.falciparum and p.vivax respectively. The multivariable logistic regression analysis showed thatliving in rural residence [AOR=1.77: 95% CI 1.10–2.85], having educated mother [AOR=0.406: 95% CI 0.26–0.63], age of child ([AOR=2.98: 95% CI 1.41–6.32], sex of child [AOR=1.99: 95% CI 1.29–3.08], not sleep under ITN [AOR=9.10: 95% CI 1.01- 82.58], ITN availability [AOR=2.23: 95% CI 1.01- 4.89] and history of malaria infection among family members [AOR=9.10: 95% CI 1.01–82.58] were the independent predictors of malaria infection among under five children.

Conclusion

The overall prevalence of malaria among under-five children was high compared to the national prevalence of malaria among the general population. Health care providers (HCPs) should educate parents/guardians regarding proper utilization of ITN at night. In addiotion, they should provide early treatment for febrile family members to halt the transmission of malaria. The regional government should give due attention to supply of ITN and enhance the awareness of the community. Additional longitudinal studies are recommended.

Molecular epidemiology of malaria parasite amongst patients in a displaced people's camp in Sudan

BACKGROUND

Despite the importance of epidemiological studies in the development of effective control strategies and provision of basic health services for refugees and internally displaced persons (IDPs), data on the prevalence of malaria are limited. Thus, this study was conducted to estimate the molecular prevalence of malaria amongst the displaced population in Ardamata IDP camp in Al-Geneina City, Sudan.

METHODS

A cross-sectional study was conducted from July 2018 to December 2018 to estimate malaria prevalence amongst the displaced population in Ardamata IDP camp in Al-Geneina City, Sudan. A total of 380 patients with suspected malaria were recruited. Nested polymerase chain reaction (nPCR) assays were performed to detect the Plasmodium genus and species.

RESULTS

Of 380 patients, 232 (61.1%) were positive for malaria. Plasmodium falciparum was the only prevalent species detected amongst the study population. nPCR analysis revealed that none of the samples had Plasmodium vivax, Plasmodium ovale or Plasmodium malariae. The malaria prevalence rate was higher amongst males (67.1%) than in females (56.8%), and gender was the only risk factor that was significantly associated with malaria infection (p = .042).

CONCLUSIONS

Despite control programmes, malaria remains a significant cause of illness amongst a displaced population. The high prevalence of malaria infection in this study indicates that additional health facilities and control strategies should be implemented in displaced camps and the surrounding areas.

Plasmodium falciparum and Plasmodium vivax Prevalence in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Malaria is a protozoan disease caused by the Plasmodium species. Among the five Plasmodium species. Among the five Plasmodium falciparum and Plasmodium vivax malaria are by far the most predominant and widely distributed in Ethiopia. Malaria is one of the leading causes of morbidity and mortality globally, particularly in the sub-Saharan countries including Ethiopia. It is also a major obstacle to socio-economic development in the country.

METHODS

Articles were searched from PubMed, Google Scholar, and Science Direct databases. The pooled prevalence estimates were analyzed using the DerSimonian-Laird random-effects model and the possible sources of heterogeneity were evaluated through subgroup analysis, metaregression, and sensitivity analysis. Publication bias was analyzed using funnel plots and Egger's test statistics. The data management and analysis were done using STATA 15.1 version software.

RESULTS

Among 922 studies initially identified, thirty-five full-text articles fulfilled the inclusion criteria and included in the study. The combined, Plasmodium falciparum and Plasmodium vivax malaria are by far the most predominant and widely.

CONCLUSIONS

This systematic review and meta-analysis showed a high malaria prevalence in Ethiopia. Therefore, previous prevention and control measures should be revised and/or strengthened as appropriate and new strategies should be implemented. In addition, technical, financial and material support, and coordination of the regional capacity building and logistics should be adequately implemented.

Quality of fixed dose artemether/lumefantrine products in Jimma Zone, Ethiopia

Background

Malaria caused by Plasmodium vivax and Plasmodium falciparum is among the major public health problems in most endemic areas of the world. Artemisinin-based combination therapy (ACT) has been recommended as a first-line treatment for uncomplicated Plasmodium falciparum malaria almost in all endemic regions. Since ineffectively regulated medicines in resource limited settings could favour infiltration of poor quality anti-malarial medicines into pharmaceutical supply chain and jeopardize a positive treatment outcome, regular monitoring of the quality of anti-malarial medicines is critical. Thus, the aim of this study was to assess the quality of fixed dose combination (FDC) artemether (ART)/lumefantrine (LUM) tablets available in Jimma zone, Ethiopia.

Methods

This study was conducted in Jimma zone, Ethiopia. A total of 74 samples of FDC ART/LUM (20 mg ART/120 mg LUM) tablets were collected from 27 public facilities. All samples were subjected to visual inspection and the relevant information was recorded. The samples were transported to Jimma University Laboratory of Drug Quality (JuLaDQ) and stored at ambient temperature (20 °C to 25 °C) until analysis. The Pharmacopoeial conform/non-conform methods and the risk-based Derringer’s desirability function approach were employed to assess the pharmaceutical quality of the investigated products.

Results

The visual inspection results revealed that there were no signs of falsified in the investigated products. Identification test results of samples indicated that all samples contained the stated active pharmaceutical ingredients (APIs). The results of uniformity of mass indicated that all samples complied with International Pharmacopoeial specification limits. The assay results, expressed as percent label claim (%lc) of ART (89.8 to 108.8%, mean ± SD = 99.1 ± 3.9%) and LUM (90.0 to 111.9%, mean ± SD = 98.2 ± 3.8%) revealed that, all samples complied with International Pharmacopoeia acceptance specification limits (i.e. 90–110%lc), except one generic product (IPCA Laboratories Ltd., India) which contains excessive LUM (111.9 ± 1.7%lc). The risk priority number (RPN) results revealed that assay (RPN = 392) is relatively the most critical quality attribute followed by identity (RPN = 280) and mass uniformity (40). Quality evaluation based on psycho-physical Harrington’s scale revealed that more than 96% of samples were within the acceptable ranges (D ≥ 0.7–1.0).

Conclusions

Both Pharmacopoeial and risk-based desirability function approaches to quality evaluation applied to the investigated products revealed that above 96% FDC ART/LUM tablets circulating in public settings of Jimma zone are of good quality.

Electronic supplementary material

The online version of this article (10.1186/s12936-019-2872-1) contains supplementary material, which is available to authorized users.

Application of Kingdon and Hall Models to Review Environmental Sanitation and Health Promotion Policy in Ethiopia: A Professional Perspective as a Review

Background

In the world, many countries, including Ethiopia, are framing policies to roll back the problem of the sanitation. For this, the Kingdon and Hall models are the two distinct models formed to articulate the policy agenda to the health problem. The Kingdon model includes problem, policy and politics streams whereas the Hall model includes legitimacy, feasibility and support of the health policies. Therefore, this review aims to integrate the two models with diseases prevention and health promotion policies of Ethiopia.

Methods

We used the existing frameworks of the models as a guiding principle. Then, we applied the frameworks of the two models as an important consideration to interlink policy agenda to a given health problem. We also described the existing scientific literature about the sanitation and health promotion. After thoroughly reviewing, possible policy inputs and country setups were included with a brief discussion by comparing different kinds of literatures.

Results

The two models are recognized as an opportunity to get an essential sanitation policy. The government settled and has closed links to the new innovation as an emerged discourse. Therefore, the two model streams came together for setting sanitation problem on the policy agenda. The technical feasibility, public acceptability and congruence with existing values were all judged to be favorable.

Conclusion

The integration of policies within the policy frameworks has very important outputs in various countries. Therefore, the field specialists should figure out the problem of policy integration through policy evaluation researches.

Sequence-based identification of Anopheles species in eastern Ethiopia

BACKGROUND

The recent finding of a typically non-African Anopheles species in eastern Ethiopia emphasizes the need for detailed species identification and characterization for effective malaria vector surveillance. Molecular approaches increase the accuracy and interoperability of vector surveillance data. To develop effective molecular assays for Anopheles identification, it is important to evaluate different genetic loci for the ability to characterize species and population level variation. Here the utility of the internal transcribed spacer 2 (ITS2) and cytochrome oxidase I (COI) loci for detection of Anopheles species from understudied regions of eastern Ethiopia was investigated.

METHODS

Adult mosquitoes were collected from the Harewe locality (east) and Meki (east central) Ethiopia. PCR and Sanger sequencing were performed for portions of the ITS2 and COI loci. Both NCBI's Basic Local Alignment Search tool (BLAST) and phylogenetic analysis using a maximum-likelihood approach were performed to identify species of Anopheles specimens.

RESULTS

Two species from the east Ethiopian collection, Anopheles arabiensis and Anopheles pretoriensis were identified. Analyses of ITS2 locus resulted in delineation of both species. In contrast, analysis of COI locus could not be used to delineate An. arabiensis from other taxa in Anopheles gambiae complex, but could distinguish An. pretoriensis sequences from sister taxa.

CONCLUSION

The lack of clarity from COI sequence analysis highlights potential challenges of species identification within species complexes. These results provide supporting data for the development of molecular assays for delineation of Anopheles in east Ethiopia.

Social determinants of malaria in an endemic area of Indonesia

Background

Malaria is an increasing concern in Indonesia. Socio-demographic factors were found to strongly influence malaria prevalence. This research aimed to explore the associations between socio-demographic factors and malaria prevalence in Indonesia.

Methods

The study used a cross-sectional design and analysed relationships among the explanatory variables of malaria prevalence in five endemic provinces using multivariable logistic regression.

Results

The analysis of baseline socio-demographic data revealed the following independent risk variables related to malaria prevalence: gender, age, occupation, knowledge of the availability of healthcare services, measures taken to protect from mosquito bites, and housing condition of study participants. Multivariable analysis showed that participants who were unaware of the availability of health facilities were 4.2 times more likely to have malaria than those who were aware of the health facilities (adjusted odds ratio = 4.18; 95% CI 1.52–11.45; P = 0.005).

Conclusions

Factors that can be managed and would favour malaria elimination include a range of prevention behaviours at the individual level and using the networks at the community level of primary healthcare centres. This study suggests that improving the availability of a variety of health facilities in endemic areas, information about their services, and access to these is essential.

Electronic supplementary material

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Trend analysis of malaria prevalence in Halaba special district, Southern Ethiopia

OBJECTIVE

The study aimed to determine the prevalence of malaria in Halaba special district, Southern Ethiopia, from 2013 to 2017.

RESULTS

Of a total 583,668 malaria suspected cases examined during the study period, 55,252 (9.5%) were microscopically confirmed to be positive for malaria, at the rate of 27,712 (50.2%) females and 27,540 (49.8%) males (P = 0.95). The highest prevalence of 8454 (15.3%) malaria cases were observed in Halaba health center, followed by Halaba district hospital, at 7290 (13.2%), while the lowest cases, 1765 (3.2%), were confirmed in Wejago health center. The highest prevalence of malaria, 25,716 (46.5%), was registered among the age group ≥ 15 year old (P = 0.006). Plasmodium vivax and Plasmodium falciparum were the two major malaria parasites detected in this study, with the prevalence of 33,855 (62.3%) and 21,397 (38.7%), respectively (P = 0.0001). The detected high prevalence of P. vivax in this study may clearly indicate that more attention has been given to control P. falciparum strains in the study area. This may be a great challenge for the achievement of malaria elimination goals. Therefore, all concerned bodies should act collaboratively to combat the high prevalence of P. vivax from the study district.

The prevalence of asymptomatic malaria parasitemia and associated factors among adults in Dembia district, northwest Ethiopia, 2017

Background

Malaria is still a leading cause of morbidity and mortality in many developing countries including Ethiopia. Its prevalence has been declining among Ethiopian adults, especially in Dembia district. However, it is still at the top of diseases list at the district. Hence, the study aimed to determine the prevalence and the factors that contribute to its being the major public health concern despite different preventive and control measures in place.

Methods

A community based cross-sectional study was conducted from October 11 to November 16, 2017. The multistage sampling technique was employed to select 832 study participants. A rapid diagnostic test were used to confirm the disease. Data were entered using Epi info version 7 and was analyzed by Statistical Package for Social Science (SPSS) version 20. The logistic regression model was performed to examine the association of factors with malaria parasite.

Results

Out of the 832 adults included in the study, 6.7% (95% Confidence Interval (CI: 5.2–8.7)) were confirmed to be malaria parasite carriers. The dominant plasmodium species was Plasmodium falciparum [46 (82%)]. According to the multivariable logistic regression analysis, male sex (Adjusted Odds Ratio (AOR = 4.5; 95%CI: 2.1–9.5), adult age 15–19 years (AOR = 4.5; 95%CI: 2.1–9.7), travel history (AOR = 5; 95%CI: 2.34–12.25), and stagnant water around home (AOR = 3.7; 95%CI: 1.57–8.87) increased the probability of malaria infectivity, while Insecticidal Treated Nets (ITN) utilization (AOR = 0.2; 95%CI: 0.09–0.31) decreased it.

Conclusion

Malaria is still an important public health challenge among adults in the study area. Male sex, age 15–19 years, travel history, living around stagnant water, and not using ITN increased the probability of infection. Therefore, the District Health office and Health extension workers should work to increase ITN distribution and focus on reducing malaria breading sites through community participation.

Cost-effectiveness of a combined intervention of long lasting insecticidal nets and indoor residual spraying compared with each intervention alone for malaria prevention in Ethiopia

Background

The effectiveness of long lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), for malaria prevention, have been established in several studies. However, the available evidence about the additional resources required for a combined implementation (LLIN + IRS) with respect to the added protection afforded is limited. Therefore, the aim of this study was to compare the cost-effectiveness of combined implementation of LLINs and IRS, compared with LLINs alone, IRS alone, and routine practice in Ethiopia.

Methods

The study was performed alongside a cluster randomized controlled trial of malaria prevention conducted in Adami Tullu district, in Ethiopia, from 2014 to 2016. In addition, literature-based cost-effectiveness analysis—using effectiveness information from a systematic review of published articles was conducted. Costing of the interventions were done from the providers’ perspective. The health-effect was measured using disability adjusted life years (DALYs) averted, and combined with cost information using a Markov life-cycle model. In the base-case analysis, health-effects were based on the current trial, and in addition, a scenario analysis was performed based on a literature survey.

Results

The current trial-based analysis showed that routine practice is not less effective and therefore dominates both the combined intervention and singleton intervention due to lower costs. The literature-based analysis had shown that combined intervention had an incremental cost-effectiveness ratio of USD 1403 per DALY averted, and USD 207 per DALY averted was estimated for LLIN alone. In order for the ICER for the combined intervention to be within a range of 1 GDP per capita per DALY averted, the annual malaria incidence in the area should be at least 13%, and the protective-effectiveness of combined implementation should be at least 53%.

Conclusions

Based on the current trial-based analysis, LLINs and IRS are not cost-effective compared to routine practice. However, based on the literature-based analysis, LLIN alone is likely to be cost-effective compared to 3 times GDP per capita per DALY averted. The annual malaria probability and protective-effectiveness of combined intervention are key determinants of the cost-effectiveness of the interventions.

Trial registration PACTR201411000882128 (Registered 8 September 2014). http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201411000882128