Malaria is one of the major global public health problems affecting different segments of the population, commonly women and children, and an estimated 228 million cases of malaria occurred worldwide in the year 2018 [
The disease is transmitted by the bite of the infected female
The implementing various malaria control interventions in Ethiopia such as the use of insecticide-treated bed nets, indoor residual spraying, and treatment of cases with arthemicinin-based combination therapies resulted in promising improvements [
Dembecha is one of the malaria-prone areas in the region, and according to the Dembecha Health Center report, malaria is among the top ten leading causes of morbidity in the area. Although malaria is the top listed reason for the health center’s visit and admissions in the area, there are no documented studies. Further, small and mobile subpopulation groups that are difficult to track may reintroduce malaria in areas where it had been eliminated [
The study was conducted in Dembecha Health Center. Dembecha is a town in northwestern Ethiopia, 350 km north of Addis Ababa. Located in the West Gojjam Zone of the Amhara Region, this town has a latitude and longitude of 10°33
A retrospective cross-sectional study was conducted between February and April 2018 in Dembecha Health Center.
Five years (Sep. 2011/12-Aug. 2015/16) secondary data were collected from the laboratory record logbook. Variables such as date of examination, total clinically treated and confirmed cases in months and years, types of malaria species, and sociodemographic data such as age and sex were collected. Data was collected by experienced medical laboratory technicians. Any incomplete data such as the sociodemographic and malaria diagnosis results which were not properly documented were excluded. In the health center, microscopy was used as the gold standard to confirm the presence of
Patients’ data including dates of health center visit, sociodemographic characteristics, and laboratory results were entered into EpiData 3.1 and then exported to SPSS version 24 software. Descriptive statistics were used to summarize the data. Line graphs were used to show the trends over the five years. To assure the quality of the data, a well-prepared checklist was used. The training was given for five data collectors and the supervisor. The collected data were checked for completeness and consistency daily. Data cleaning was also done using SPSS. Chi-square test was used to compare the, association of malaria burden by sex and age groups.
A total of 12,766 blood films were requested over the last five years, 2011/12 and 2015/16 at Dembecha Health Center. The number of microscopically confirmed malaria cases was 2086 (16.34%), and an average of 417 malaria confirmed cases was recorded annually (Table
Annual trends in total malaria cases in Dembecha Health Center, northwestern Ethiopia (2011/12-2015/16).
Year | Blood films examined | Lab confirmed malaria cases |
---|---|---|
2011/12 | 3,024 | 669 |
2012/13 | 2,088 | 739 |
2013/14 | 2,762 | 246 |
2014/15 | 2,789 | 249 |
2015/16 | 2,103 | 183 |
Total | 12,766 | 2086 |
Results from the record review showed a fluctuating trend in the malaria cases within the past five years. Between the years 2011/12 and 2012/13, a statistically significant increment of malaria morbidities was seen followed by a sharp decline between the years 2012/13 and 2013/14 (
Trends of malaria prevalence in Dembecha Health Center, northwest Ethiopia (2011/12-2015/16).
Overall, out of 2086 confirmed malaria cases, males [1229 (58.9%)] were more affected by malaria infection than females [857 (41.1%)] in all the years (
Distribution of confirmed malaria cases by sex at Dembecha Health Center, northwest Ethiopia (2011/12-2015/16).
Sex | Total case examined | Slide positive no. (%) | Mixed no. (%) | ||
---|---|---|---|---|---|
Male | 7243 | 1229 (58.9) | 826 (67.20) | 345 (28.07) | 58 (4.71) |
Female | 5523 | 857 (41.1) | 607 (70.82) | 204 (23.80) | 46 (5.36) |
Total | 12,766 | 2086 | 1433(68.7) | 549 (26.3) | 104 (5) |
Regarding the trends in malaria species across the age groups, results depicted that in all age groups,
Trends of malaria species across age groups in at Dembecha Health Center, northwest Ethiopia (2011/12-2015/16).
According to our record review,
Despite the rise and fall seen, malaria cases were reported in almost every months and season of the year. Taking a look at the distribution of these species across the season, the maximum number of cases of
The distribution of
Malaria is a major public health concern in Ethiopia responsible for substantial amounts of morbidities and mortalities. Its distribution and transmission vary from place to place. This document review was aimed to assess the trend in confirmed malaria cases over five years by a person, composition of
The trend analysis result showed that malaria cases were fluctuating over the five years but ultimately showed a decline. This fluctuating yet declining trend was consistent with other studies [
Following the steady increment of cases, a sharp decline was observed from 2012/13 to 2013/14. According to the information obtained from the health center, the reduction of morbidities related to malaria coincides with the increased attention given to malaria prevention and control programs and activities in the community after the preceding alarming results. It also matches with the time Ethiopia was among the countries which achieved a high number of insecticide-treated mosquito net deliveries. Similarly, several efforts were underway to control malaria such as enhancing investments in malaria reduction, delivery of rapid diagnostic tests, wide coverage of arthemicinin-based combination therapies, the use of indoor residual spraying, and different vector control programs as the components of scale-up of malaria interventions that were on the go by the Federal Ministry of health of Ethiopia to fit with the global goal to be achieved by 2020 [
In our study,
According to studies conducted in different parts of Ethiopia, males were found to be more prone to malaria infection as compared to females [
Regarding the age group distributions, increased numbers of malaria morbidities were seen among those >20 years. These groups are more prone to malaria, since they are on their productive age and with family responsibilities exposing them for mobilizations to different areas. Furthermore, the majority of them are from rural areas, where most of them are engaged in agricultural activities that are usually conducted outdoor.
The other important finding in our study was that malaria was observed in almost every months of the year. Also, the relative dominance of all malaria cases was noticed during spring (September, October, and November) and autumn (March, April, and May) seasons, respectively. This is line with the fact that in Ethiopia, malaria transmission peaks biannually from September to December (after the predominant rainy season) and from April to May (following the minimal rainfall season), which coincides with the major harvesting seasons [
Our results indicated that the trend in malaria prevalence was fluctuating yet decreasing in the subsequent years. However, the figure implies that malaria is a major public health problem in the study area affecting the productive segments of the population and its occurrence coincides with the major harvesting seasons. Malaria prevention and control programs should be strengthened taking these implications into account. Also, interventions aimed to combat the infection should give due focus to the predominant species. Further studies involving primary data in the study area are also recommended.
Standard deviation
Statistical package for social sciences
World Health Organization.
All datasets on which the conclusions of the manuscript rely are presented in the manuscript.
Ethical clearance letter was obtained from the department of public health, college of health sciences of Debre Markos University with a protocol number of MID/233/10/18. Letter of Permission to conduct the study was obtained from Dembecha town health office and Dembecha Health Center. All patient’s information was kept confidential.
The authors declare that they have no competing interests.
AF and DH conceived, designed the study, supervised the data collection, and performed the data analysis and interpretation. BK, YM, and AA assisted in designing the study, data analysis, and interpretation. AF and DH drafted the manuscript. All authors read and approved the final manuscript.
The authors thank Debre Markos University for its ethical approval. The authors also thank Dembecha health office and the health center administrators, supervisors, and data collectors.