Abdissa Biruksew

Malaria remains a significant public health concern in Ethiopia. Understanding the historical backgrounds and future trends of malaria incidence is crucial for customizing local specific intervention strategies. The spatiotemporal patterns and putative modeling of future trends of malaria in the Jimma Zone have not been thoroughly investigated. This study aimed to model the spatiotemporal patterns and prediction of future malaria trends in Jimma Zone, Oromia, Ethiopia, Ethiopia from 2022 to 2026. This study analyzed a decade of historical malaria data (2012–2021) from 15 districts of Jimma Zone. A District-level annual parasite incidence (API) and Standardized incidence ratio (SIR) were calculated, and malaria risk maps were developed. Moran’s I and Monte Carlo statistics were used for assessing spatial clustering of malaria incidence, while time series analysis with the Autoregressive Integrated Moving Average (ARIMA) model was used for analyzing the temporal patterns and predicted for the future trends. A total of 1,718,471 individuals were screened for malaria between 2012 and 2021, with 359,655 (20.93%) confirmed cases. Plasmodium falciparum, P. vivax and mixed infections accounted for 52.71%, 43.62% and 3.67%, respectively. Malaria incidence decreased dramatically by 96.13%, with the API falling from 87.97 per 1,000 population at risk in 2012 to 3.40 in 2021. It was revealed that there was random distribution of malaria transmission across districts. API and SIR maps identified potential risk areas and cold spots. The disease exhibited seasonal patterns, peaking from August to November (maximum in September) and from March to June. Despite a decline trend, malaria remains a potential threat in areas like Chora Botor and Shebe Sonbo. Forecasting with the ARIMA (0, 1, 3) x (1, 1, 0) model for 2022–2026 suggests stability in malaria incidence, with seasonal fluctuations but no significant trends. Malaria incidence in Jimma Zone was significantly decreased from 2012 to 2021, reaching notably low risk levels by 2021. However, the disease persists in areas such as Chora Botor and Shebe Sonbo, indicating ongoing risk of transmission. The seasonal pattern of malaria underscores the need for targeted interventions during peak periods. Spatial autocorrelation analysis showed no distinct patterns, suggesting the necessity for continued surveillance in historically high-risk areas. While forecasts suggest a stable malaria cases, maintaining vigilance and adapting interventions based on emerging trends is essential to sustain control progress towards elimination. Finally, future studies should incorporate key factors like climate variables (temperature, rainfall, humidity), topographic features, intervention coverage, and other environmental determinants, which were not included in our analysis.

Background: Schoolchildren with asymptomatic malaria infections often go undiagnosed and untreated, serving as reservoirs for infection that hamper malaria control and elimination efforts. In this context, little is known about the magnitude of asymptomatic malaria infections in apparently healthy schoolchildren in Ethiopia. This study was aimed at determining the prevalence of asymptomatic malaria infection and its associated factors in apparently healthy schoolchildren in Ethiopia. Methods: From September 2021 to January 2022, a school-based cross-sectional study was conducted on 994 apparently healthy schoolchildren (aged 6–15 years) selected from 21 primary schools in the Gomma district, of Jimma zone, southwestern Oromia, Ethiopia. A multi-stage sampling technique was used to select schools and participants. After allocating the total sample proportionally to each school and then to each grade, participants were selected using the lottery method from a list of student records (rosters). Finger-pricked blood samples were collected for microscopy blood film preparation and malaria rapid diagnostic test (RDT) (SD Bioline Malaria Ag Pf/Pv). Moreover, dry blood spots (DBSs) were prepared onto filter papers for quantitative real time polymerase chain reaction (qPCR) analysis. Results: As determined by RDT and microscopy, the prevalence of asymptomatic malaria was 2.20% and 1.51%, respectively. Using qPCR, the overall prevalence was 5.03% (50/994). Of this, Plasmodium falciparum, Plasmodium vivax and mixed infections accounted for 90%, 6% and 4%, respectively. Submicroscopic asymptomatic malaria infection was also accounted for 70% (35/50) of the overall prevalence. Household head age, nighttime outdoor activities of household heads, family history of malaria, absence of insecticide-treated nets (ITN), and presence of stagnant water around the houses are all significantly associated with asymptomatic malaria infections among schoolchildren. Conclusions: This study found that both RDT and microscopy underestimated the prevalence of asymptomatic malaria in schoolchildren. However, qPCR was able to detect even low levels of parasitaemia and revealed a higher prevalence of asymptomatic submicroscopic malaria infections. The findings imply that schoolchildren with asymptomatic malaria infection are potential hotspot for malaria reservoir that fuels ongoing transmission. Therefore, it is imperative to include schoolchildren and schools in malaria intervention package and equally important is the adoption of more advanced and sensitive diagnostic tools, which would be crucial for successful malaria control and elimination efforts. Targeted interventions for asymptomatic malaria-infected schoolchildren can provide invaluable support to the National Malaria Control Programme in controlling and eventually eliminating the disease.

Background: One of the major roadblocks to the falciparum malaria elimination programme is the presence of a portion of the population, such as school children, with asymptomatic malaria infection. Targeting such reservoirs of infections is critical to interrupting transmission and enhancing elimination efforts. The NxTek^™ Eliminate Malaria Pf test is a highly sensitive rapid diagnostic test (hsRDT) for the detection of HRP-2. However, knowledge gaps exist in Ethiopia on the diagnostic performance of hsRDT for the detection of Plasmodium falciparum in school children with asymptomatic malaria. Methods: A school-based cross-sectional study was conducted from September 2021 to January 2022 on 994 healthy school children (aged 6–15 years). Finger-pricked whole blood samples were collected for microscopy, hsRDT, conventional RDT (cRDT or SD Bioline Malaria Ag Pf/P.v), and QuantStudio^™ 3 Real—Time PCR system (qPCR). The hsRDT was compared to cRDT and microscopy. qPCR and microscopy were used as reference methods. Results: The prevalence of Plasmodium falciparum was 1.51%, 2.2%. 2.2% and 4.52%, by microscopy, hsRDT, cRDT and qPCR, respectively. Using qPCR as reference, the sensitivity of hsRDT was higher (48.89%) than the microscopy (33.3%), and showed 100% specificity and a positive predictive value (PPV). Microscopy showed similar specificity and PPV as hsRDT. Using microscopy as a reference, the diagnostic perforrmances of both hsRDT and cRDT were similar. Both RDTs demonstrated identical diagnostic performances in both comparison methods. Conclusions: hsRDT has the same diagnostic performance as cRDT but improved diagnostic characteristics than microscopy for detection of P. falciparum in school children with asymptomatic malaria. It can be a useful tool for the national malaria elimination plan of Ethiopia.