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

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Prevalence and Risk Factors of Asymptomatic Plasmodium Infection in Gondar Zuria District, Northwest Ethiopia Infection and Drug Resistance Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Prevalence and Risk Factors of Asymptomatic Plasmodium Infection in Gondar Zuria District, Northwest Ethiopia This article was published in the following Dove Press journal: Infection and Drug Resistance Awoke Minwuyelet1 Background: Malaria is one of the major public health problems worldwide. In Ethiopia, an Tegegne Eshetu1 increase in malaria incidence may be attributed to the presence of community-wide asymp­ Dagnaneh Milikit1 tomatic Plasmodium infection. This study aims to assess asymptomatic Plasmodium infec­ Yibeltal Aschale 2 tion and associated factors in Gondar Zuria district, Northwest Ethiopia. Methods: A community-based cross-sectional study was conducted in Gondar Zuria district 1 Department of Medical Parasitology, from May to June 2019. Angacha and Hamsafeg villages were randomly selected from School of Biomedical and Laboratory Sciences, College of Medicine and Health Tachtseda and Hamsafeg kebeles, respectively. Fifty-three (53) households were selected Sciences, University of Gondar, Gondar, using systematic random sampling to recruit a total of 251 study participants. Ethiopia; 2Department of Medical Laboratory Sciences, College of Health Sociodemographic data were collected using structured questionnaires. Thin and thick Sciences, Debre Markos University, blood films were prepared and examined for evidence of parasites. Data were entered and Debre Markos, Ethiopia 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 sig­ nificantly 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. Keywords: asymptomatic malaria, Plasmodium infection, Gondar Zuria, Ethiopia Background Malaria remains a serious global health problem in terms of both morbidity and mortality, resulting in enormous medical, economic and social impacts.1–3 It is caused by the genus Plasmodium and transmitted by female anopheline mosquitoes. Correspondence: Yibeltal Aschale Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium College of Health Sciences, Debre Markos University, P.O. Box 269, Debre ovale and Plasmodium knowlesi are Plasmodium species that infect humans, of Markos, Ethiopia which P. falciparum and P. vivax pose the greatest threat in humans.1,4 Although Tel +251922444340 Email [email protected] malaria mortality rates declined from 2015 to 2017 by 7.2% (from 469,000 in 2015 submit your manuscript | www.dovepress.com Infection and Drug Resistance 2020:13 3969–3975 3969 DovePress © 2020 Minwuyelet et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/ http://doi.org/10.2147/IDR.S278932 terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Minwuyelet et al Dovepress to 435,000 in 2017), malaria incidence has increased by significant reductions in morbidity and mortality.12 2.2% (from 214.2 million in 2015 to 219 million in 2017). However, a report published in 2018 showed that the This may imply the presence of some bottlenecks such as incidence of malaria has been increasing, implying the undetectable levels of parasitemia and the absence of presence of challenges ahead of the national malaria elim­ sensitive diagnostic tools in the global effort of malaria ination strategic plan.8 elimination.5 At present, malaria transmission is sustained Therefore, this study aims to assess the prevalence, within populations regardless of effective treatment of parasitemia level and associated factors of asymptomatic active cases, as misdiagnosed asymptomatic individuals Plasmodium infection with respect to population demogra­ serve as potential gametocyte carriers and transmitters.6 phy in Gondar Zuria district, Northwest Ethiopia. As Malaria is distributed mainly in three WHO regions, a result, policymakers should pay attention to the basic namely, the African region, Southeast Asian region and guidelines on the prevention and control of asymptomatic Eastern Mediterranean region. The African region is home Plasmodium infection to scale up malaria elimination to the highest number of malaria cases and deaths.7 In efforts in Ethiopia and across malaria-endemic countries. 2017, an estimated 200 million malaria cases and In addition, this study could provide information to insti­ 404,550 million deaths were recorded in the African tutions in the country working on designing effective pre­ region. Plasmodium falciparum is the most prevalent spe­ vention and control strategies against malaria. cies, accounting for 99.7% of estimated malaria cases.5 In Ethiopia, three-fourths of the land mass is malarious Methods 8 and 60% of the population is at risk. Transmission is Study Area and Period intense in places where the longevity of the mosquito is The study was conducted in Gondar Zuria district, higher because the parasite has enough time to complete Northwest Ethiopia, from May to June 2019. This district its maturation within the mosquito. The transmission pat­ is located 45 km from Gondar town and 729 km from tern is seasonal and unstable, consisting of two transmis­ Addis Ababa, the capital of Ethiopia. The area of Gondar sion seasons: major (September–December) and minor Zuria district is 1108.53 km2, with a population density of (April–June). The other months (January–March) and 188.4 people/km.13 According to the 2007 Ethiopian sta­ (July–August) typically represent low malaria transmis­ tistics agency, an average of five people were counted per sion seasons in most communities.8–10 household. It has a total annual rainfall of 1047.6 mm, According to the Ethiopian Federal Ministry of Health mean maximum temperature of 27.4°C, mean minimum report, there were about 2.2 million malaria cases (con­ temperature of 14.7°C and relative humidity of 45%. It is firmed by either blood film examination or rapid diagnos­ estimated that the district has an altitude ranging between tic tests) and 662 deaths in all age groups, of which 64% 1750 and 2600 m above sea level, and it is found just to was due to P. falciparum and 36% was due to P. vivax.8 the north of Lake Tana. According to the zonal health Children with severe malaria frequently develop severe department report, the district is malarious; the streams anemia, respiratory distress and cerebral malaria. Multi- and irrigation water serve as permanent anopheline breed­ organ failure is also common in adults.11 Malaria ing sites during dry seasons. Gondar Zuria district has deaths have reduced by 98% from 2006 to 2017 (from seven health centers and 44 health posts providing services 41,000 estimated deaths to 662).8 However, it is unclear for people in and around the district. whether this reversal and stagnation of malaria prevalence are associated with submicroscopic infections and sexual stage gametocytes. Study Design The current Ethiopian malaria elimination strategy A community-based cross-sectional study was conducted incorporates the use of artemisinin combination therapy to determine the prevalence and associated factors of (ACT) as the first-line drug for the treatment of uncompli­ asymptomatic Plasmodium infections. cated P. falciparum and chloroquine (CQ) against P. vivax, and the use of indoor residual spraying (IRS) and long- Inclusion and Exclusion Criteria lasting insecticide-treated nets (LLITNs).3,12 The nation­ Individuals who are permanent residents of the district and wide distribution of rapid diagnostic test (RDTs), ACTs, aged 6 months or older were included. Individuals with LLITNs and IRS in Ethiopia since 2005 has resulted in clinical symptom of malaria and those taking antimalarial 3970 submit your manuscript | www.dovepress.com Infection and Drug Resistance 2020:13 DovePress Dovepress Minwuyelet et al drugs 1 month prior to and during data collection were films using pre-labeled microscopic slides for the detec­ excluded. tion, identification and quantification of the Plasmodium parasite. The blood films were stained with 10% fresh Sample Size Determination Giemsa
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