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Analysis of Trends of Malaria from 2010 to 2017 in Boricha District, Southern Ethiopia Desalegn Dabaro1,4*, Zewdie Birhanu3 and Delenasaw Yewhalaw2,4

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Analysis of Trends of Malaria from 2010 to 2017 in Boricha District, Southern Ethiopia Desalegn Dabaro1,4*, Zewdie Birhanu3 and Delenasaw Yewhalaw2,4 Dabaro et al. Malar J (2020) 19:88 https://doi.org/10.1186/s12936-020-03169-w Malaria Journal RESEARCH Open Access Analysis of trends of malaria from 2010 to 2017 in Boricha District, Southern Ethiopia Desalegn Dabaro1,4*, Zewdie Birhanu3 and Delenasaw Yewhalaw2,4 Abstract Background: Ethiopia has made a signifcant progress of malaria control. Currently, the country has adopted and is implementing the World Health Organization very ambitious, but achievable, malaria elimination plan through exten- sive eforts. The regular evaluation of its performance is vital for plausible improvement. Thus, the aim of this study was to determine the trends of malaria infection in Boricha district, Southern Ethiopia. Methods: A retrospective study was conducted in all health facilities of the district. All malaria cases registered dur- ing 2010 to 2017 were reviewed to determine the trends of malaria morbidity. EpiData 3.1 was used for data entry and data were analysed using SPSS version 20.0. Results: A total of 135,607 malaria suspects were diagnosed using microscopy and rapid diagnostic test over the last 8 years, of which 29,554 (21.8%) were confrmed positive cases. Plasmodium falciparum, Plasmodium vivax and mixed infections (both species) accounted for 56.3%, 38.4% and 5.2% of cases, respectively. Except in 2013 and 2014, Plasmo- dium falciparum was the dominant species over P. vivax. Of the total confrmed cases 51.6% were adults ( 15 years) followed by 24.5% of 5–14 years, and 23.9% of under 5 years. In general, malaria morbidity was signifcantly≥ reduced over the last 8 years. The positivity rate declined from 54.6% to 5% during 2010 to 2017, and the case incidence rate per 1000 population at risk also declined from 18.9 to 2.2 during the same period. Malaria was reported in all months of the year, with peaks in November, followed by September and July. Malaria transmission has strong association with season (x2 303.955, df 22, p < 0.0001). = = Conclusion: In general, a signifcant reduction of malaria morbidity was observed over the past 8 years. However, further investigation using advanced diagnostic tools is vital to determine the level of sub-microscopic infections to guide the elimination plan. In addition, eco-epidemiological analysis at fne-scale level is essential to devise area- specifc interventions. Keywords: Malaria, Positivity rate, Incidence rate, Ethiopia Background of burden followed by Asia. In 2017 alone, there were an Malaria remains a worldwide public health problem estimated 219 million cases and 435,000 deaths due to causing a signifcant number of morbidity, mortality, and malaria worldwide, where 92% of cases and 93% deaths huge economic loss despite an intensive implementation occurred in Africa [1, 2]. of interventions. Every year, it afects millions of people Ethiopia is one of the malaria endemic countries in the worldwide, with remarkable regional variations; devel- world with 60% of population at risk of infection. It has oping countries, mainly in Africa, bear the largest share long been a serious public health threat causing a signif- cant number of sickness and deaths each year, and one of the top ten causes of morbidity in 2018. Te disease *Correspondence: [email protected] 1 Yirgalem Hospital Medical College, Yirgalem, Ethiopia occurs throughout the year with the considerable sea- Full list of author information is available at the end of the article sonal and geographical variations across the country. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/ zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Dabaro et al. Malar J (2020) 19:88 Page 2 of 10 Te peaks time of transmission ranges from September at 304 km from capital city of Ethiopia, Addis Ababa. It to December, following the main rainy seasons (June to covers a total area of 588.1 km2. Te altitude of the dis- September), while the minor transmission occurs during trict ranges from 1001 to 2076 metres above sea level, April and May, following the February to March rains. with a mean annual rainfall ranging from 801 to 1000 Plasmodium falciparum and Plasmodium vivax are the millimetres and the mean annual temperature ranges two dominant parasites, contributing 60% and 40% mor- from 17.6 to 22.5 °C [15]. bidity, respectively [3, 4]. At the last census, there were 325,161 populations in In 2018 alone, there were 904,495 cases and 213 deaths the district. Most of them live in rural areas, and agri- of malaria in Ethiopia. Te highest morbidity, 724,996 culture is the major livelihood of the community. Te (80.1%), was due to P. falciparum, while remaining common agricultural crops in the district where maize, 166,340 (18.4%) and 13,159 (1.5%) were due to P. vivax tef, sweet potato and cabbage, while perennials includes and mixed infection (P. falciparum + P. vivax), respec- banana, cofee, khat and sugarcane [16]. tively. Malaria afects all segments of population while Administratively, the district has 39 rural and 3 urban the children bear the greatest share of burden followed by kebeles (the lowest administrative unit). Both public and pregnant women [5, 6]. private health facilities provide healthcare service to the Recognizing the burden of disease, Ethiopia has community. Te public facilities include one primary implemented diferent malaria prevention and control hospital, ten health centres and 39 health posts. Te pri- strategies with the aim of reducing malaria morbidity, vate health facilities in the district include one non-gov- mortality and economic loss. Te interventions used ernmental clinic, one medium clinic, fve primary level include distribution of insecticide-treated bed nets, clinics, three drug stores and eleven drug vendors [17]. indoor residual spraying, drainage of stagnant water, A diagnosis and treatment service of malaria has been improved healthcare utilization, provision of intermittent provided in all public health facilities and one private preventive therapy to pregnant women, and early diagno- clinic (non-governmental clinic in the district). Diag- sis and prompt treatment, prevention and rapid manage- nosis is either clinical or parasitological as per national ment of malaria epidemics and surveillance of disease. guideline recommendation. A clinical diagnosis is based Te country has been applying free of charge provision of on signs and symptoms of patients, with a history of malaria prevention and control services. Currently, Ethi- having fever in the last 48 h or if patients had gone to opia is implementing malaria elimination programme to malaria-endemic areas within the last 30 days. Parasi- end the disease by 2030 [7, 8]. tological diagnosis is based on multi-species RDTs or Te concerted application of malaria control strategies light microscopy. Treatment using clinical diagnosis is has resulted in noticeable achievements throughout the the only option to diagnose malaria if there is no RDT world, and Ethiopia is one of the countries where remark- and microscope. Artemether-lumefantrine and a single able progress has been made. As of the 2018 global dose of primaquine is the recommended frst-line treat- malaria report, the incidence rate of malaria declined ment for confrmed P. falciparum or mixed infection (P. by 18% from 2010 to 2017. Similarly, in the same period, falciparum + P. vivax), and chloroquine plus 0.25 mg/kg the estimated number of cases dropped from 239 million primaquine for P. vivax. Oral quinine is recommended to to 219 million, and the number of deaths dropped from frst trimester pregnant women and underweighted chil- 607,000 to 435,000. Despite this, malaria still remains a dren with P. falciparum, otherwise chloroquine is a safe public health problem worldwide [1, 2, 9]. Te incidence, treatment for pregnant women and infants. Intravenous prevalence and mortality rate of the disease in Ethiopia or intramuscular artesunate is the preferred frst-line followed a similar pattern [10–14]. treatment for severe malaria, and if this is not available Te analysis of malaria morbidity trend in every malar- intramuscular artemether is the alternative treatment. ious area helps to understand the dynamics of disease Intravenous quinine infusion is given when there is no transmission. Such information is crucial to devise evi- artesunate or artemether [18]. dence-based and area-specifc interventions. Hence, the aim of this study was to analyse the 8 years trends of Study design malaria transmission in Boricha district, Southern A health facility-based retrospective study was con- Ethiopia. ducted to determine the trends of malaria morbidity over the 8 years (2010–2017) in Boricha district, Southern Methods Ethiopia. Study area Te study was conducted in Boricha district (Fig. 1), which is in the Sidama zone, Southern Ethiopia, located Dabaro et al. Malar J (2020) 19:88 Page 3 of 10 Fig. 1 Map of study area Source of information tools used for diagnosis, result of diagnosis and species of Te source of information was malaria laboratory regis- parasite.
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