BackgroundCommunity-based health insurance (CBHI) schemes are an emerging tool for providing financial protection against health-related poverty. In Ethiopia, CBHI is being piloted in 13 districts, but community experience and satisfaction with the scheme have yet to be studied. Therefore, this study aimed to assess the experiences and satisfaction of households enrolled in a pilot CBHI scheme.MethodsA community-based cross-sectional study method was used in one pilot district in South Ethiopia. Data were collected in March and April 2014. 386 households enrolled in the CBHI scheme were sampled by simple random sampling. Data were collected by trained data collectors using a pre-tested structured questionnaire. Descriptive statistics and bivariate and multiple linear regression analyses were performed. P values less than 0.05 and 95 % confidence intervals were used to determine associations between independent and dependent variables.ResultsThe study revealed that overall household satisfaction with CBHI was 91.38 %. Moreover, there was a significant association between health service provision and CBHI members’ satisfaction scores. For instance, household heads that strongly disagreed with laboratory services provision had an average 0.878 decrease in CBHI satisfaction score compared to household heads that strongly agreed. CBHI process- and management-related factors were also significantly associated with satisfaction.ConclusionsSatisfaction with CBHI was high. Age, family size, laboratory services provision, health services provider friendliness, CBHI offices opening times, membership card collection process, and time interval to use of services were significant predictors of satisfaction with CBHI.

Ethiopia is one of the few African countries where Plasmodium vivax is co-endemic with P. falciparum. Malaria transmission is seasonal and transmission intensity varies mainly by landscape and climate. Although the recent emergence of drug resistant parasites presents a major issue to malaria control in Ethiopia, little is known about the transmission pathways of parasite species and prevalence of resistant markers. This study used microsatellites to determine population diversity and gene flow patterns of P. falciparum (N = 226) and P. vivax (N = 205), as well as prevalence of drug resistant markers to infer the impact of gene flow and existing malaria treatment regimes. Plasmodium falciparum indicated a higher rate of polyclonal infections than P. vivax. Both species revealed moderate genetic diversity and similar population structure. Populations in the northern highlands were closely related to the eastern Rift Valley, but slightly distinct from the southern basin area. Gene flow via human migrations between the northern and eastern populations were frequent and mostly bidirectional. Landscape genetic analyses indicated that environmental heterogeneity and geographical distance did not constrain parasite gene flow. This may partly explain similar patterns of resistant marker prevalence. In P. falciparum, a high prevalence of mutant alleles was detected in codons related to chloroquine (pfcrt and pfmdr1) and sulfadoxine-pyrimethamine (pfdhps and pfdhfr) resistance. Over 60% of the samples showed pfmdr1 duplications. Nevertheless, no mutation was detected in pfK13 that relates to artemisinin resistance. In P. vivax, while sequences of pvcrt-o were highly conserved and less than 5% of the samples showed pvmdr duplications, over 50% of the samples had pvmdr1 976F mutation. It remains to be tested if this mutation relates to chloroquine resistance. Monitoring the extent of malaria spread and markers of drug resistance is imperative to inform policy for evidence-based antimalarial choice and interventions. To effectively reduce malaria burden in Ethiopia, control efforts should focus on seasonal migrant populations.

BackgroundMalaria is the most prevalent communicable disease in Ethiopia, with 75% of the country’s landmass classified as endemic for malaria. Accurate information on the distribution and clinical prevalence of Plasmodium vivax and Plasmodium falciparum malaria in endemic areas, as well as in Duffy-negative populations, is essential to develop integrated control strategies.MethodsA total of 390 and 416 community and clinical samples, respectively, representing different localities and age groups across Ethiopia were examined. Malaria prevalence was estimated using nested PCR of the 18S rRNA region. Parasite gene copy number was measured by quantitative real-time PCR and compared between symptomatic and asymptomatic samples, as well as between children/adolescents and adults from the local community. An approximately 500-bp segment of the human DARC gene was amplified and sequenced to identify Duffy genotype at the -33rd nucleotide position for all the clinical and community samples.ResultsPlasmodium vivax prevalence was higher in the south while P. falciparum was higher in the north. The prevalence of P. vivax and P. falciparum malaria is the highest in children compared to adolescents and adults. Four P. vivax infections were detected among the Duffy-negative samples. Samples from asymptomatic individuals show a significantly lower parasite gene copy number than those from symptomatic infections for P. vivax and P. falciparum.ConclusionsGeographical and age differences influence the distribution of P. vivax and P. falciparum malaria in Ethiopia. These findings offer evidence-based guidelines in targeting malaria control efforts in the country.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0596-4) contains supplementary material, which is available to authorized users.

BackgroundThe emergence and spread of insecticide resistance in the major African malaria vectors Anopheles gambiae (s.s.) and An. arabiensis may compromise the current vector control interventions and threatens the global malaria control and elimination efforts.MethodsInsecticide resistance was monitored in several study sites in Ethiopia from 2013 to 2015 using papers impregnated with discriminating concentrations of DDT, deltamethrin, bendiocarb, propoxur, malathion, fenitrothion and pirimiphos-methyl, following the WHO insecticide susceptibility test procedure. Mosquitoes sampled from different localities for WHO bioassay were morphologically identified as An. gambiae (s.l.) using standard taxonomic keys. Samples were identified to species using species-specific polymerase chain reaction (PCR) and screened for the presence of target site mutations L1014F, L1014S and N1575Y in the voltage gated sodium channel (VGSC) gene and G119S in the acethylcholinesterase (AChE) gene using allele-specific PCR. Biochemical assays were performed to assess elevated levels of acetylcholinesterases, carboxylcholinesterases, glutathione-S-transferases (GSTs) and cytochrome P450s monooxygenases in wild populations of An. arabiensis, compared to the fully susceptible Sekoru An. arabiensis laboratory strain.ResultsPopulations of An. arabiensis were resistant to DDT and deltamethrin but were susceptible to fenitrothion in all the study sites. Reduced susceptibility to malathion, pirimiphos-methyl, propoxur and bendiocarb was observed in some of the study sites. Knockdown resistance (kdr L1014F) was detected in all mosquito populations with allele frequency ranging from 42 to 91%. Elevated levels of glutathione-S-transferases (GSTs) were detected in some of the mosquito populations. However, no elevated levels of monooxygenases and esterases were detected in any of the populations assessed.Conclusions Anopheles arabiensis populations from all surveyed sites in Ethiopia exhibited resistance against DDT and pyrethroids. Moreover, some mosquito populations exhibited resistance to propoxur and possible resistance to bendiocarb. Target site mutation kdr L1014F was detected in all mosquito populations while elevated levels of glutathione-S-transferases (GSTs) was detected in some mosquito populations. The reduced susceptibility of An. arabiensis to propoxur and bendiocarb, which are currently used for indoor residual spraying (IRS) in Ethiopia, calls for continuous resistance monitoring, in order to plan and implement evidence based insecticide resistance management.Electronic supplementary materialThe online version of this article (10.1186/s13071-017-2342-y) contains supplementary material, which is available to authorized users.

Background: Knowledge about the modes of transmission and preventive measures of malaria are important preceding factors for the acceptance and use of proven control tools by the community. Objective: To assess knowledge, attitude and practices (KAP) about modes of malaria transmission and preventive methods in the study areas. Methods: A cross-sectional study was conducted in three urban areas of Assosa zone, Western Ethiopia from January to February, 2006. Data analysis was carried out using SPSS for windows version 12.0.1. Adjusted odds ratio and 95% confidence intervals were employed to test the strength of association. Results: About 48% of the study participants were aware that malaria can be transmitted by mosquito bites. Thirty percent (30%), of respondents were aware that mosquitoes carry disease causing microorganism, 95% were aware that mosquitoes bite during night, and 61% were aware that mosquitoes rest at dark places inside the house. Sleeping under a mosquito net and eliminating mosquito-breeding sites were identified by 58% and 52% of respondents, respectively, as major malaria preventive measures. Respondents' education and wealth status were associated with comprehensive knowledge on malaria preventive measures (OR= 2.42, 95% CI: 1.09, 5.4 and OR= 3.89, 95% CI: 1.99, 7.6, respectively). Conclusion: Knowledge of the role of mosquitoes in malaria transmission and comprehensive knowledge about malaria prevention strategies among the study population were observed to be lower than 50%. Comprehensive behavioral change and communication is required to improve the knowledge of the mode of malaria transmission and its preventive and control measures.