Background Brucellosis is an important neglected bacterial zoonotic disease that has been affecting animals and humans for decades. Malaria has been considered major cause of illness in tropical areas, including Ethiopia. This study aimed to identify prevalence and risk factors of human brucellosis and malaria among patients with fever in malaria-endemic areas attending health institutes in Awra and Gulina district, Afar Region, Ethiopia. Methods A purposive cross-sectional study was conducted among febrile patients who attended health institutes in Awra and Gulina district of Afar region from February to May 2019. 3–5 ml blood samples were collected, thick and thin blood films were prepared and examined for malaria; serum was separated and tested for anti-Brucella using Rose Bengal Plate Test, and the seropositives were subjected to ELISA. Data were entered using EpiData3.1 and analyses were performed using Stata SE 14. Results A total of 444 febrile individuals (59.5% female) of age ranging from 2 to 83 years (mean = 26.1, SD =  ± 11.8) were participated in this study. The overall seroprevalence of brucellosis was 31.5% (95% CI; 27.4–36.0%) by RBPT and 15.8% (95% CI; 12.7–19.7%) by ELISA, as well as the prevalence of malaria (P. falciparum) was 4.3% (95% CI; 2.7–6.6%) among febrile patients. Malaria was more common in males (7.2% 95% CI; 4.2–12.1%) than in female (2.3% 95% CI; 1.0–5.0%, p = 0.01) and in non-married than in married (7.6% 95% CI; 4.1–13.6% vs. 2.9% 95% CI; 1.5–5.4%, p = 0.02). Being male (AOR = 2.41, 95%CI: 1.36–4.26, p < 0.002), drinking raw milk (AOR = 26.68, 95%CI: 3.22- 221.13, p = 0.002) and boiled milk (AOR = 17.52, 95%CI: 2.06—149.04, p = 0.009) and touching aborted fetus/discharges without protective (AOR = 2.56, 95%CI: 1.01–6.528.50, p = 0.048) were independently associated with brucellosis among febrile patients. Conclusion The prevalence of brucellosis in fever patients in this study area is higher than malaria. Consumption of raw milk and contact with animal discharge can cause significant risk of Brucella infection. So, brucellosis disease must be sought in the differential diagnosis, like ELISA test that can be used to differentiate from other febrile diseases like malaria.

Background: Brucellosis is an important neglected bacterial zoonotic disease that affects animals and humans for decades. The aim of this study was to determine the sero-prevalence and risk factors of human brucellosis among febrile patients visited health institutes at Awra and Gulina district of Afar region Ethiopia.Methods: A purposive cross-sectional study was conducted among 444 febrile patients visiting two health institutes in Awra and Gulina district of Afar region from February to May 2019. A 3-5ml blood samples were collected, thick and thin blood films were examined microscopically for malaria; serum was separated and tested antibody of Brucella using Rose Bengal Plate Test (RBPT) and positives ones were further subjected to ELISA. Data were entered using EpiData3.1 and analyses were performed using StataSE 14.Results: A total of 444 febrile individuals (59.5% female) of age ranging from 2-83 years (mean= 26.1, SD = ±11.8) participated in this study. The overall sero-prevalence of brucellosis was 31.5 % and 15.8% by RBPT and ELISA, respectively and 4.3% of the patients were positive for P. falciparum. Being male (AOR=2.41, 95%CI: 1.36 – 4.26, p < 0.002), drinking raw milk (AOR=15.42, 95%CI: 5.17 - 45.95, p < 0.001) and touching aborted fetus/discharges without protectives (AOR= 3.70, 95%CI: 1.61 - 8.50, p = 0.02) were independently associated with brucellosis among febrile patients.Conclusion: Human brucellosis is highly prevalent in pastoralist patients presenting with fever in this study area. Consumption of raw milk and contamination with aborted or discharge of animals are major risk factors. Hence, brucellosis should be considered as an important public health problem in this study area.