Malaria epidemiology and stratification of incidence in the malaria elimination setting in Harari Region, Eastern Ethiopia

Abstract

Background Ethiopia has shown notable progress in reducing the burden of malaria over the past two decades. Because of this progress, the country has shifted efforts from control to elimination of malaria. This study was conducted to analyse the malaria epidemiology and stratification of incidence in the malaria elimination setting in eastern Ethiopia. Methods A retrospective study was conducted to analyse the epidemiology of malaria by reviewing the district health office data from 2013 to 2019 in Harari Region. In addition, three years of sub-district level malaria data were used to stratify the malaria transmission intensity. Malaria interventions (Long-lasting insecticidal nets [LLIN] and indoor residual spraying [IRS]) employed were reviewed to analyse the intervention coverage at the Regional level. Descriptive statistics were used to show the malaria transmission in terms of years, season and species of the malaria parasite. Incidence rate per 1000 population and death rate per 1 000 000 population at risk were computed using the total population of each year. Results In the Harari Region, malaria incidence showed a more pronounced declining trend from 2017 to 2019. Plasmodium falciparum, P. vivax and mixed infections accounted for 69.2%, 30.6% and 0.2% of the cases, respectively. There was an increment in malaria intervention coverage and improved malaria diagnosis. In the year 2019 the coverage of LLIN and IRS in the Region were 93.4% and 85.1% respectively. The annual malaria incidence rate dropped from 42.9 cases per 1000 population in 2013 to 6.7 cases per 1000 population in 2019. Malaria-related deaths decreased from 4.7 deaths per 1 000 000 people annually in 2013 to zero, and there have been no deaths reported since 2015. The malaria risk appears to be heterogeneous and varies between districts. A higher number of malaria cases were recorded in Erer and Jenella districts, which constitute 62% of the cases in the Region. According to the sub-district level malaria stratification, there was shrinkage in the malaria transmission map and about 70% of the sub-districts have achieved elimination targets. Conclusions In the Harari Region, malaria morbidity and mortality have been significantly declined. Thus, if this achievement is sustained and scaling-up of the existing malaria prevention and control strategies by focusing on those populations living in the higher malaria transmission districts and sub-districts, planning of malaria elimination from the study area might be feasible.

Decreasing Trend of Plasmodium Falciparum and Vivax Transmission in Mojo Health Center, East Shoa Oromia Region, Ethiopia: a Retrospective Study

“…In spite of that, the peak in malaria cases occurred in July followed by November which is harvesting season during and after the main rainfall. The highest cases of malaria were detected during autumn (September-November) which was in consistent with the ndings of the studies carried out in Dembia [6], Dembecha [17], Northwest Tigray [4], Ataye [25], Guba [11], Jimma [41], and Harari [20]. It might be due to the heavy rains creating suitable environment for the breading of Anopheles mosquitoes.…”

“…The current study found that the total number of microscopically con rmed malaria cases were 793 with a proportion rate of 4.2%. It was markedly lower than previous studies conducted out of Ethiopia elsewhere (25.9%-30.3%) [15,16], and in several parts of the country such as in Dembia (21.8%) [6], Dembecha (16.34%) [17], Guba (51.04%) [11], Sibu Sire (20.07%) [18], Arjo-Didessa sugar development site (33.4%) [19], Harari (46.9%) [20], Chalia district (7.55%) [21], Abeshge (33.8%) [22], and Bale Zone (66.7%) [23]. The overall prevalence of the current study was also relatively lower than the ndings from other parts of Ethiopia like Northwest Tigray (6.96%) [4], Wereta (5.4%) [24], Kombolcha (7.52%) [9], Ataye (8.4%) [25], Halaba (9.5%) [5], Wolkite (8.56%) [26] and Arsi Negelle (11.45%) [27].…”

Current Status and the Epidemiology of Malaria in the Middle East Region and Beyond

“…Previous studies have shown that travelers or returning travelers from Ethiopia have also contributed to imported malaria cases in Qatar [ 25 ] and Kuwait [ 26 , 43 , 45 ]. Although the number of total malaria cases in Ethiopia is still very high, the country has shown notable progress in reducing the burden of malaria over the past two decades and this has shifted efforts from control to elimination of malaria in some regions of the country such as the Harari Region in Eastern Ethiopia [ 69 ]. The data showed that malaria incidence in the Harari Region declined from 42.9 cases per 1000 population in 2013 to only 6.7 cases per 1000 population in 2019 and malaria-related deaths decreased from 4.7 deaths per 1,000,000 population annually in 2013 to zero in 2015.…”

“…The data showed that malaria incidence in the Harari Region declined from 42.9 cases per 1000 population in 2013 to only 6.7 cases per 1000 population in 2019 and malaria-related deaths decreased from 4.7 deaths per 1,000,000 population annually in 2013 to zero in 2015. Also, P. falciparum, P. vivax and mixed infections accounted for 69.2%, 30.6%, and 0.2% of the cases, respectively [ 69 ]. Ethiopia has set a goal to eliminate malaria by 2030 and artemether-lumefantrine treatment is being used as one of the cornerstone strategies for uncomplicated P. falciparum malaria [ 70 ].…”

An evaluation of repellency and feeding inhibition of ethno-medicinal plants against major malaria vectors in southern Ethiopia

“…In 2018, 93% of malaria cases and 94% of malaria-related deaths were from sub-Saharan African countries [ 2 ]. In Ethiopia, malaria is the leading vector-borne disease, and the population living in malaria risk areas is still suffering from it [ 3 – 5 ].…”