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Background Despite consecutive decades of success in reducing malaria transmission, Ethiopia went off track towards its goal of malaria elimination by 2030, as outlined in the NMCP malaria strategy. Recent malaria outbreaks in Ethiopia are attributed to the emergence and spread of diagnostic and drug-resistant Plasmodium falciparum, increased insecticide resistance in major vectors and the spread of invasive Anopheles stephensi. The effects of the COVID-19 pandemic, environmental anomalies and internal conflicts have also potentially played a role in increasing malaria transmission. This study aimed to evaluate the contribution of environmental factors and An. stephensi to the spatiotemporal trends of recent malaria cases in Ethiopia. Methods Clinical malaria case data reported weekly between January 2013 and January 2023 were obtained from the Ethiopian Public Health Institute (EPHI), Addis Ababa. A negative binomial regression model was used to explain the variability and potential overdispersion in the weekly number of malaria cases reported across Ethiopian administrative zones. This model incorporated fixed effects for selected environmental factors and random effects to capture temporal trends, zone specific seasonal patterns, spatial trends at the zone level, and the presence of An. stephensi and its impact. Results Our negative binomial regression model highlighted 56% variability in the data and slightly more than half (55%) was due to environmental factors, while the remainder was captured by random effects. A significant nationwide decline in malaria risk was observed between 2013 and 2018, followed by a sharp increase in early 2022. Malaria risk was higher in western and northwestern zones of Ethiopia compared to other zones. Zone-specific seasonal patterns, not explained by environmental factors, were grouped into four clusters of seasonal behaviours. The presence of An. stephensi was not shown to have any significant impact on malaria risk. Conclusions Understanding the spatial and temporal drivers of malaria transmission and therefore identifying more appropriate malaria control strategies are key to the success of any malaria elimination and eradication programmes in Ethiopia. Our study found that approximately 50% of malaria risk variability could be explained by environmental, temporal, and spatial factors included in the analysis, while the remaining variation was unexplained and may stem from other factors not considered in this study. This highlights the need for a better understanding of underlying factors driving local malaria transmission and outbreaks, to better tailor regional programmatic responses. Graphical Abstract
Background Despite consecutive decades of success in reducing malaria transmission, Ethiopia went off track towards its goal of malaria elimination by 2030, as outlined in the NMCP malaria strategy. Recent malaria outbreaks in Ethiopia are attributed to the emergence and spread of diagnostic and drug-resistant Plasmodium falciparum, increased insecticide resistance in major vectors and the spread of invasive Anopheles stephensi. The effects of the COVID-19 pandemic, environmental anomalies and internal conflicts have also potentially played a role in increasing malaria transmission. This study aimed to evaluate the contribution of environmental factors and An. stephensi to the spatiotemporal trends of recent malaria cases in Ethiopia. Methods Clinical malaria case data reported weekly between January 2013 and January 2023 were obtained from the Ethiopian Public Health Institute (EPHI), Addis Ababa. A negative binomial regression model was used to explain the variability and potential overdispersion in the weekly number of malaria cases reported across Ethiopian administrative zones. This model incorporated fixed effects for selected environmental factors and random effects to capture temporal trends, zone specific seasonal patterns, spatial trends at the zone level, and the presence of An. stephensi and its impact. Results Our negative binomial regression model highlighted 56% variability in the data and slightly more than half (55%) was due to environmental factors, while the remainder was captured by random effects. A significant nationwide decline in malaria risk was observed between 2013 and 2018, followed by a sharp increase in early 2022. Malaria risk was higher in western and northwestern zones of Ethiopia compared to other zones. Zone-specific seasonal patterns, not explained by environmental factors, were grouped into four clusters of seasonal behaviours. The presence of An. stephensi was not shown to have any significant impact on malaria risk. Conclusions Understanding the spatial and temporal drivers of malaria transmission and therefore identifying more appropriate malaria control strategies are key to the success of any malaria elimination and eradication programmes in Ethiopia. Our study found that approximately 50% of malaria risk variability could be explained by environmental, temporal, and spatial factors included in the analysis, while the remaining variation was unexplained and may stem from other factors not considered in this study. This highlights the need for a better understanding of underlying factors driving local malaria transmission and outbreaks, to better tailor regional programmatic responses. Graphical Abstract
Background After consecutive decades of success in reducing malaria, Ethiopia went off target to meet the 2030 malaria elimination goal. The current nationwide malaria outbreaks are attributed to emergence and spread of diagnostic and drug resistant Plasmodium falciparum, increased insecticide resistance and the spread of invasive Anopheles stephensi. COVID-19 pandemic, environmental anomalies and internal conflicts are also potential factors for malaria increase. This study aimed to evaluate the contribution of environment and An. stephensi in the spatiotemporal trends of malaria in Ethiopia.Methods A negative binomial regression model was used to describe variability and potential overdispersion in the weekly number of malaria cases across Ethiopian zones. Its components included fixed and random effects, temporal trends, zone-specific seasonality, and zone-level spatial trends.Results Significant temporal trend in malaria risk was observed nationwide, a decline from 2013 to 2018 followed by a sharp increase starting in early 2022. While environmental variables were able to explain slightly over half (55%) of the variability, the rest was captured by a residual seasonal variation; itself showing large geographic clusters. Zones of the western and northwestern regions exhibited higher malaria risks compared to other zones. The spread of An. stephensi did not emerge as contributor in our model.Conclusions The waning in the success of malaria program in Ethiopia could palpably eased by having due focus on predictable environmental factor. The random local spatiotemporal variations shaping malaria risk distribution emphasize the need for tailored intervention and better understanding of underling factors that potentially drive local epidemic.
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