THE PREVALENCE AND ASSOCIATED FACTORS OF MALARIA

INFECTION AMONG RESIDENT OF SORO DISTRICT, HADIYA ZONE,

SOUTHERN ETHIOPIA: A SEVEN-YEAR RETROSPECTIVE STUDY

MSc Thesis

BY:

DELELEGN ZELEKE

HAWASSA UNIVERSITY

HAWASSA, ETHIOPIA

OCTOBER, 2020
i
THE PREVALENCE AND ASSOCIATED FACTORS OF MALARIA

INFECTION AMONG RESIDENT OF SORO DISTRICT, HADIYA ZONE,

SOUTHERN ETHIOPIA: A SEVEN-YEAR RETROSPECTIVE STUDY

BY:

DELELEGN ZELEKE ID No Biok/006/09

ADVISOR: MELESE BIRMEKA (PhD)

A Thesis Submitted To the Department of Biology, School of Graduate Studies

HAWASSA UNIVERSITY

In partial fulfillment of the requirement for the degree of masters of Science in biology

HAWASSA, ETHIOPIA

October, 2020

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 APPROVAL SHEET
SCHOOL OF GRADUATE STUDIES
HAWASSA UNIVERSITY

As Thesis Research advisor, I hereby certify that I am read and evaluated this thesis prepared,

under my guidance, by Delelegn Zeleke, entitled: The Prevalence And Associated Factors of

Malaria Infection among Resident of Soro District, Hadiya Zone, and Southern Ethiopia: A

Seven Years Retrospective study. I recommend that it can be submitted as fulfilling of the thesis

requirement.

Advisor: Dr.Melese Birmeka (PhD) signature_______________ Date__________________

As member of the Board of Examiners of the M.Sc. Thesis Open Defense Examination, we

certify that we have read and, evaluated the thesis prepared by Delelegn Zeleke and examined

the candidate. We recommended that the thesis be accepted as fulfilling the Thesis requirement

for the Degree of Master of Science in Biology.

Chairman_________________________Signature________________Date_________________

Internal examiner___________________signature__________________Date______________

External examiner_____________signature_____________Date___________________

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 DECLARATION

I hereby declare that this M.Sc. thesis is my original work and has not been presented for a

degree in any other university, and all sources of material used for this thesis have been duly

acknowledged.

Name:

Signature:

Date:

This M.Sc. thesis has been submitted for examination with my approvals advisor.

Name: Major Advisor:

Signature:

Date:

Place and Date of Submission:

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 LIST OF ABBREVIATIONS

CI Confidence Interval
EMA Essential Malaria Action

FMOH Federal Ministry of Health

HEW Health Extension Workers

HH Household

IRS Indoor residual spraying

ITNs Insecticide-treated nets

MIS Malaria Indicator Survey

MOH Ministry of Health

MOP Malaria Operational Plan

N Number

NSPMPC National Strategic Plan for malaria prevention, control

OD Odds ratio

PMI Presidents Malaria Initiative

RBM Rolls Back Malaria

RDT Rapid Diagnostic Test

SBCC Social behavior change communication

SNNPR Southern nation nationalities and peoples region

SPSS Statistical Package for Social Science

WHO World Health Organization

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 ACKNOWLEDGMENT

Firstly, my special thanks go to the Almighty God, who did all things. I would like to thank my

advisor Dr.Melese Birmeka for his nice approach, devoting time and energy, earnest guidance,

critical comment, willingness to share experience, treatment, encouragement and timely

suggestion that would give this research a success. I am grateful Hawassa University department

of biology for supporting me by budget. I would like thank Gimbichu primary hospital staff

members and Soro district health office for giving necessary information. I would also thank

Soro district residents those attending Gimbichu primary hospital for their cooperation in my

study and voluntarily necessary response for questionnaire. The last but not the least, I am

thankful to all those who directly or indirectly involved in my research work especially my

family for their continuous encouragement of my research work success.

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 Table of contents
Contents pages
DECLARATION ......................................................................................................................................... iii

LIST OF ABBREVIATIONS ...................................................................................................................... iv

LIST OF FIGURES ..................................................................................................................................... ix

ABSTRACT.................................................................................................................................................. x

1. Introduction ............................................................................................................................................... 1

1.1. Background ........................................................................................................................................ 1

1.2 Statement of the problem .................................................................................................................. 3
1.3. Objectives of the study....................................................................................................................... 5
1.3.1. General objective ........................................................................................................................ 5
1.3.2. Specific objectives ...................................................................................................................... 5
1.4. Research questions. ............................................................................................................................ 5
1.5. Significance of the study .................................................................................................................... 5
2. LITERATURE REVIEW ......................................................................................................................... 7

2.1. Global epidemiology of malaria ........................................................................................................ 8

2.2. Malaria in Africa ................................................................................................................................ 8
2.3. Malaria in Sub-Saharan Africa .......................................................................................................... 9
2.4. Malaria in Ethiopia .......................................................................................................................... 10
2.5. Malaria in SNNPR ........................................................................................................................... 11
2.6. The Malaria Parasites ....................................................................................................................... 11
2.7. The Malaria Vector .......................................................................................................................... 12
2.8. The Life Cycle of Malaria Parasite .................................................................................................. 14
2.9. The Malaria Disease ........................................................................................................................ 19
2.10. Risk Factors to Malaria Infection................................................................................................... 20
2.11. Genetic resistance against malaria ................................................................................................. 21
2.12. Prevention and Control of Malaria................................................................................................. 22
3. MATERIALS AND METHODS ............................................................................................................ 24

3.1. Description of the study area ........................................................................................................... 24

3.2. Study design ..................................................................................................................................... 27
3.3. Sample size determination ............................................................................................................... 27

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 3.4. Study population .............................................................................................................................. 27
3.5. Methods of data collection ............................................................................................................... 28
3.6. Data Analysis ................................................................................................................................... 29
3.7. Data quality control.......................................................................................................................... 29
3.8. Ethical Considerations ..................................................................................................................... 30
4. RESULTS ............................................................................................................................................... 31

4.1 Socio –demographic characteristics of respondents ......................................................................... 31

4.2 Risk factors characteristics of study participants in Soro district, southern Ethiopia ....................... 33
4.3. Prevalence of malaria in the Soro district, Southern Ethiopia (October to January) ....................... 35
4.4 logistic regression analysis of risk factors which related with prevalence of malaria ...................... 36
4.5. Trends of malaria in Soro district, between 2013-2019 ................................................................... 38
5. Discussion ............................................................................................................................................... 41

6. CONCLUSION AND RECOMMENDATIONS .................................................................................... 46

6.1 Conclusion ........................................................................................................................................ 46

6.2 RECOMMENDATION .................................................................................................................... 46
7. REFERANCES ....................................................................................................................................... 48

8. APPENDIX ............................................................................................................................................. 56

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 LIST OF TABLES

Table 1: Socio –demographic characteristics of respondents in Soro district, Southern Ethiopia

...................................................................................................................................................... .32

Table 2: Risk factors characteristics of study participants in Soro district, southern Ethiopia

................................................................................................................................................. …..34

Table 3: Logistic regression analysis of the risk factors related the with prevalence of malaria

................................................................................................................................................... …36

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 LIST OF FIGURES

Figure 1: Location map of the Soro district (source: Soro woreda Administration) .................... 26

Figure 2: Prevalence of malaria in Plasmodium species distribution (October to January) ......... 35

Figure 3: Malaria prevalence from suspected patients in Soro district (2013-219). ..................... 39

Figure 4:Trends of malaria cases by plasmodium species distribution between 2013- 2019 ....... 40

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 ABSTRACT

Malaria is major health problem in the world particularly in developing countries including

Ethiopia which is a leading cause of illness and deaths. In Ethiopia different control measures

have been taken but, it is still the health problem of Population. Hence, this study aimed to

determine the prevalence and associated factors of malaria infection among resident of Soro

district, Hadiya Zone Southern Ethiopia. A seven-year (2013-2019) malaria data had been

collected from Gimbichu primary hospital laboratory registration book and current institutional

based cross-sectional study data was collected from 403 malaria suspected patients in this

hospital from Octeber,2019-January,2020.A structure and pre-tested questionnaire was used to

gather information of respondents and blood samples by laboratory technicians. Finally, the

data were entered and analyzed using SPSS version 21. Logistic regression analysis was

performed to examine the association of risk factors with malaria positivity. From retrospective

study 65,221 cases were examined of these 29,663(45.5%) were positive for malaria and from

these 55.3% P.falciparum, 40.6% P.vivax and 4.1% mixed infection. The current institutional

based cross-sectional study overall prevalence of malaria was 17.87 %, (86.1% P.vivax, 8.3%

P.falciparum and 5.5% mixed infection). In logistic regression analysis risk factors like

residence live in rural, presence of pregnancy, less income level, absence of LLINs, less NO of

LLINs, presence of mosquito breeding site near to houses, and housing condition were

significantly associated with malaria infection (p<0.005).High prevalence of malaria infection

was seen in the study area. Therefore, effective malaria control measures should be implemented

in order to decrease prevalence of malaria infections.

Keywords: Ethiopia, Malaria, Plasmodium, Prevalence, Risk factors

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 1. Introduction
1.1. Background

Malaria is one of the most dangerous vector-borne diseases (Stratton et al., 2008). It remains a

major public health problem in many countries of the world. According to the latest World

Health Organization (WHO) estimates, released in December 2015, there were 212 million cases

of malaria in 2015 and 429,000 deaths. Between 2010 and 2015 malaria incidence among

populations at risk fell by 21% globally, during the same period, malaria mortality rates among

population at decreased by 29%. An estimated 6.8 million malaria deaths have been averted

globally since 2001 (WHO, 2015).

The WHO Africa region continues to carry a disproportionately high share of the global malaria

burden. In 2015, the region home to 90% of malaria cases and 92% of malaria deaths. Some 13

countries mainly in sub-Saharan Africa account for 76% of malaria cases and 75%deaths

globally. In areas with high transmission of malaria, children under five are particularly

susceptible to infection, illness and deaths, more than two thirds (70%) of all malaria deaths

occur in this age group between 2010 and 2015, the under-five malaria deaths rate fell by 29%

globally (WHO,2015).

Malaria is a serious and sometimes a fatal disease caused by a parasite that commonly infects a

certain type of mosquito which feeds on humans. People who get malaria are typically very sick

with high fevers, shaking, chills (feeling of being cold), and flu-like illness (flu-means infectious

disease like a very bad cold, that causes fever pains and weakness) (Gupta et al., 2015). Malaria

in humans is caused by five species of parasites belonging to the genus Plasmodium;

P.falciparum, P. vivax, P. malaria and P. Oval and P. Knowlesi (WHO, 2015). Plasmodium

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falciparum and P. vivax are the major malaria parasites (MIS, 2011), Anopheles arabiensis the

major vector in Ethiopia (Abebe et al., 2012).

The problem of malaria is very large in Ethiopia where it has been the major cause of illness and

death for many years (Dawit et al, 2012).In 2014/2015, the annual performance report showed

the total number of laboratory confirmed plus clinical malaria cases were 2,174,707.Of those

cases 1,867,059(85.9%) were confirmed by either microscopy or rapid diagnostic tests (RDT)

out of which 1,188,627(63.7%) were P.falciparum and 678,432(36.3%) P.vivax and 662 malaria

deaths were among all age groups (PMI, 2017). The 2015 MIS data indicated that parasite

prevalence in Ethiopia was 0.5% by microscopy and 1.2% by RDTs for areas below 2,000

meters of altitude and less than 0.1% prevalence above 2,000 meters.

Malaria transmission exhibits a seasonal and unstable (unbalanced) pattern in Ethiopia, with

transmission varying with altitude and rainfall. The major malaria transmission season in the

country is from September to December, following the main rainy season from June/July to

September. There is a shorter transmission season from April to May following the shorter rainy

season in some parts of the country. Currently, areas bellow 2,000 meters of altitude are

considered malarious (NSPMPC, 2010). Since peak malaria transmission often coincides with

the planting and harvesting season, and the majority of malaria burden is among older children

and working adults in rural agricultural areas, there is a heavy economic burden in Ethiopia

(PMI, 2017).

The risk of malaria infection is depends on living environment such as housing condition and

breeding sites. Furthermore, the inadequate use of control measure, low income, illiteracy, land

use and the house material play a big role (Stratton et al., 2008; Yamamoto et al., 2010). Factors

2
that may cause outbreaks of malaria was, migration of infected people into vector rich area

populated with susceptible individuals, arrival of new efficient vectors, breakdown of vector

control measures, resistance of the parasites to treatment and resistance of the vectors to

insecticides (Gemechu et al., 2015).

The most important components for reducing burden of malaria include: more sensitive

diagnostic tools, effective use of anti-malarial drugs and improved personal protection and

mosquito vector control (FMOH, 2012). The main vector control activities implemented in

Ethiopia includes; Indoor Residual Spray (IRS), Long Lasting Insecticide Treated Nets (LLIN‟s)

and mosquito larval source reduction (FMOH, 2012).

Even though, the presence of a control and prevention program, the majority of Ethiopian

population is still at risk from malaria including the Hadiya zone, Soro district. According to the

district health office report, malaria is one of the leading public health problems in Soro district.

This is due to the favorable climatic conditions for survival of Anopheles mosquitoes and

availability to the mosquito breeding site. Therefore, this study was aim at assessing malaria

reported cases in Gimbichu primary hospital in the past seven years (2013-2019) and for the

current situation of prevalence malaria infection and risk factor, institutional based cross

sectional study was carried out from October, 2019-January, 2020.

1.2 Statement of the problem

Malaria control and interventions have been implemented and the recent past and intensified as

an efforts to attain the World Health Assembly, Roll Back Malaria, Millennium Development

Universal targets with the aim of reducing and interrupt disease transmission in Sub Saharan

Africa including Ethiopia. In Ethiopia including Soro district using there are different types of

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malaria control measures such as the use of Artemisinin combine therapy(ACT), the use of

insecticide treated bed nets(ITNs),Indoor residual spraying of insecticide(IRS) have been

implemented. Also, the aim of PMI also to reduce malaria morbidity and malaria related

mortality by 70% by 2015 through scaling up coverage of proven malaria prevention and control

intervention including LLINs and IRS in households (EMA, 2012).

Despite of all these efforts yet malaria is still the public health problem of Soro district which

causes serious health problem, as a result of health problem caused by malaria disease increasing

students‟ absenteeism from school during malaria epidemics significantly reduces learning

capacity of students, death of children under age 5 years, sickness in pregnant women, adults

that cause not to produce in their full potential during malaria season, the high morbidity and

mortality rate in the adult population significantly reduces production activities which cause the

famine and poverty. This verifies that there could be several reasons for this situation in areas

where laboratory facilities are lacking, clinical diagnosis and rapid diagnostic test (RDT) are

widely used to facilitate malaria control attempts, socio demographic/economic or environmental

factors and low effectiveness of these interventions than expected. Hence, this study attempted to

examine association factors contributing to this problem and determine the prevalence of malaria

infection. Hence, retrospective study from 2013-2019 and institutional based cross-sectional

study would be carried out from October 2019-January, 2020 among patients visiting Gimbichu

primary hospital Soro District, Hadiya Zone, Southern region, Ethiopia.

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1.3. Objectives of the study

1.3.1. General objective

 To assess the prevalence and associated factors of the malaria infection among

resident of Soro district, Hadiya zone, Southern Ethiopia. A seven-year

retrospective study.

1.3.2. Specific objectives

 To determine the prevalence of malaria parasite that causes malaria disease in study

area.

 To identify the risk factors that may contribute to malaria transmission in the area.

 To assess the trends of malaria infection for the past seven years (2013– 2019)

1.4. Research questions.

Basic questions that could be answer by this study:

 What was the prevalence of malaria infection among patients visiting Gimbichu

primary hospital?

 What factors that might be contribute to malaria transmission in the area?

 What is the trend of malaria infection in the past seven years (2013-2019)?

1.5. Significance of the study

This study will have an important input in determining the prevalence of malaria infection and

risk factors so as to develop effective intervention for controlling transmission of malaria. The

research findings will also serve as a starting point to enable other researcher to conduct further

studies on prevalence and risk factor of malaria parasite infection in the study area. The study

finding would contribute basic and current information about prevalence of malaria infection and

it might aid the, NGOs and other concerned bodies with valuable information in the planning and

implementation of intervention activities to prevent and control malaria infection. It can also be
5
valuable to the association working in health care professional specifically health extension

workers and public health programs.

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 2. LITERATURE REVIEW

Malaria is a life threatening disease caused by parasites that are transmitted to people through the

bites of infected female mosquitoes. Most deaths are caused by P. falciparum because P. vivax,

P. ovale and P. malariae generally cause a milder form of malaria. The species P.Knowlesi

rarely causes disease in humans (WHO, 2014).

About 3.2 billion people almost half of the world‟s populations are at risk of malaria. Young

Children, pregnant women and non-immune travelers from malaria-free areas are particularly

vulnerable to the disease when they become infected. Malaria is preventable and curable, and

increased efforts are dramatically reducing the malaria burden in many places (WHO, 2016).

Between 2000 and 2015, malaria incidence among population at risk (the rate of new cases) fell

by 37% globally. In the same period malaria death rates among populations at risk fell by 60%

globally among all age groups and by 65% among children under five. In 2015 the region was

home to 88% of malaria cases and 90% of malaria death (WHO, 2016). Malaria is caused by

Plasmodium parasites. The parasites are spread to people through the bites of infected female

Anopheles mosquitoes. The mosquito bites introduce the parasite from the mosquito‟s saliva into

a person‟s blood (WHO, 2014).

In 2015, approximately 3.2 billion people-nearly half of the world‟s population were at risk of

malaria. Most of malaria cases and deaths occur in sub-Saharan Africa. However, Asia, Latin

America and to a lesser extent the Middle East are also at risk. In 2015 97 countries and

territories had ongoing malaria transmission. Some population groups are at considerably higher

risk of contracting malaria, and developing severe disease than others. These include infants,

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children under five years of age, pregnant women and patients with HIV/AIDS as well as non

immune migrants, mobile populations and travelers (WHO, 2015).

2.1. Global epidemiology of malaria

Malaria transmission occurs in all six continents except Antarctica regions. Globally, an

estimated 3.3 billion people in 97 countries and territories are at risk of being infected with

malaria and developing disease, and 1.2 billion are at high risk (WHO, 2014).

According to World Health Organization report (WHO, 2016), in 2015 an estimated 212 million

cases, 429,000 deaths occurred globally, 92% WHO Africa region followed by WHO South East

Asia region 6% and the WHO Eastern Mediterranean region 2%. Almost all deaths (99%)

resulted from P. falciparum malaria. Plasmodium vivax is estimated to have been responsible for

3,100 deaths in 2015, with most (86%) occurring outside Africa. An estimated 303, 000 malaria

deaths were occurred in children age under 5 years. Malaria mortality rates are estimated to have

declined by 62% globally between 2000 and 2015 and by 29% between 2010 and 2015. In

children age under 5 years, they are estimated to have fallen by 69% between 2000 and 2015 and

by 35% between 2010 and 2015. At the beginning of 2016, malaria was considered to be

endemic in 91 countries and territories, down from 108 in 2000.

2.2. Malaria in Africa

Most malaria cases in 2017 were in the WHO African Region (200 million or 92%), followed by

the WHO South-East Asia Region with 6% of the cases and the WHO Eastern Mediterranean

Region with 2%. Fifteen countries in Africa and India carried almost 80% of the global malaria

burden. Five countries accounted for nearly half of all malaria cases worldwide (WHO, 2018):

Nigeria (25%), Democratic Republic of the Congo (11%), Mozambique (5%), India (4%) and

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Uganda (4%). The 10 highest burden countries in Africa reported increases in cases of malaria

in 2017 compared with 2016. Of these, Nigeria, Madagascar and the Democratic Republic of the

Congo had the highest estimated increases, all greater than half a million cases. In contrast, India

reported 3 million fewer cases in the same period, a 24% decrease compared with 2016.

Rwanda has noted estimated reductions in its malaria burden, with 430,000 fewer cases in 2017

than in 2016, and Ethiopia and Pakistan estimated decreases of over 240,000 cases over the same

period. The incidence rate of malaria declined globally between 2010 and 2017, from 72 to 59

cases per 1000 population at risk. Although this represents an 18% reduction over the period, the

number of cases per 1000 population at risk has stand at 59 for the past 3 years. The WHO

African Region accounted for 93% of all malaria deaths in 2017. Although the WHO African

Region was home to the highest number of malaria deaths in 2017, it also accounted for 88% of

the 172,000 fewer global malaria deaths reported in 2017 compared with 2010 (WHO,2018).

2.3. Malaria in Sub-Saharan Africa

The Sub-Saharan Africa carries a disproportionally high share of the global malaria burden. In

2017, 1.4billion was invested in low-income countries (World Health

Organization, 2018). Africa the greatest burden of malaria cases and deaths, an

estimated 60% of all cases and over 80% of malaria deaths occur in sub Saharan

Africa. In sub Saharan Africa malaria is responsible for 1 in 5 of all childhood

deaths the most malaria infections in sub-Saharan Africa are caused by p.

falciparum 93% of which principal vectors are anopheles, and estimated that

one million of people in Africa die from malaria each year and most of these are

children under 5 years (Shraddha,2015).

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In 2015 the region was home to 88% of malaria cases and 90% of malaria death. Most of

malaria cases and deaths occur in sub-Saharan Africa (WHO, 2016).The vast majority of deaths

occur in sub-Saharan Africa where malaria also presents major obstacles to social and

economic developments. There are at least 300 million acute cases of malaria each year

globally resulting in more than a million deaths (RBM, 2003).

2.4. Malaria in Ethiopia

Malaria is a major public health problem in Ethiopia (FMOH, 2009). More than 75% of the total

area of Ethiopia is malarias, and 54 million people are vulnerable (Aschalew and Tadesse, 2016).

According to the World Malaria Report of 2012, more than 60% of the Ethiopian population was

at risk of malaria, and approximately 62% of all malaria cases were due to p. falciparum. P.

falciparum and P. vivax are the major malaria parasites in Ethiopia.

Anopheles arabiensis, a member of the An. gambiae complex, is the primary malaria vector in

Ethiopia, with An. funestus, An. pharoensis and An. nili as secondary vectors. An. nili can be an

important vector for malaria, particularly in Gambella Regional State. An. pharoensis is widely

distributed in Ethiopia and has shown high levels of insecticide resistance, but its role in malaria

transmission is unclear (PMI, 2015).

Peak malaria transmission occurs between September and December in most of Ethiopia, after

the main rainy season from June to August. Certain areas experience a second “minor” malaria

transmission period from April to June, following a short rainy season from February to March.

January and July typically represent low malaria transmission seasons (PMI, 2015).The

epidemiological pattern of malaria transmission is generally unstable and seasonal in Ethiopia.

The transmission levels vary from place to place because of differences in altitude and rainfall

10
patterns. Although, malaria distribution largely determined by altitude through its effect on

temperature (MIS, 2007; MIS, 2011).

There are four major eco-epidemiological strata of malaria in the country are: Malaria free

highland areas above 2,500 meter altitude, Highland fringe areas between 1,500 – 2,500 meter

(which are affected by frequent epidemics), Lowland areas below 1,500 meters (with seasonal

pattern of transmission) and, Stable malaria areas (characterized by all year round transmission)

limited to the western lowlands and river basins (FMOH, 2006).Risk of malaria is highest in

western lowland of Oromia, Amahra, Tigray, and almost the entire region of Gambella and

Benishangul Gumuz regions. Some small scale studies have documented on malaria parasite

prevalence between 10.4-13.5 % in Gambella; 7.6-14.1% in Tigray; 4.6% in Amahra; 0.9 % in

Oromia; and 5.4% in Southern Nation Nationality and People Region in all age groups

(Aschalew and Tadesse, 2016).

2.5. Malaria in SNNPR

In the Southern Nations, Nationalities and Peoples' Region (SNNPR), Ethiopia about 65% of the

population is living in malaria endemic areas (FMOH, 2012). In the region, malaria is the

primary cause of outpatient and inpatient consultations and hospital deaths (SNNPR, 2013).

2.6. The Malaria Parasites

Malaria in humans is caused by five species of parasites belonging to the genus Plasmodium; P.

falciparum, P. vivax, P. malariae and P. ovale are human malaria species that are spread from

one person to another via the bite of female mosquitoes of the genus Anopheles. In recent years,

human cases of malaria due to P. Knowlesi have been recorded; this species causes malaria

among monkeys in certain forested areas of South-East Asia. Current report suggests that P.

Knowlesi malaria is not spread from person to person, but rather occurs in people when an

11
Anopheles mosquito infected by a monkey then bites and infects humans (zoonotic transmission)

( WHO, 2015).

Plasmodium falciparum and p. Vivax malaria pose the greatest public health challenge. P.

Falciparum is most prealvent on the African continent, and is responsible for most deaths from

malaria. P. Vivax has a wider geographic distribution than p. Falciparum because it can develop

in the anopheles mosquito vector at lower temperatures, and can survive at higher altitudes and

in cooler climates. It also has a dormant liver stage (known as a hypnozoite) that enables it to

survive for long periods as a potential reservoir of infection. The hypnozoites can activate

months later to cause a relapse. Although p. Vivax can occur throughout Africa, the risk of

infection with this species is quite low, because of the absence in many African populations of

the Duffy gene, which produces a protein necessary for p. Vivax to invade red blood cells. In

many areas outside Africa, infections due to p. Vivax are more common than those due to p.

Falciparum (WHO, 2014).

All four species of plasmodium are known to occur in Ethiopia. However, p. Falciparum and p.

Vivax are the most dominant malaria parasites in the country, accounting for 60% and 40% of

malaria cases, respectively. P. Malariae accounts for less than 1% and p. Ovale is rarely reported

(NSPMCP, 2010).

2.7. The Malaria Vector

Anopheles arabiensis, An. funestus, An. Gabiaesi, An. melas, An. merus, An. moucheti and An.

nili have been reported as the dominant vector species in Africa. Among these, An. gambiaesis

and An. arabiensis are the most efficient vectors in malaria transmission (Hay et al., 2010).

Small, temporary, clear, sunlit and shallow fresh water pools are necessary for the breeding of

An. arabiensis the dominant vector in Ethiopia (Abebe et al., 2012; Fekadu et al., 2013).

12
Moreover, temperature and moisture (measured as precipitation or humidity) are the key

environmental determinants for the vector life cycle (Depinay et al, 2004). The malaria vector

requires water to complete its life cycle: egg, larva, pupa, and the adult (Jaston, 2004).

Among many species of Anopheles found in Ethiopia, Anopheles arabiensis (Anopheles

gambiae) is major malaria vector in Ethiopia. It is widely distributed in the country and is

usually the vector of epidemic malaria. Anopheles arabiensis mainly breeds in small, temporary,

and sun-lit water collections such as rain pools. It becomes abundant at the beginning and end of

the big rainfalls. However, it can also breed in a wide variety of other types of water bodies. It is

found in all parts of Ethiopia both in lowland as well as in the highland areas up to 2000 m above

sea level (Ashenafi, 2008).

Anopheles pharoensis is a widely distributed anopheline across the country. It is considered to

play a secondary role in malaria transmission along with Anopheles funestus and Anopheles nili.

It is mostly found in the lake and reservoir area and its density increases after September when

the density of Anopheles arabiensis starts to fall (FMOH, 2014). Anopheles funestus is a highly

adaptable species, allowing it occupies and maintain its wide distribution and utilize and conform

to the many habitat and climatic condition. Anopheles arabiensis and Anopheles funestus is

thought to occur frequently in locality along swamps of Baro and Awash River and shores of

lakes Tana in the north and the Rift valley however, it appears to have a more ubiquitous range

(FMOH, 2014).Anopheles nili was first described in Ethiopia in the Gambella region. Larvae of

all members of the An. Nili complex are found in vegetation at the edges of fast flowing streams

and are more abundant along rivers in degraded forest and savannah (FMOH, 2014).

13
2.8. The Life Cycle of Malaria Parasite

The malaria parasite has a complex, multistage life cycle occurring within two living things, the

vector mosquitoes and the vertebrate hosts. The survival and development of the parasite within

the invertebrate and vertebrate hosts, in intercellular and extracellular environment is made

possible by a toolkit (a set of tools in a box or bag) of more than 5000 genes and their specialized

proteins that help the parasite to invade and grow within multiple cell type and to evade (avoide)

host immune responses (Laurence et al., 2002).

Mosquitoes are the definitive hosts for the malaria parasites where in the sexual phase of the

parasites life cycle occurs. The sexual phase is called sporogony and results in the development

in numerable infecting forms of the parasite within the mosquito that induce disease in the

human host following their injection with the mosquito bite. When the female anopheles draws a

blood meal from an individual infected with malaria the male and female gametocytes of the

parasite find their way into the gut of the mosquito. The Molecular and cellular changes in the

gametocytes help the parasite to quickly adjust to the insect host from the warm-blooded human

host and then to initiate the sporogonic cycle (Carolina and Sanjeev, 2005).

The male and female gametes fuse in the mosquito gut to form zygotes, which subsequently

develop into actively moving ookinetes that burrow into the mosquito mid gut wall to develop

into oocysts. Growth and division of each oocyst produces thousands of active haploid forms

called sporozoites. After the sporogonic phase of 8-15 days, the oocyst bursts and releases

sporozoites into the body cavity of the mosquito, from where they travel to and invade the

mosquito salivary glands. When the mosquito thus loaded with sporozoites takes another blood

meal, the sporozoites get injected from its salivary glands into the human blood stream, causing

malaria infection in the human host. It has been found that the infected mosquito and the parasite

14
mutually benefit each other and there by promote transmission of the infection. The plasmodium

infected mosquitoes have a better survival and show an increased rate of blood feeding,

particularly from an infected host (Carolina and Sanjeev, 2005). With the mosquito bite, tens to a

few hundred invasive sporozoites are introduced into the skin, following the intradermal

deposition some sporozoites are destroyed by the local macrophages, some enter the lymphatics,

and some others find a blood vessel (Ashley et al., 2008). The sporozoites that enter a lymphatic

vessel reach the draining lymph node where in some of the sporozoites partially develop into

exoerythrocytic stage (Ashley et al., 2008) and may also prime the T cells to mount a protective

immune response (Michael and Denise, 2007).

The sporozoites that find a blood vessel reach the liver within a few hours. It has recently been

show that the sporozoites travel by a continuous sequence of stick-and-slip motility, using the

thrombospondin- related anonymous protein (TRAP) family and an actin-myosin motor. The

sporozoites then negotiate through the liver sinusoids, and migrate into a few hepatocytes, and

then multiply and grow within parasitophorous vacuole. Each sporozoite develops into a schizont

containing 10,000-30,000 merozoites (Kebaier et al., 2009).

The growth and development of the parasite in the liver cells is facilitated by a favorable

environment created by the circum sporozoites protein of the parasite. The entire pre-

erythrocytic phase lasts about 5-16 days depending on the parasite species: on an average 5-6

days for P.falciparum, 8 days for P.vivax, 9 days for P. ovale, 13 days for P. malariae and 8-9

days for P. Knowles (Malcolm, 2006).

The merozoites that develop within the hepatocyte are contained inside host cell-derived vesicles

called merosomes that exit the liver intact thereby protecting the merozoites from phagocytosis

15
by kupffer cells. These merozoites are eventually released into the blood stream at the lung

capillaries and initiate the blood stage of infection thereon. In P.vivax and P. ovale malaria, some

of the sporozoites may remain dormant for months within the liver. Termed as hypnozoites, these

forms develop into schizonts after some latent period, usually of a few weeks to months. It has

been suggested that these late developing hypnozoites are genotypically different from the

sporozoites that cause acute infection soon after the inoculation by a mosquito bite and in many

patients cause relapses of the clinical infection after weeks to months (Olivier et al., 2008). Red

blood cells are the center stage for the asexual development of the malaria parasite. Within the

red blood cells repeated cycles of parasitic development occur with precise periodicity and at the

end of each cycle, hundreds of fresh daughter parasites are released that invade more number of

red blood cells. The merozoites released from the liver recognize, attach and enter the red blood

cells (RBCs) by multiple receptor-ligand interactions in as little as 60 seconds. This quick

disappearance from the circulation into the red cells minimizes the exposure of the antigens on

the surface of the parasite there by protecting these parasite forms from the host immune

response (William, 2007).

The invasion of the merozoites into the red cells is facilitated by molecular interactions between

distinct ligands on the merozoite and host receptors on the erythrocyte membrane. P.vivax

invades only Duffy blood group positive red cells, using the Duffy-binding protein and the

reticulocyte homology protein, found mostly on the reticulocytes. The more virulent P.

falciparum uses several different receptor families and alternate invasion pathways that are

highly redundant. Varieties of duffy binding –like (DBL) homologous proteins and the

reticulocyte binding –like homologous proteins of P. falciparum recognize different RBC

receptors other than the duffy blood group or the reticulocyte receptors. Such redundancy is

16
helped by the fact that P.falciparum has four duffy binding-like erythrocyte-binding protein

genes, in comparisons to only one gene in the DBL-EBP family as in the case of P.vivax

allowing P. falciparum to invade any red blood cell (Ghislaine et al., 2009).

The process of attachment, invasion and establishment of the merozoite into the red blood cells is

made possible by the specialized apical secretary organelles of the merozoite, called the

micronemes, rhoptries and dense granules. The initial interaction between the parasite and the

red cells stimulates a rapid “wave” of deformation across the red cell membrane, leading to the

formation of a stable parasite-host cell junction. Following this, the parasite pushes its way

through the erythrocyte bilayer with the help of the actin myosin motor, proteins of the

thrombosponding-related anonymous protein family (TRAP) and aldolase, and creates a

parasitophorous vacuole to seal itself from the host cell cytoplasm thus creating a hospitable

environment for its development within the red cell, at this stage the parasite a appear as an

intracellular “ring” (Laurence et al., 2002).

Within the red blood cells the parasite numbers expand rapidly with a sustained cycling of the

Parasite population. Even though the red blood cells provide some immunological advantage to

the growing parasite, the lock of standard biosynthetic path ways and intra cellular organelles in

the red blood cells tend to create obstacles for the fast-growing intra cellular parasites. These

impediments are overcome by growing ring stages by several mechanisms: by restriction of the

nutrient to the abundant hemoglobin, by dramatic expansion of the surface area through the

formation of a tub vesicular network, and by export of a range of remodeling and virulence

factors into the red blood cell (Olivier et al., 2008).

17
Hemoglobin from the red blood cell, the principal nutrient for the growing parasite, is ingested in

to a food vacuole and degraded. The amino acids thus made available are utilized for protein bio

synthesis and the remaining toxic heme is detoxified by heme polymerase and sequestrated as

hemozoin (malaria pigment). The parasite depends on anaerobic glycolysis for energy, utilizing

enzymes such as Plasmodium lactose dehydrogenase (PLDH), plasmodium aldolase etc. As the

parasite grows and multiplies with in red blood cell the membrane permeability and cytosolic

composition of the host cell is modified (Virgilio et al., 2003).

These new permeation path way induced by the parasite in the host cell membrane help not only

in the uptake of solutes from the extra cellular medium but also in the disposal of metabolic

wastes, and in the origin and maintenance of electro chemical ion gradients. At the same time,

the premature hemolysis of the highly permeabilized infected red blood cells is prevented by the

excessive ingestion, digestion and detoxification of the host cell hemoglobin and its discharge

out of the infected RBCs through the new permeation path ways, there by preserving the osmotic

stability of infected red blood cells (Kieran , 2001).

The erythrocyte cycle occurs every 24 hours in case of P. Knowlesi, 48hours in cases of P.

Falciparum, P. vivax, P. ovale and 72 hours in case of P. malariae. During each cycle, each

merozoite grows and divided within the vacuole in to 8-32 (average 10) fresh merozoites,

through the stages of ring, trophozoites and schizont. At the end of the cycle, the infected red

blood cells rupture, releasing the new merozoites that in turn infected more RBCs. With sun

bridled growth, the parasite number can rise rapidly to levels as high as 1013 per host (Brian et

al., 2008). A small proportion of asexual parasites do not undergo schizogony but differentiate in

to the sexual stage gametocytes. These male or female gametocytes are extracellular and

18
nonpathogenic and help in transmission of the infection to others through the female anopheline

mosquitoes, where in they continue the sexual phase of the parasites life cycle.

2.9. The Malaria Disease

The socioeconomic burden resulting from malaria disease is huge: 1) the high morbidity and

mortality rate in the adult population significantly reduces production activities; 2) the

prevalence of malaria in many productive parts of the country prevents the movement and

settlement of people in resource -rich low-lying river valleys; exposing a large population of the

country to repeated droughts, famine and overall hopeless poverty; 3) the increased school

absenteeism during malaria epidemics significantly reduces learning capacity of students; 4)

coping with malaria epidemics substantially increases public health expenditures (Wakgari et al.,

2006). There are three principal ways in which malaria can contribute to death in young children

First, an overwhelming(very great) acute infection, which frequently presents as seizures or

unconsciousness (cerebral malaria), may kill a child directly and quickly. Second, repeated

malaria infections contribute to the development of severe anemia, which substantially increases

the risk of death. Third, low birth weight – frequently the consequence of malaria infection in

pregnant women – is the major risk factor for death in the first month of life (RBM, 2003). In

addition, repeated malaria infections make young children more susceptible to other common

childhood illnesses, such as diarrhea and respiratory infections, and thus contribute indirectly to

mortality (Molineaux, 1997). Malaria transmission peaks bi-annually from September to

December and April to May coinciding with major harvesting season with serious consequences

for the subsistence Economy of Ethiopia‟s countryside, and for the nation in general (Wakgari et

al., 2006).

19
2.10. Risk Factors to Malaria Infection

Malaria transmission in Ethiopia occurs mainly at altitudes < 2000 m, although endemic regions

> 2000 m have been reported (MOH; 2010).The levels of malaria risk and transmission intensity,

however, show marked seasonal, inter-annual and spatial variability, with the exception of the

southwestern international border low land area where transmission is year-around (Zhou et al.,

2016). Malaria risk factor becomes higher in rural areas of developing countries (Donnelly et al.,

2005). A large number of malaria causing factors including the proximity to the vector breeding

site, the inadequate use of control measure, low income, illiteracy, land use and the house

material play a big role (Straton et al., 2008). Malaria occurrence is higher in low income people.

(WHO, 2012) suggested that these people are characterized by low access to health care facilities

and lack of financial means to pay for vector control technologies such as ITNs and IRS and

Anti-malarial drugs. The same groups of people were characterized by bad quality of house

material that favors anopheles mosquito (Yamamoto et al., 2010). The development of drug

resistance to commonly used anti-malarial drugs is a principal factor which increases the chance

for parasites to evolve and become resistant to the other medicine which poses one of the greatest

threats to malaria control and has been linked to recent increases in malaria prevalence. Drug

resistance has been confirmed in only two of the four human malaria parasite species, P.

falciparum and P. vivax (Yarcho, 2011). The study done on the household risk factors for

malaria among children in the Tigray, Ethiopian highlands had shown that malaria transmission

varied from village to village and even from family to family in the same village. In this case,

housing conditions like earth roof, animal sleeping in the house, windows, open eaves, no

separate kitchen and one sleeping room were significantly associated with malaria (Gebreyesus

et al., 2000).The risk of malaria infection is significantly depends on living environment such as

20
housing condition and breeding sites. Furthermore, the inadequate use of control measure, low

income, illiteracy, land use and the house material play a big role (Stratton et al., 2008;

Yamamoto et al., 2010).

2.11. Genetic resistance against malaria

According to a 2005 review, due to the high levels of mortality and morbidity caused by malaria

especially the P. falciparum species it has placed the greatest selective pressure on the human

genome in recent history. Several genetic factors provided some resistance to it including sickle

cell trait, thalassaemia traits, glucos-6-phosphate dehydrogenase deficiency, and the absence of

Duffy antigens on red blood cells (Kewaiatkowski, 2005).The impact of sickle cell trait on

malaria immunity illustrates some evolutionary trade-offs that have occurred because of endemic

malaria. Sickle cell trait causes a change in the hemoglobin molecule in the blood. Normally red

blood cells have a very flexible biconcave shape that allows them to move through narrow

capillaries, however, when the modified hemoglobin molecules are exposed to low amounts of

oxygen or crowd together due to dehydration, they can stick together forming stranding that

cause the cell to sickle or distort into a curved shape . In these stands the molecule is not as

effective in taking or releasing oxygen, and the cells not flexible enough to circulate freely. In

the early stages of malaria the parasite can cause infected red cells to sickle, and so they are

removed from circulation sooner. This reduces the frequency with which malaria parasite

complete their life cycle in the cell. Individuals who are homozygous (with two copies of the

abnormal hemoglobin beta allele) have sickle- cell anemia, while those who are heterozygous

(with one abnormal allele and one normal allele) experience resistance to malaria without severe

anemia. Although the shorter life expectancy for those with the homozygous condition would

21
tend to disfavor the traits survival, the trait is preserved in malaria prone regions because of the

benefits provided by the heterozygous form (Hedrick, 2011).

2.12. Prevention and Control of Malaria.

Methods uses to prevent malaria infection include medications, mosquito eliminating and the

preventive of bites of anopheles mosquitoes. According to WHO (2016), Cases of malaria can be

prevented by vector control (stopping mosquitoes from biting human beings), by

chemoprevention (providing drugs that suppress infections) or potentially, by vaccination. The

most commonly used methods to prevent mosquito bites are sleeping under an ITNs and

spraying the inside walls of a house with an insecticide – IRS. These two core vector-control

interventions- use of ITNs and IRS are considered to have made a major contribution to the

reduction in malaria burden since 2000, with ITNs estimated to account for 50% of the decline in

parasite prevalence among children aged 2-10 years in sub-Saharan Africa between 2001 and

2015. The 7% in 2015 compared with 37% in 2010. For countries in sub-Saharan Africa, it is

estimated to proportion of the population in sub-Saharan Africa protected by vector control was

estimated at 53% of the population at risk slept under an ITNs in 2015, increasing from 5% in

2005 and from 30% in 2010. The proportion of households with one or more ITNs increased to

79% in 2015.Insecticide based vector control remains a key component of malaria prevention

and control in Ethiopia. The two major vector control intervention implemented to prevent in

Ethiopia are targeted IRS of houses and distribution of LLINs. IRS is targeted to area where

malaria burden is high and highland fringe with epidemic risk. The LLINs policy is to achieve

and maintain universal coverage of population residing in malaria risk area through mass

campaigns and continuous distribution to achieve and maintain LLINs use level above 80% by

all age groups through SBCC activities (PMI, 2017). Indoor residual spraying (IRS), the use of

22
chemical insecticides on the walls and roof of houses in order to kill and repel mosquitoes has

been proven to be an effective way to reduce malaria transmission, especially in areas with low

and variable seasonal transmission (Mabaso et al, 2004).Chemical spray of houses is done just

before the transmission season to prevent epidemics and check seasonal peaks. DDT is used for

indoor spraying of houses and organophosphates use is limited to areas where DDT resistant

vectors are detected. As the trend of malaria changes over time, there should be a strong

monitoring system for the effectiveness of the insecticides used (MOH, 2002).The NMSP 2014–

2020 aims for universal access to prompt malaria diagnosis and highly effective treatment

services for the entire Ethiopian population. The NMSP strategic objective for malaria diagnosis

specifies that by 2017, 100% of suspected malaria cases are diagnosed using a RDT or

microscopy within 24 hours of fever onset. The NMSP aims to train all HEWs and laboratory

professionals in malaria laboratory diagnosis and provide all health posts with RDTs and health

centers and hospitals with microscopy and other malaria laboratory commodities. The NMSP

states that Artemisinin combine therapies (ACTs) should be available at all public health

facilities to treat all P. falciparum infections, whereas chloroquine continues to be first-line

treatment for P. vivax cases (PMI, 2016).As stated by Aschalew and Tadesse (2016),

Environmental management also the most popular malaria preventive method in Ethiopia.

Communities are destroying mosquito breeding sites, clearing stagnant water, covering spring

water, eradicating dirt from the compound. The larval stage of mosquito requires stagnant water

to develop. Filling ponds and draining marshes close to human habitation reduces the number of

adult mosquitoes able to transmit the disease (MOH, 2002).Community education regarding

malaria and the use of ITNs and its supply progressed as one major control strategy of malaria in

the country (FMOH, 2006); (Aschalew et al., 2016).

23
 3. MATERIALS AND METHODS

3.1. Description of the study area

The study was conducted in Soro Woreda, Hadiya Zone in the Southern Nations, Nationalities,

and Peoples' Regional State (SNNPR). Soro Woreda is one of thirteen (13) Woreda and four (4)

town administration of the Hadiya zone.

Soro Woreda is boarded on the North of Gombora woreda, South of Duna woreda, west south of

Mirab Soro woreda, East of Lemo woreda and west of Oromia region. The two town

administrations are surrounded by Soro woreda: namely;-Gimbichu and Jajura town

administration. It is far from 264km from Addis Ababa. Also, it far 200 km far from Hawassa

City the regional capital, of the SNNPR and 32km far from Hosanna zonal town of Hadiya zone.

It is located on the coordinates: 7°30′N 37°35′E.

The total area of the square kilometer is 706 square kilometers. Mean annual temperature in

degree centigrade 17.6-27.5 and the rainfall is 1001ml-1400ml. Based on the Census conducted

by the Central Statistical Agency of Ethiopia, (2007) it has a total population of 233,015, of

which 115,825 are men and 117,190 are women. This specific research work focus on Soro

Woreda in the Hadiya Zone (CSA, 2007).

The homeland of Soro Woreda people is one of the most densely populated areas in Hadiya

Zone. The majority of peoples are farmers. Enset plant constitutes the base of their subsistence

economy. The stable food in many parts of the Hadiya including Soro woreda is „Wesasa” or

Bread of Ensete plant. They also cultivate many crops such as barely, wheat, maize, teff,

sorghum, peas, beans and vegetables like cabbage, and fruit like avocado, mango, and the like.

They also rear animals, such as cows, horses, sheep, and goats. The rearing cattle‟s in the study

24
area is the cultural outcome of the Soro people which is known as xiibeen woo‟o ganima (rearing

cattle more than one hundred cattle‟s). This is the unique cultures of Soro people in Hadiya

Zone. The Hadiya people are famous in production of wheat Ethiopia (some people called it the

smallest Canada).Topographically the Soro Woreda lies within an elevation range of 1500 to

2850 meters above sea level. The slope in general declines East to West with most drainage

being direct to the Gibe River. The Woreda has three agro-ecological zones Degas (23.7%)

Weynadega (64.7%) and Kola (11.6%). (Soro woreda Finance and Economic Development

office, 2019 reports).According to the district health office report, malaria is one of the leading

public health problems in Soro district. This is due to the favorable climatic conditions for

survival of Anopheles mosquitoes and availability to the mosquito breeding site.

25
Figure 1: Location map of the Soro district (source: Soro woreda Administration)

26
 3.2. Study design

An institutional based cross-sectional study was carried out from October 2019-January 2020, on

malaria suspected patients visiting at Gimbichu primary hospital. Furthermore, a retrospective

study data was collected to identify past seven-year (2013-2019) malaria trend in Soro district.

3.3. Sample size determination

Calculation of sample size was estimated using Daniel‟s formula N =z2 p (1-p)/d2 (Daniel, 2004).

Where p = 50%, since there is no previous reported malaria prevalence study in the area, d =

margin of error equals to 5% and z =standard score corresponds to 1.96, with a 95% confidence

interval. Therefore, sample size was 384. To compensate for non-response and incompleteness,

additional 5% was added. Then the total sample size was 403 participants.

Where:-

N- Total number of subjects required in the population

Z= a standardized normal deviate value that correspond to a level of statistical significance equal

to 1.96

P= estimate of prevalence of malaria is 50%

D= margin of error which correspond to the level of precision of results desired

N = (1.96)2 0.5(1-0.5) =384

(0.05)2

Non-response rate = 5% of N = 5/100 (384) = 19

Total sample size 384+19=403

3.4. Study population

The study populations were patients who were visit Gimbichu primary hospital in the period

between October, 2019-January, 2020.

27
3.5. Methods of data collection

A seven years (2013–2019) retrospective data and institutional based cross-sectional study data

on malaria suspected patients at Gimbichu primary hospital on malaria prevalence was collected

from October, 2019 to January, 2020. The data was collected from both primary and secondary

sources.

A structured and pre-tested questionnaire was used to gather information on their socio-

demographic/economic status, included sex, age, marital status, family size, income level of the

household, educational status, pregnancy and occupation of the house holder, the presence of

breeding site nearby their home, main material of room's roof and wall, presence of opening on

the wall, anti-malarial spraying in the past 12 months, possession and use of LLINs.

Individual participants, totally 403, who came to Gimbichu primary hospital for all health

service, were malaria suspected patients. Two laboratory technicians were recruited and provided

with three days of training on the study objectives and protocol as well as recording formats.

Finger prick blood (a small blood volume) was collected from malaria suspected patients. Two

bloods slides each composed of thick and thin blood films were taken from each study

respondents by a medical laboratory technician according to the standard operating procedure

protocol and standards (WHO, 2009). Slides were labeled and air-dried horizontally in a slide

and thin blood films were fixed with methanol after drying and both thick and thin slides were

stained with 3%Giamsa for 30 minutes. Blood slides were read and cross-checked by senior

laboratory technologists at the laboratory unit as either positive or negative for blood parasites,

p.falciparum positive, p.vivax positive or mixed infection with both p.falciparum and p.vivax.

Then, parasite positivity was determined from thick smear and species identification was carried

28
out from thin smear slide preparations. Microscopic examination was done at 100x magnification

or oil immersion.

A seven-year retrospective study data was collected from secondary source by using registered

book of patient information in the hospital, reports of Soro district health office, published and

unpublished documents that use to gather information by using prepared data recording format.

3.6. Data Analysis

First, the data was checked and organized in to different sequences before enter Microsoft Office

Excel. Then data were coded and entered into Microsoft Office Excel, cleaned and exported to

statistical package for social sciences (SPSS) version 21 for analysis. Descriptive statistics like

the frequencies and percentages were employed. Cross-tabulations were plotted before logistic

regressions analyses were performed. Logistic regression analyses were employed to examine

covariates with malaria infection. The association between dependent variables (positivity and

negativity of malaria infection) and independent variables like socio-demographic variables and

others risk factors variables were measured and tested odd ratio with a 95%CI. Statistical

significance was defined at P-values less than 0.05 (P<0.05). Then, the result of the finding was

presented by using words, table, percentage, frequency, and figures.

3.7. Data quality control

The questionnaire was first prepared in English and translates in to Amharic and retranslates to

English was performed by the independent individuals to check for consistency of the meanings

of the questions. Data collectors were trained properly. A pre-test of appropriateness of the

questionnaire was done before the actual data collection. During the data collection, constant

monitoring and supervision was carried out and during data collection in the hospital and at the

29
end of each day, the data were reviewed and checked for errors, completeness, accuracy and

consistency before entry into Microsoft Office Excel and corrective measures were taken.

3.8. Ethical Considerations

Supporting letter was obtained from Department of Biology College of Natural and

computational sciences in Hawassa University and also supporting letter was obtained from Soro

Woreda health office and Gimbichu primary hospital to undertake the study. The permission was

obtained from patients prior to data collection, if the patient‟s age will less than 18 years; an

assent was obtained from parents or caretakers/guardians. Confidentially was maintained.

30
 4. RESULTS

4.1 Socio –demographic characteristics of respondents

Socio-demographic characteristics of respondents are summarized in Table 1.A total of 403

respondents were participated in this study, of which 215(53.3%) were males and 188(46.7%)

were females. Eighty (19.9%) participants were at age below 5 years, 101(25.1%) were between

age of 5-20 years, 170(42.2%) were between age of 21-45 years; and 52(12.9%) were at age

above 45 years. One hundred thirty nine (34.5%) participants of this study unmarried,

253(62.8%) were married, 4(1%) were divorced; and 7(1.7%) were his/her wife/ husband died.

Most of the respondents were live in the rural. One hundred twenty four (30.8%) respondents

were uneducated, 112(27.8%) were able only to read and write, 54(13.4%) had primary school,

92(22.8%) had secondary school and 21(5.2%) had higher education. Eighteen (9.6%) were self

reported pregnancy women and170 (90.4%) had not pregnancy.

As indicated in table 1 the monthly income of the majority of the respondents of the HH

275(68.2%) was <1000 ETB per month income and 128(31.8%) was greater than 1000 ETB

monthly income. Most of the respondents HH, 263(65.3%) were farmers, 93(23.1%) were self-

employed, 27(6.7%) were private sector and 20(5%) were public servants. Sixty six (16.4%)

respondents HH of had family size less than 4; and 337(83.6%) had family size more than four

(Table1).

31
Table 1: Socio –demographic characteristics of respondents in Soro district, Southern Ethiopia

Characteristics Frequency Percentage (%)

Sex
Male 215 53.3
Female 188 46.7
Age
<5 80 19.9
5-20 101 25.1
21-45 170 42.2
>45 52 12.9
Marital status
Single 139 34.5
Married 253 62.8
Divorced 4 1.0
Widowed 7 1.7
Residence
Urban 96 23.8
Rural 307 76.2
Education status of HH
Illiterate 124 30.8
Read and write 112 27.8
Primary school 54 13.4
Secondary school 92 22.8
Higher education 21 5.2
Pregnancy(self-reported
n=188)
Present 18 9.6
Absent 170 90.4
Family size
<4 66 16.4
>4 337 83.6
Income level
<1000 275 68.2
>1000 128 31.8
Occupation
Public servant 20 5.0
Self employed 93 23.1
Private sector 27 6.7
Farmer 263 65.3

32
4.2 Risk factors characteristics of study participants in Soro district, southern Ethiopia

The risk factors characteristics of these study participants summarized in table 2. From total

Respondents 232(57.6%) were utilized LLINs and 171(42.4%) had not and not utilized the

LLINs, and 135(33.5%) respondents had only one bed net, 97(24.1%) had two bed nets and

171(42.4%) had not any kind of LLINs. Also most of the respondents were use LLINs as

protective methods from malaria infection and the rest of respondents were use environment

sanitation and IRS chemicals in their houses, while 160(39.7%) respondents were sprayed IRS

chemicals past 12 months in their houses and 243(60.3%) were not sprayed chemicals past 12

months in their houses. One hundred thirty four (33.3%) respondents HH near the house had the

mosquito breeding site and 269(66.7%) had not mosquito breeding site near the their houses

while the housing condition of most respondents not good like 140(34.7%) respondents houses

had opening on wall of houses and 263(65.3%) had not opening in wall of their houses and the

majority of respondents houses roof made by thatch and wall made by sticks and mud (Table 2).

33
Table 2: Risk factors characteristics of study participants in Soro district, southern Ethiopia

Characteristics Frequency Percentage (%)

Possession and utilize LLINs

Yes 232 57.6

No 171 42.4
Number of LLINs
One 135 33.5
Two 97 24.1
No any LLINs 171 42.
Preventive methods
Use LLINs 232 57.6
Use IRS 160 39.7
Environmental sanitations 11 2.73
Use IRS past 12 months
Yes 160 39.7
No 243 60.3
Mosquito breeding site
YES 134 33.3

NO 269 66.7
House wall opening
YES 140 34.7
NO 263 65.3
House wall type
stone wall 12 3.0
Sticks and mud 391 97.0
House roof type
corrugated iron sheet 119 29.5
284 70.5
Thatch

34
4.3. Prevalence of malaria in the Soro district, Southern Ethiopia (October to January)

During the study period a total of 403 malaria-suspected patients were taken blood samples and

examined for malaria cases of this overall prevalence was 17.87% (72 patients were positive for

malaria infection out of 403 participants) of 72 patients or overall prevalence of 17.87%

62(15.38%) were positive for p.vivax cases, 6(1.49%) positive for p.falciparum cases and

4(0.99%) were positive for mixed infection (p.falciparum and p.vivax) cases. From total

prevalence cases 39(55.7%) were males positive for malaria and 33(44.3%) females. In this

study area plasmodium vivax was predominant species of plasmodium parasite. The relative

plasmodium species proportions of positive cases were 86.11% p. vivax, 8.33% p.falciparum,

and 5.55% mixed infections (figure2).

20.00%

18.00%
17.87%
16.00%

14.00% 15.38%

12.00%

10.00%

8.00%

6.00%

4.00%

2.00%

0.00% 1.49%
0.99%
Total slide positive p.f p.v mixed infection

Figure 2: Prevalence of malaria in Plasmodium species distribution (October to January)

35
4.4 logistic regression analysis of risk factors which related with prevalence of malaria

There are varieties of risk factors related with prevalence of malaria infection. Table 3 showed

the result from logistic regression analysis of risk factors that related with prevalence of malaria

infection. However, sex and age did not show statistically significant association with malaria

infection (p>0.05).The residence of respondents, pregnancy, income level of respondent,

possession and use of LLINs, types of preventive methods, mosquito breeding site, house wall

opening, house wall type, and house roof type were statistically significant related with the risk

of malaria infection(p<0.05). Urban residents were found to be 80% protective from getting

malaria infection than living rural(OR=0.197, 95% CI; 0.077-0.504, p<0.001), respondents HHs

having less income were found to be 6 times higher risk for getting malaria infection than more

income HHs (OR=6.421,95%CI;2.703-15.251, p<0.001).Possession and utilization of LLINs

were found to be 89% less likely to be malaria infected than those who had no utilize LLINs

(OR=0.113, 95%CI;0.059-0.214,P<0.001),and also using LLINs as preventive methods for

malaria infection were found to be more protective than using other protective methods

(OR=0.125, 95%CI;0.061-0.255,p<0.001). Presence of mosquito breeding site around the house

of respondents 30 times higher risk factor for malaria infection than absence of mosquito

breeding site around their house(OR=29.829,95%CI;13.661-65.129,p<0.001) and also presence

of house wall opening on their house was 9 times more likely to be risk than absence of house

wall opening(OR= 9.36,95%CI5.15-17.01).House roof made of by corrugated iron sheet were

83% protective from getting malaria infection than those their house made by thatch

(OR=0.175,95%CI;0.074-0.417,p<-0.001)(Table 3).

36
Table 3: Logistic regression analysis of the risk factors related the with prevalence of malaria

Variables No Malaria test OR 95%CI p-value

result

Positive Negative

Sex
Male 215 39(18.14) 176(81.86) 1.041 0.624-1.736 0.878
Female 188 33(17.55) 155(82.44) 1.00
Age
<5 80 26(32.5) 54(67.5) 2.022 0.879-4.653 0.098
5-20 101 15(14.85) 86(85.15) 0.733 0.304-1.768 0.489
21-45 170 21(12.35) 149(87.65) 0.592 0.259-1.354 0.214
>45 52 10(19.23) 42(80.77) . 1.00 .
Residence
Urban 96 5(5.21) 91(94.79) 0.197 0.077-0.504 0.001
Rural 307 67(21.82) 240(78.18) 1.00
Pregnancy
Present 18 7(38.89) 11(61.11) 2.872 1.047-7.878 0.040
Absent 170 26(15.29) 144(84.71) 1.00
Income level of HH
<1000 275 66(24) 209(76) 6.421 2.703-15.251 <0.001
>1000 128 6(4.69) 122(95.31) 1.00
Posses &Uses LLINs
YES 232 13(5.60) 219(94.4) 0.113 0.059-0.214 <0.001
NO 171 59(34.50) 112(65.5) . 1.00 .
Number of LLINs
One 135 13(9.37) 211(90.37) 0.200 0.104-0.385 0.001
Two 97 0(0) 97(100) 0.011 0.011-8.327
No any LLINs 171 59(34.71) 112(65.29) 1.00
Preventive method
Use of LLINs 232 21(9.05) 211(90.95) 0.125 0.061-0.255 <0.001
Use of IRS 160 50(31.25) 110(68.75) 0.635 0.337-1.195 0.159
Env/tal sanitation 11 5(45.45) 6(54.54) 1.00 .
Mosquito Breeding
Site
YES 134 64(47.76) 70(52.24) 29.829 13.661,65.129 <0.001
NO 269 8(2.97) 261(97.03) 1.00
House wall opening
YES 140 55(39.28) 85(60.72) 9.363 5.153,17.013 0.001
NO 263 17(6.46) 246(93.54) 1.00
House Roof Type
Corrugated iron sheet 119 6(5.04) 113(94.96) 0.175 0.074-0.417 <0.001
Thatch 284 66(23.24) 218(76.76) 1.00

37
4.5. Trends of malaria in Soro district, between 2013-2019

According to Gimbichu primary hospital registered book of patient information and Soro district

health office malaria cases annually report, from 2013-2019 a total of 65,221 malaria suspected

patients gave blood films for malaria rapid diagnosis. From those blood films 29,663(45.5%)

were positive for malaria and 35,558(54.5%) were negative for malaria cases; and from these

identified plasmodium species p.falciparum accounts 16,392(55.3%), p.vivax accounts 12,055

(40.6%) and mixed infection (p.falciparum and p.vivax) cases accounts 1201 (4.1%) of malaria

prevalence throughout the seven years of period. In 2013, highest number of malaria-suspected

patients (N=14,461) were rapid diagnosis tests takes place and 10,779(74%) of them were

microscopically confirmed cases or positive cases for malaria were recorded. On the other hand

the least number of cases (N= 12,520) in 2017 were rapid diagnosis tests takes place and N=

1298(10.4%) and (N=3142) in 2019 were rapid diagnosis tests takes place 414(13.2%) of them

were microscopically confirmed cases for malaria were recorded. Generally, malaria cases in

study area showed decline manner from 2013 to 2019 except in 2016(figure 3).

38
 16000

14000

12000

10000 Total malaria

cases
8000 Slide positive
cases
6000 Negative cases

4000

2000

0
2013 2014 2015 2016 2017 2018 2019

Figure 3: Malaria prevalence from total suspected patients in Soro district (2013-219).

Malaria cases in this study by malaria plasmodium species showed from 2013 to 2019 about

55.3%, 40.6%and 4.1% were due to p-falciparum, p-vivax and mixed infection respectively.

From 2013 to 2019 malaria prevalence cases by plasmodium species showed fluctuating trend

and a decreases manner. The prevalence of malaria plasmodium species trends were 58% in

2013, 54% in 2014, 42% in 2015,70.1% in 2016,42.5% in 2017 , 32% in 2018, 20% in 2019

were p-falciparum cases; and 39% in 2013, 44% in 2014, 57% in 2015, 16.9% in 2016, 56.7%

in 2017, 67.6% in 2018, 79.9% in 2019 were p-vivax cases and 3.4% in 2013,1.5% in 2014, 1%

in 2015, 12.9% in 2016, 0.8% in 2017, 1.4% in 2018, 1.7% in 2019 were mixed infection

(p.falciparum and p.vivax) cases recorded. From 2013 to 2019, the prevalence of p.falciparum

highest cases record in 2016 (70.1%) but, in another years showed a decreases and prevalence of

p.vivax showed fluctuating trend. The prevalence of mixed infection (p.falciparum and p-vivax)

showed a fluctuating trend and highest cases recorded in 2016 (12.9%) (Figure4).

39
 12000

10000 Total slide

positive cases
P.falciparium
8000

P.vivax
6000
Mixed
4000

2000

0
2013 2014 2015 2016 2017 2018 2019

Figure 4: Trends of malaria cases by plasmodium species distribution between 2013- 2019

40
 5. Discussion

Malaria is a major public health problem in Ethiopia including study area. Over the past years,

the disease has been consistently reported as the leading cause of outpatient visits,

hospitalization, and death in health facilities across the country (Wakgari et al., 2003).In this

study from the hospital reported data, the highest proportion of annual malaria cases (74.5%) was

in (2013) and the lowest malaria cases (10.4%) in (2017), and showing a fluctuating trend in past

seven years (2013-2019). While malaria infection prevalence at similar seasons of the year

October to January from 2013-2019 is compared with current institutional based cross-sectional

study of October to January of 2020, the highest prevalence (74.5%) was recorded in 2013, the

next highest (58.7%) being recorded in 2016.The lowest prevalence (10.4%) was recorded in

2017 of the year. In the current institutional based cross-sectional survey the overall prevalence

of malaria infection was (17.87%) which was lower than previous years of overall prevalence of

malaria infection (45.5%) of (2013-2019) of the October to January. This is due to the

governmental policy which focused on diseases prevention by raising public awareness through

health extension workers and health development army volunteers providing community-based

awareness at the household level (MOH,2010).Most of the local communities were aware of the

transmission routes and the causes of malaria.

The current institutional based cross-sectional survey study of the overall prevalence similar to

another study reported from Metema Hospital,(Getachew et al., 2013),Dilla district,(Eshetu et

al., 2015),Kola Diba district,(Abebe et al., 2012); and higher than study made from Wolkite

Health center(Degifie Bereka,2017)which was 7.7% and Arba Minch Hospital (Belayneh,2014)

which was 7%.Additionally this study overall prevalence was lower than another study report

from Hallaba district,(Girma,2014),Sibu Sira district,(Temesgen et al., 2015),East shewa zone of

41
Oromia region (Firew et al., 2017) 82.4%,20.07%and 25% respectively. This difference might be

due to altitude variation, climatic differences that may contribute to great role for breeding of

Anopheles vector and socio-demographic characteristics of study participants, study period,

sample size and study area.

The predominant plasmodium species detected in study area was p.vivax accounts (86.1%),

followed by p.falciparum accounts(8.3%) and mixed infection (p.falciparum and

p.vivax)(5.6%).The overall plasmodium species proportion was found to be 15.38% p.vivax,

1.49% p. falciparum, and 0.99% mixed infection from overall prevalence of malaria

infection(17.87%). This study result contradict with the general national wide plasmodium

species composition paradigm in Ethiopia where p.falciparum makes up about 60% and the rest

of p.vivax 40% (FMOH, 2004); and another study reported from Meteme Hospital (Getachew et

al.,2013),Ayire district (Eliyas,2014),Armeya woreda(Gemechu et al.,2015) and Arba Minch

Hospital (Belayneh,2014), where p.falciparum were predominant species. This might be due to

topographic difference, a higher prevalence of p.falciparum occurs in the lowlands. This study

result similarity with study reported from Wolkite Health center (Degifie Bereka, 2017), Dilla

district (Eshetu et al., 2015), Hallaba (Girma, 2014) and East shewa zone of Oromia region

(Firew et al., 2017) where p.vivax is the predominant of plasmodium species. This might be due

to topographic similarity, a high prevalence of p.vivax occurs in highlands or it could be

relapsing characteristics of p.vivax at the time of cold season.

Although, the result of this study showed that prevalence of malaria infection was higher in

males than females from the malaria slide positive cases (18.14%) were males and (17.33%)

were females, but it was not showed statistically significant relationship between prevalence of

malaria infection and sex or age, this study is similar to previous study (Graves et al.,2009).This

42
is an agreement with the finding reported from Ethiopia ( Ayele et al., 2013) Kola Diba (Abebe

et al., 2012),Meteme hosipital (Getachew et al.,2013) but differs from the finding reported from

Nigeria (Okonto et al.,2009),and Hallaba health center (Girum et al.,2014).The prevalence of

malaria infection in this study was (32.5%) detected in the age group <5 and followed by

(19.23%) in age >45.This might be due to children under five age have lower immunity to

resistance of malaria infection and exposure to the malaria and any kind of disease.

In this study the positivity of malaria infection had statistically significant association with

residence. This study result line with the study reported from Dilla (Eshetu et al., 2015) which

the higher prevalence of malaria infection rate in the rural areas than urban areas. This might

showed rural areas have low awareness, poor housing condition, low economic level and less

effective malaria control measure were applied than urban areas. In this study pregnancy of

women had statistically significant association with malaria infection. This is due to lower

immunity to resistance to malaria positivity of malaria infection. Also low income level of HH

had statistically significant association with malaria infection positivity. The low income level

was higher risk for malaria infection than higher income level, because of less access to

preventive measures and health care, poor housing condition that increase entry of mosquito and

high susceptibility due to poor health and balanced diet (Dejene, 2014). This study finding

similarity with other workers who reported that family employment status was associated with

malaria prevalence among the under-five and associated factors in Muleba district-kagera region

(Mushashu, 2012), and suggests that those people are characterized by low access to health care

facilities and lack of financial to buy for vector control technologies such as INTs, IRS and Anti

Malaria Drugs (WHO, 2012).

43
In the case of possession and utilization of LLINs had statistically significant association with

malaria positivity to control malaria vector and to reducing malaria transmission. The

respondents of HHs ownership of LLINs decrease the risk of malaria infection than those who

did not ownership and not use of LLINs during bed time. This result is similarity to another

study reported from Hadiya zone (Delil, 2014),Dembia district (Mesafint et al., 2017),and Jiga

area, Northwest Ethiopia (Seble,2014). To contrary, some studies conducted in Africa countries

revealed that the utilize of LLINs, did not show a significance difference in malaria mortality and

morbidity study reported from Jimma town (Abebe et al.,2011). Also the number of LLINs, the

condition of LLINs and use last night LLINs of respondents HH had statistically significant

association with positivity of malaria infection. However, the respondents of HH had good

LLINs decrease the probability to expose risk of malaria infection than those who had not good

bed nets, use last night of LLINs decrease risk of malaria infection than those who did not use

previous night and the number LLINs/HH was related with decrease prevalence of malaria

among respondents. This study finding similar to other study reported southern Ethiopia (Loha,

2013) who reported that the prevalence of malaria was lower in those districts having more than

one LLINs/HH.

In this study the using indoor residual spraying (IRS) past 12 months was not statistically

significant association with positivity of malaria infection but, IRS remains one of the key

strategies of the NMCP though primarily used for epidemic prevention and response. IRS with

insecticide has been shown to be highly effective as a malaria control and measure in reducing

the incidence of malaria infection and death in a number of situations (Sintasath et al., 2005).

This study agree with the finding reported from Jiga area, Northwest Ethiopia (Seble, 2014), but

44
this study disagree with the reported from study Muleba district-kagera region Tanzania

(Mushashu, 2012).

The malaria infection positivity was associated with mosquito breeding site around the house of

respondent statistically significant. The highest prevalence rate was found among responding

were living around their house to the mosquito breeding site than those absence of mosquito

breeding site in their house .This study agree with other study reported from Jiga area, Northwest

Ethiopia (Seble,2014) and from Southern Ethiopia (Loha,2013).

In this study another risk factors like housing condition of respondent HH such as house wall

opening, house wall type and house roof type were contribute for high rate of malaria infection

prevalence. From this risk factors house wall opening and house roof type were statistically

significant association with rate of prevalence of malaria infection. This study agrees with other

studies (Straton et al., 2008; Yamamoto et al., 2010; and Gebrayesus et al., 2000).

45
 6. CONCLUSION AND RECOMMENDATIONS

6.1 Conclusion

Based on the finding obtained from this study, the following conclusions can be drawn

 The finding of this study in a seven-year retrospective study showed that high prevalence

of malaria infection was observed among Soro district.

 In this study finding a seven-year retrospective study from (2013-2019) showed that

fluctuating trend and declined manner, and the overall prevalence of malaria infection

were 45.5%.

 The overall prevalence of malaria parasites in current institutional based cross-sectional

study was 17.87%; plasmodium vivax predominant followed plasmodium falciparum and

mixed infection.

 The finding revealed that residence being rural, lower monthly income, pregnancy of

women, none utilization of bed nets with insecticide, the presence of mosquito breeding

site nearer to the house, housing condition of residence such as house wall opening and

house roof type were increases prevalence of malaria infection and transmission of

parasite.

6.2 RECOMMENDATION

Malaria is the major health problems and developmental challenges facing the world. To reduce

this problem the following recommendations based on this finding would be drawn;

 Health extension workers should be enhance the awareness of residence to use the

malaria vector control measures such as insecticide bed nets (ITNs) and IRS utilizing

effectively.

46
 Government and non-government organization should be distribute key vector control

facilities like insecticide treated bed nets (ITNs) and Indoor residual spraying (IRS) for

rural communities especial with low monthly income societies.

 Enhanced and sustained health care education about malaria infection, its associated risk

factors, prevention methods for residence by different bodies.

 Health extension workers should be focus on mosquito breeding site near to homes and

stagnant water which favorable for Anopheles mosquito and should be clean by

community participation.

 Residence should be improve the housing conditions like house wall opening, house roof

type and house environments.

 Finally, governmental and non-governmental organization should be make it their

ultimate aim of publicizing the awareness of malaria infection, its causes, and prevention

methods and associated risk factors of malaria infection.

47
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 8. APPENDIX

Appendix 1: Written consent form for questionnaires.

Dear respondent, this form is prepared to get your informed consent thereby to take part and

provide data to the interview prepared for educational study for post graduate program at

Hawassa University, Department of Biology. The aim of this interview is to obtain data about

prevalence malaria infection. Therefore, your genuine responses to the entire interview are

extremely valuable.

So, when you are taking part in this interview session, you will be asked questions related to

malaria and examine you or your family with malaria symptoms by taking blood smear to

examine for malaria parasites.

The information you provide will be kept confidential and you won‟t be identified. You are also

free to withdraw from the interview any time without any penalty. If you have any enquiry about

the study and procedures of providing data (answering questions), you are at liberty to ask the

researcher at any time.

Appendix 2: ENGLISH QUESTIONNAIRER

PART I: PARTICEPANTS OR HH CHARACTERISTICS

1. Sex Male--------- Female---------

2 .If the sex is female, have you pregnancy A. Yes B. No

3. Age--- A. <5 B. 6-20. C. 21-45 D.>45

4. Marital status of HH A. Single B. Married C. Divorced D. Widowed

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5. Residence, A. Urban B. Rural

6. Educational status of house holder?

A. Illiterate B. only read and writes C. primary school D. 2o School. E. Higher education

7. Occupation of householder? A. public servant B. Self-employed C. Private sector D, farmer

8. Family size of you/your house hold? A.<4 B.>4

9. Average income of the household? A. <1000 B.>1000

PART II: INSECTICIDE SPRAYING AND HOUSING ENVIRONMENT

10. Is there insecticide treated bed net in the HH? A. Yes B. No

11. If yes, how many ITNs do you have in the HH? A. 1 B. 2

12. Are use you last night LLINs? A. Yes B. No

13. Is malaria preventable? A. Yes B. No

14. If yes, which preventive measure do you use to get protected from malaria?

A. Household spray with insecticide B. Use of bed Nets C. Environmental

management

15. Is there any mosquito breeding site available nearby your home?

A. Yes B. No

16.If yes, what type of breeding site available nearby your home?

A. Streams B. Canals C. Ditches D. Stagnant water .E. Others

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17. Do you (your family) have and use insecticide treated bed net? A. yes B.No

18. Was the house sprayed with insecticide in the last 12 months? A. Yes B. No

19.Is opening present in the wall? A. yes B, No

20. What is the Main material of the Room‟s Wall? A. stone wall D. sticks and mud

21. What type of you/your HH house roof? A. Corrugated iron sheet B. thatch

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Appendix 3: Amharic consent/assent form

የወባ በሽታ ስርጭት በአከበቢ ማህበረሰብ ጤና ሊይ ያሇውን ጒዳት፤ የበሽታውን ስርጭት እና

የሰበት ዓመት ዳሰሰ ጥናት ሇማውቅ እያጠናሁ እገኛሇሁ ።የዚህ ጥናት አሇማ በዚህ አከበቢ

ያሇውን የበሽታ ስርጭት እና ተጽዕኖውች ማውቅ በሽታውን ሇማከሊከሌ እና ሇማቆጣጠርያ

ያሇውን ሊማውቅ ታስቦ ነው። ይህም በሽታውን በወረዳው ውስጥ እያደረሰ ያሇውን ስርጭት

እና የማህበረሰብ ተሳትፎ በሽታውን ሇመከሇከሌ እና መቆጣጠርያ ያሇውን ጠቀሜታ ሇማወቅ

ነው።እርስዎ በዚህ ጥናት ሊይ ይሳተፉ ዘንድ በአክብሮት ተጋብዘዋሌ።በዚህ ጥናትሇመሳተፍ

ከተስማሙ በመጠይቅ ሇይ እንድሳተፉ እና ጥያቄውን መሌስ እንድትስዎት እንጥይቃሇን።

ትብብርዎ ሙለ በሙለ በፈቃደኝነት ሊይ የተመሰረተ ነው።ስሇ ትብብርዎ በጠም

እናመሰግናሊን።

Appendix 4: Amharic questionnaire. የወባ ስርጭት ዙሪያ ሇሚደረግ ጥናት መረጀ

መሰባሰቢያ ቅጽ።

1, ፆታ ሀ. ወንድ ሇ. ሴት

2, ፆታ ሴት ከሆኖት ነፍሰጡር ነው？ ሀ. አዎ ሇ. አይደሇም

3, እድሜ ሀ. <5 ሇ. 6-20 ሐ. 21-50 መ. >45

4,የጋብቻ ሁኔታ ሀ. ያሇገባ ሇ. ያገባ ሐ. የፈታ/ች መ. የሞታ/ች

5, እርስዎ የሚኖሩ አከበቢ ሀ,ገጠር ሇ,ከተማ

6,የቤተሰብኃሇፊየትምህርትደረጀ ሀ. ያሌተመረ ሇ.ማንበቢናመጽፍሚችሌ ሐ.

የመጀመሪያደረጀት/ት መ,2ኛደረጀት/ት ሠ,ከፍተኛት/ት

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7, የቤተሰብዎ የሥራ ሁኔታ ሀ, መንግስትሰረተኛ ሇ, የግሌተደደር ሐ ,በግሌሴክቴር መ

,አርሶአደር

8. የቤተሰቡ ብዛት ሀ. ከ4 በታቸ ሇ.ከ4 በሊይ

9, የቤተሰብዎ የገቢ መጠን ሀ, ከ1000 በታች ሇ, ከ1000በሊይ

10. በቤትዎ ውስጥ አጎበር አሇ? ሀ. አሇ ሇ. የሇም

11. መላስዎ አዎ ከሆነ ምን ያህሌ አጎበር አሇዎት? ሀ. 1 ሇ.2

12 .በአሁኑ ሰዓት አጎበሩን ትጠቀማሇችሁ? ሀ. አዎ ሇ አይደሇም

13,ወባ የሚከሇካሌ ነው？ ሀ. አዎ ሇ. አይደሇም

14,መሌሱአዎከሆነየሚከሇካሇመንገድ ሀ,አጎበርመጠቀም ሇ.ፀረ-ነፍሰትፍሉትመርጨትሐ.

አከበቢውንመቆጠጣር

15. በአከበቢያችሁ ሇወባ ትንኝ መረቢያ የሚሆን ቦታ አሇ? ሀ. አዎ ሇ. አይደሇም

16.መሌሱ አዎከሆነ ምን አይናት ቦታ አሇ? ሀ. የጎርፍወሃ ሇ. የቦይወሃ ሐ.

የማይንቀሰቀስወሃ መ.ላሇ_______

17. ሇእርሰዎ ወይም ሇቤተሰበዎ አጎበር አሇው እና በኬምከሌ የተነከረ አጎባር ትጠቃመሊችሁ

ሀ. አዎ ሇ. አይደሇም

18. ቤተዎ በፀረ-ወባትንኝ በሇፎ 12 ወርተረጭቶሌ? ሀ, አዎ ሇ, አይደሇም

19. በሚኖሮት ቤት ግድግደ ቀደደ አሇ? ሀ, አዎ ሇ, አይደሇም

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 20.የቤትዎ ግድግደ በዋናነት የተሰረው ከምንድ ነው? ሀ, ከድንገይናስምንቶ

ሇ.ከእንጨትናከጭቃ

21.የቤትዎ ጣሪያ በዋናነት ከምንድነው የተሰራው? ሀ. ከቆርቆሮ ሇ. ከሣር

APPENDIX 5: Trends Of Malaria in Gimbichu Primary Hospital (Soro Woreda or

District) Between 2005-2011E.C

Year Total malaria Sex Lab. result prevalence

suspected Species of malaria
patients
M F positive negative p.f p.v mixed
M F M F
2005
2006
2007
2008
2009
2010
2011

Appendix 3: Laboratory results reporting format of respondents

Respondent Card № Sex Age Malaria test result Plasmodium species Remark
No
positive negative p.f p.v mixed

61