University of Gondar

College of Medicine and Health Science, School of Medicine,

Department of Internal Medicine
A thesis proposal submitted to school of medicine, department of internal
medicine, college of medicine and health science in partial fulfilment of the
requirements for master of in clinical tropical infectious disease and HIV medicine

Principal investigator Yemataw Kifilie (BSc)

ADVISORS Dr. Getahun Mengistu (MD. Internist)

Dr. Gebrehiwot Lema (MD. Internist)
Mr. Tigabu Kidie (MPH)
The full title of the research Prevalence of Malaria and its associated factors among
project Pregnant Women in East Dembia district, Northwest ,Ethiopia,
2023

Duration of project From March 15 To June 15, 2023

Study area East Dembia, Northwest ,Ethiopia

Total project cost 37,180 ,ETB
Address Email : birhanuyemataw8@gmail.com
Tele :+251-995-32-77-47
 UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF INTERNAL MEDICINE

Prevalence of malaria and its associated factors among Pregnant Women in East
Dembia district, North West Ethiopia

Yemataw Kifilie Birhanu (BSc)

Advisors:

Dr. Getahun Mengistu (MD. Internist)

Dr. Gebrehiwot Lema (MD. Internist)

Mr. Tigabu Kidie (MPH)

A Thesis Proposal Submitted to Department of Internal Medicine, College of Medicine and

Health Sciences, University Of Gondar In Partial Fulfillment Of The Requirements for The
Degree of Master in Clinical Tropical Infectious Disease and HIV medicine

JUNE, 2023

GONDAR, ETHIOPIA
Acknowledgement

First of all, I would like to thank God for allowing me to overcome all difficulties. I feel your
guidance every day. You were the one who made me finish the proposal. I will continue to trust
you.
I would like to express my deep gratitude to the Department of Internal Medicine, school of
Medicine and Health Sciences, University of Gondar for their support in executing this proposal.
I would like to express my sincere gratitude to my advisors Dr. Getahun Mengistu, Dr.
Gebrehiwot Lema and Mr. Tigabu Kidie for making this effort possible.

I would like to thank the staff of the University of Gondar post Graduate Library (UoG) for
locating the material. I would also like to extend a special thank you to all my family for their
continued support and understanding during the writing proposal time.
Declaration

I, the undersigned, MSc student declare that this thesis proposal is my original work in
fulfillment of the requirements for the degree of Master in Clinical Tropical Infectious Disease
and HIV medicine

Name: Yemataw Kifilie Birhanu

Signature: ______________

Place of submission: Department of internal medicine, College of Medicine and Health

Sciences, University of Gondar

Date of Submission: ____________________________

This dissertation proposal has been submitted for ethical review with my approval as university
advisors

Advisors:

Name signature

Dr. Getahun Mengistu (MD, INTERNIST) 1,

____________________

Dr. Gebrehiwot Lema (MD, INTERNIST) 2, ____________________

Mr. Tigabu Kidie (MPH) 3,

_____________________
Table of Contents
Acknowledgement..........................................................................................................................iii
Declaration......................................................................................................................................iv
Abbreviation and Acronym...........................................................................................................vii
List of tables.................................................................................................................................viii
List of figures..................................................................................................................................ix
Summary..........................................................................................................................................x
1. Introduction..................................................................................................................................1
1.1 .Statement of the Problem.................................................................................................1
1.2.1. Prevalence of malaria among pregnant women.............................................................3
1.2.2. Malaria risk factors among pregnant women.................................................................4
1.3 .Conceptual Framework........................................................................................................8
1.4. Justification of the Study.......................................................................................................9
2. Objective of the Study...............................................................................................................10
2.1. General Objective...............................................................................................................10
2.2. Specific Objective...............................................................................................................10
3. Methods and Materials..............................................................................................................11
3.1. Study setting........................................................................................................................11
3.2. Study Design and Period.....................................................................................................12
3.3. Population...........................................................................................................................12
3.3.1. Source Population.........................................................................................................12
3.3.2. Study Population..........................................................................................................12
3.4. Inclusion and Exclusion Criteria.........................................................................................12
3.4.1. Inclusion Criteria..........................................................................................................12
3.4.2. Exclusion Criteria.........................................................................................................12
3.5 Sample Size Determination and Sampling Procedure.............................................................12
 3.5.1. Sample Size Determination..........................................................................................12
3.5.2. Sampling Technique and Procedure.............................................................................13
3.6. Variable of the Study..........................................................................................................15
3.6.1. Dependent Variable......................................................................................................15
3.6.2. Independent Variable...................................................................................................15
3.7. Operational Definition........................................................................................................15
3.8. Data Collection Tools.........................................................................................................16
3.8.1. Data Collection Tools and Procedure...........................................................................16
3.8.2. Data Quality Control Assurance...................................................................................16
3.9. Data Processing and Analysis.............................................................................................16
4. Ethical Consideration.................................................................................................................16
5. Dissemination of Results........................................................................................................17
6. Work Plan..................................................................................................................................18
7. Budget Breakdown....................................................................................................................19
8. References..................................................................................................................................20
9. Annex.........................................................................................................................................23
Annex 1: Information sheet........................................................................................................23
Annex 2: consent form...............................................................................................................25
Annex 3: Assurance of the investigator.....................................................................................26
Annex 4: Malaria questionnaire.................................................................................................27
Abbreviation and Acronym

IPTp: intermittent preventive treatment for pregnant

IRS: indoor resedue spray
ITN: Insecticidal Treated Nets
RDT: rapid diagnostic test
List of tables

Table 1 sample size calculation from previous literature (3) .......................................................13

Table 2 cost of research project....................................................................................................17

List of figures
Figure 1, conceptual framework from previous literature ..............................................................9

Figure 2, diagramatic presention of sampling procedure .............................................................13

figure 3, work plan........................................................................................................................17

Summary
Introduction: Malaria is one of the major causes of morbidity and mortality in developing
countries including Ethiopia. Malaria in pregnancy is estimated to cause about 15% of maternal
deaths globally, accounting for over 10,000 maternal and 200,000 neonatal deaths annually. This
study will determined the prevalence of malaria and its associated factors among pregnant
women in East Dembia district
Objectives: To assess the prevalence of malaria and its associated factors among pregnant
women in East Dembia. Northwest, Ethiopia, 2023
Method: A community based cross-sectional study design will be employed in Dembia district
from May 25 19 to June 25, 2023. A total of 395 individuals will be selected using multistage
sampling technique. A blood sample will be taken from each study participants and rapid
diagnostic test will be used to confirm malaria disease. Interviewer administered semi structured
questionnaire and observational checklist adapted from previous studies will be used to collect
information. Data will be cleaned and entered using EpiData and exported to Stata for further
analysis. Bi-variable and multi-variable logistic regression analysis will be performed to examine
factors associated with malaria. Variables with a p-value of less than 0.05 in multivariable
logistic regression analysis will be considered as significant.

Work plan and budget: the study will be conducted from May 25 19 up to June 25 and the total
budget is 34,965 ETB
1. Introduction
1.1 .Statement of the Problem

Malaria is a protozoan illness that is brought on by parasites called plasmodium (1).

P.falciparum, P,vivax, P.malariae, P.ovale, and P.knowlesi are five of the species that cause the
disease (2, 3). Which is one of the leading cause of mortality and morbidity in many developing
countries (4). Malaria is a significant cost to both individuals and governments. Direct costs (e.g.
Illness, treatment, premature death) are estimated to be at least 12 billion US$ (5).

Around 241 million cases of malaria are expected worldwide in 2020, with 627,000 deaths (6).

The sub-Saharan region accounted for 92% of deaths and 90 % of cases: mortality is
concentrated among a number of high-risk groups, including pregnant women and young
children(7).It is estimated that more than 75% of Ethiopia's land mass is infested with malaria,
which affects four to five million people annually and is home to about 52 million people
(8).Among those infected with malaria, severe anemia, hepatic dysfunction, cerebral malaria,
acute renal failure, and hypoglycemia are among the serious complications that can arise (9,
10). places where the disease is common are less than 2000 m asl (above sea level).The two
major agricultural seasons—September to December and April to May—coincide with its peak
transmission times (11).
In tropical and subtropical nations, malaria infection during pregnancy is a serious public
health issue and puts both the pregnant mother and her fetus at risk (3). Approximately 125
million pregnant women live in areas around the world where they are at risk of contracting
malaria during pregnancy, which is thought to be responsible for at least 10,000 maternal deaths
and 200,000 newborn deaths annually (7, 12). The risk of contracting malaria increases for
about 35 million pregnant women in Sub-Saharan Africa each year(7). Despite this,
research estimating the prevalence of malaria in pregnant women in Ethiopia has produced
highly inconsistent and contradictory results(10). More recent studies have found that between 2
and 44 percent of pregnant women have malaria (13).

Malaria during pregnancy can result in a number of pregnancy-related side effects, such

as intrauterine growth retardation, miscarriage, and stillbirth. Maternal anemia, low birth
weight, and premature birth (5)
The basic mechanism of increased vulnerability is not well understood. However, studies have
shown that it is related to parasitological, immunologic, and epidemiological factors (5, 14, 15).
Given their limited access to ITNs and knowledge of the In order, women who do not attend
ANC services may therefore be more at risk for malaria and its adverse effects(13).
In recent years, the Ethiopian government has significantly stepped up its efforts to
combat malaria. Diagnostic procedures, artemisinin-based combination therapy (ACT) for the
treatment of severe cases, intermittent preventive therapy in pregnancy (IPTp) for the prevention
and control of malaria among pregnant women, insecticide-treated bed nets (ITNs), and indoor
residual spraying (IRS) are a few of these initiatives. As a result, malaria mortality and
morbidity have significantly decreased across the country. But throughout Ethiopia, including in
the Dembia district, malaria continues to be a serious public health issue (5, 16). Due to the fact
that COVID-19's ongoing pandemic was challenging. Areas with an endemic problem of malaria
are among those where COVID-19 is present. Because of the reciprocal side effects, which
include patients having less access to malaria treatment for patients with malaria due to the fear
of access to healthcare centers leading to worse outcomes and diagnostic delays will lead to poor,
low ITN uptake, widespread parasite drug resistance, and insecticide resistance in the vector are
all major contributors to the country's rising prevalence (13, 17, 18).Therefore, the purpose of
this study is to evaluate the prevalence of malaria among pregnant women in the study area as
well as its contributing factors. This aids in the implementation of the most effective malaria
prevention and control measures
1.2. Literature review
1.2.1. Prevalence of malaria among pregnant women
In malaria-endemic areas, malaria infection during pregnancy (PM) is a major cause of maternal
and perinatal morbidity and mortality. The clinical presentation is influenced
by the level of malaria immunity among pregnant women and the rate of transmission. Low birth
weight (LBW) and neonatal death are potential consequences of PM in areas with low
(unstable) transmission. Low immunity results in severe disease. A greater number of PM cases
will be seen in areas with stable malaria transmission, but these cases may also be accompanied
by asymptomatic infection and placental parasitemia (19)

A survey was conducted in Colombia to determine the prevalence of malaria among pregnant
mothers. The data obtained indicate that in samples of peripheral and placental blood by
microscopy and PCR. A total of 787 pregnant women were registered: plasmodium infection was
confirmed microscopically in 4,2%(20)

A systematic review conducted in sub-Saharan Africa among pregnant women found that the
prevalence of malaria was 26.1%. According to the species specific pooled prevalence estimate,
plasmodium falciparum was the dominant followed by plasmodium vivax at 3% (21)

An investigation was conducted in the state of Ekiti in southwestern Nigeria. The results showed
that of the 380 pregnant women examined, 153 (40.2%) were positive for malaria parasites. The
highest prevalence of malaria parasites 18 (51.4 %%) was observed between the ages of 36 and
39 years. Multigravidae were 1.19 times more susceptible to malaria than Primigravidae, First
trimester women were more frequently infected with malaria parasites 40 (75.4%) than second
trimester 46 (23.3%) and third trimester 67 (51.9%) women (22). Another facility based cross-
sectional study was conducted in Nigeria Delta state prevalence of malaria Two hundred and
sixty three (62.9%) pregnant women tested positive for malaria (7)

A study carried out on pregnant mothers in Sudan, using a cross-sectional approach, revealed a
prevalence rate of malaria showed was 12.7% and the predominant species was plasmodium
falciparum (23).
A systematic review conducted in Ethiopia in 2019, the estimated pooled prevalence of malaria
among pregnant women was 12.72 % (24)

Community-based cross sectional study conducted in 2020, Merti district, Oromia region,
Ethiopia, the prevalence of malaria among pregnant women was 3.6%. The proportions of
Plasmodium falciparum and Plasmodium vivax were 6 (46.2%) and 7 (53.8%), respectively. Out
of 13 Plasmodium species identified, the gametocyte carriage rate was 4 (30.7%) (25).

A research carried out in various regions of Ethiopia revealed that the occurrence of p. vivax
malaria among pregnant mothers ranged from 2.4% to 53.8%.(24, 26-28)

Another cross-sectional survey took place in North-Shoa, prevalence of asymptomatic malaria

infection was 5.7% (15/263) and 3.4% (9/263) by using microscopy and RDTs, respectively.
Plasmodium falciparum was a dominant species 9 (3.4%) and Plasmodium vivax accounted for 6
(2.3%) of Plasmodium infections as detected by microscopy (29) .

A study was conducted in Damot Woyide district, Southern Ethiopia show that while
multigravida women were more infected with P. vivaxas compared to Primigravida. Individuals
in the third trimester were more infected (4%) than those in the first trimester (1%), and the
difference was statistically significant (5)

Institutional based cross-sectional study was conducted in three health centers in Northwest
Ethiopia, the prevalence of malaria among pregnant women was 20.8% (65/312) of which
12.2% (38/312), 4.8% (15/312) and 3.8% (12/312) were P. falciparum, P. vivax and mixed
infections, respectively (30)

A community –based cross-sectional study was conducted among pregnant mothers in the
Sherkole refugee camp in the Benishangul Gumuz region of western Ethiopia. The malaria
prevalence was 10.2% (3)
1.2.2. Malaria risk factors among pregnant women
A research carried out in the southern region of Venezuela revealed that P, vivax malaria was
prevalent among expectant mothers. 71% of the women were aged 25 years or younger, and
adolescent pregnancies were frequent (17 out of 52). Infections were primarily detected in the
third trimester of pregnancy (63.4%) ((31). Similar study conducted in Nigeria maternal age
related with higher incidence of malaria An investigation carried out in Nigeria on pregnant
mothers revealed that maternal age was linked to a higher incidence of malaria (32)

A study conducted in Colombia revealed that Most of the infected by malaria pregnant women
were living in the urban/peri-urban area of the municipalities, at the lower socioeconomic status,
and around half of them had water bodies around their homes. Living in urban/peri-urban was
associated with being infected, the proportion of Primigravidae was similar between infected
and non - infected pregnant women compared to 11.8% and 10.1% in second pregnancy and
multigravida, respectively. The results showed a significant association between gravidity and
malaria infection (39.1% vs. 38.3%) (20). However similar study was conducted in Sudan to
examine factors related to malaria infection among pregnant women. The study found that
malaria was more widespread in primigravida women, with 24.2% (15/62) affected. (23)

Engaging in open-air pursuits prior to sunrise and post-sunset camping as well as nocturnal
outdoor undertakings exhibited a noteworthy correlation with contracting malaria [in that order
(33).

A cross-sectional study was carried out in the Sherkole refugee camp, located in the Benishangul
-Gumuz regional state of western Ethiopia. The study focused on the utilization of ITNs,
consultation about malaria prevention methods during the trimester of pregnancy and gravidity
among the community. The study found significant associations between these factors and
malaria infection during pregnancy. Furthermore, the odds of malaria infection decreased by
22% for each one-year increase in the pregnant women's age. Pregnant women who did not
utilize ITNs were 14.98 times more likely to contract malaria compared to those who did (27).
Similar study conducted

a study conducted in Damot Woyide district, Southern Ethiopia family factors show that size
less than or equal to three, 73% less likely exposed to malaria than family size greater than 3.
Multigravidae 90% less likely infected with malaria as compared to Primigravidae. Women
using ITNs always were) less likely infected with malaria as compared to those not using at all.
In addition use of IRS in the last twelve month was 98% protective than not using (5, 34).
Similar study conducted southern Nigeria respondents from a family size of 1-6 were more
likely by an odds ratio of 2.123 to test positive to malaria parasite compared with those from
family size of > 6 ((7).

A study was carried out in the Merti District of the Oromia region in Western Ethiopia to
investigate the prevalence of asymptomatic Plasmodium among pregnant women. The results
showed that pregnant women with a past Plasmodium infection and residing in close proximity
to still water bodies (within a distance of 1 km from breeding sites of vectors) had a significant
association .(28). This result also supported by studies conducted in northwest Ethiopia (30)

A study carried out Damot Woyide district, Southern Ethiopia More than 99% of the respondents
had information about malaria and majority (83.2%) claimed that their source of information was
health workers and community meetings. Nine in ten (91.7%) women knew that malaria was
transmitted by the bite of mosquitoes. Moreover 346 (82%) of the participants were fully aware
that ITNs protect from mosquito bite and play a major role in controlling malaria transmission.
Three hundred and fifteen (74.6%) mentioned that they obtained ITNs from public health
facilities and 308 (73%) stated that they use ITNs regularly. Almost 80% perceived that using
Indoor Residue Spray (IRS) was advantageous, since it killed mosquitoes, while 91 (21.6%)
worry that IRS has side effect due to its bad smell and with the fear that it may kill domestic
animals (5)

Another cross-sectional study was conducted in Addis-zemen North-western Ethiopia show that
out of 235 subjects, 217 (91.6%) of the participants mentioned fever as a symptom of malaria
and headache was mentioned by 183 (81%) of women. All of participants 235 (100%) said
malaria can be transmitted through mosquito biting whereas 8 (3.4%) women said that malaria
can be transmitted through direct contact.(35).another study conducted in northwest and west
Ethiopia indicated that pregnant women who are illiterate more affected by affected than those
who had attended secondary school and above (3, 30)

A research carried out in Ethiopia revealed that households possessing an insecticide-treated net
had lower chances of contracting malaria. With every additional net, the likelihood of a positive
malaria diagnosis test reduced by 54% People who slept outdoors were seventy-seven times
more prone to catching malaria in comparison to those who slept indoors. Within the study
location, the utilization of bed nets and indoor residual spraying were among the variables that
exhibited a negative correlation with the prevalence of malaria. Among the groups surveyed,
individuals who did not use bed nets at home were eleven times more likely to develop malaria
than those who frequently utilized bed nets. Conversely, people who were absent during the time
of spraying had fourteen times higher chances of contracting malaria than those who had sprayed
their homes (36)

Dwellings that were subjected to insecticide spraying within the last six months had a 3-fold
decrease in the likelihood of contracting malaria. This finding is reinforced by the outcome of a
research carried out in Nigeria.(32). But studies conducted in Zimbabwe revealed that there was
no statistical difference in the risk of contracting malaria between those that had their houses
sprayed and those that did not.(37)
1.3 .Conceptual Framework
Broken line show that each independent variable indirectly related to cause of malaria

The ownership and use of ITNs, Geographical differences in ANC services, and women’s
cultural beliefs and socio-economic status. Access to ANC services may also represent a
challenge if the road conditions are poor or if the distance to the nearest health facility presents a
barrier

Socio factors
Malaria knowledge

 Age  Cause of malaria

 Educational status  Prevention method
 Mode of
 Family size
transmission
 Marital status  Sign and
 Monthly income symptoms

Obstetric factor

 Trimester
 Gravidity Malaria
 ANC follow-up
 Distance from
health center

Environmental and
geographical
difference factor

 Stagnant
water
 Irrigation

Figure 1, conceptual framework 1(3-5, 7, 13, 30)

1.4. Justification of the Study

Infection with malaria poses a risk to 125 million pregnant women worldwide, with sub-Saharan
pregnant women accounting for 28% of annual malaria cases. Malaria’s effects extend beyond
pregnant women to include newborns and infants(30).

East Dembia is known malarias site in The Amhara region.  Under endemic conditions, children
under the age of five years, and pregnant mothers, are most likely to be infected as they have
weaker immunity. And result in undesirable pregnancy outcomes like an elevated risk of
abortion, stillbirth, early delivery, and low-birth weight infants. The proper prevention and
control measures must be implemented among pregnant women because they are the group most
susceptible to malaria.

Each year, the number of cases of malaria can multiply by three. And it still ranks
among the illnesses that are most common in the study area. According to my review there is no
community-based research on the prevalence of malaria and its risk factors
among pregnant mothers. This study aims to show the extent and crucial role that malaria
continues to play in public health issues among pregnant women in the district, despite numerous
preventive and control measures. The result of this study will provide East Dembia district,
central Gondar Zone, Amhara region health bureau and federal ministry of health, and various
international partners with useful information on the prevalence of malaria and its associated
factors. Which is essential for concentrating prevention strategies and programs.

.
2. Objective of the Study
2.1. General Objective

To assess the prevalence and its associated factors of malaria among pregnant women in East
Dembia district, Ethiopia, 2023

2.2. Specific Objective

 To determine the prevalence of malaria among pregnant women

 To identify its associated factors of malaria among pregnant women
3. Methods and Materials
3.1. Study setting
The study will be conducted among pregnant women in East Dembia district. This is located in
central Gondar zone, Amhara region, North West of Ethiopia on the border with Lay Armachiho
district in North, Chilga district and Gondar Town in North West, and west Dembia in North
East, Lake Tana and Gondar Zuria district in West and South East respectively. The total
population of the district are about 218,169 of which 107,994 [49.5%] are male and 110,175
[50.5] female. There are 1 primary hospital, 5 health center and 30 health posts all health
facility’s serve malaria diagnosis and treatment. A total of 30 malarious kebeles in the district
from which five kebeles are urban and 30 kebeles (the smallest political administration) are rural.
An altitude of the district ranges from 1800m-2600m above sea level., Climatic condition of the
District is 100% temperate and annual rain fall ranges from 772mmHg 1260mmHg. Annual
temperature of the District also ranges from 18 - 30 degree Celsius. There are 10 health centers,
30 health posts and 20 private clinics that have given health service for the community (16)

3.2. Study Design and Period

A community based cross-sectional study design will be employed from May 25 to June 25
3.3. Population
3.3.1. Source Population

Source population will be all pregnant women in East Dembia district

3.3.2. Study Population
All pregnant women selected kebeles East Dembia district
3.4. Inclusion and Exclusion Criteria
3.4.1. Inclusion Criteria

The study population consists of pregnant women in the selected kebeles that were available
during the data collection period

3.4.2. Exclusion Criteria

Pregnant women with mental illnesses and severely disabling medical conditions will be
excluded excluded from the study.
3.5 Sample Size Determination and Sampling Procedure
3.5.1. Sample Size Determination
The sample size was determined using a single proportion formula, 95% confidence level, 3%
margin of error, and prevalence of asymptomatic malaria among pregnant women was 10.2%
(3)

n = (Z α/2)2*P (1-P)

d2

Where n= Minimum sample size

P= prevalence of malaria among pregnant women (20.8%)

Z = standard normal distribution 95% CI (1.96)
d = margin of error (3%)

n = (1.96)2*(0.102) * (1-102)) = 390.9≈ 391

(0.03)2

n=391

For the second specific objective the sample size was calculated using Epi-info version 7
StatCalc by taking statistically significant and pertinent factors for malaria infection with the
consideration of 1:1 unexposed to exposed ratio, 95% confidence level and 80% power .

Sample size calculation to prevalence and its association factors of malaria among asymptomatic
pregnant women in west Ethiopia
Table 1 sample size calculation from previous literature (3)

Table 1 sample size calculation from previous literature (3) 1

Variable COR P( exposed) P (non- power Confidence n Ratio

expose level (unexp:expo)
d
ITN utilization 13.15 36.6% 4,2% 80% 95% 79 4.5
Consultation and 11.47 40.5% 5.6% 80% 95% 93 6.23
education about the
prevention methods of
malaria during ANC

By comparing the sample size from the first and second specific objectives we selected the
largest sample size which is 391. Then, we consider 10% and design effect 2 finally 860
participants will be enrolled in the study.
3.5.2. Sampling Technique and Procedure
A multi stage sampling technique will be used for the selection of the representative pregnant

8 kebeles with a total of 3025 pregnant women were chosen by simple random sampling in order
to create the first 860 samples of pregnant people from a total of 30 kebeles in the district. In
the second stage, the sample size will be distributed proportionally among the 8 kebeles based on
the number of pregnant women in each kebeles, with a range of 67 to 215
households in each kebeles, and then households will be chosen using a simple random sampling
technique. In the event that there are multiple eligible women living in a single household, a
lottery method was used to choose one. Finally, pregnant women in the household will take.
 Total pregnant women 8 kebeles East Dembia district =3025

Proportional allocation each kebeles

Mekuamia Dirmara Gendewa

Senbet Deber Ambagualit Girarge Sufankara Gubia

N=265 N=150 N=80

N= 258 N=191 N=158 N=244 N=76

n= 111 n=70 n =70

n=108 n=80 n=139 n=215 n=67

n=860

Figure 2.diagramatic presentation of sampling procedure

3.6. Variable of the Study
3.6.1. Dependent Variable
 Malaria infection status test RDT
3.6.2. Independent Variable

 Socio demographic factors: age, marital status, occupational status, educational

status, residence, monthly income , sleeping areas, housing condition, cultural belief
 Obstetric factor: gravidity, parity, trimester of pregnancy, history of abortion
 Malaria prevention measures: ITN ownership, indoor residual spraying (IRS) use
of personal protective measures and ITN utilization.
 Health service use: accessibility of ANC visit, place of delivery for the previous
child, previous infection during pregnancy and health education about malaria
prevention method during ANC follow up. Distance
 Environmental factors: stagnant water, irrigation

3.7. Operational Definition

Pregnant: Women of confirmed urine Human Chorionic Gonadotropin (HCG) hormone positive
in laboratory.(30)

Febrile infections: infections are plasmodial infections detected by any method in the presence
of fever (axillary temperature ≥37.5°C) or history of fever in the last three days (20)

Malaria exposure: Malaria was defined as the presence of asexual parasites on a blood smear.
Plasmodium species and parasitemia were determined by microscopy for all positive smears.(38)

Knowledge:

 Good Knowledge- those who scored more than 60% of correct response for Knowledge
related questions (35)
 Poor Knowledge—those who scored less than 60% of correct response for Knowledge
related questions (35)
.

3.8. Data Collection Tools

3.8.1. Data Collection Tools and Procedure
The interviewer-administered Semi-structured questionnaire will used to collect the required
information. For those pregnant women who were on ANC follow-up, the data collector
reviewed their antenatal follow-up cards to cross-check the information given by them. Card
information checked includes; gravidity, parity, and gestational age at first ANC visit. Following
the interviews, blood was obtained from the third finger of women’s left hand. First, the tip of
the finger was wiped with a piece of cotton wool lightly soaked in alcohol. Then piercing with
sterile lancet was done and the blood allowed to flow freely without squeezing the finger. Then,
5 μl (μl) blood was collected and a single small drop was added on the CareStart RDT to
examine the presence or absence of malaria and to differentiate its species. The RDT read and
determine the species qualitatively after 15–20 min of putting the blood to the kit.

3.8.2. Data Quality Control Assurance

Before actual data collection pretest will be conducted in Balageb kebeles from 5% (43 pregnant)
of the sample size which are not included in the main study. During data collection 8 health
extension workers and 1 clinical nurse professional will be participated as a data collector and
1BSc nurse as a supervisor. Both data collectors and supervisor will be trained for 1 days on all
aspects of data collection procedure. The supervisor and the principal investigator closely follow
the daily performance and appropriateness of the data collection.

3.9. Data Processing and Analysis

The collected data will be double entered and cleaned by using Epi Info 7.2 and transferred to
SPSS for data management then entered to STATA 14 for further analysis. Bi-variety and multi-
variable analysis will be performed to examine the association of covariates with malaria
infection. All risk factors with p-value < 0.25 by bi-variety analysis will be entered in to multi-
variable analysis to control confounding variables. The method used in multi-variable model will
be forced entry. The Hosmer and Lemeshow goodness of fit test will be checked. The association
between the dependent and independent variables will be measured and tested using P-value and
95% CI for OR. The significant level will be considered at p-value < 0.05
4. Ethical Consideration
This research will be conducted after the ethical clearance obtained from the research and ethics
committee of University of Gondar. Then an official letters will be written to Amhara health
bureau and East Dembia for permission and support. Prior to blood sample collection the
objective, the risks, benefits, incentives, procedures and issue of confidentiality will be clearly
explained to the study participants. The confidentiality of the participants will be maintained by
omitting the names during data collection. A verbal informed voluntary consent will be taken
from participants. Participants with positive malaria Parasite will be linked to the nearest health
facilities for treatment according to national malaria guide line.

5. Dissemination of Results
The results of this study will be presented to the University of Gondar, College of Medicine
and Health Sciences. In addition, feedback on the study results will be provided by
translating the results to the East Dembia District Health office , Central Gondar zone Health
directive and Amhara Regional Health bureau for easier application. And it is presented in
various seminars and workshops. Finally, it is published in peer-reviewed journals.
6. Work Plan
Figure 3, work plan. Work plan for assessment of prevalence of malaria and its associated factors
pregnant women in East Dembia, northwest, Ethiopia, 2023

No Activity Responsible March April May June

person
1 Proposal writing PI
&defense
2 Securing fund for PI
research
3 Collections of tools PI
and selection of
data collectors
4 Training of data PI and data
collectors and collectors
presenting
5 Data collection Data
collectors
6 Data entry, PI
cleaning and
compilation
7 Data analysis PI
8 Report writing PI
9 Submission of first PI
draft to advisor
10 Preparation and PI
Mock defense
11 Submission and PI
theses defense
12 Dissemination of PI and
results advisor
7. Budget Breakdown
Budget break down for the assessment of prevalence of malaria and its associated factors
pregnant among women in East Dembia, northwest, Ethiopia, 2023

Table 2, cost of research project

I, PERSONAL COST
Multiply remark
S Item Unit of Number Estimate
. measurement s Quantity ing Unit d cost
factor
n cost ( ETB
Of days No of (ETB)
o (ETB)
participa
nts
1 Training Day 2 10 200 200 2000
2 Supervision Day 30 1 250 250 7500
3 Data collection Day 5 9 200 200 9000
Subtotal 18,500
II, TRANSPORT AND COMMUNICATION
s. Item Unit Quantity Multiplyi Unit Estimat Remark
n measurement ng factor cost ed total
o (ETB) cost
1 Mobile card ETB 10 50 50 500
2 Transport person 7 200 200 1400
Subtotal 1900
III, STATIONARY AND OTHER MATERIALS

s. Item Unit of Quantity Multiplyi Unit Estimat remark

n measurement ng factor cost ed cost
o (ETB)
1 A-4 size paper Pack 2 600 600 1200
2 Pen Piece 20 25 25 500
3 Note book Pieces 2 100 100 200
3 RDT kit Box 15 340 340 5100
4 Disposable Box 10 300 300 3000
Glove
5 Cotton Roll 6 150 150 900
6 Alcohol 70% Bottle 6 200 200 2000
7 Subtotal 12900

Budget summary
1 personal cost 18,500
2 transport and communication cost
1,900

3 stationary and other cost 12900

Contingency 5% 1665
Grand total 34,965

Note: current market inflation one cause of increase budget

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30. Almaw A, Yimer M, Alemu M, Tegegne B. Prevalence of malaria and associated factors among
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Malaria in pregnancy complications in Southern Venezuela. Malaria journal. 2021;20(1):186.
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with malaria infection among pregnant women in a semi-urban community of north-western Nigeria.
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9. Annex

Annex 1: Information sheet

Title of the Research Project: prevalence and its associated factors of malaria among pregnant
women in East Dembia, northwest, Ethiopia, 2023

Name of Principal Investigator: Yemataw Kifilie Birhanu

Name of the Organization: University of Gondar, College of Medicine and Health Sciences,
school of medicine, department of internal medicine.

Name of the Sponsor: self

Introduction: These information sheet and consent forms clarify the purpose of study in order to
get your willingness to participate.

Purpose of the Research Project: The finding of this study primarily provides information for
University of Gondar and East Dembia district malaria prevalence and its associated factors.
Finally the result will help the district to take action accordingly and this study will also serve as
a base for other researchers who want to study about malaria prevalence and its associated
factors in advance. So the investigator of this study is intended to assess the prevalence of
malaria infection and its associated factors in the health centers.

1. Procedure: To select the study participants, first a list of 30 kebbles will be obtained from the
East Dembia district health office from which 6 kebelles will be selected by using simple random
technique and considered as a primary sampling unit. The estimated sample size will be
proportionally distributed to the selected 6 kebbles based on their total pregnant in the kebbles
and considered as a secondary sampling unit. Finally, lottery method will be used to select any
single participants.

2. Risk and /or Discomfort: you may feel waste of time & displeasure, but by participating in
this study it only takes 3 to5 minutes & the result will be important for you & your families, so
that the policy makers & administrators give emphasis for your need.

3 .Benefits: this study helps to determine the burden of malaria and identify its associated factors
in the district.

4. Incentives: Investigators will not be given any incentives or payment to earn in this study

5. Confidentiality: The information attainment from the chart will be kept confidential. It will be
stored in a file using codes, locked with a password. And it will not be exposed to anyone except
the principal investigator. In addition, it will be used only for this particular research, but, no
other purposes.

5. Whom to contact: This research project will be reviewed and approved by the institutional
review board of School of medicine, College of Medicine and Health Science, University of
Gondar. If you want additional information, you can contact the following individuals and you
may ask at any time you want.

6. Right of Refusal: Any time you have the full right to reject from participating in this research.
You have also a right to withdraw from this study at any time you wish, without losing any of
your rights.

7. Whom to contact: This research project will be reviewed and approved by the institutional
review board of School of medicine, College of Medicine and Health Science, University of
Gondar. If you want additional information, you can contact the following individuals and you
may ask at any time you want..
Name of interviewer: Yemataw Kifilie Birhnu (BSc)

Mobile: +251-995-32-7747

Email: birhanuyemataw8@gmail.com

Advisors:

Dr. Getahun Mengistu (Internist) =0918173181, email= getalemk04@gmail.com

Dr. Gebrehiwot Lema (internist), tale=0912211987, email=gebrelema1921@gmail.com
Mr. Tigabu Kidie (MPH), tale=+251-9-23-55-33-80,email=tigabukidie@gmail.com

Annex 2: consent form 1

We are collecting data for an investigator doing his study for the partial fulfillment of master’s
degree in clinical tropical infectious disease and HIV medicine. We will like to ask some
questions related to malaria risk factors. The aim of this study is to assess the prevalence of
malaria and its associated factors in East Dembia, North West Ethiopia, 2023. However, your
honest answers for questions related to malaria risk factors will help us better understand on
malaria risk factors and to recommend appropriate strategies to solve the problem. Thus you are
chosen to participate in the study with equal chance. The goal of this study is to show the burden
of malaria and the pertinent factors related to the infection which may help concerned bodies,
responsible authorities & others to take interventions based on the study findings. To
successfully reach at the programmed goal of the research, I am requesting your help. By
participating in the study you may waste your time, but this may not be considered as harm when
compared with importance of the research to the community. The questionnaire do not concern
on the personal information, which will help to maintain confidentiality. You have full right to
refuse from participating in this research if you don’t want to participate. However your honest
participation and answers to the questionnaires will help us in better understanding of the gaps
within the study area. So would you willing to participate actively and honestly.

A. Yes B. No

Contact person in need investigator:

E-Mail: birhanuyemataw8@gmail.com Tel: +251- 995-32-77-47,

THANK YOU!!

Annex 3: Assurance of the investigator 1

The undersigned agrees to accept responsibility for the scientific, ethical and technical conduct
of the research project and provision of required progress reports as per terms conditions of the
research and publications office of the University of Gondar.

Name of the student: yemataw kifilie (BSc)

Date____________ signature__________

Approval of the advisors:

Advisors Name Signature

1. ___________________ ____________

2. ___________________ _____________

3 ___________________ _____________
Annex 4: Malaria questionnaire in East Dembia1

UNIVERSITY of GONDAR

SCHOOL OF MEDICINE

DEPARTMENT OF INTERNAL MEDICINE

Research Questionnaire on Malaria Infection East Dembia, 2023

Date of data collection: ______________________

Name of data collector: ______________________

Name of health center: _______________________

ID number of participants: __________________________

Address: Kebelle: ___________________________

RDT test result: a) positive

b) Negative
 If positive malaria species detected:

a) P.Falciparum
b) P. vivax
c) Mixed

Part one -socio-demographic variables

001 Age ---------------

002 Educational status 1.None (has no formal education

2. primary (1-8)

3.secondary (9-12)

4 )above collage

003 Residence 1.urban

2.rural

004 Occupation 1). Daily laborer 2).House wife

3). Merchant 4) Gov’t employee

005 Family size ________________

Part Two - socio –economic variables

006 Did you have any travel history in the 1. Yes 2. No
past 3 months

007 Sleeping areas during night time 1. inside the home

2 . outside the home

008 Monthly income _______________

009 Do you have any outdoor activities 1.Yes 2.No

before dawn and dusk?

010 Do you have any toilet facilities? 1.Yes 2 No

011 If Q 17 is Yes What type of toilet 1. Pit latrine

facilities?
2.Toilet with flush

3, environmental factors
012 Is there any stagnant 1.Yes
water around home? 2. No
013 If Q 12 is Yes distance 1. < 1 km
from home 2. >1 km
014 If there any irrigation 1.yes
water around your home 2. no
015 If Q 14 is yes distance A ) <1km
from home B )>1km
4, Obstetric factor
016 Gestational period 1. first trimester

2.second trimester

3.third trimester
017 Parity 1.Primigravidae

2. Secundigravidae

3, Multigravidae

018 Do you have ANC follow-up? 1,Yes

2,No

019 Number of ANC follow-up --------------

5, knowledge question

020 Have you ever heard of an illness called 1. Yes

malaria?
2. No

021 Source of information 1. Media

2. Health workers

3. Community meeting

022 If Q 20 is Yes What do you think is the 1. Mosquito bite

cause of malaria?
2. Eating dirty food

3. Drinking dirty water

 4 .Cold weather

5.Others_____________
_______

023 Do you know symptoms of malaria? 1.Fever

2. Headache

3 .Feeling cold

4. Thirsty

5. Vomiting

Prevention method

024 Do you have bed net? 1. Yes

2. No
026 If Q is 23 Yes number of bed net? ___________________
027 Source of ITN 1. In public health facility
2,.In private health facility
3. Buying from shop
027 If Q 24 is Yes do you always sleep 1. always
under mosquito net? 2. most of the time
3.sometimes
4. never
028 Was your house sprayed with indoor 1. Yes
residual spray in the last 12 month? 2, No
029 Opinion about IRS 1. Advantageous
2. Side effect