STATUS OF MALARIA INFECTION AND ITS ASSOCIATED
ANTHROPOGENIC RISK FACTORS IN HADERO TOWN,
SOUTHERN ETHIOPIA
MSc THESIS
ZEMEDE ABEBE
OCTOBER, 2015
HARAMAYA UNIVERSITY, HARAMAYA
Status of Malaria Infection and its Associated Anthropogenic Risk
Factors in Hadero Town, Southern Ethiopia
A Thesis Submitted to the Department of Biology,
Postgraduate Program Directorate
HARAMAYA UNIVERSITY
In Partial Fulfillment of the Requirements for the Degree of
MASTER OF SCIENCE IN MICROBIOLOGY
Zemede Abebe
October, 2015
Haramaya University, Haramaya
HARAMAYA UNIVERSITY
POSTGRADUATE PROGRAM DIRECTORATE
I hereby certify that I have read and evaluate this Thesis entitled “Status of Malaria
Infection and its Associated Anthropogenic Risk Factors in Hadero Town, Southern
Ethiopia”. I recommend that it be submitted as fulfilling the thesis requirement.
Sissay Menkir (PhD)
Name of Advisor
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Date
Sewnet Mengistu (PhD)
Name of Co. Advisor
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Date
As member of the Board of the Examiners of the MSc Thesis Open Defense Examination,
I certify that I have read and evaluated the Thesis prepared by Zemede Abebe and
examined the candidate. We recommend that the thesis be accepted as fulfilling the Thesis
requirements for the degree of Master of Science in Microbiology.
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Final approval and acceptance of the Thesis is contingent upon the submission of its final
copy to the Council of Postgraduate Program Directorate (CPPD) through the candidate’s
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ii
DEDICATION
I dedicate this Thesis to my Families.
iii
STATEMENT OF THE AUTHOR
By my signature below, I declare and affirm that this Thesis is my own work. I have
followed all ethical and technical principles of scholarship in the preparation, data
collection, data analysis and completion of this Thesis. Any scholarly matter that is
included in the Thesis has been given recognition through citation.
This Thesis is submitted in partial fulfillment of the requirements for a Master degree at
the Haramaya University. The Thesis is deposited in Haramaya University Library and is
available to borrowers under the rules of the Library. I solemnly declare that this Thesis
has not been submitted to any other institution anywhere for the award of any academic
degree, diploma or certificate.
Brief quotations from this Thesis may be made without special permission provided that
accurate and complete acknowledgement of source is made. Requests for permission for
extended quotation from or reproduction of this Thesis in whole or in part may be granted
by the Head of the School or Department when in his or her judgment the proposed use of
the material is in the interests of scholarship. In all other instances, however, permission
must be obtained from the author of the Thesis.
Name: Zemede Abebe
Signature: ______________
Date: ____________________
School/Department: ________________________________________________
iv
BIOGRAPHICAL SKETCH
The author was born on March 10, 1982 in Kembata Tembero Zone of Southern Ethiopia.
He attended his primary school at Hobichaka Primary School and his secondary school at
Shinshicho Secondary School. He joined Addis Ababa University in 1999/2000 and
graduated with BSc. Degree in Biology in 2004. From 2005-2006 he had been teaching
biology at Sodo Ber Secondary School, Wolaita Sodo town in southern Ethiopia and from
2007 until now he is teaching biology at Hadero Secondary School. In July 2010, he joined
Haramaya University, Department of Biology to pursue his masters study in Microbiology.
v
ACKNOWLEDGEMENTS
First, I would like to express my deepest gratitude to my advisors, Dr Sissay Menkir and
Dr Sewnet Mengistu for their guidance and encouragement at all steps of this study.
I would like to express my sincere gratitude to Hadero Health Office staff members and
Hadero Health Center staff members for their unlimited cooperation and support by
providing necessary materials and information, allowing me to use the laboratory facilities
and provide me technical support. My special thanks goes to Hadero Health Center
laboratory technicians, Kidist Yohannes and Desalegn Gebre, without whom blood sample
collection and diagnosis would have been very difficult. I would like to thank all Health
extension workers in Hadero town and sampled population who participated in this study,
without them the study would not succeed.
I would also like to thank my colleagues in Hadero Secondary and Preparatory School for
their encouragement, support and cooperation in reducing the burden of work at school
during the study periods.
Moreover, my great thanks go to all my family members for their encouragement and
support during the study periods. Special thanks go to my brother Alemayehu Abebe and
Ato Paulos Lamore for their moral, financial and material support.
Above all I thank the almighty God!!!
vi
ACRONYMS AND ABBREVIATIONS
ACIPH
Addis Continental Institute of Public Health
ACT
Artemisinin-based Combination Therapy
AL
Arthemisisin-Lumefantrine
CDC
Center for disease control
CSA
Central Statistical Agency
DDT
Dichlorodiphenyltrichloroethane
EHNRI
Ethiopian Health and Nutritional Research Institute
FMOH
Federal Ministry of Health
HHC
Hadero Health Center
HTZWARDO
Hadero Tunto Zuria Woreda Agriculture and Rural Development Office
HTZWHO
Hadero Tunto Zuria Woreda Health Office
ITNs
Insecticide Treated Mosquito Nets
IRS
Indoor Residual Spray
LLIN
Long lasting insecticide treated nets
MIS
Malaria Indicatory Survey
MOP
Malaria Operational Plan
PMI
President’s Malaria Initiative
RBM
Roll Back Malaria
RDT
Rapid Diagnostic Test
RUM A
Rapid Urban Malaria Appraisal
SNNPR
Southern Nations Nationalities and People’s Region
SSA
Sub-Saharan Africa
WHO
World Health Organization
WMR
World malaria report
vii
TABLE OF CONTENTS
STATEMENT OF THE AUTHOR
iv
BIOGRAPHICAL SKETCH
v
ACKNOWLEDGEMENTS
vi
ACRONYMS AND ABBREVIATIONS
vii
LIST OF TABLES
xi
LIST OF FIGURES
xii
LIST OF TABLES IN THE APPENDIX
xiii
ABSTRACT
xiv
1. INTRODUCTION
1
2. LITERATURE REVIEW
5
2.1 The Malaria Parasites
5
2.2 Route of Transmission and Life Cycle of Malaria Parasite
5
2.3 Malaria Vectors
6
2.4 Global Malaria Situation
7
2.5 Malaria in Ethiopia
9
2.5.1 Epidemiology
9
2.5.2 Burden of the Disease
10
2.5.3 Role of Human Factors in Spread of Malaria in Ethiopia
11
2.6 Malaria Control and Prevention Methods
11
2.6.1 Early Diagnosis and Treatment
12
2.6.2. Vector Control
12
2.6.2.1 Insecticide treated mosquito nets (ITNs)
13
2.6.2.2 Indoor residual spray (IRS)
13
2.6.2.3 Environmental management
13
2.7 People’s Knowledge and Practice towards Malaria Transmission and
Prevention
14
3. MATERIALS AND METHODS
16
viii
TABLE OF CONTENTS (Continued…)
3.1. Description of the Study Area
16
3.2 Study Design
18
3.3 Study Population
18
3.4 Sample Size Determination
18
3.5 Sampling Technique
19
3.6 Method of Data Collection
19
3.6.1 Questionnaire Survey
19
3.6.2 Collection of Malaria Health Records
19
3.6.3 Blood Sample Collection and Preparation of Blood Films
19
3.6.4 Microscopic Examination of Blood Samples for Malaria Parasites
20
3.7 Data Analysis
20
3.8 Data Quality Control
20
3.9 Ethical Consideration
20
4. RESULTS AND DISCUSSION
21
4.1 Socio-Demographic Characteristics of the Study Participants Used as
Source Blood Samples
21
4.2 Socio-Demographic Characteristics of Study Participants Included in
the Questionnaire Survey
22
4.3 Ten Years Trends of Malaria Prevalence in Hadero Health
Center 24
4.4 Prevalence of Malaria Infection in the Study Area
28
4.5 People’s Knowledge about Transmission, Prevention and Control of
Malaria
29
ix
TABLE OF CONTENTS (Continued…)
4.6 Factors Affecting Effective Utilization of Insecticide Treated Mosquito
Nets and Indoor Residual Sprays
32
4.7 Anthropogenic Factors Contributing to Transmission of
Parasites
Malaria
34
5. SUMMARY AND CONCLUSION
36
5.1 Summary
36
5.2 Conclusion
38
5.3 Recommendations
39
6. REFERENCES
39
APPENDICES
46
Appendix I Questionnaire
46
Appendix II Questionnaire (Amharic Version)
49
Appendix III Written Consent Form
51
APPENDIX IV Written Consent Form (Amharic)
52
Appendex V Appendex Tables
54
x
LIST OF TABLES
Table
Page
1. Socio-demographic characteristics of study participants (n=422) in blood
examination in Hadero town, during October to December, 2014
21
2. Socio-demographic characteristics of heads of households who participated (n=106)
in the questionnaire survey in Hadero town during October to December, 2014
23
3. Annual malaria prevalence rates among outpatients in Hadero Health Center,
from 2004 to 2013.
25
4. Prevalence of malaria in sample population by age, during October- December, 2014. 28
5. Prevalence of malaria in sample population by sex, October – December, 2014
29
6 .Knowledge of participants about symptoms and transmission mechanisms of
malaria, and mosquito behaviors, Hadero town, 2014
30
7. Practices of people towards malaria prevention and control, Hadero town,
southern Ethiopia, 2014
31
8. Characteristics of Insecticide Treated Net ownership and use of households, Hadero
town, 2014
33
xi
LIST OF FIGURES
Figure
Page
1. Life cycle of malaria parasite
6
2. Map of World malaria distribution
9
3. Map of the study area
17
4. Trends of Plasmodium species infection rates in Hadero Health Center from
2004 to 2013.
26
5. The distribution of malaria parasite infection rates among male and female
outpatients at Hadero Health Center from 2004 to 2013.
26
6. Monthly trends of malaria positive cases for the last 10 years in Hadero Health Center,
2004-2013.
27
7. Anthropogenic factors contributing transmission of malaria, Hadero Town,
Sothern Ethiopia, 2014
35
xii
LIST OF TABLES IN THE APPENDIX
1. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2004
54
2. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2005
54
3. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2006
55
4. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2007
55
5. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2008
56
6. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2009
56
7. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2010
57
8. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2011
57
9. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2012
58
10. Annual malaria prevalence with age, sex and parasite type in Hadero Health Center,
2013
58
xiii
Status of Malaria Infection and Its Associated Anthropogenic Risk
Factors in Hadero Town, Southern Ethiopia
ABSTRACT
Malaria is one of the major public health problems in Ethiopia. The aim of the current
study was to determine prevalence of malaria infection and associated anthropogenic risk
factors as well as people’s knowledge and practice towards the transmission, prevention
and control measures among households in Hadero town. The investigation was conducted
in one peak malaria transmission season from October to December, 2014. The study
involved a cross-sectional household survey for malaria cases, the socio-demographic
characteristics, level of knowledge towards cause, transmission and prevention of malaria
and use of retrospective clinical records from health institution of the Hadero town. SPSS
Version 16.0 was used for statistical data analysis. Within the last decade (2004–2013) a
total of 32,296 blood films were collected for malaria diagnosis in Hadero Health Center
and 11,554 microscopically confirmed malaria cases were recorded. Regarding malaria
parasites, Plasmodium vivax, Plasmodium falciparum and mixed infection of both species
accounted for 53.3%, 46.1%, and 0.6%, respectively, with a fluctuating trend of
prevalence rates. In this study a total of 422 thick and thin blood films were collected from
selected household members and examined for malaria parasite. The prevalence of
malaria parasite was 2.1% of which P.vivax and P.falciparum accounts for 1.9% and
0.2%, respectively. More females (55.6%) were infected than males (44.4%), but the
difference was not statistically significant (P>0.05). Relatively higher prevalence rate of
malaria infection was observed among ages ≥15 years old (1.4%) than ages 5-14 years old
(0.5%) and <5 years old (0.2%) but the differences were not statistically significant
(P>0.05). A high level of knowledge about the cause, transmission and preventive methods
of malaria was observed among the respondents, but there was problem of implementation.
However, a considerable proportion of study participants had misconception about the
cause and transmission of malaria suggesting the necessity of health education to raise the
community’s awareness about the disease. At the same time environmental sanitation to
avoid vector breeding sites was highly recommended in the study area.
Key word: anthropogenic, knowledge, Malaria, P. falciparum, Prevalence
xiv
1. INTRODUCTION
It has been over 135 years since the causative parasites of malaria were discovered.
However, malaria still remains a major global public health challenge. Malaria is caused
by infection with single-celled protozoan parasites belonging to the genus Plasmodium and
transmitted by female mosquitoes of the Anopheles genus. The four malaria parasite
species that infect and cause disease in humans are Plasmodium falciparum, P.vivax, P.
malariae and P.ovale (WHO, 2011; Cox, 2010). The fifth species that is recently known to
infect human beings is P.knowlesi (CDC, 2014). Other Plasmodium species infect
primates, rodents, birds and lizards. Several of these species, particularly those that infect
rodents, have been used in experimental studies and for testing malaria drug and vaccines.
The first symptoms of malaria are nonspecific; lack of sense of wellbeing, headache,
fatigue, abdominal discomfort, and muscle aches followed by fever are all similar to the
symptoms of a minor viral illness (Nicholas et al., 2008). In general, malaria is
characterized by periodic bouts of severe chills and high fever. Serious cases of malaria
can result in death if left untreated (EHNRI, 2012).
Malaria was once wide spread in North America and other temperate regions. Today, the
disease occurs mostly in tropical and subtropical regions, particularly in sub-Saharan
Africa and Southeast Asia. The disease is also found in Central and South America,
Oceania, and in some Caribbean islands (WHO, 2012; CDC, 2013).
Malaria threatens the lives of 40% of the world’s population. Each year, there are an
estimated 300-500 million clinical cases and more than 1million death globally, the
majority of whom are young children. Africa has the greatest burden of malaria cases and
deaths in the world. About 90% of malaria cases occur in Africa South of the Sahara
(SSA). In 2010, of the 216 million cases and 655,000 deaths worldwide, 81% and 91%,
respectively were from SSA. In Africa, malaria is responsible for about 20-30% of hospital
admissions and about 30-50% of outpatient consultations (WHO, 2011).
Public health officials had hoped to wipe out malaria during the 20th century. However,
malaria parasites have developed defenses against many antimalarial drugs. This response,
known as drug resistance, makes the drugs less effective. In addition, the Anopheles
mosquitoes that transmit the disease have become resistant to many insecticides (WHO,
2014).
2
Malaria’s cost to human and social wellbeing is enormous. The economic loss from
malaria was estimated to be more than US$12 billion every year, and this was mainly due
to the heavy toll it inflicts on families in rural areas. There are evidences that show malaria
and poverty are intimately connected. Malaria is a major cause of poverty, and poverty
exacerbates the malaria situation. Malaria predominantly affects rural and poor populations
that have little or no access to current prevention and treatment tools (Tren, 2000;
Anonymous, 2013).
Malaria is mostly a disease of hot climate. It often exhibits strong seasonality, reflecting
seasonal patterns of precipitation, temperature and land use. The female Anopheles
mosquito, which transmits the malaria parasite survives in warm and humid climates where
pools of water provides perfect breeding grounds. It proliferates in conditions where
awareness is low and health care systems are weak (Michael et al., 2012).
Malaria remains a global health problem, and public health efforts today focus on
controlling it. In addition, a worldwide effort is underway to develop a vaccine that
protects people against the disease. In the meantime, it is believed that sleeping under bed
nets treated with insecticide can greatly reduce deaths from malaria, especially among
children (Daddi et al., 2010).
Ethiopia is mostly affected by malaria epidemic primarily due to its varying topographical
and climatic features. Malaria was previously considered as a major public health threat to
people living in lowland areas of the country. In recent years, however, the disease has
been expanding its geographic coverage and it is increasingly recognized as a major health
problem in midlands and even in some highland areas of the country (Wakgari, 2006).
In Ethiopia, malaria remains one of the most public health problems despite considerable
efforts made to control it (FMOH, 2012). Approximately 75% of the land mass where 68%
of the total population live is malarious (PMI, 2015). That is, more than 50 million people
are at risk from malaria. The Federal Democratic Republic of Ethiopia, Ministry of Health
estimated that there are more than 5 million clinical cases and thousands of deaths due to
malaria each year. However, the epidemiological pattern of the disease varies from place to
place and even from time to time. Malaria transmission peaks bi-annually from September
to December and April to May, coinciding with the major cropping seasons. This has
serious consequences for Ethiopia’s subsistence economy and for the nation in general.
3
Major epidemics occur every five to eight years with focal epidemics as the commonest
form (FMOH, 2011).
In Ethiopia, human factors that are contributing a lot to the spread of malaria include
population growth and movement, urbanization, water development schemes, agricultural
development, conflicts, low level of education and improper use of drugs and bed nets and
consequences of the emerging drug resistant malaria (Aynalem, 2008).
Due to availability of favorable conditions for the vector to develop and multiply, malaria
tends to predominantly occur in rural areas (Asnakew et al., 2009). However, studies
documented increased malaria transmission in urban areas. This could be associated with
the rapid growth of cities coinciding with lack of proper sanitation, poor housing and poor
drainage of surface water that facilitate human-mosquito interaction and subsequent
malaria transmission (Prathiba, 2012).
Currently in Ethiopia, the national strategy to control malaria consists of: early diagnosis
and treatment, use of insecticide treated mosquito nets (ITNs), use of indoor residual spray
(IRS) and environmental management. Information on how these strategies work in the
population together with the identification of the main determinants that influence
protective behaviours related to community knowledge and practices are required to
monitor and evaluate the progress of the malaria control effort (Abebe et al., 2012).
In Ethiopia, the community health extension workers provide malaria prevention and
control information and conduct activities in nearly all malaria endemic areas. Regardless
of these prevention and control efforts, malaria still remains as the major cause of
morbidity, mortality and socio-economic problems in some parts of the country due to
many factors (Dawit et al., 2012). Some of the factors accelerating the spread of disease
are weak community health services, increased migration of people from malarious rural
areas to urban areas, limited tradition of indoor residual insecticide spraying and bed net
use, increased number of man-made mosquito breeding sites, irrigation schemes and water
collection reservoirs (Wakgari et al., 2006).
The Southern Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia is one of the
regions of the country, which is highly affected by malaria. Although there is a lot of
documented information on malaria at national and regional level, there was no
documented information on prevalence of malaria and the practice of intervention
4
mechanisms in the Hadero district, SNNPR. The knowledge of the cause, mode of
transmission and individual’s preference of prevention and control measures of malaria
vary among individual households (Yared et al., 2007). Therefore, an epidemiological
study involving determination of prevalence of malaria and its associated anthropogenic
risk factors in Hadero town would be important as a pre-requisite to recommend and
design appropriate prevention and control measures in the study area. Therefore, the
purpose of this study was to determine the current status of malaria infection and
associated anthropogenic risk factors as well as people’s knowledge and practice toward
the disease transmission and control measures in Hadero town, Southern Ethiopia.
General objective
To determine the prevalence of malaria infection and associated anthropogenic factors as
well as to assess people’s knowledge and practice towards the disease transmission,
prevention and control measures among households in Hadero town, Kembata-Tembaro
Zone, Southern Ethiopia.
Specific objectives

To elucidate the trend of malaria infection in the study area over the last 10 years
(2004-2013).

To determine the current prevalence of malaria parasites among inhabitants in the
study area.

To assess the people’s knowledge and practice towards malaria transmission,
prevention and control methods in the study area.

To identify factors affecting effective utilization of insecticide treated mosquito
nets and indoor residual spray among households in the study area.

To assess anthropogenic risk factors contributing to the transmission of the malaria
parasites in the study area.
5
2. LITERATURE REVIEW
2.1 The Malaria Parasites
Malaria parasites are micro-organisms that belong to the genus Plasmodium. There are
more than 100 species of Plasmodium, which can infect many animal species such as
reptiles, birds, and various mammals (CDC, 2012). Malaria is a disease caused by blood
parasites of the genus Plasmodium, which infects human and insect hosts alternatively.
Four plasmodium species are known to infect humans: Plasmodium falciparum,
Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae. Recently, a new malaria
parasite species named P. knowlesi has been identified in Asia affecting both humans and
animals (EHNRI, 2012). Malaria due to P. falciparum is most deadly and it predominates
in Africa; P. vivax is less dangerous but more widespread and other species are found
much less frequently (WHO, 2012).
2.2 Route of Transmission and Life Cycle of Malaria Parasite
Malaria infection may be acquired congenitally from mother to baby across the placenta,
from platelet or blood transfusions and from the use of shared needles; however it is most
frequently initiated with the bite of an infected, female Anopheles mosquito, which injects
the sporozoite stage of the parasite with its bite into blood stream (EHNRI, 2012).
The life cycle of plasmodium involves several stages both in human host and in mosquito
vector (Fig 1). The sporozoite injected in to blood stream travel to the liver. Upon
sporozite replication in the liver, merozoites release into the blood stream. The merozoite
bind to the surface then enters the red blood cells (RBC). The parasite then undergone
growth through the ring and trophozoite stages, finally producing schizonts containing
multiple merozoites (erythrogenic cycle). Matured schizonts destruct RBCs and release
merozoites into the bloodstream, which re-invade new RBCs. Occasionally, parasite
maturation will result into production of gametocytes which may be released into the
bloodstream and subsequently taken up by the mosquito, via a bite. The gametocytes
undergo the sexual stage of development (sporogenic cycle) in the mosquito. When the
mosquito takes next blood meal, 10-14 or more days later, it can again infect a human host
(CDC, 2004; Lamb et al., 2006).
6
Figure 1 Life cycle of malaria parasite
Source: CDC http:// www.dpd.cdc.gov/dpdx/HTML/Malaria.htm.
2.3 Malaria Vectors
Malaria parasites are transmitted from person to person by female mosquitoes belonging to
the genus Anopheles (WHO, 2000). Females Anopheles mosquitoes require several blood
meals before laying eggs, while males feed by sucking fruit juices (CDC, 2013).
There are about 400 different species of Anopheles mosquitoes. Of these only 60 of them
transmit malaria under natural conditions, and only 30 are of major importance (Joel G.,
2001). Of the later, the Anopheles gambiae complex and Anopheles funestus are the most
efficient vectors for P. falciparum transmission in SSA (Mwangangi et al., 2013).
Anopheles gambiae subspecies is the most anthropophagic species in the complex and the
most important, probably the world’s most efficient malaria vector with characteristic
indoor and outdoor resting. Anopheles arabiensis occurs in most areas of tropical Africa
and could be considered as a major target for control, as a major vector where malaria
transmission is stable (Fortenille and Lochouran, 1999).
7
Some of the factors related to malaria transmission are the number (density), human-biting
habits, and longevity of Anopheline mosquito vectors are the most important. Mosquito
longevity is particularly important, because the portion of the parasite’s life cycle that takes
place within the mosquito from gametocyte ingestion to subsequent inoculation can take
from 8 to 30 days, depending on ambient temperature. In general, sporogony within the
mosquito is not completed at temperatures below 16 – 18°c, and transmission does not
occur (CDC, 2012).
Even though entomological findings conducted so far indicated the presence of 42
Anophelines species in Ethiopia, only An. arabiansis is known to play crucial role in
malaria transmission in the country. Others such as An. funestus, An. phareonnsis and An.
nili playing secondary role (Niguse, 1988). Anopheles arabiensis is the principal vector of
epidemic malaria in all administrative regions of Ethiopia (Birkinesh, 1995; Bayissa,
2007).
2.4 Global Malaria Situation
Malaria is a major public health and medical concern in many part of the world, especially
in countries of tropics and subtropics (Dash et al., 2007). Malaria occurs worldwide,
through its heavily concentrated in what area categorized by world health organization
(WHO) as the African, South east Asia, Eastern Mediterranean and Western Pacific
regions. Sub-Saharan Africa (SSA) is the hardest hit region in the world, and parts of Asia
and Latin America also face significant malaria epidemics (CDC, 2013).
According to the WHO, estimated half of the world’s population is at risk of malaria
infection (Alexander et al., 2012). Malaria is prevalent in 106 countries, referred to as
malaria endemic countries (Figure 2). According to 2011 World malaria report (WMR),
there was 216 million malaria episodes of which 86% of cases were in children under five
years of age, and 650,000 malaria death in 2010. Globally, despite of a 17% reduction in
the number of reported cases and 26% reduction in the number of deaths in 2010 as
compared to 2000, malaria is still a ubiquitous killer (Tobgay et al., 2013; Suleman et al.,
2013). About 81% of all malaria cases and 91% of all malaria-related deaths occurred in
the WHO Africa region (Andargie et al., 2013; WH O, 2011).
8
There are 43 malaria-endemic countries in the Africa region. The WHO Southeast Asia
region was home to 13% of all malaria cases and 6% of malaria-related deaths. Of the 10
malaria-endemic countries in the South-East Asia region, India, Myanmar (Burma), and
Indonesia make up 94% of all confirmed malaria cases. The WHO Eastern Mediterranean
region was home to 5% of all malaria cases and 3% of malaria-related deaths. In the
region, Sudan, Pakistan, Yemen, and Afghanistan make up 97% of confirmed malaria
cases. Western Pacific representing less than 1% of estimated global cases. There were 10
malaria-endemic countries in this region. Cambodia, Papua New Guinea, and Solomon
Islands represented 75% of the region’s reported cases in 2010(WHO, 2012).
Despite of increasing efforts to control, eliminate or eradicate malaria in many countries, it
continues to affect million of people’s worldwide, especially in SSA. The effort to control
malaria is hindered by ineffective treatment and vector control strategies that cannot be
sustained in economically disadvantageous countries (Feachem, 2010).
The rapid increase of the world's urban population has major implications for the
transmission and epidemiology of malaria and other vector-borne diseases (Lines et al.,
1994). Heterogeneity in urban malaria transmission patterns is driven mostly by human
activity, urban development and environmental determinants (Wang et al., 2006). For
instance, the emergence of urban malaria as major public health problem in many small,
medium and metropolitan cities of India, which was essentially the result of a man made
problem such as of rapid and casual expansion of the cities, inadequate piped water supply,
storage of water in cisterns, disuse or scarce use of wells, developmental activities,
aggregation of migrant labor force and overall population movement (Hay et al., 2005).
Although malaria widely infects rural communities of Sub Saharan Africa, it has been
gaining attention as an urban disease even if suitable vector breeding sites are scarce in
highly populated areas. In such urban areas the urban poor are at far higher risk from
malaria (Donnelly et al., 2005).
9
Figure 2 Map of World malaria distribution
(Source:http://www.nature.com/nrmicro/journal/v4/n9_supp/figtab/nrmicro1525F2.html )
2.5 Malaria in Ethiopia
2.5.1 Epidemiology
Malaria is one of the top ranking causes of morbidity and mortality in Ethiopia. It is also
one of the main causes of hospitalization and death in all corners of the country (Tulu,
1993). In Ethiopia, approximately 68% of the recently estimated 92 million total
populations, about 63 million people are at risk of malaria infection (Adugna et al., 2013).
The Dega zone of Ethiopia (altitude above 2,500 meters) with a mean annual temperature
of 10-150C are malaria free. Much of Woina-Dega zone (altitude 1500-2500 meters) is also
malaria free, especially the zone in the 2000-2500 meters above sea level (Aynalem, 2008).
Malaria in Ethiopia often occurs below 2000 meters, with short lived transmission
following the rains (PMI, 2013). There is little risk of malaria above 2000 meters.
However, malaria epidemics have been recorded up to 2400 meters during periods when
increased temperature and adequate precipitation are conducive for both vector survival
and parasite development within the vector (Tewoderos, 2006). It has been estimated that
approximately 68% of the Ethiopian people live in areas less than 2000m of altitudes and,
thus, are considered to be at risk of malaria. The western, central and eastern highlands, as
well as the highland-fringe areas along the Rift Valley are especially vulnerable to
epidemics (PMI, 2013).
10
Unlike large part of Sub-Saharan Africa, the pattern of malaria transmission in Ethiopia is
unstable and seasonal. Therefore, the protective immunity of the population is generally
low and all age groups are at risk of infection (Adugna et al., 2013). Most malaria cases
were observed in persons over five years of age, although children under five and pregnant
women are most vulnerable to the severe effects of infection (FMOH, 2011). Even though
the occurrence of all human malaria parasites is reported, Plasmodium falciparum and
Plasmodium vivax are epidemiologically the most important malaria parasites in the
country. Plasmodium falciparum has been the major causes of high case fatality (Adugna
et al., 2013).
2.5.2 Burden of the Disease
Despite the low malaria parasite prevalence compared to many African countries, malaria
remains the leading communicable disease seen at health facilities in Ethiopia (PMI, 2013).
According to the WHO, in 2010 there were 4,068,764 probable and confirmed cases of
malaria and 1,581 reported deaths from malaria in Ethiopia (WHO, 2011). Malaria
transmission peaks bi-annually from September to December and April to May, coinciding
with the major harvesting seasons (FMOH, 2012). This seasonality has serious
consequences for the subsistence economy of Ethiopia’s countryside and for the nation in
general (Dawit et al., 2013). Malaria affect the population during the planting and
harvesting seasons, cutting down productive capacity at the time when there is the greatest
need for agricultural work. The disease has also been associated with loss of earnings,
school attendance, and high treatment cost. During epidemics, health facilities are
overwhelmed with patients and many resources are diverted to deal with the emergency
(FMOH, 2011).
The socioeconomic burden resulting from malaria includes reduced production activities;
prevents the movement and settlement of people in resource-rich lowlands, therefore
caused concentration of population in non-malaria risk highland areas and resulted in a
massive environmental and ecological degradation and loss of productivity, exposing a
large population of the country to repeated droughts, famine and overall poverty. The
increased school absenteeism during malaria epidemics significantly reduces learning
capacity of students. Coping with malaria epidemics overwhelms the capacity of the
health services in Ethiopia, and thus substantially increases public health expenditures
(Aynalem, 2008).
11
2.5.3 Role of Human Factors in the Spread of Malaria in Ethiopia
Human factors in Ethiopia contributing to the spread of malaria include population growth
and movements, urbanization, water development schemes, agricultural development, and
improper use of drugs and the attendant consequences of the emerging drug resistant
malaria parasites. High vector population densities, together with large human population
create a favorable condition for vector-man contact which finally leads to increased rate of
malaria epidemic. Rapid population growth in rural area forces the poor to migrate to
urban areas increasing the spread of urban malaria (Aynalem, 2008).
Rapid growth in urban population results a number of man-made mosquitoes breeding sites
include construction of borrow pits and brick making pools, garbage dumps, old tires, and
discarded containers in household and office compounds. Urban areas have also
traditionally not been included in spray operations or bed-net distribution programs. When
favorable climatic conditions for transmission exist, the high urban population density, the
presence of multiple breeding sites, the lack of indoor residual spray, and lower household
bed-net coverage, allow for rapid spread of malaria. Micro and Macro dams for irrigation
and hydroelectric power generation contribute a lot for malaria infection in the nearby
people (Tewodros, 1999; 2006).
The low educational level of malaria sufferers often fail to adhere prescription
requirements, or stop medication all together up on feeling well. As is the case elsewhere
where malaria is endemic drug-resistance has been the inevitable outcome in many parts of
Ethiopia. There is no national study on drug resistance in Ethiopia but isolated studies have
shown drug resistance to be less than 5% in Humera and as high as 18% in Zway
(Afework, 2006).
2.6 Malaria Control and Prevention Methods
In Ethiopia since 2005, the National Malaria Control Program intensified the deployment
of key malaria interventions including Artemisinin-combination therapy (ACT), malaria
rapid diagnostic tests (RDTs), and vector control measures. Thus, in recent years, malaria
burden decreased and large-scale epidemics were absent (Adugna et al., 2013).
maximal
benefit
from
the
current
effective
malaria
prevention
and
For
control
armamentariums, such as ITNs or indoor residual spraying (IRS), early diagnosis with
12
microscopic examination and rapid diagnosis tests and treatment of confirmed malaria
cases with ACT, it is imperative that communities are educated to enable them to make
informed decisions. Therefore, mobilizing of the necessary human and material resources,
particularly the community itself is extremely important in the control of malaria
epidemics (Wakgari et al., 2005; Tobgay et al., 2013)
2.6.1 Early Diagnosis and Treatment
Ensuring prompt and effective treatment will prevent most cases of uncomplicated malaria
from progressing to severe and fatal illnesses. To avoid this progression, treatment must
begin as soon as possible, generally within 24 hours after symptoms onset. Effective
malaria treatment requires improved diagnosis of malaria ( laboratory-based microscopy or
use of RDTs); well trained health workers and constant availability of highly efficacious
medicines as close to the patient as possible to ensure prompt access (Ameyu, 2008;
FMOH,2012).
Laboratory evidence providing confirmation of malaria (i.e. microscopy or RDT) by
malaria species requires prompt treatment with the appropriate anti-malarial medications
(FMOH 2012; EHNRI, 2012). P. falciparum patient should be treated with appropriate
doses of Artemisinin-based combination therapy (ACT) and P. vivax with Chloroquine.
Treatment with Primaquine is recommended at health center and hospital level for patients
who are P. vivax positive and are not living in malaria endemic areas. Mixed infection of
P. falciparum and P. vivax should be treated with Arthemisisin-Lumefantrine (AL).
Pregnant women with P. falciparum in the first trimester and children weighing less than
five kilograms need to be treated with oral Quinine, an alternative to AL (FMOH, 2012;
Suleman et al., 2013).
2.6.2. Vector Control
The goals of malaria vector control are two-fold: to protect individual people against
infective malaria mosquito bites and to reduce the intensity of local malaria transmission at
community level by reducing the longevity, human-vector contact and density of the local
vector mosquito population. The most broadly applied interventions are long lasting
insecticidal nets (LLINs) and indoor residual sprayings (IRS). These interventions work by
reducing human vector contact and by reducing the life span of adult female Anopheles
mosquitoes (WHO, 2012).
13
2.6.2.1 Insecticide treated mosquito nets (ITNs)
Insecticide treated nets (ITNs), which include both LLINs and conventional nets that are
later treated with an insecticide, work both by protecting the person sleeping under the net
and by extending the effect to an entire area (community level)(WHO, 2012). In recent
years there has been a large scale-up of vector control for protection against malaria in
SSA, primarily through the expanded provision of ITNs and LLINs with funding from
international sources (Yukich et al., 2013).
Ethiopia is implementing a range of malaria control interventions which include prompt
malaria treatment, selective vector control using ITNs and IRS. However study conducted
in Oromya and Amhara regional State showed, ITNs was not consistently used by all
members of the households. Inappropriate use and misuse of ITNs was common. There
was also doubt about the effectiveness when used over a long period of time. Preference to
certain shape and color of ITNs by some people was also noted. Distribution of ITNs
didn’t consider the size of family. Proper utilization of ITNs can be ensured through
availing ITNs which is adequate for all members of the family (ACIPH, 2009).
According to Ethiopian national malaria indicator survey (MIS) 2011, progress has been
observed in terms of net use among children under 5 in households that owned nets
(EHNRI, 2011).
2.6.2.2 Indoor residual spray (IRS)
IRS involves the application of insecticides to the inner surface of dwellings where many
vector species of Anopheline mosquitoes tend to rest after taking a meal. IRS is effective in
rapidly controlling malaria transmission, hence in reducing the local burden of malaria
morbidity and mortality, provided that most houses and animal shelters in targeted
communities are treated. DDT has a comparatively long residual efficacy as an insecticide
for IRS (WHO, 2012).
2.6.2.3 Environmental management
Environmental management refers to planning, organizing, caring out and monitoring of
activities for the modification and manipulation of environmental factors with an
inspection to preventing or minimizing vector propagation and reducing man-vector
14
contact (WHO, 2011). Since mosquitoes need water to breed, environmental management
involves the modification of the environment to make it unfavorable for the vectors to
breed. Measures include draining or filling up of ponds and borrow pits, intermittent
draining of irrigated areas and construction of drainage channels (HaileMariam, 2010).
Characterization of mosquito breeding habitats is often accomplished with the goal of
guiding larval control interventions as well as the goal of identifying areas with higher
disease risk (Valle et al., 2013).
Study carried out in Ghana showed, the breeding sites that had clear and shallow water
produced higher densities of Anopheline larvae than domestic waste water. Generally, the
mosquito breeding sites that were identified within the study area included sand ponds,
edges of streams, drainage channels on sugar cane and vegetable cultivation sites and
temporary pools created after rains, choked drains, pools of water collecting in foundations
of uncompleted buildings and abandoned sand winning sites(Nartey et al., 2013).
WHO recommends that vector control interventions of IRS and ITNs may be
complemented mosquito larval source management. Anti-larval measures are advisable
only in a minority of settings, where mosquito breeding sites are few, fixed, and findable.
Various larval control methods used in malaria endemic countries are habitat modification,
chemical larviciding and biological larviciding (WHO, 2012).
A study carried out in Kenya revealed that adding early season larval control and IRS to
high ITNs coverage has limited added impact on outdoor malaria transmission. Alternative
control methods were needed to eliminate outdoor transmission and long-lasting Bacillus
thuringiensis israelensis (Bti) formulation was needed to sustainably suppress larval
population (Zhou et al., 2013).
2.7 People’s Knowledge and Practice towards Malaria Transmission and
Prevention
Knowledge about the mode of transmission and preventive measures of malaria is
important factors for acceptance and use of proven control tools by the community. A
study carried out so far indicated most of the community members in the country had
correct knowledge about causes, symptoms, mode of transmission and prevention methods
of malaria. But some misconceptions include transmission via utensils and eating certain
15
food items also observed (Yared et al., 2007). Most people recognize ITNs, IRS and early
treatment as strategies for malaria prevention and control; however the majority also
believed environmental management to be effective prevention strategy (ACIPH, 2009).
Study conducted in Jimma town showed that most of the residents responded that mosquito
bite as a cause of malaria. However some residents were perceived that malaria is caused
by exposure to cold weather and excessive heat, drinking bad water and eating rotten fruits.
The study also showed that community members believed that malaria is treatable disease
(Alemayehu, 2008). Another study conducted in Shashamane Woreda, Oromia regional
State shown that 72.6% of respondents were associated the cause of malaria with
mosquitoes and 18.9% associated the disease with hunger, sun stroke, cold, bad odor, body
contact with patients and even with evil spirit. From this study participants, 68% had
perceived malaria as preventable disease by draining, 64.4% by using ITNs and 22.2% by
taking tablets (Kedir, 2011).
Study in Shewa Robit town, northeastern Ethiopia, showed that majority of study
participants were associated the cause of malaria with mosquito bite, while some
associated it with lack of personal hygiene, exposure to cold weather, hunger, chewing
maize stalk, body contact with malaria patient, flies and respiratory route as cause of
malaria. All respondents were believed that malaria is preventable disease. However,
knowledge gaps about the cause and transmission of malaria were also observed among the
residents in the study area (Andargie, 2013).
Study conducted in Sarpang district, Bhutan, showed that majority of community members
Know the causes of malaria, its symptoms and seeking health facility as the first line of
treatment for malaria. This study indicated that community-directed interventions can be
utilized as an effective means for improving knowledge, attitude and practice in the
malaria-endemic areas (Tobgay et al. 2013).
16
3. MATERIALS AND METHODS
3.1. Description of the Study Area
The study was carried out in Hadero town, southern Ethiopia, from October to December,
2014. Hadero town is situated in north central part of Southern Nations Nationalities and
People’s Regional State (SNNPR), Kembata Tembaro Zone, Hadero Tunto Zuria Woreda.
Hadero is located 291Km south of Addis Ababa via Hossana and 380Km via Shashamene.
The woreda lies between 7°6′ 40″N & 7°18′20″N; and 37o 24′ 15″E & 37°48′18″E
longitude (Fig 3). The altitude ranges from 1100m asl at Ajora to 2650m asl at the highest
peak of Boha Tora (HTZWARDO, 2014).
The annual minimum and maximum temperature range from 18 to 32 degree centigrade,
respectively. The mean annual temperature is 25 degree centigrade. The rainfall is bimodal
pattern occurring during mid February – April (small rains) and June-August (main rainy
season).The mean annual rainfall is about 1200mm. The landscape of the area is plain
(42%), sloppy (46%), mountainous (7%) and gorge (5%). Most of the area is known to
have fertile soil, which is suitable for agricultural activities. The livelihood of the
communities is based on mixed farming (cultivation of crop and raring animals)
(HTZWARDO, 2014).
Hadero Tunto Zuria woreda covers a total area of 16,689sq.Km and has 16 kebeles (lowest
administrative unit) with total population of 130,304. The area experiences “daga” (12%),
“woina-dega” (87%) and “Kola” (1%) climates (HTZWARDO, 2014). All the “kola” and
“woina-dega” kebeles are endemic to malaria. There are four health centers in the woreda.
Each kebele has at least one health extension worker who is assigned to provide home-tohome health service to the community (HTZWHO, 2014).
Hadero town having woine-daga climatic condition is one of the hot spot malarious
kebeles with total population of 21,117. The town is divided into four sub-kebeles (01, 02,
03 and 04) and 26 villages with total households of 4,310. Most of the dwellers of Hadero
town are merchants and urban farmers. The majority of inhabitants are Protestants
(91.8%), Ethiopian Orthodox Christianity (4.79%) and Catholic (2.51%) believers. There
is one governmental health center and 9 private clinics and pharmacies in the town. There
17
are 6 health extension workers who are assigned to provide home-to- home health service
to the community in the kebeles. The town is enclosed by two rivers: Sana River from
west and Doje River from east borders. There is small scale irrigation from small dam at
Sana River and directly diverted water from Doje River that cross through the town in west
and east parts, respectively (CSA, 2007; HTZWARDO, 2014).
Study area
Figure 3 Map of the study area
18
3.2 Study Design
Community based cross-sectional investigation was conducted to assess the status of
malaria infection and associated anthropogenic factors among the inhabitants in Hadero
town, from October to December, 2014. The data was gathered using structured
questionnaire survey and parasitological examination of blood samples. In addition, the ten
years (2004 - 2013) malaria record was obtained from Hadero health Center.
3.3 Study Population
The study population was all members of the households of different age groups, sexes,
health conditions and educational backgrounds in Hadero town. Heads of households were
selected for questionnaire survey. All individual members of the selected households who
can give blood sample were included in this study.
3.4 Sample Size Determination
The sample size of this study was estimated using the statistical formula at 95% confidence
interval and 5% sampling error (Hassan, 1991):
n=
2
Z
( α⁄2) P(1−P)
d2
Where n = Sample size, p = 0.5 (prevalence value)
Zα/2=1.96 (Z=score corresponds to 95% confidence interval.)
d= 0.05 (margin of error)
2
n=
(1.96) (0.5)(0.5)
(0.05)
2
= 384
To minimize an error arising from the likelihood of non-compliance and non-responsive
sample population, 10% of the sample population was added to the above calculated
sample size. Therefore, 422 sample populations were included in the present study from
106 households. Assuming that 4 is the average family sizes, 106 household heads were
selected for questionnaire administration.
19
3.5 Sampling Technique
The total population of the Hadero town was considered as the study unit or source
population for this study. The source population was divided into 4 kebeles (01, 02, 03 and
04) and 26 villages. A multi-stage systematic random sampling technique was employed to
select the study participants. First three Kebeles (01, 02 and 04) were selected by lottery
method from Hadero town. Then 8 villages were randomly selected from selected Kebeles.
The number of households in selected villages was determined by proportion to the size of
households in each village. Systematic random sampling that means every 13th household
was selected for collection of blood samples and questionnaire survey.
3.6 Method of Data Collection
3.6.1 Questionnaire Survey
The questionnaire was first developed in English language by researcher and later
translated to Amharic and Kambatagna language (Appendixes 1 and 2). Before the real
data collection the questionnaire was tested using few individuals from Mugunja kebele
which was outside of the study area and with similar climatic conditions. The questionnaire
data was collected by researcher and health extension workers. The information was
collected from household heads or members of household whose ages were 18 years and
above. The questionnaire data included the socio-demographic information, knowledge
about malaria transmission, prevention and control methods, use of anti-malaria drugs,
utilization of insecticide treated mosquito nets and other malaria related issues.
3.6.2 Collection of Malaria Health Records
The health record for malaria cases was systematically collected and recorded on pre
structured format by investigator. The health records for the past 10 years (2004 - 2013)
were obtained from Hadero Health Center (Appendix 5).
3.6.3 Blood Sample Collection and Preparation of Blood Films
The finger tip of the study individual was cleaned with alcohol moistened cotton and dried
with a piece of dry cotton. Blood samples from sample population were collected by
pricking their finger-tips using sterile blood lancet and fixed on the slides with the help of
laboratory technicians from Hadero Health Center. Using the drop of blood, thin and thick
blood smears were made on a single glass slide per individual and labeled. The smears
20
were air-dried and the thin smear was fixed with 100% methanol for 30 seconds. The slides
were transported to HHC. Following this, the smears were stained with 10% Giemsa for 10
minutes (EHNRI, 2012).
3.6.4 Microscopic Examination of Blood Samples for Malaria Parasites
A Blood film was microscopically examined for malaria parasite based on a standard
operating procedure (SOP) in Hadero Health Center. The presence of malaria parasites on
thick blood smear was examined by using high power magnification objective (40x) and
the identification of Plasmodium species from the thin blood smear was done through oil
immersion objective (100x).
3.7 Data Analysis
SPSS version 16.0 was used for statistical data analysis. Descriptive statistics were used to
describe demography of the participants and the distribution of Plasmodium species. Cross
tabulation analysis was conducted to show the association of some socio-demographic
characteristics of sample populations with malaria. Statistical significance was defined at
P-values less than 0.05.
3.8 Data Quality Control
Before data collection, pre test for questionnaire was done among inhabitants in nearby
area with similar environmental condition outside of the study area and the necessary
correction of questionnaire was made. To ensure accurate and reliable results, quality
control was applied to laboratory procedures and for diagnosing parasites. The standard
operating procedure (SOP) was strictly followed.
3.9 Ethical Consideration
The study was reviewed and approved by local health officials and obtained letter of
permission. The aim of study was explained to Hadero District health Office and Hadero
Health Center officers before data collection. All the study participants were clearly
informed about the purpose of study and asked to participate in the study. Written
informed consent was obtained from each household of the study participants (Appendices
3 and 4). During the study period, all malaria cases were treated by proper type of
antimalarial drugs.
21
4. RESULTS AND DISCUSSION
4.1 Socio-Demographic Characteristics of the Study Participants used as
source of Blood Examination
A total of 422 individuals who were volunteers to give blood samples for blood film
examination in Hadero town from October to December, 2014 were included in this study.
With regard to the sex composition of the study participants, 205(48.6%) and 217(51.4%)
were males and females, respectively. The majority of the study participants were from
Kambata ethnic group (53.8%) and they were predominantly Protestant Christians
(73.9%). The ages of the study participants ranged from 1-60 years with the majority being
15 years and above old (Table 1).
Table 1 Socio-demographic characteristics of study participants (n=422) in blood
examination in Hadero town, during October to December, 2014
Variables
Sex
Description
Male
Female
Individuals tested for malaria
N (%)
205 (48.6)
217 (51.4)
Age
< 5 years
5-14 years
≥15 years
61 (14.5)
162 (38.4)
209 (49.5)
Religion
Protestant
Orthodox
Catholic
Muslim
311 (73.7)
78 (18.5)
30 (7.1)
3 (0.7)
Ethnicity
Kambata
Tembaro
Donga
Hadiya
Wolita
Others
227 (53.8)
41 (9.7)
42 (10.0)
54 (12.8)
25 (5.9)
33(7.8)
22
4.2 Socio-Demographic Characteristics of Study Participants involved in
the Questionnaire Survey
As shown in Table 2, one hundred six household heads participated in the questionnaire
survey. Regarding the sex of the participants, males were 66% and females constitute 44%.
The age of participants was between 18-60 years. The highest proportion was in the age
group of 31-45 years (52.8%) and the least age group was >45 years old. About 77% of
survey participants were married and 15.1%, 6.6% and 0.9%, were unmarried, widowed
and divorced, respectively. Most of the study participants were merchants (46.2%) and
government employees (16.0%). The rest were house wives (12.3%), students (12.3%),
farmers (7.5%) and daily labor workers (5.7%). About 86% of participants were literate
(had formal education); few household heads were illiterate (12.3%) (Unable to read and
write) and only one household head (0.9%) was able to read and write (Table 2).
About 86% of participants had access of media and 32.1% of the surveyed heads of the
households had a functioning radio whereas ownership of television was 54.7%. Regarding
their residential houses, less than half (46.2%) of the heads of households had cement
plastered house and all of the study participants had tin sheet covered houses. Majority of
the houses (48.1 %) had two bed rooms, 28.3% had three and above bed rooms and 23.6%
had only one bed room. More than half (54.7%) of the heads of the households interviewed
consisted of 3 - 10 family members and the average family size was 4 (Table 2).
23
Table 2 Socio-demographic characteristics of heads of households who participated
(n=106) in the questionnaire survey in Hadero town during October to December,
2014
Heads of the Household
N=106 (%)
Variables
Description
Sex
Male
Female
70 (66)
36 (34)
Age
18-30 years
31-45 years
>45 years
31 (29.2)
56 (52.8)
19 (17.9)
Religion
Protestant
Orthodox
Catholic
Muslim
70 (66.0)
26 (24.5)
9 (8.5)
1 (0.9)
Ethnicity
Kambata
Tembaro
Donga
Hadiya
Wolyita
Others
56 (52.8)
10 (9.4)
11 (10.4)
15 (14.2)
6 (5.7)
8 (7.5)
Marital
status
Married
Unmarried
Widowed
Divorced
82 (77.4)
16 (15.1)
7 (6.6)
1 (0.9)
Educational
status
Illiterate
Read and write
Grade1-4
Grade 5-8
Grade 9 and above
13 (12.3)
1 (0.9)
22 ( 20.8)
33 (31.1)
37 (34.9)
Occupation
Merchants
Farmer
House wife
Government employed
Student
Daily labor worker
49 (46.2)
8 (7.5)
13 (12.3)
17 (16.0)
13 (12.3)
6 (5.7)
Access to media
Yes
No
91 (85.8)
15 (14.2)
24
4.3 Ten Years Trends of Malaria Prevalence in Hadero Health Center
As the result shown in Table 3, within the last decade (2004–2013) a total of 32,296 blood
films were requested for malaria diagnosis in Hadero Health Center and 11,554 (35.8%)
microscopically confirmed malaria cases were reported. There was a fluctuating trend of
malaria prevalence within the last decade. This result was lower than the findings of other
study in Kola Diba, northern Ethiopia (39.6%) (Abebe et al., 2012). But it was higher
compared to the study done in Fincha, western Ethiopia (30%) (Bayissa, 2007) and the
country’s overall prevalence (23.8%) (PMI, 2013). This difference might be due to
environmental differences, climatic differences, altitude variation, and other factors that
affect malaria case occurrences in different study areas.
As shown in Table 3, in year 2004, the annual cumulative prevalence of malaria was 45%,
which was above the overall average malaria prevalence (35.8%). In 2005, it was reduced
to 33%, but it increased to 46.7% in 2006. In 2007, it declined to 42.5%, then rise up to
57.8% in 2008. In the next two years (2009 and 2010) prevalence of malaria was reduced
to 29.4% and 20.1%, respectively. But in 2011, it increased to 43.4%. Then in 2012, it was
reduced to 13%. In 2013, the lowest malaria prevalence (10%) was recorded. The year
2011 was the period in which the highest malaria cases were occurred, which seems to be
epidemic. But in the subsequent year (2012) the malaria cases strongly declined. As
shown in Table 3 annual malaria prevalence among outpatients tested for malaria at
Hadero Health Center varies from 10% to 57.8%. The results of this study revealed that
during the last ten years, a fluctuating trend of occurrence of malaria cases was observed in
the study area. The reduction in malaria cases during 2012-2013 might be due to
availability of antimalarial drugs for treatment and increased attention to malaria control
and prevention by government and other bodies (Abebe et al., 2012). The result coincides
to malaria situation in the world: In general the overall burden of malaria morbidity and
mortality decreased significantly over the last three years (WHO, 2013).
25
Table 3 Annual malaria prevalence rates among outpatients in Hadero Health Center, from
2004 to 2013.
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Total examined (N) 3418
4115
3506
3714
1956
1580
2402
6178
3923
1504
Total positive (N)
1541
1363
1637
1578
1131
465
483
2683
515
158
Prevalence(%)
45
33
46.7
42.5
57.8
29.4
20.1
43.4
13
10
P P. falciparum (N)
844
510
487
920
365
135
297
1598
161
12
(%)
P.vivax (N)
(%)
54.7
37.4
29.7
58.3
32.3
29
61.5
59.6
31.3
7.5
697
853
1150
658
766
329
174
1032
351
146
41.7
67.7
70.8
36
38.4
68.1
92.5
45.3
62.6
70.3
Mixed
0
0
0
0
0
1
12
53
3
0
(%)
0
0
0
0
0
0.2
2.5
2
0.6
0
Key: P. falciparum = Plasmodium falciparum
P. vivax = Plasmodium vivax
As the result in Figure 4 showed, Plasmodium species detected in the Hadero Health
Center were P. falciparum and P. vivax. Both species of Plasmodium were recorded in
each year with fluctuation of predominance one over another for the last decade. In 2004,
P.falciparum was more prevalent than P.vivax and the opposite was true for 2005/06. In
2007 the cases of P.falciparum exceeded that of P.vivax. From 2008-2009, P.vivax
infection was dominant. But from 2010-2011, P.falciparum was more prevalent than
P.viax and few numbers of mixed infections of both P.falciparum and P.vivax were
recorded (Figure 4).This finding coincides with the malaria parasite distribution in Ethiopia
which indicates that P.falciparum and P.vivax are the two predominant malaria parasites in
the country (Wakgari et al., 2005).
26
1800
1600
Malaria cases
1400
1200
1000
Pf
800
Pv
600
Mixed
400
200
0
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Years
Figure 4 Trends of Plasmodium species infection rates in Hadero Health Center from 2004
to 2013.
According to the review of malaria records in the last ten years in the study area, males and
females were affected almost equally by malaria disease. The malaria infection rate among
males was 49.7% and among females was 50.3%. Moreover, malaria cases reported in both
2683
sexes and in all age groups in the study area are summarized in Figure 5.
3000
2007
255
260
515
84
74
158
779
799
2006
500
male
female
234
231
465
252
231
483
774
863
2005
1131
1358
1325
1578
683
680
585
546
711
830
1500
1000
1637
1363
1541
2000
2004
malaria cases
2500
total
2013
2012
2011
2010
2009
2008
0
Years
Figure 5 The distribution of malaria parasite infection rates among male and female
outpatients at Hadero Health Center from 2004 to 2013.
27
Despite the relative fluctuation of malaria trends in the study area, malaria cases occurred
in almost all months and seasons of the year. More malaria positive cases were detected
during autumn (April – May), which was the mild peak season of malaria transmission
(Fig. 6). As a result of IRS spray around the study area every August of each year, there
was suppression of malaria positive cases during the spring (September-November) which
was supposed to be the highest peak transmission period. The minimum malaria cases were
observed during winter (January-March) seasons. The study area experienced perennial
malaria because the environmental and climatic situations permitted the continual breeding
of the vector in permanent breeding site (FMOH, 2004).
Malaria cases in HHC, 2004-2013
700
2004
600
2005
2006
2007
500
Malaria cases
2008
2009
400
2010
2011
300
2012
2013
200
100
0
Jan
Feb
Mar April May June July
Aug
Sep
Oct.
Nov Dec.
Months
Figure 6 Monthly trends of malaria positive cases for the last 10 years in Hadero Health
Center, 2004-2013.
28
4.4 Prevalence of Malaria in the Study Area
A total of 422 individuals who were selected from 106 households of Hadero town were
participated in the blood examination during October-December, 2014. The study
participants were composed of all age groups and both sex. The microscopic results
showed that only 9 (2.1%) of people examined were Plasmodium positive in the household
surveys. Of these, 8 (88.9%) were caused by P.vivax and only one case (11.1%) was due to
P.falciparum. This result was in contrast to study result in Butajira where 10.9%
prevalence (Adugna et al., 2013) and comparable to study conducted in Jimma town in the
same year. It is also lower than report from Pawe (14.7%), western Ethiopia (Habtamu,
2011). No mixed infection and other species were detected (Abebe et al., 2012). It was also
lower compared to reports from other malaria endemic areas of Ethiopia (4.5%), SNNPR
(2.5%)) and Kenya (18%) (MIS, 2012; Peter et al., 2007). This might be due to the intense
and diverse malaria control strategies undertaken in the area. The intervention made so far
has significantly reduced prevalence of malaria in some endemic areas of Ethiopia (Tsige,
2013).
In this survey, although malaria infection was observed in all age groups, a relatively more
malaria prevalence (1.4%) was detected in the age groups 15 years and above followed by
(0.5%) and (0.2%) infection prevalence at age of 5-14 years and below 5 years age groups,
respectively (Table 4). The low prevalence at age below 5 years most likely related to
appropriate use of ITNs in these age groups. In the age above 15 years, relatively high
prevalence of P. vivax might be due to relapses of P.vivax in these age groups. Overall
malaria infection among different age groups was not statistically significant (P > 0.05).
Table 4 Prevalence of malaria in sample population by age, during October- December,
2014.
Plasmodium species
Age group Total
(in years) examined
N (%)
<5
63 (14.9)
5-14
162 (38.4)
≥15
197(46.7)
malaria
cases
N (%)
1(0.2)
2(0.5)
6(1.4)
Total
422 (100)
N= number
9(2.1)
prevalence
P. falciparum P. vivax
N (%)
N (%)
0 (0.0)
1(11.1)
0(0.0)
2 (22.2)
1(11.1)
5 (55.6)
1(11.1)
8(88.9)
X2
P-value
0.106 0.601
1.06
0.261
1.476 0.191
29
In this study, variation of malaria infection was seen between sexes. The prevalence of
malaria was higher in females (55.6%) than males (44.4%) and this difference was not
statistically significant (P>0.05) (Table5). The result was in contrast to study report in
Pawe, western Ethiopia and Kemisie, northern Ethiopia, higher prevalence of malaria was
observed in males than females (Habtamu, 2011; Hailemariam, 2010).
Table 5 Prevalence of malaria in sample population by sex, October – December, 2014
Plasmodium species prevalence
Sex
Total
Examined
N (%)
malaria
positive cases
N (%)
P. falciparum
N (%)
P. vivax
N (%)
Mixed
N(%)
Male
205 (48.6)
4 (0.9)
1 (11.1)
3 (33.3)
0(0)
Female
217 (51.4)
5 (1.2)
0 (0.0)
5 (55.6)
0(0)
9 (2.1)
1 (11.1)
8 (88.9)
0(0)
Total
422 (100)
X2 = 1.406
P-value = 0.236
Of the total malaria cases only one case (11.1%) was found to be P.falciparum gametocyte
carriers. The rest 5(55.6%) of malaria cases were found to show early stages (ring and
early trophozoite) and 3(33.3%) of mature schizont stages of P.vivax.
4.5 People’s Knowledge about Transmission, Prevention and Control of
Malaria
The result of people’s knowledge about malaria transmission, prevention and control
mechanism which were collected using questionnaires during October-December, 2014 are
summarized and presented in (Table 6). Malaria is known as “Shekere” in Kambatagna
(local language) which is most commonly used term in the study area. Most of the study
participants 103(97.2%) were affected by malaria at least once in their life time and 94.3%
of them believed that malaria was one of the major health problems in the study area. This
result was in agreement with previous reports from Shewa Robit town, north eastern
Ethiopia (Andargie et al., 2013), and it was contrasted to another study in Kemisie,
northern Ethiopia (HaileMariam, 2010).
30
As shown in the Table 6, most of the participants (98.1%) responded that they knew the
symptoms of malaria and responded as fever, headache, shivering and vomiting as
symptom of malaria. About 88.7% of respondents associated the transmission of malaria
with bite of mosquitoes. This awareness was higher than the level reported in urban areas
of Assosa Zone (39.5%), western Ethiopia (Yared et al., 2007) and semi-urban areas of
Gilgel Gibe, south western Ethiopia (Fessahaye et al.,2008). High level of awareness might
be due to better access to mass media and the presence of house-to-house health extension
services, which focuses on information and education. However, some respondents
associated cause of malaria with respiratory rout (3.8%), body contact with infected person
(0.9%) and did not know the cause of malaria (1.9%). The rest (4.7%) were associated the
cause of malaria with exposure to hot and cold weather, lack of personal hygiene and
hunger. Such misunderstandings have also been reported by other studies in Ethiopia
(Daddi et al., 2010). Most participants believed that mosquitoes bite human at night time
(71.7%), breeding in stagnant water (66%) and rest at dark places in the house wall and
roofs (85.8%). This correct perception among respondents was encouraged to take
appropriate preventive measures.
Table 6 Knowledge of participants about symptoms and transmission mechanisms of
malaria, and mosquito behaviors, Hadero town, 2014
Variables
Reponses
Frequency (%)
Affected by malaria at least once
Yes
No
103 (97.2)
3 (2.8)
Know symptom of malaria
Yes
No
105 (99.1)
1 (0.9)
Symptom of malaria
Fever, headache, shivering, vomiting…
Other symptoms
104 (98.1)
2 (1.9)
Transmission mechanism
of malaria
Mosquito bite
Via respiratory rout
Body contact
I don’t know
94 (88.7)
4 (3.8)
1 (0.9)
2 (1.9)
Breeding site of mosquitoes
stagnant water
Unknown
70 (66.0)
24 (22.6)
Biting time of mosquitoes
Day time
Night time
Any time
Dark places in the roofs and walls
Other places
2 (1.9)
76 (71.7)
28 (26.4)
91 (85.8)
15 (14.2)
Resting place of mosquitoes
31
As shown in Table 7, all the study participants replied that malaria was treatable disease
and 75.5% of them had chosen government clinics for treatment. About 60.4% of
respondents were advised Coartem and 33% were advised Chloroquine during treatment.
Majority of the participants (82.1%) believed that malaria cause death if not treated. This
result was consistent to other studies in Shewa Robit (Andargie et al., 2013). Most of
participants (94.3%) were believed that malaria is preventable disease and 69.8%, 12.3%
and 13.3%, of them were being using insecticide treated bed nets, indoor residual spray
and, respectively (Table 7).
Table 7 Practices of people towards malaria prevention and control, Hadero town, southern
Ethiopia, 2014
Variables
Responses
Malaria is treatable disease
Yes
No
106(100)
0(0)
First choice for treatment
Government clinics
Private clinics
80(75.5)
26(24.5)
Type of medicine advised
Coartem
Chloroquine
Others
64(60.4)
35(33)
7(6.6)
Outcome of malaria if not treated
Death
Disability
Others
87(82.1)
15(14.2)
4(3.8)
Malaria is preventable disease
Yes
No
100(94.3)
6(5.7)
Main prevention method
Use insecticide treated bed nets
Spray houses with insecticides
Environmental manipulation
Drain stagnant water
Others
95(89.6)
53(50)
14(13.2)
79(74.5)
5(4.7)
Move to malarious area
outside of the study area
Yes
No
91(85.8)
15(14.2)
Doje irrigation contribute for breeding
of the vector of malaria parasites
Yes
No
Unknown
Frequency (%)
89(84)
16(15.1)
1(0.9)
The result of study showed that 74.5% of study participants were involved in the
environmental modification to reduce vector breeding site. Since mosquitoes need water to
breed, environmental management involves the modification of the environment to make it
32
unfavorable for the vectors to breed. Study carried out in Ghana showed the breeding sites
that had clear and shallow water produced higher densities of Anopheline larvae than
domestic waste water (Valle et al., 2013). During the investigation periods, the observed
suitable mosquito breeding sites in the study area were the edges of rivers in Sana River
and Doje River might create conducive breeding sight during dry seasons. Other conditions
considered as suitable environment for vector breeding during wet seasons include water
collected in pots, vegetable cultivation, especially Enset which collect and hold water
within its upper side opened fleshy stem, temporary pools created on the streets after rain
and water collected in foundations of uncompleted buildings. These conditions must be
considered by concerned body to avoid vector breeding sites.
4.6 Factors Affecting Effective Utilization of Insecticide Treated
Mosquito Nets and Indoor Residual Sprays
As showed in Table 8, majority of households (96.3%) that participated in the study had
ITNs/LLIN. About 14% of households owned only one ITN/LLIN, 60% owned two ITNs/
LLIN and 23% had three and above ITNs/LLIN. Many of the study participants (53%)
were sleep frequently under ITNs/LLIN and 26% of them were contracted malaria after
ITN/LLINs utilization. This might be resulted from inappropriate use of ITNs/LLIN. ITNs
are less protective when not used properly or when torn (MOH, 2002). Some people
(0.9%) didn’t used ITNs due to lack of knowledge about its importance and others (8.5%)
for unknown reasons (Table 8). In hot climates ITNs may be uncomfortable to use due to
poor ventilation (MOH, 2002). This result agreed to studies carried out at Chano Mille,
southern Ethiopia (Eskindir et al., 2013). The observed high ITNs coverage (96.3%) in the
study area coincides with low malaria prevalence (2.1%) during study period.
Majority of the household heads (53.6%) responded that they had ITNs/LLIN and used it
for its primary purpose. But 39.6% respondents were used ITNs/LLIN inappropriately.
Some people were spread it under the bed, on a chair, on the floor surface and in kitchen
walls in order to prevent cockroaches and other insects. Others were spread it on the
surface of bed to prevent bugs and lice. The investigator also absorbed that many of the
households used it as a rope to tie fence and other goods. It was also observed that most of
the households hanged ITNs over the doors and windows to kill mosquitoes that come to
home. Few study participants responded that they put it in the house as it was packed. This
results suggest that addressing community-specific practices and attitudes prior to ITNs
33
distribution promotes consistent and correct use, and helps to change attitudes towards bed
nets as a preventative health measure (Maria et al., 2009).
Table 8 Characteristics of Insecticide Treated Net ownership and use of households,
Hadero town, 2014
Variable
Responses
frequency (%)
Number of ITNs/LLIN
in household
None
One
Two
Three and above
4(3.7)
15(14.2)
64(60.4)
23(21.7)
Used insecticide treated mosquito
nets in the previous night
Yes
No
95(89.6)
11(10.4)
Frequency of sleeping under
ITNs/LLIN
always
sometimes
57(53.6)
42(39.6)
Source of ITNs/LLIN
Government
Shop
99(93.4)
2(1.9)
Infected by malaria after
ITNs/LLIN use
Yes
No
28(26.4)
73(68.9)
The reason for not using
ITNs
Lack of ITNs
Lack of knowledge
of importance of ITNs
Other reasons
1(0.9)
1(0.9)
9(8.5)
The result of this study showed that 50% of the houses were sprayed IRS within last 12
months. Most of the study participants responded that they know IRS as a chemical which
kills mosquitoes. But 50% of them did not spray their houses by insecticides within the last
12 months for different reasons. Some of the reasons for not spraying the houses were the
white colored stain of the DDT lasts for a long time on walls and in order to not dispute the
equipment from house to outside during spray periods. Some others did not aware about its
importance against malaria vector (Belete Achiqo, personal communication). Indoor
spraying is one of the most valuable tools in malaria vector control. IRS involves the
spraying of inside walls with a long lasting (residual) insecticide. A variety of insecticides
are available for indoor spraying, and selection of which insecticide to use will depend on
the local situations (MOH, 2002). Out of the 50% respondents that their houses were
sprayed by insecticides in the last 12 months, few were re-plastered the walls to decorate
34
their house and other reasons. Re-plastering reduce the potency of the insecticides (MOH,
2002). This result was in contrast to studies carried out at Shashemene Woreda, Oromia
Regional State, where 83.4% of IRS coverage (Kedir, 2011).
4.7 Anthropogenic Factors Contributing to Transmission of Malaria
Parasites in Hadero Town
In the study area, there were small scale irrigation farming that were developed from two
rivers “Doje and Sana” which cross the town in the east and west direction, respectively.
This might had increased Anopheles mosquitoes breeding sites. Specially the ‘Doje’
irrigation had open water channels which were suitable for mosquito breeding. Although
there was effort to control a vector of Plasmodium by government of Ethiopia, there are
still challenges to avoid vector breeding and transmission of malaria parasites. Irrigation
schemes might intensify malaria by increasing the level of prevalence during the dry
seasons (Abebe et al., 2011).
Another important factor contributing for vector breeding was absence of municipal
drainage system. The topography of Hadero town was mostly plain, which can collect and
reserve rain water. The investigator observed that after rainfall, running water collected at
different places near residents’ houses which might create conducive environment for
breeding of mosquitoes (Figure 7). There were also open water wells around residence
houses and broken water pipes which were leaking water on the surfaces and which
resulted water pools on the streets. These conditions created conducive environment for
vector breeding in the study area. Anopheles mosquito prefers small open sunlit pools for
egg laying (Richared, 2007).
Since many of the residents of Hadero town were merchants, most (86%) of them practice
to move from one area to another malaria endemic area in the nearby lowlands whereby
they may contract malaria. High immigration rate of population from nearby highland
areas was also considered during the last 5 years for settlement and other commercial
purpose (Belete Achiqo, personal communication). These groups have not developed
immunity against malaria parasites and affected severely.
One of the main commercial crops in the study area was Ginger which is dried outdoor. It
takes long time to dry. In order to keep it from thieves people practiced to sleep outdoor
during dry seasons which expose them to mosquito bite at night time.
35
In general, increased urban population, irrigation and farming schemes, absence of
municipal drainage system and high population movements contributed the opportunity to
contract by malaria in present study area.
Figure 7 Anthropogenic factors contributing to transmission of malaria, Hadero Town,
Sothern Ethiopia, 2014
36
5. SUMMARY AND CONCLUSION
5.1 Summary
Malaria is the number one health problem in Ethiopia with 75% of the lands where 68% of
the total population lives is malarious. The purpose of this study was to determine the
current status of the prevalence of malaria infection and its associated anthropogenic
factors and people’s knowledge and practice towards its transmission, prevention and
control measures in Hadero town. The study involved a household based cross-sectional
survey to determine prevalence and species of malaria parasites by microscopic
examination; used questionnaire to assess people’s knowledge and prevention methods of
malaria, collecting data of the last ten years (2004-2013) clinical records from health center
for malaria cases, from October to December 2014.
The results of the study revealed that during the last ten years, a fluctuating trend of
occurrence of malaria cases was observed in the study area. A decrease in the number of
malaria cases occurred from 2007–2009 with a minimum number of malaria cases reported
in 2013. However, there was increased number of malaria cases in 2010 with the peak
number of malaria cases being reported in 2011, which seems to be epidemic. Concerning
the seasonality, high peak malaria case observed during March to May and September to
December for the last 10 years which are the wet seasons in the study area. The two
malaria parasites detected in the study area were, P.vivex and P.falciparum with fluctuating
trends dominance of the two species each year.
The study revealed lower malaria prevalence (2.1%) compared to report from other areas
of Ethiopia and Africa. The predominant plasmodium species detected among the current
study participants was P.vivax. Only one individual was positive for P.falciparum. The low
prevalence of malaria may be associated with high concern taken to control a vector by
ITNs and IRS.
The questionnaire survey results showed that all respondents had ever heard of malaria and
more than 94% of them believed that malaria was one of the most important health
problems in the study area. The result also showed that the community members had good
knowledge about causes and mode of transmission of malaria. Majority of participants
associated malaria with mosquito bites. But there were also misconception in participants
37
regarding the mode of transmission of malaria parasites. Bad weather, respiratory rout
(3.8%), body contact with infected person (0.9%) and did not know the cause of malaria
(1.9%) were some of the responses. These misconceptions might affect the way people
respond to malaria prevention and control. Thus, there is need to clear these
misconceptions by giving clear and repeated education and message through the
community education and mass media. Most of the participants were familiar with at least
one of the classical symptoms of malaria which is expected for a population in endemic
areas where people are aware of the clinical manifestations of the disease. The knowledge
about symptoms of malaria and its treatment method was 99.1% and 100% respectively.
Majority prefers government clinics to private clinics, 75% and 25% respectively for
treatment. This might be associated to cost effectiveness of the people.
This study showed that majority of the participants had ITNs (96.3%) and about half (50%)
of the participants sprayed their houses with IRS. But only 53% of them sleep frequently in
ITNs and the rest used it inappropriately. The result suggests that addressing community
based practices and attitude change prior to ITNs distribution necessitate. Among 50%,
who sprayed their house with insecticides, few were re-plastered the house which reduce
the potency of the insecticides. Based on this findings of the study ITNs and IRS, which
are the best methods to reduce the incidence of malaria transmission by reducing vector
population and preventing human mosquito contact were not fully applied. Therefore, in
addition to distribution and house spraying, health education on malaria should be
implemented to control malaria in the study area.
Small scale irrigation and farming were developed from two rivers “Doje River and Sana
River” which cross the town in the east and west direction, respectively might contribute
for the breeding of Anopheles mosquitoes. High population movement into and out of the
town were absorbed during last 5 years. The increased immigration results population
density together with increased mosquito population increases the malaria incidence. In
addition to ITNs and IRS, environmental management could be essential to protect the
malaria vector. But in the study area there were several man made risk factors were
identified which create conducive environment for vector breeding.
38
5.2 Conclusion
Based on the information from the study result, the following conclusion drawn about the
malaria situation in Hadero town:

This study showed that during the last ten years, a fluctuating trend of occurrence of
malaria cases in Hadero town.

Malaria occur in all season of the year and relatively more prevalent in April-May than
other seasons in the last decade.

P. falciparum and P. vivax were the species of plasmodium that cause malaria in the study
area.

In the last decade (2004-2013) males and females were equally affected by malaria.

The results confirmed that malaria parasitaemia was present in all age groups, but
prevalence varied among the groups.

The present study results indicated that currently there was relatively low malaria
prevalence (2.1%) in the study area.

As the result showed the level of knowledge about malaria cause, transmission, and
preventive methods of the study participants was found to be high, but practice of utilizing
prevention and control method was low.

There were some misconceptions about the cause and transmission of malaria in the study
population. Thus, appropriate health education should be implemented to correct
misconceptions.

ITNs/LLIN coverage reached to 96.3%, but ITNs use fraction was 53.6%. Some
households did not sprayed IRS in the houses. So health education programs must focus on
practice of effective utilization of ITNs/LLIN and IRS.

As shown in the result anthropogenic factors also contributed their share for malaria
prevalence in the study area; thus, attention should be given to anthropogenic factors.
39
5.3 Recommendations

IRS and ITNs/LLIN provision must be continued in sustainable manner since there are
small scale irrigation activities, construction works and other suitable environmental
conditions for malaria vector breeding in the study area.

Hadero Tunto Zuria Woreda health office can potentially use the existing knowledge
about cause of malaria and ITNs/LLIN protection in malaria control program to improve
the observed utilization problem.

Strengthening of supervision on ITNs/LLIN and IRS utilization should be a great concern
by the Hadero town health extension workers as well as by woreda health office.
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APPENDICES
Appendix I Questionnaire
Haramaya University School of Graduate studies, Department of Biology, Masters of
Science in Microbiology, questionnaire format for collection of information on malaria
47
prevalence and associated anthropogenic risk factors in Hadero town, Kembata Tembaro
Zone, Southern Ethiopia, 2014.
Thank you in advance for your genuine response!
I.
Socio-demographic Characteristics
Village (Kebele) _________________ house no.__________ Code no. ___________
1. Sex:
Male 
Female 
2. Religion: Protestant Christian  Orthodox  Catholic  Muslim  Others 
3. Ethnicity: Kembata  Tembaro Donga  Hadiya  Wolaita Others 
4. Age: 0-5  6-14 
15 and above 
5. Marital status: Unmarried  Married 
6. Family Size: M ______
F ______
Widowed 
Divorced 
T _______
7. Educational status: Illiterate  Grade 1-4  Grade 5-8 
Grade 9 and above 
8. Occupation: Merchant  Farmer  House wife 
Government employed 
Student  Daily labor worker 
10. Do you have an access to media? Yes 
No 
11. If your answer to question 10 is yes, what kind of media?
Radio 
TV 
News paper 
others 
12. Type of house: Mud plastered  Cement plastered wall  Stone wall 
13. Number of BR: one BR 
Two BR 
Three BR 
> Three BR 
Note:- NGO = Non-Governmental organization BR= Bed Room
II.
Knowledge and practice towards malaria
1. Have you ever caught with malaria?
1/ Yes
2/ No
2. Do you know the symptoms of malaria? 1/ Yes
2/ No
3. If your answer for question 2 is yes, what is the symptom of malaria?
1/ fever, headache body ache, shivering, vomiting
4. Is malaria a health problem in your area? 1/ Yes
2/ others
2/ No
48
5. What is the mode of transmission of malaria? 1/ Body contact with infected person
2/ Mosquito bite
3/ Respiratory route
4/ others
6. Which one is the breeding site of mosquito in your environment?
1/ Animal wastes
2/ Stagnant water
3/ Unknown
7. Do you know the biting time of mosquito?
1/ Day time
8.
2/ at night
3/ any time
Where is the resting place of female anopheles mosquitoes?
1/ Dark places in house walls and roofs
III.
2/ other places
Perception and practice of protective measures of malaria
9. Is malaria treatable?
1/ Yes
2/ No
10. If your answer is ‘Yes’ for question 9, where is your first choice of treatment?
1/
government clinics
2/ private clinics
11. Which types of Medicine are you advised to use?
A/ Coartem
B/ Chloroquine
C/ Others
12. What will be the outcome of malaria if not treated at the beginning?
1/ Death
2/ Disability
13. Is malaria preventable? 1/ Yes
3/ Unknown
2/ No
3/ Unknown
14. What is the preventive method of Mosquito?
1/Using bed nets
2/ Indoor residual spray
3/ environmental manipulation
4/ others
15. Do you spray insecticides in your house?
1/ Yes
2/ No
16. Did you use insecticide treated mosquito nets last night? 1/ Yes
2/ No
17. How frequently you use LLIN/ITNs?
1/ every day
2/ some times
18. Do all family members use insecticide treated mosquito nets? 1/ Yes
19. From where do you get ITN? 1/Government
2/ Nongovernmental organization
20. How many ITNs do you have in your home?
1/ one
2/ two
3/ three and above
21. Have you contracted malaria after bed net use? 1/ Yes
2/ No
22. If you never used ITNs/LLINs, what is the reason?
1/ Lack of ITNs
2/ No
2/ Do not know importance of ITNs
3/ other
49
23. Do you accept that “Sana and Doje” irrigations contribute for the breeding of the
vector of malaria parasite? 1/ Yes
2/ No
24. Do you participate in the community to remove stagnant water in your society?
1/ Yes
2/ No
25. Have you been in malarious area outside of Hadero? 1/Yes
2/ No
26. Do rainfall and temperature influence growth of the vector?
1/ Yes
IV.
2/ No
Open end questions (for Experts )
1. What are the environmental condition the create suitable conditions for malaria
vector breeding in Hadero town?
2. Do you think anthropogenic factors contribute to transmission of malaria in
Hadero town?
3. If your response is ‘Yes’, what are these factors?
Appendix II Questionnaire (Amharic Version)
uN[TÁ ¿’>y`c=+ ÉI[ U[n ƒUI`ƒ TTEÁ ÃI SÖÃp uY’-Qèƒ ƒUI`ƒ ¡õM ¾}²ÒË Ø“ƒ c=J”
¯KT¬ uGÅa Ÿ}T ¾¨v uiታ Y`߃“ }ÁÁ» ‹Óa‹ ²<]Á S[Í KScwcw ’¬::
ƒ¡¡K— Gdw­” KSÓKê ¾ “X” UM¡ƒ u¡õƒ xታ¬ ÃÖkS<::
50
ƒ¡¡K— ULi uSe׃­ ›TcÓ“KG<!
I . TIu^© G<’@ታ
መንደር (ቀበሌ) ----------------- የቤት ቁጥር ------------ መለያ ቁጥር(ኮድ) ------------1. ïታ፡ ፡ ወንድ
ሴት
2. ሀይማኖት፡ ፕሮቴስታንት
ኦርቶዶክስ
ካቶሊክ
3. ብሔረሰብ፡ ከምባታ
ጠምባሮ
ዶንጋ
4. ዕድሜ ፡ 0-5 ¯Sƒ
6-14 ¯Sƒ
5. የጋብቻ ሁኔታ፡ ያገባ
ያላገባ
6. የቤተሰብ ብዛት ወ --------
ተማሪ
ሀዲያ
ሌላ
ወላይታ
ሌላ
15 ¯Sƒ ˆ“ በላይ
ባል/ምስት የሞተበት
ፍቺ
ሴ ---------- ድ ---------
7. የትምህርት ደረጀ፡ የቀለም ት/ት ያልወሰዳ
8. የሥራ ዓይነት፡ ነጋዴ
ሙስልም
ግብርና
1-4
9 እና ከዚያ በላይ
5-8
የቤት እመቤት
የመንግሰት ሠራተኛ
የቀን ሠረተኛ
9. የመገናኛ ዘዴዎችን ያገኛሉ ? አዎ
አይደለም
10. ለጥያቄ ቁጥር 10 መልስዎ አዎ ከሆነ የትኛዉን ዓይነት? ሬድዮ
11. የቤትዎ ዓይነት፡ የጭቃ ግድግዳ
12. ቤትዎ ስንት የመኝታ ክፍሎች አሉት ?
በስሚንቶ የተለሰነ
አንድ
ቴሌቭዥን
ጋዜጣ
ሌላ
ከድንጋይ የተሠራ
ሁለት
ሶስት
ከሶስት በላይ
II. ስለወባ በሽታ ያለዉ ግንዛቤ
1. በወባ በሽታ ተይዘዉ ያዉቃሉ? 1/አዎ
2/ አይደለም
2. የወባ በሽታ ምልክት ያዉቃሉ? 1/ አዎ
2/ አይደለም
3. ለጥያቄ ቁጥር 2 መልስዎ አዎ ከሆነ የወባ በሽታ ምልክቱ ምንድን ነዉ?
1/ ትኩሳት፣ ራስ ምታት፣ ማንቀጥቀጥ፣ ማስታወክ ወዘተ.
4. በእርስዎ አከባቢ ወባ የጤና ችግር ነዉ? 1/ አዎ
2/ ሌላ
2/ አይደለም
5. ወባ በምን ይይዛል? 1/ በበሽታ ከተያዘ ሰዉ በንክኪ
2/ በትንኝ
6. የትንኝ መራቢያ ሥፍራ የት ነዉ? 1/በከብቶች እበት ዉስጥ
3/ በትንፋሽ
4/ በሌላ
2/ በማይንቃሳቀስ ዉሃ ዉስጥ
አይታወቅም
7. የወባ ትንኝ ሰዉን የምትነክሰዉ በየትኛዉ ሰዓት ነዉ? 1/ ቀን
2/ ማታ
8. የወባ ትንኝ ማረፍያ ሥፍራ የት ነዉ? 1/ ጨለማ በሆነ የቤት ጣሪያና ግድግዳ
III. ስለ ወባ በሽታ ያለዉ አመለካካትና የመከላከያ ኤርምጃ
9. የወባ በሽታ በህክምና ማዳን ይቻላል?
1/አዎ
2/ አይደለም
3/ በማንኛዉም ጊዜ
2/ ሌላ ቦታ
3/
51
10. መልስዎ አዎ ከሆነ ለህክምና የሚመርጡት የት ነዉ?
1/ የመንግስት ክሊኒክ
2/ የግል ክሊኒክ
11. በወባ በሽታ ስያዙ የትኛዉን መዲኃኒት ተጠቅመዋል? 1/ ኳርተም
12. ህክምና ካልተደረገ የወባ በሽታ ምን ያስከትላል? 1/ ሞት
2/ ክሎሮክዉን
2/ የአካል ጉዳት
3/ ሌላ
13.
የወባ በሽታ እንዳይይዝ መከላከል ይቻላልን 1/ አዎ
14.
በየትኛዉ ዘዴ መከላከል ይቻላል? 1/ በኬምካል የተነከረ የአልጋ አጎበር በመጠቀም
2/ አይደለም
2/ ፀረ-ትንኝ መዲኃኒቶችን በቤት ዉስጥ በመርጫት
3/ የትንኝ መራቢያ ሥፍራዎችን በማስወገድ 4/ ሌላ
15.
የፀረ-ትንኝ መዲኃኒቶችን በቤትዎ ዉስጥ አስረጭተዉ ያዉቃሉ? 1/ አዎ
16.
vKð¬ Tታ ኬT>ካል የተነከረ የአልጋ አጎበር ተጠpመªM?
1/ አዎ
17.
ኬምካል የተነከረ የአልጋ አጎበር uምን ያህል ጊዜ ይጠቀማሉ?
1/ ሁልጊዜ
18.
ሁሉም የቤተሰብ አበላት ይጠቀማሉ? 1/ አዎ
19.
አጎበር ከየት ያገኛሉ? 1/ ከመንግስት
20.
በቤትዎ ስንት አጎበር አለ? 1/ አንድ
21.
አጎበር መጠቀም ከጀመሩ በኋላ ወባ ታመዉ ያዉቃሉ?
22.
እeŸ³_ ›Ôv` "M}ÖkS<&ያልተጠቀሙበት ምክንያት ምንድን ነዉ?
2/ ስለ አጎበር ጥቅም ዕዉቀቱ ስለሌላ˜
3/ ሌላ
2/ አይደለም
2/ አይደለም
2/ አንዳንዴ
2/ አይደለም
2/ መንግስታዊ ካልሆኑ ድርጅቶች
2/ ሁለት
3/ ሦስትና ከዚያ በላይ
1/ አዎ
2/ አይደለም
1/ አጎበር ስለሌላ
3/ ሌላ
23.
የዶጄ መስኖ ለወባ ትንኝ መራባት ምቹ ሁኔታ ይፈጥራል ብለዉ ያምናሉ? 1/ አዎ
24.
በካበቢዎ የማይንቃሳቀስ ዉሃ ካለ ያስወግዳሉን?
25.
ከሀደሮ ዉጭ ወባማ አከባቢዎችን ሄደዉ ያዉቃሉ?
26.
ዝናብና የአየር ሁኔታ በትንኝ ዕድገት ላይ ተጽዕኖ ያደርጋሉ? 1/ አዎ
1/ አዎ
1/ አዎ
2/ አይደለም
2/ አይደለም
2/ አይደለም
2/ አይደለም
IV KvKS<Á ¾k[u SÖÃp
1. uGÅa Ÿ}T ¬eØ K¨v ƒ”˜ S^vƒ U‡ ¾J’< ›Ÿvu=Á© G<’@ታ­‹ U”É” “†¬?
2. uGÅa Ÿ}T ¾c­‹ ¾°Kƒ Ÿ°Kƒ ˆ”penc? K¨v uiq S}LKõ ›e}ªê* Õ^ªM;
3. SMe­ ›­” ŸJ’ ¾ƒ™‡ ˆ”penc?­‹ “†¬ K¨v uiq S}LKõ Ÿõ}— ›e}ªê* ¾T>Áu[¡~ƒ;
Appendix III Written Consent Form
I am conducting a study on the current situation of malaria infection and associated
anthropogenic risk factors in Hadero town.
You are requested to participate in this study. If you agree, I would like to obtain finger
prick blood sample from you/or your children which would be used only to detect the
presence of malaria parasite. You will not get any risk in participating but you may
experience a small pain during finger pricking. When you or your children are found
52
positive for malaria parasite you will receive standard drugs free of charge. The
information in your records is confidential.
Your participation in this study is completely voluntary and you can refuse to participate or
free to withdraw yourself from study at any time. If you have any questions you have the
right to get proper explanation.
I am informed to my satisfaction about the purpose of this study and the nature of
laboratory investigation. I am also aware of my right to withdraw out from this study at
any time during the course of the study without having to give reasons for doing so. This
consent format has been read out to me in my language and I understand the content and I
am voluntarily giving my consent to participate in the study.
Study code no. __________
Name _________________________
signature ____________ Date __________
Investigator Name ___________________ Signature ____________ Date _________
APPENDIX IV Written Consent Form (Amharic)
¾Ø“ƒ }dታò ¾eUU’ƒ pê
SKÁ lØ`----------------------¾}dታò¬ eU ---------------------------------------- °ÉT@ ----------------- ïታ
¾I¡U“ vKS<Á¬ eU ----------------------------------------
53
እ’@ -------------------------------------------- ¾}vMŸ<ƒ ¾GÅa Ÿ}T ’ª] uŸ}T‹”
u¾¨p~ uT>Ÿc}¬ ¾¨v uiታ Ø“ƒ ¬eØ እ”Éd}õ ðnÅ— SJ’@”“ ›KSJ’@” }ÖÃo›KG<:: Ø“~
¾uiታ¬ Y`߃ ÁKuƒ” Å[Ë KSÑUÑU እ“ }ÁÁ»’ƒ ÁK†¬” c¬ W^i ‹Óa‹” uSKÁƒ SõƒH@
KSÖqU ታex ¾}²ÒË SJ’<” upÉT>Á }’Óa—M::
K²=I Ø“ƒ ÁÑKÓM ²”É uðnŘ’ƒ ¾}SW[} ¾¨v U`S^ እ’@“ u?}cxŠ እ”É“Å`Ó }ÖÃo›KG<::
uÅT‹” ¬eØ ¨v ›UÜ }Iªe ¾}Ñ– እ”ÅJ’ ›eðKÑ>¬” SÉኃ’>ƒ u’í እ”ÅT>cÖ” }’Óa—M:: Öwታ
ÅU Ÿ×ƒ uT>¨cÉuƒ ¨pƒ MUÉ vK¬ ¾Ö?“ vKS<Á ¾I¡U“ Å”w uT>ðpŬ ¾”êI“ ›Övup
Å[Í እ”ÅT>Ÿ“¨” }ÑMïM—M:: u²=IU SW[ƒ እ’@U J”Ÿ< u?}cxŠ U`S^¬” KTÉ[Ó Ÿ×ታ‹”
Öwታ ÅU KSe׃ }eTU‰KG<:: ŸðKÓG< T”—¬U ¬Ö?ƒ uT>eØ` እ”ÅT>Á´ }’Óa—M::
Ÿ²=I Ø“ƒ uT”—¬U c¯ƒ KS¬×ƒ እ”ÅU‹M }’Óa˜ uØ“~ KSdታõ SeTSቴ” uò`T KT[ÒÑØ
እ¨ÇKG<::
¾}cታò¬ eU -------------------------------------- ò`T ----------- k” -------------------¾›Ø˜¬ eU ---------------------------------------- ò`T ---------- k” --------------------¾Ue¡` eU ----------------------------------------- ò`T ---------- k” ---------------------
54
Appendex V Appendex Tables
Appendix Table 1 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2004
Month
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
Total
examined
250
199
165
376
408
423
263
295
302
243
270
224
3418
Total
positive
99
112
85
214
269
135
94
105
180
85
98
65
1541
Pf
Pv
42
57
23
115
213
95
49
61
109
24
44
12
844
57
55
62
99
56
40
45
44
71
61
54
53
697
Pf +
Pv
0
0
0
0
0
0
0
0
0
0
0
0
0
M
F
40
54
42
90
105
85
38
53
74
40
50
30
701
59
58
43
114
164
50
56
52
106
45
48
25
820
Prevalence
(%)
39.6
56.2
51.5
56.9
65.9
31.9
35.7
35.6
59.6
34.9
36.3
29
45
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
Appendix Table 2 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2005
Month
Total
examined
Total
positive
Pf
Pv
Pf +
Pv
M
F
Prevalence
(%)
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
312
324
270
351
359
423
611
270
309
351
290
245
4115
68
70
72
124
112
205
247
103
111
125
56
70
1363
44
45
42
73
84
42
66
28
30
27
18
11
510
24
25
30
51
28
163
181
75
81
98
38
59
853
0
0
0
0
0
0
0
0
0
0
0
0
0
32
38
42
70
59
94
110
60
56
60
30
32
683
36
32
30
54
53
111
137
43
55
65
26
38
680
21.7
21.6
26.7
35.3
31.2
48.5
40.4
38.1
35.9
35.6
19.3
28.6
33
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
55
Appendix Table 3 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2006
Month
Total
examined
Total
positive
Pf
Pv
Pf +
Pv
M
F
Prevalence
(%)
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
244
206
216
270
351
195
249
367
344
104
109
97
138
155
76
114
150
154
55
41
36
51
65
27
43
41
12
49
68
61
87
90
49
71
109
142
0
0
0
0
0
0
0
0
0
62
45
44
67
77
30
58
60
74
42
64
53
91
78
46
56
90
80
42.6
52.9
44.9
51.1
44.1
38.9
45.8
40.9
44.8
Oct.
Nov.
Dec.
405
324
335
219
169
152
19
46
51
200
123
101
0
0
0
100
65
72
119
44
80
54
52.1
45.4
Total
3506
1637
487
1150
0
754
843
46.7
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
Appendix Table 4 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2007
Month
Total
examined
Total
positive
Pf
Pv
Pf +
Pv
M
F
Prevalence
(%)
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
324
271
356
409
435
219
192
202
247
405
408
246
3714
128
151
123
196
193
67
93
67
123
179
165
93
1578
51
81
40
116
169
60
82
62
51
104
73
31
920
77
70
83
80
24
7
11
5
72
75
92
62
658
0
0
0
0
0
0
0
0
0
0
0
0
0
54
72
68
99
90
34
38
29
71
85
89
50
779
74
79
55
97
103
33
55
38
52
94
76
43
799
39.5
55.7
34.5
47.9
44.4
30.6
48.6
33.2
49.8
44.2
40.4
37.8
42.5
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
56
Appendix Table 5 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2008
Month
Total
examined
Total
positive
Pf
Pv
Pf +
Pv
M
F
Prevalence
(%)
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
108
97
123
327
275
138
105
119
108
262
183
111
1956
59
45
61
230
193
91
64
62
35
135
91
65
1131
4
6
4
134
95
24
9
8
29
38
5
9
365
55
39
57
96
98
67
55
54
6
97
86
56
766
0
0
0
0
0
0
0
0
0
0
0
0
0
35
24
27
132
97
42
29
30
15
66
51
37
585
24
21
34
98
96
49
35
32
20
69
40
28
546
54.6
46.4
49.6
70.3
70.1
65.9
60.9
52.1
32.4
51.5
49.7
58.5
57.8
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
Appendix Table 6 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2009
Month
Total
examined
Total
positive
Pf
Pv
Pf +
Pv
M
F
Prevalence
(%)
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
135
81
162
135
167
131
177
212
118
54
189
141
1580
25
51
78
29
41
29
35
30
37
37
41
32
465
4
3
39
18
12
14
5
6
7
6
13
8
135
21
48
39
11
29
15
29
24
30
31
28
24
329
0
0
0
0
0
0
1
0
0
0
0
0
1
10
29
34
19
21
16
13
14
28
20
16
14
234
15
22
44
10
20
13
22
16
9
17
25
18
231
18.5
62.9
48.1
21.5
24.5
22.1
19.8
14.1
31.4
68.5
21.7
22.7
29.4
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
57
Appendix Table 7 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2010
Month
Total
examined
Total
positive
Pf
Pv
Pf +
Pv
M
F
Prevalence
(%)
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
137
143
162
281
403
241
216
189
159
190
149
132
2402
15
14
20
73
124
87
46
48
16
19
11
10
483
3
4
10
59
87
58
29
33
1
8
2
3
297
12
10
10
14
33
24
14
15
15
11
9
7
174
0
0
0
0
4
5
3
0
0
0
0
0
12
9
5
7
31
70
54
27
23
6
8
7
5
252
6
9
13
42
54
33
19
25
10
11
4
5
231
10.9
9.8
12.3
25.9
30.8
36
21.3
25.4
10.1
10
7.4
7.6
20.1
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
Appendix Table 8 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2011
Month
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
Total
examined
285
279
378
1065
961
621
405
451
480
624
406
233
6178
Total
positive
43
56
237
611
445
304
175
120
187
204
198
103
2683
Pf
Pv
25
29
108
467
312
210
65
74
101
91
73
43
1598
18
27
105
128
123
91
110
46
86
113
125
60
1032
Pf +
Pv
0
0
24
16
10
3
0
0
0
0
0
0
53
M
F
17
31
140
294
240
149
88
59
92
99
103
44
1356
26
23
97
317
205
155
87
61
95
105
95
59
1325
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
Prevalence
(%)
15.1
20.1
62.7
57.4
46.3
48.9
43.2
26.6
38.9
32.7
48.8
44.2
43.4
58
Appendix Table 9 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2012
Month
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
Total
examined
304
312
291
218
288
216
243
308
432
581
406
324
3923
Total
positive
38
40
39
23
25
11
23
25
120
70
55
46
515
Pf
Pv
8
10
8
8
3
6
5
2
36
41
22
12
161
30
30
31
15
18
5
18
23
81
29
33
34
351
Pf +
Pv
0
0
0
0
0
0
0
0
3
0
0
0
3
M
F
20
21
22
10
7
5
7
16
68
24
28
20
255
18
19
17
13
16
6
16
9
52
46
27
26
260
Prevalence
(%)
12.5
12.8
13.4
10.5
9.5
5.1
9.5
8.1
27.8
12
13.5
14.2
13.1
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
Appendix Table 10 Annual malaria prevalence with age, sex and parasite type in Hadero
Health Center, 2013
Month
Jan.
Feb.
Mar
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
Total
Total
examined
285
224
195
306
345
298
368
318
281
306
309
210
1504
Total
positive
9
8
20
27
24
13
6
11
14
10
9
7
158
Pf
Pv
0
0
5
2
0
0
0
0
0
4
0
2
12
9
8
15
25
24
13
6
11
14
6
9
5
146
Pf +
Pv
0
0
0
0
0
0
0
0
0
0
0
0
0
M
F
5
3
12
13
13
8
2
5
9
7
4
5
86
4
5
8
14
11
5
4
6
5
3
5
2
72
Pf= Plasmodium falciparum Pv= Plasmodium vivax M= male F= female
Prevalence
(%)
3.2
3.6
10.3
8.8
7
4.4
1.6
3.5
5
3.3
3
3.3
10.5