Plasmodium infections and associated risk factors among parturients in Jawi district, northwest Ethiopia: a cross-sectional study.

BACKGROUND: Pregnant women have an increased risk of Plasmodium infections and disease. Malaria in pregnancy is a major public health problem in endemic areas. Assessment of the burden and risk factors of malaria in pregnancy across different malaria transmission settings is required to guide control strategies and for malaria elimination. Thus, the current study is generating such evidence from parturient women in northwest Ethiopia. METHODS: A cross-sectional study was conducted among 526 pregnant women admitted to the delivery rooms of selected health facilities in Jawi district, northwest Ethiopia, between November 2021 and July 2022. Data on the socio-demographic, clinical, obstetric, and malaria prevention practices of pregnant women were collected using interviewer-administered questionnaires and from women's treatment cards. Malaria was diagnosed by light microscopy, rapid diagnostic test, and multiplex real-time polymerase chain reaction. Risk factors for malaria were evaluated using bivariable and multivariable logistic regression models. A P-value of < 0.05 was considered statistically significant. RESULTS: Among the examined parturient women, 14.3% (95% CI 11.4-17.5%) had Plasmodium infections. The prevalence of peripheral, placental, and congenital malaria was 12.2% (95% CI 9.5-15.3%), 10.9% (95% CI 8.2-14.1%), and 3.7% (95% CI 2.3-6.1%), respectively. About 90.6% of peripheral and 92% of placental Plasmodium infections were asymptomatic. Plasmodium infection at parturiency was independently predicted by maternal illiteracy (AOR = 2.03, 95% CI 1.11-3.74), primigravidity (AOR = 1.88, 95% CI 1.01-3.49), lack of antenatal care follow-up (AOR = 2.28, 95% CI 1.04-5.03), and history of symptomatic malaria during pregnancy (AOR = 4.2, 95% CI 2.32-7.59). Moreover, the blood group O phenotype was significantly associated with placental malaria among the primiparae. CONCLUSIONS: Overall, asymptomatic Plasmodium infections were prevalent among parturients in northwest Ethiopia. Maternal illiteracy, primigravidity, lack of antenatal care follow-up, and history of symptomatic malaria during pregnancy were the risk factors for malaria during parturiency. Thus, promotion of a healthy pregnancy through ANC follow-up, strengthening malaria prevention and control practices, and screening of malaria in asymptomatic pregnant women are suggested to reduce its burden in pregnancy.

Impact of sugarcane irrigation on malaria vector Anopheles mosquito fauna, abundance and seasonality in Arjo-Didessa, Ethiopia.

BACKGROUND: Despite extensive irrigation development in Ethiopia, limited studies assessed the impact of irrigation on malaria vector mosquito composition, abundance and seasonality. This study aimed to evaluate the impact of sugarcane irrigation on species composition, abundance and seasonality of malaria vectors. METHODS: Adult Anopheles mosquitoes were collected using CDC light traps from three irrigated and three non-irrigated clusters in and around Arjo-Didessa sugarcane irrigation scheme in southwestern Ethiopia. Mosquitoes were surveyed in four seasons: two wet and two dry, in 2018 and 2019. Mosquito species composition, abundance and seasonality were compared between irrigated and non-irrigated clusters. Anopheles mosquitoes were sorted out to species using morphological keys and molecular techniques. Chi square was used to test the relationships between Anopheles species occurrence, and environmental and seasonal parameters. RESULTS: Overall, 2108 female Anopheles mosquitoes comprising of six species were collected. Of these, 92.7% (n = 1954) were from irrigated clusters and 7.3% (n = 154) from the non-irrigated. The Anopheles gambiae complex was the most abundant (67.3%) followed by Anopheles coustani complex (25.3%) and Anopheles pharoensis (5.7%). PCR-based identification revealed that 74.7% (n = 168) of the An. gambiae complex were Anopheles arabiensis and 22.7% (n = 51) Anopheles amharicus. The density of An. gambiae complex (both indoor and outdoor) was higher in irrigated than non-irrigated clusters. The overall anopheline mosquito abundance during the wet seasons (87.2%; n = 1837) was higher than the dry seasons (12.8%; n = 271). CONCLUSION: The ongoing sugarcane irrigation activities in Arjo-Didessa created conditions suitable for malaria transmitting Anopheles species diversity and abundance. This could drive malaria transmission in Arjo-Didessa and its environs in both dry and wet seasons. Currently practiced malaria vector interventions need to be strengthened by including larval source management to reduce vector abundance in the irrigated areas.

Dry season occurrence of Anopheles mosquitoes and implications in Jabi Tehnan District, West Gojjam Zone, Ethiopia.

BACKGROUND: Generating evidence on the dry season occurrence of the larval and adult stages of Anopheles mosquitoes helps to design effective malaria vector control strategy as the populations of the vectors is expected to be low. METHODS: Larval and adult stages of Anopheles were surveyed during dry seasons in Mender Meter, Jiga Yehlmidar and Wongie Berkegn villages, Jabi Tehnan District, West Gojjam Zone, Ethiopia. Larvae were surveyed (along the available surface water collections), sampled, identified into genus, counted and late instars of the genus Anopheles identified into species. Indoor-resting adult mosquitoes were collected using insecticide aerosol spray, processed and identified into species. Data was analysed using SPSS version 20.0 to determine frequencies, mean differences and associations. RESULTS: A total of 3127 Anopheles larvae were collected among which most (91.7%; 2869/3127) were from streams followed by ponds (4.3%; 136/3127) and swamps (3.9%; 122/3127). Anopheles gambiae sensu lato was the most prevalent (84.9%; 921/1085) followed by Anopheles cinereus (7.0%; 76/1085), Anopheles chrysti (3.7%; 40/1085), Anopheles demeilloni (2.8%; 30/1085) and Anopheles rhodesiensis (1.6%; 18/1085). The mean number (mean = 15.3) of An. gambiae from Jiga Yehlmidar was significantly (p = 0.024) higher than the corresponding number (mean = 3.2) from Mender Meter. The mean number (mean = 36.3) of An. gambiae larvae in April 2017 was significantly (p = 0.001) higher than the number (mean = 4.0) in December 2013 and the number (mean = 2.6) in March 2013. A total of 1324 adult Anopheles were collected of which the highest proportion (79.1%; 1048/1324) was An. gambiae, followed by An. chrysti (11.7%; 155/1324), An. demeilloni (6%; 80/1324), An. cinereus (2.6%; 35/1324) and Anopheles coustani (0.5%; 6/1324). The highest proportion (54.3%; 569/1048) of the An. gambiae was collected from Wongie Berkegn followed by Jiga Yehlmidar (23.6%; 247/1048) and Mender Meter (22.1%; 232/1048). The mean number (mean = 7.8) of adult An. gambiae caught in Wongie Berkegn was significantly (p = 0.018) higher compared to the number (mean = 3.0) in Mender Meter. No significant difference was observed in the mean number of adult An. gambiae between the seasons. CONCLUSION AND IMPLICATION: Streams were prolific breeding habitats of Anopheles mosquitoes followed by ponds and swamps in the dry seasons. In addition, a high population of indoor resting An. gambiae was caught from indoors. This implies the need for a strengthened vector control during dry seasons using breeding habitat management and improved housing in addition to the existing insecticide (LLINs and IRS) based interventions in Jabi Tehnan District, West Gojjam Zone, Ethiopia.

Use of epidemiological and entomological tools in the control and elimination of malaria in Ethiopia.

Malaria is the leading public health problem in Ethiopia where over 75% of the land surface is at risk with varying intensities depending on altitude and season. Although the mortality because of malaria infection has declined much during the last 15-20 years, some researchers worry that this success story may not be sustainable. Past notable achievements in the reduction of malaria disease burden could be reversed in the future. To interrupt, or even to eliminate malaria transmission in Ethiopia, there is a need to implement a wide range of interventions that include insecticide-treated bed nets, indoor residual spraying, improved control of residual malaria transmission, and improved diagnostics, enhanced surveillance, and methods to deal with the emergence of resistance both to drugs and to insecticides. Developments during the past years with increasing awareness about the role of very low levels of malaria prevalence can sustain infections, may also demand that tools not used in the routine control efforts to reduce or eliminate malaria, should now be made available in places where malaria transmission occurs.

Assessment of Clarias gariepinus as a biological control agent against mosquito larvae.

BACKGROUND: The emergence and spread of insecticide resistant mosquitoes renewed interest in investigating the use of larvivorous fish as a biological control agent. The potential of Clarias gariepinus fish in controlling Anopheles arabiensis and culicine larvae was assessed under laboratory and semi-field conditions. RESULTS: Small size (15-20 cm) C. gariepinus fish consumed greater number of mosquito larvae than the large size fish (25-40 cm) in the multivariate regression model (ß = 13.36, 95 % CI = 4.57, 22.15). The Anopheles larvae consumed was greater in number than the culicines larvae consumed by the fish (ß = 12.10, 95 % CI = 3.31, 20.89). The number of larvae consumed was greater during the night hours than during the light hours (ß = 30.06, 95 % CI = 21.27, 38.85). Amount of supplementary fish food did not cause significant differences in the number of mosquito larvae consumed by the fish among different groups. C. gariepinus was observed to feed on mosquito larvae under laboratory and semi-field conditions. CONCLUSION: C. gariepinus fed on the larvae of An. arabiensis and culicines readily. Hence, it can be used as an alternative mosquito control agent in Ethiopia where the breeding habitats are small and localized.

Past five-year trend, current prevalence and household knowledge, attitude and practice of malaria in Abeshge, south-central Ethiopia.

BACKGROUND: In Ethiopia malaria remains a leading cause of outpatient consultation despite massive control efforts. This study was aimed at analysing 5-year retrospective trend and current prevalence of malaria as well as community knowledge, attitude and practice (KAP) in Walga Health Centre (WHC) catchment area in Abeshge District, south-central Ethiopia. METHODS: A cross-sectional, household survey was conducted to determine malaria prevalence and KAP in December 2013. Further, malaria cases reported from WHC in 2008-2012 were extracted. A multi-stage, random sampling technique was used to select study participants from four kebeles. Of 800 participants, 400 were interviewed to assess their KAP about malaria and the other half were recruited for malaria microscopy. RESULTS: Overall, 11,523 (33.8%) slide-confirmed malaria cases were reported (no fatalities) among 34,060 outpatients diagnosed in 2008-2012. There was successively significant decline in malaria prevalence from 2009 onwards although a significant rise was noticed in 2009 compared to 2008 (p<0.0001). Male malaria suspects (17,626) were significantly higher than of females (16,434) (p=0.0127) but malaria prevalence was not significantly variable between sexes. Individuals who were ≥15 years constituted 44.9% of the patients. Although most participants (78.8%) associated mosquito bites with malaria, the remaining mentioned exposure to rain or body contact with malaria patients as causes of malaria. Mosquito nets, draining stagnant water and indoor residual spraying were the most frequently mentioned malaria preventive measures. In the parasitological survey, a single individual (0.25%) with mixed Plasmodium falciparum-Plasmodium vivax infections was found. CONCLUSION: Although malaria remains a primary cause of outpatient admission in WHC, the retrospective data showed a significantly declining trend. This together with the very low prevalence in the current parasitological survey suggests the effectiveness of ongoing control interventions in the locality.

Undernutrition and associated risk factors among school age children in Addis Ababa, Ethiopia.

BACKGROUND: Causes of child undernutrition are diverse and change in space and time. Investigating current determinants of undernutrition remains vital to design an effective intervention strategy. The study assessed prevalence of undernutrition and its associated factors among children living in Addis Ababa, Ethiopia. METHODS: A community based cross-sectional study was conducted in 459 school age children and their parents or caregivers living in Lideta sub-city, Addis Ababa, Ethiopia. Participants were selected using a multi-stage simple random sampling technique. Height and weight of children was measured and their parents or care givers were interviewed for factors associated with undernutrition. RESULTS: About 31% (n = 141) of the children were undernourished (19.6% stunted, 15.9% underweight). Being male, higher birth order (>2), larger family size (6-8), low meal frequency (≤3 times) in a day prior to the survey and mud floor house were significantly associated with undernutrition. Similarly, the risk of underweight increased significantly with an increase in age, birth order, family size and also the absence of hand washing facilities. The odds of undernutrition was lower in children born to 20-30 years old mothers compared to those born to mothers younger than 20 years. CONCLUSIONS: Undernutrition is prevalent among school age children living in Lideta sub city, Addis Ababa. Policy makers should consider school age children in their nutrition policy documents and implement screening program and intervention strategy.

Distribution and utilization of vector control strategies in a malarious village of Jabi Tehnan District, north-western Ethiopia.

BACKGROUND: Adequate coverage and proper use of long-lasting insecticidal nets (LLINs) and indoor residual spaying (IRS) reduce density of indoor-resting mosquitoes, man-mosquito contact and malaria infection. However, distribution, ownership and usage of the interventions may vary among households in a malarious area, which in turn limits the impact of interventions on the transmission of malaria. A study was undertaken to assess distribution and utilization of LLINs and IRS in a malarious village of north-western Ethiopia. METHODS: A total of 352 randomly selected households in Jiga Yelmdar village, Jabi Tehnan District of north-western Ethiopia were interviewed using a structured questionnaire. The most important questions included distribution and utilization of LLINs/IRS and knowledge by the households of malaria and the interventions. RESULTS: More than 99% of the respondents had information about malaria. About 97% of the households had at least one LLIN and 89.3% of houses had been treated with IRS within the previous six months. Only 58.2% of the LLIN-owning households had used the nets the previous night. Not being a malaria transmission season was the main reason cited by 69.7% of the households for not using their LLINs the previous night. The most preferred malaria control strategy in the village was LLINs (cited by 71.1%) followed by IRS (cited by 14.5%). About 29% of the households had a history of malaria within the previous six months and the great majority of them (86.3%) sought treatment at the Jiga Yelmdar Health Post or Jiga Health Centre. CONCLUSION: Residents of Jiga Yelmdar village were knowledgeable about malaria and the control strategies of the disease such as LLINs and IRS. Although LLIN use is their most preferred strategy, the compliance rate was low which probably contributed to the 29% of household-level malaria infection in the village within the previous six months. This indicates the need for improved compliance to LLINs and IRS in the village.

Assessment of Urogenital Schistosomiasis Knowledge, Attitudes and Practices Among Abobo Communities in Gambella Regional State, Southwestern Ethiopia.

Background: Knowledge about community awareness and practices related to a disease, among other things, helps to plan relevant control strategies. This study assessed the knowledge, attitude, and practices (KAPs) of the community in Abobo district of Gambella Regional State in Southwestern Ethiopia about urogenital schistosomiasis (UGS), which is endemic to the region. Methods: A community-based cross-sectional study was conducted in 2022. A pretested structured questionnaire was administered. Multivariable logistic regression was used to examine factors associated with KAPs variables. Results: Most study participants (90.6%) responded they have previously heard of UGS. Over 95% of the participants knew at least 1 symptom of UGS and 30% knew the transmission cycle. About 15.9% and 26.8% knew keeping environmental hygiene and refraining from using cercariae infested water, as preventive methods, respectively. Over half of the participants (50.1%) disagreed or did not know that urinating close to the river/dam water contributes to transmission, and almost all participants had contact with the dam/river water in one way or another. Education status and history of having the infection were the key significant correlates of most KAPs variables. Conclusion: Most of the community members had poor knowledge and attitudes about the mode of transmission and preventive measures of UGS. Thus, besides school-based mass drug administration (MDA), UGS control efforts in the region should incorporate health education in conjunction with safe water supplies, and provision of sanitary facilities to effectively reduce the transmission of the disease.

Evaluating the Performance of FlukeCatcher at Detecting Urogenital Schistosomiasis.

Urine filtration microscopy (UFM) lacks sensitivity in detecting low-intensity Schistosoma haematobium infections. In pursuit of a superior alternative, this study evaluated the performance of FlukeCatcher microscopy (FCM) at detecting S. haematobium eggs in human urine samples. Urine samples were collected from 572 school-age children in Afar, Ethiopia in July 2023 and examined using UFM and FCM approaches. Using the combined UFM and FCM results as a reference, the sensitivity, negative predictive value, and agreement levels for the two testing methods in detecting S. haematobium eggs in urine samples were calculated. The sensitivity and negative predictive value of detecting S. haematobium eggs in urine samples for FCM was 84% and 97%, respectively, compared to 65% and 93% for UFM. The FCM test results had an agreement of 61% with the UFM results, compared to 90% with the combined results of FCM and UFM. However, the average egg count estimates were lower when using FCM (6.6 eggs per 10 mL) compared to UFM (14.7 eggs per 10 mL) (p < 0.0001). Incorporating FCM into specimen processing could improve the diagnosis of S. haematobium infection but may underperform in characterizing the intensity of infection.

Ecology and Infection Status of Sand Flies in Rural and Urban Cutaneous Leishmaniasis Endemic Areas in Northwest Ethiopia.

Cutaneous leishmaniasis (CL) caused by Leishmania aethiopica is transmitted by Phlebotomus longipes in northern Ethiopia. No studies have been conducted to investigate the transmission dynamics of CL, despite its high endemicity in both rural and urban settings. Evidence on the ecology and behavior of the vector from this area are required to develop integrated disease control strategies. Sand flies were collected in the dry and wet seasons in 2021 in CL-endemic rural Gindmeteaye and urban Addis-Alem in northwest Ethiopia. Trapping was performed with sticky and Centers for Disease Control and Prevention (CDC) light traps in three habitats, including inside patients' houses, peridomestic areasand in caves/rocky areas. Sand flies were morphologically identified to species level. Female Phlebotomus species were categorized according to blood feeding status and tested by spliced-leader (SL-) ribonucleic acid (RNA) polymerase chain reaction (PCR) to screen for Leishmania infection. Of 1161 sand flies, the majority (77%) were P. longipes, six (0.5%) were P. orientalis and the remaining were Sergentomyia. The abundance of the 430 female P. longipes was significantly linked to seasonality (p < 0.001), with the majority in the dry season occurring in the outdoor rocky (37%) and peridomestic (34%) sites, while, in the wet season, most (62%) were captured indoors. This seasonality was more pronounced in rural Gindmeteaye, where housing construction is poor. The number of blood-fed and gravid P. longipes was significantly higher in the wet (31%; 22%), compared to the dry season (13%; 8%), and their proportion was highest indoors. Eighteen (4%) female P. longipes were Leishmania positive, with highest infection prevalence in caves (7% compared to 3% indoors, p = 0.022), and in the dry season (6%, p < 0.001). Phlebotomus orientalis specimens were all captured in May in rural Gindmeteaye, five indoors and one in a peridomestic site. Further research should be conducted to investigate the absolute contribution of humans and indoor transmission to the transmission cycle of CL. Inhabitants of endemic villages should be made aware that evening outdoor activities near caves may increase their exposure to infectious sand flies. Whether P. orientalis can breed and become infected at high altitudes should be further studied.

Impact of housing condition on indoor-biting and indoor-resting Anopheles arabiensis density in a highland area, central Ethiopia.

BACKGROUND: Exposure of individuals to malaria infection may depend on their housing conditions as houses serve as biting and resting places of vectors. This study describes the association of housing conditions with densities of indoor-biting and indoor-resting Anopheles arabiensis in Hobe, Dirama and Wurib villages of a highland area in central Ethiopia. METHODS: Data on housing conditions, including presence of house apertures, number of occupants and number and the type of domestic animal tethered inside, were collected. Indoor-biting mosquitoes were sampled using Centers for Disease Control (CDC) light traps and indoor-resting mosquitoes sampled with pyrethrum spray catches (PSCs) monthly for two years (July 2008 to June 2010). Female anophelines were identified to species and processed. Univariate and general linear estimating equation allowing for repeated measures were used to assess the contribution of housing conditions for indoor-biting and indoor-resting An. arabiensis. RESULTS: About 96% (4,597/4,788) of anophelines were caught inside residential houses. Nine anopheline species were identified, among which An. arabiensis was most prevalent (2,489; 52%). Vectors entering houses were higher in those situated at low (ß = 4.475; 95% CI = 3.475-5.476; p <0.001; ß = strength of the association) and medium (ß = 2.850; 95% CI = 1.975-3.724; p <0.001) altitudes compared to high altitude, and where houses have no windows (ß = -0.570; 95% CI = -1.047-0.094; p =0.019) compared with those that have. Numbers of indoor-resting vectors were higher in those situated at low (ß = 6.100; 95% CI = 4.571-7.629; p <0.001) and medium (ß = 4.411; 95% CI = 2.284-6.537; p <0.001) altitudes compared to high altitudes, and where houses had open eaves (ß =1.201; 95% CI = 0.704-1.698; p <0.001) compared with those that had closed eaves. CONCLUSION: Housing conditions such as presence of open eaves, absence of window, location at low and mid altitudes, were strong predictors of indoor exposure to An. arabiensis bite in a highland area of south-central Ethiopia.

Blood meal sources and entomological inoculation rates of anophelines along a highland altitudinal transect in south-central Ethiopia.

BACKGROUND: The role of anophelines in transmitting malaria depends on their distribution, preference to feed on humans and also their susceptibility to Plasmodium gametocytes, all of which are affected by local environmental conditions. Blood meal source and entomological inoculation rate of anophelines was assessed along a highland altitudinal transect in south- central Ethiopia. METHODS: Monthly adult anopheline sampling was undertaken from July 2008 to June 2010 in Hobe (low altitude), Dirama (mid altitude) and Wurib (high altitude) villages located at average elevations of 1800 m, 2000 m and 2200 m, respectively. Anophelines were collected using CDC light trap, pyrethrum space spray catches (PSC) and artificial pit shelter methods. Upon collection, females were categorized according to their abdominal status and identified to species. Their human blood index, sporozoite rate and entomological inoculation rate was determined. RESULTS: A total of 4,558 female anophelines of which Anopheles arabiensis was the most prevalent (53.3%) followed by Anopheles demeilloni (26.3%), Anopheles christyi (8.9%), Anopheles pharoensis (7.9%) and Anopheles cinereus (3.6%) were caught and tested for blood meal source or sporozoite infection depending on their abdominal status. The proportions of human fed and bovine fed An. arabiensis were generally similar. In the low altitude village, there were 0.3% (1/300) and 0.2% (1/416) Plasmodium falciparum infected An. arabiensis among the CDC trap catches and PSC respectively. The percentage of Plasmodium vivax infected An. arabiensis were 3% (9/300) and 0.7(3/416) among the CDC and PSCs respectively in the village. In addition, there were 1.4% (1/71) and 50% (1/2) P. vivax infected An. pharoensis from the CDC light trap and PSCs, respectively. In the mid altitude village, 2.5% (1/40) and 1.7% (1/58) from among the CDC and PSCs of An. arabiensis respectively carried P. vivax sporozoites. Among the CDC light trap catches; there were 3.7 and 0 P. falciparum infective bites per year per household for An. arabiensis in the years July 2008 to June 2009 and July 2009 to June 2010 respectively in the low altitude village. The corresponding numbers for P. vivax infective bites for An. arabiensis were 33 and 14.5 in the same village. Space spray catches revealed 0.32 P. vivax infective bites per household for An. pharoensis during the first year in the low altitude village. CONCLUSION: Anopheles arabiensis was the most prevalent vector of P. vivax and P. falciparum malaria in the low and mid altitude villages followed by An. pharoensis. Annual entomological inoculation rates showed that vivax malaria transmission was higher than that of the falciparum and both decreased with increase in altitude.

In vivo antimalarial activity of a labdane diterpenoid from the leaves of Otostegia integrifolia Benth.

In Ethiopian traditional medicine, the leaves of Otostegia integrifolia Benth. are used for the treatment of several diseases including malaria. In an ongoing search for effective, safe and cheap antimalarial agents from plants, the 80% methanol leaf extract O. integrifolia was tested for its in vivo antimalarial activity, in a 4-day suppressive assay against Plasmodium berghei. Activity-guided fractionation of this extract which showed potent antiplasmodial activity resulted in the isolation of a labdane diterpenoid identified as otostegindiol. Otostegindiol displayed a significant (P < 0.001) antimalarial activity at doses of 25, 50 and 100 mg/kg with chemosuppression values of 50.13, 65.58 and 73.16%, respectively. Acute toxicity studies revealed that the crude extract possesses no toxicity in mice up to a maximum dose of 5000 mg/kg suggesting the relative safety of the plant when administered orally. The results of the present study indicate that otostegindiol is among the antimalarial principles in this medicinal plant, and further support claims for the traditional medicinal use of the plant for the treatment of malaria.

The potential of addressing asymptomatic malaria in the context of malaria elimination in Ethiopia: Scoping review.

Objectives: Currently, evidence synthesis targeting asymptomatic malaria infections in Ethiopia are scarce. This review intended to collect and organize information on asymptomatic malaria. Methods: A Joanna Briggs Institute, scoping review protocol was used. Searches for peer-reviewed articles published between 01 January 2010 and 10 August 2022, were done through a variety of databases, and gray literatures. Results: 17 articles were included out of 7672 articles identified. There was no any longitudinal study to trace forward these asymptomatic malaria cases. The reviewed studies did not address how asymptomatic malaria could be treated. Moreover, living in index houses, their neighbours and family sizes were the main predictors and more associated with onward transmission of malaria. Asymptomatic malaria (ASM) infection might persist in all seasons except June-August, for which data is lacking. Conclusions: Therefore, as implication of research and policy, it would be necessary to focus on index families and their neighbours in prevention of ASM, conducting longitudinal studies to ascertain when and how many asymptomatic malaria cases without fever during diagnosis would develop clinical malaria. As well, establishing a more sensitive diagnostic technique of malaria surveillance. It is also necessary to provide information regarding the feasibility of treating asymptomatic malaria cases in Ethiopia.

Cutaneous leishmaniasis in Kutaber District, Ethiopia: Prevalence, sand fly fauna and community knowledge, attitude and practices.

Background: Cutaneous leishmaniasis (CL) affects 25% of the population living in the highlands of Ethiopia. CL intervention has not decreased the number of leishmaniasis patients. A cross-sectional study was conducted to determine CL prevalence, community's knowledge, attitude and practices (KAP), and the sand fly fauna in Kutaber district, northeast Ethiopia. Methods: A retrospective, community-based cross-sectional study was conducted in Boru Meda Hospital from December 2014-March 2021 to study CL prevalence of Kutaber district. A Pre-tested, well-structured questionnaire was used to collect data on the participants' socio-demographic characteristics, KAP towards CL and knowledge about sand fly vectors. Chi-square test and logistic regression analysis were used in the study, and data were analyzed using SPSS version 23 (p < 0.05). Results: A total of 10,002 (14.02%), of which 71,325 samples were confirmed as positive for CL. The infection rate of CL in females (7.1%) was a little bit higher than males (7.0%). More cases were recorded among 15-29 age category. The study also revealed that 77.1% of the respondents had poor knowledge about CL treatment, prevention, clinical presentation and disease transmission. Farmers tended to have poorer knowledge about sand flies than non-workers and students (32.7 vs. 35 and 44.1%; P = 0.049). Housewives had poorer knowledge about sand flies than farmers and workers (22.2 vs. 32.7 and 33.3%; P = 0.023). Phlebotomus longipes comprised the highest composition (80%) of the sand fly species identified in Kutaber district. Conclusions: The data showed that the community had poor knowledge about CL, vector, and transmission mode. CL preventive measures were prevalent, implying the need to raise CL awareness. Phlebotomus longipes was identified as the most dominant sand fly species which accounted for CL. The findings can be used in developing an effective control strategy to reduce CL transmission in the study area and elsewhere in Ethiopia.

Sero-prevalence of visceral leishmaniasis and its associated factors among asymptomatic individuals visiting Denan health center, southeastern Ethiopia.

BACKGROUND: In the Somali region of Ethiopia, visceral leishmaniasis (VL) is a public health concern. However, VL epidemiology and sand fly vectors have not been well studied in various areas of the regional state, including Denan district. Therefore, this study was conducted to determine the sero-prevalence, associated factors, and distribution of sand fly vectors of VL in Denan district, south-eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted from April to September 2021 among VL patients with classic signs and symptoms visiting Denan Health Center in south-eastern Ethiopia. Using a convenience sampling method, 187 blood samples were collected from individuals who visited Denan Health Center during the study period. Blood samples were subjected to Direct Agglutination Test for the detection of antibodies to VL. A pre-tested structured questionnaire was also used to gather information on risk factors and other characteristics of knowledge and attitude assessment. Sand flies were also collected from indoor, peri-domestic, mixed forest, and termite mounds using light and sticky traps to determine the fauna and abundance. RESULTS: The overall sero-prevalence rate was 9.63% (18/187). The sero-prevalence was significantly associated with outdoor sleeping (OR = 2.82), the presence of damp floors (OR = 7.76), and sleeping outdoor near animals (OR = 3.22). Around 53.48% of the study participants had previously heard about VL. Study participants practiced different VL control methods, including bed nets (42%), insecticide spraying (32%), smoking plant parts (14%), and environmental cleaning (8%). In total, 823 sand fly specimens, comprising 12 species in two genera (Phlebotomus and Sergentomyia), were trapped and identified. The most abundant species was Sergentomyia clydei (50.18%), followed by Phlebotomus orientalis (11.42%). Also, a higher proportion of P. orientalis was found in termite mounds (65.43%), followed by mixed forest (37.8%) and peri-domestic (20.83%) habitats. CONCLUSION: The study demonstrated a 9.63% sero-positivity of VL and a remarkable gap in knowledge, attitude, and practices towards VL. P. orientalis was also detected, which could be a probable vector in this area. Thus, public education should be prioritized to improve the community's awareness of VL and its public health impact. In addition, detailed epidemiological and entomological studies are recommended.

Malaria and related outcomes in patients with intestinal helminths: a cross-sectional study.

BACKGROUND: The effects of helminth co-infection on malaria in humans remain uncertain. This study aimed to evaluate the nature of association of intestinal helminths with prevalence and clinical outcomes of Plasmodium infection. METHODS: A cross-sectional study involving 1,065 malaria suspected febrile patients was conducted at Dore Bafeno Health Center, Southern Ethiopia, from December 2010 to February 2011. Plasmodium and intestinal helminth infections were diagnosed using Giemsa-stained blood films and Kato-Katz technique, respectively. Haemoglobin level was determined using a haemocue machine. RESULTS: Among 1,065 malaria suspected febrile patients, 28.8% were positive for Plasmodium parasites (P. falciparum =13.0%, P. vivax =14.5%, P. falciparum and P. vivax =1.3%). Among 702 patients who provided stool samples, 53.8%, 31.6% and 19.4% were infected with intestinal helminths, Plasmodium alone and with both Plasmodium and intestinal helminths, respectively. The prevalence of infections with Ascaris lumbricoides (A. lumbricoides), Trichuris trichiura (T. trichiura), Schistosoma mansoni (S. mansoni) and hookworm (9.8%) were 35.9%, 15.8%, 11.7% and 9.8%, respectively. Out of the 222 (31.6%) Plasmodium infected cases, 9 (4.1%) had severe malaria. P. falciparum infection was more common in febrile patients infected with A. lumbricoides alone (21.3%), T. trichiura alone (23.1%) and S. mansoni alone (23.1%) compared to those without intestinal helminth infections (9.3%) (p<0.001 for all). Prevalence of non-severe malaria was significantly higher in individuals infected with intestinal helminths than in those who were not infected with intestinal helminths (adjusted OR=1.58, 95% CI=1.13-2.22). The chance of developing non-severe P. falciparum malaria were 2.6, 2.8 and 3.3 times higher in individuals infected with A. lumbricoides alone, T. trichiura alone and S. mansoni alone, respectively, compared to intestinal helminth-free individuals (p<0.05 for all). The odds ratio for being infected with non-severe P. falciparum increased with the number of intestinal helminth species (p<0.001). Mean Plasmodium density among intestinal helminth infected individuals was significantly increased with the number of intestinal helminths species (p=0.027). Individuals who were co-infected with different species of intestinal helminths and Plasmodium showed lower mean haemoglobin concentration than individuals who were infected only with Plasmodium. CONCLUSIONS: Infections with A. lumbricoides, T. trichiura and S. mansoni were positively associated with P. falciparum infection. However, further studies are required to investigate how these helminths could contribute to increased prevalence of P. falciparum infection.

Malaria microscopy performance in self-presenting febrile patients at four health facilities in Fentale district of East Shewa, Ethiopia.

BACKGROUND: Correct and reliable microscopic examination results are vital in appropriate treatment of malaria in endemic areas, mainly where Plasmodiumn falciparum and P. vivax co-exist in Ethiopia. Thus, evaluation of regular malaria microscopy performance is needed. OBJECTIVES: To evaluate the performance of regular malaria microscopy and antimalarial drug prescription practices for self presenting febrile patients at health facilities located in malaria endemic areas of upper Awash Valley, eastern central Ethiopia. METHODS: A cross sectional study design was used to recruit 260 febrile patients at four health facilities in Fentale district. All slides collected at health facilities were rechecked in reference laboratories and Kappa score was calculated to see the slide reading agreement. RESULTS: Malaria parasites from clinical cases were found in 19.6% (51/260) of the total febrile patients of which 82.4% (42/51) were infected with P. vivax and 17.6% (9/51) with P. falciparum. Overall sensitivity, specificity, positive and negative predictive values of regular malaria microscopy readings were 92.2%, 83.7%, 58% and 97.8%, respectively. Artemether-lumefantrine over prescription rates was 50.8% by the regular microscopy and 53.6% by reference microscopy. There was only a moderate agreement between regular malaria microscopy and reference microscopy with the Kappa value of 0.52. CONCLUSION: The overall reading agreement and agreement on species identification of the regular and reference microscopy were low. There was variability in performance in the different health facilities. Sensitivity, specificity, and positive predictive value of regular malaria microscopy need to be improved for accurate diagnosis and prompt treatment of malaria cases in Fentale district health facilities. There should be rational use of antimalarials especially on slide negative subjects.