Abstract
Background
Malaria continues to be the foremost deadly disease and a cause of substantial economic deficit in Ethiopia. Data from malaria monitoring programs can be used to assess prevalence and trends of the disease over time in a way to inform policy makers and prioritize control strategies. The current study assessed the malaria case trend between 2019 and 2024 based on data from 12 districts and two towns of Hadia, Gurage and Yem zones in Central Ethiopia Region.
Methods
A retrospective study design was employed to assess a six-year (2019–2024) trend of malaria cases in 12 districts and two towns selected purposively based on their location in the Ghibe valley and level of malaria burden with the support of local health authorities. District level aggregated malaria surveillance data was obtained from archives of the district and zonal health offices, carefully reviewed and analyzed. Descriptive statistics was used to calculate frequencies and percentages of seasonal and yearly malaria suspected as well as Plasmodium falciparum and Plasmodium vivax infected cases using Statistical Package for the Social Sciences version 25 software. Pearson Chi-square (χ2) was used for the test of statistical differences between/among variables. A post-hoc analysis of pairwise comparisons was carried out for identifying the specific significant difference among the groups.
Results
There were 86,604 (23.5%) Plasmodium positive individuals among the total 368,490 suspected in the previous six years period. Among the 86,604 Plasmodium positive cases, 61% were attributed to P. falciparum and 39% to P. vivax. The analysis showed increasing trend of the Plasmodium infected cases starting from 2019 with some fluctuations. The number of cases peaked in May (13,811;15.9%), autumn season (27,266; 31.5%) and spring season (25,555; 29.5% of Ethiopia. The distribution of P. falciparum and P. vivax cases differed significantly across the districts, months, seasons and years.
Conclusion
Plasmodium falciparum and P. vivax are endemic in Hadia, Gurage and Yem zones of Central Ethiopia Region. The number of cases has been increasing since 2019 in the region and highest in May, June, October and September. Furthermore, the cases peaked during the autumn and spring Ethiopian seasons, which coincide with the key farming and harvesting seasons. There is a need to sustain and scale up existing malaria intervention measures.
Keywords: Ethiopia, Plasmodium species, Prevalence, Public health, Surveillance
Background
Malaria is a fatal disease caused by protozoan parasites in the genus Plasmodium and transmitted to people through the bite of infected female Anopheles mosquitoes [1, 2]. Despite the ongoing intensive case treatment and vector control activities, 263 million people were infected globally in 2023, equivalent to an incidence of 60⋅4 cases per 1000 at-risk individuals [1]. More than 94% of these cases occurred in Africa and 52% of the global burden was shared among five African countries namely Ethiopia, Nigeria, DR Congo, Uganda and Mozambique [1, 3]. Malaria transmission dynamics is expected to change with climate through time [4, 5]. Elevated temperature and bimodal rainfall favor increased mosquito population and Plasmodium parasites leading to increased malaria transmission [5–7].
Ethiopia is among the African countries most affected by malaria [2, 8]. The disease caused more than 7.3 million cases and 1157 deaths in 2024 [2]. Malaria peaks between April and May after the short rainy season (February to May) and between September and December after the long rainy season (June to September) [2]. Anopheles arabiensis is the major malaria vector, whilst An. pharoensis, An. nili and An. funestus play minor roles in malaria transmission in limited areas [9]. Furthermore, the invasive An. stephensi is being considered a potential malaria vector in Ethiopia [10–12].
Ethiopia set a goal to eradicate malaria by 2030 through stepping up its control efforts [13, 14]. But, factors such as antimalarial drug resistance, insecticide and behavioral resistant of the major malaria vector (An. arabiensis), complexity of the control process in P. vivax, seasonal transmission with diverse micro-climates and low population immunity might challenge the effort [15, 16]. There was a substantial reduction in the burden of malaria across the country [8, 17, 18]. However, there has been increased transmission in recent years. Analysis of malaria transmission provides input for targeted intervention [4, 15, 19, 20].
Incidences of malaria were documented in several prior trend analysis studies conducted across various regions of Ethiopia including Oromia region (32%) [21], Guba district, Benishangul Gumuz region (51.0%) [22], and Harari region in eastern Ethiopia (46.9%) [23]. However, the general trend of malaria infections has not been thoroughly studied in malaria-endemic regions of the country. Particularly, such trend has not yet been adequately explored in the Central Ethiopia region where malaria is endemic. Analyzing the trend of malaria cases in the areas might help in understanding the dynamics of the disease and efficacy of existing malaria intervention approaches which in turn paves the way for designing better control strategy. This study assessed the previous six years (2019–2024) trend of malaria suspected as well as Plasmodium falciparum and P. vivax positive cases from Hadia, Gurage and Yem zones of Central Ethiopia Region.
Materials and methods
Study areas and methods
The retrospective malaria transmission trend study used data from twelve districts and two towns (Table 1 and Fig. 1) of Hadia, Gurage and Yem zones of Central Ethiopia Region. The characteristics of the zones was described in previously published article [24]. Briefly, the health care facilities in Hadia zone included 4 hospitals, 58 health centers and 305 health posts both serving for more than 1.2 million people. Gurage zone has 7 hospitals, 65 health centers and 414 health posts serving for more than 1.3 million people [25] and Yem zone has 2 hospitals, 6 health centers and 27 health posts that serve for more than 100,000 people [26].
Table 1.
Locations of fourteen districts in Central Ethiopia region where malaria data were collected for the period 2019 to 2024
| Zones | Districts | Coordinates |
|---|---|---|
| Hadia | Analemo | 7° 07′ N, 37° 35′ E |
| Duna | 7° 19′ N, 37° 40′ E | |
| East Badawacho | 7° 33′ N, 38° 24′ E | |
| Ghibe | 7° 42' N, 37° 44′ E | |
| Gombora | 7° 33′ N, 37° 40′ E | |
| Lemo | 7° 41′ N, 37° 31′ E | |
| Misha | 7° 08′ N, 37° 81′ E | |
| Shashogo | 7° 23′ N, 36° 51′ E | |
| Soro | 7° 46′ N, 37° 23′ E | |
| West Badawacho | 7° 23′ N, 37° 52′ E | |
| Hossana town | 7° 33′ N, 37° 51′ E | |
| Shone town | 7° 12′ N, 37° 58′E | |
| Gurage | Enor | 8° 00′ N, 37° 49′ E |
| Yem | Yem | 7° 58′ N, 37° 26′ E |
Fig. 1.
Map showing location of twelve districts and two towns in Central Ethiopia Region, 2025
Study design and data collection methods
A retrospective study design was employed to assess the previous six years (2019–2024) malaria cases trend on the basis of data reported by twelve districts and two towns in the three zones of central Ethiopia region. The study areas were purposively selected based on their location in the Ghibe valley, malaria endemicity and lack of similar previous studies on malaria trends, with the support of local health officials. Malaria is among the top causes of treatment seeking in health facilities in the region. Microscopy is used to diagnose malaria in health centers and hospitals while rapid diagnostic tests at rural village health posts [4]. Malaria data are reported on a weekly, monthly and yearly basis to the respective districts, from districts to zones, from zones to the Central Ethiopia Region and finally from the region to the Ethiopian Federal Ministry of Health. The data included counts of clinically suspected, P. falciparum positive and P. vivax positive cases in the period 2019 to 2024 obtained from the archives of health offices in Hadia, Gurage and Yem zones of the region. The data lacked numbers of P. falciparum and P. vivax co-infected cases.
Data analysis
The data was entered in to Microsoft Office Excel worksheet 2021, cleaned and summarized. The completeness and consistency of data was checked. All incomplete data were excluded from the analysis. Data was transported to Statistical Package for the Social Sciences version 25 software and descriptive statistics was used to calculate frequencies and percentages of malaria suspected as well as P. falciparum and P. vivax infected cases across the districts, months, Ethiopian seasons and years. The Chi-square (χ2) test was used to compare the association between P. falciparum or P. vivax positive cases and districts, months, Ethiopian seasons and years. A post hoc analysis of pairwise comparisons was performed for a significant Chi-square test to identify the significantly differed groups from one another.
Results
Malaria cases over the previous six years
A total of 368,490 malaria suspected individuals were reported from the 14 districts (Table 2). The highest number of the suspected cases were from Shashogo district (80,850; 22%) followed by Shone town (62,838; 17%). While the least (574; 0.2%) were from Duna district. Over the six years period (2019–2024), a total of 86,604 malaria cases were documented of which the highest number of cases (20,061; 23%) were reported from East Badawacho district followed by Shashogo district (19,493; 22.5%) while the fewest cases (199; 0.2%) recorded were from Duna district.
Table 2.
Number of malaria infected and suspected individuals in Central EthiopiaRegion in the last six years (2019–2024)
| Districts | Number of malaria infected (suspected) individuals per annual | ||||||
|---|---|---|---|---|---|---|---|
| 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | Total | |
| Analemo | 148 (2042) | 454 (2306) | 418 (1584) | 427 (2747) | 692 (2549) | 627 (1826) | 2766 (13,054) |
| Duna | 11 (33) | 22 (48) | 32 (140) | 55 (152) | 43 (92) | 36 (109) | 199 (574) |
| East Badawacho | 733 (2531) | 47 31 (9518) | 3780 (8423) | 4329 (10,811) | 4281 (9097) | 2207 (6671) | 20,061 (47,051) |
| Ghibe | 5 (85) | 93 (608) | 345 (1862) | 61 (605) | 804 (3052) | 1602 (4804) | 2910 (11,016) |
| Gombora | 81 (2750) | 305 (3382) | 1117 (5699) | 1531 (6605) | 2368 (8987) | 1905 (6888) | 7307 (34,311) |
| Lemo | 117 (1589) | 187 (2378) | 137 (2113) | 379 (4121) | 261 (3920) | 399 (2108) | 1480 (16,229) |
| Misha | 71 (402) | 183 (431) | 1 (17) | 6 (22) | 37 (304) | 60 (408) | 358 (1584) |
| Shashogo | 500 (10,492) | 5416 (20,595) | 3778 (14,509) | 4522 (15,090) | 2312 (10,167) | 2964 (9997) | 19,493 (80,850) |
| Soro | 3337 (2097) | 2672 (9166) | 1614 (3557) | 981 (1786) | 1306 (2387) | 2245 (5133) | 9055 (24,126) |
| West Badawacho | 245 (2988) | 1071 (4039) | 446 (2354) | 5041 (10,311) | 1361 (4716) | 1118 (2869) | 9282 (27,277) |
| Hossana town | 161 (9875) | 97 (4635) | 205 (4701) | 244 (2423) | 872 (5451) | 176 (2090) | 1755 (29,175) |
| Shone town | 209 (9773) | 831 (6407) | 979 (10,830) | 2091 (12,011) | 2057 (14,667) | 1622 (9150) | 7789 (62,838) |
| Enor | 92 (2026) | 264 (3154) | 107 (1537) | 67 (1259) | 104 (1501) | 1984 (6013) | 1266 (15,490) |
| Yem | 29 (301) | 32 (512) | 56 (469) | 50 (287) | 732 (1103) | 632 (2243) | 2883 (4915) |
| Total | 2739 (46,984) | 16,258 (67,179) | 13,015 (57,795) | 19,784 (68,230) | 17,230 (67,993) | 17,577 (60,309) | 86,604 (368,490) |
The overall number of Plasmodium infected cases showed an increasing trend over the previous six years period starting from the year 2019 with some fluctuations. Similarly, the proportion of Plasmodium infected cases showed increasing trend. Accordingly, the percentage of Plasmodium positive cases were 5.83% (2739/46984) in 2019, 24.2% (16,258/67179) in 2020, 20.16% (11,655/57795) in 2021, 24.48% (16,702/68230) in 2022, 25.34% (17,230/67993) in 2023 and 29.14% (17,577/60309) in 2024.
Among the total malaria positive (86,604/368,490; 23.5%) cases from 2019 to 2024, 52,544 (61%) were P. falciparum infected and 34, 060 (39%) were P. vivax infected. All the 12 districts and 2 towns of the region were endemic for P. falciparum and P. vivax malaria (Table 3). Among the districts, East Badawacho (20,061/86,604; 23.4%) and Shashogo (19,493/86,604; 22.5%) had relatively highest cases. Lower malaria prevalence was reported from Hossana town 1755 (6%) during the period compared to other study districts. The percentage of P. vivax cases among the Plasmodium positives was 56.04% followed by P. falciparum (43.96%) in the year 2019. But, the percentage of P. falciparum cases remained higher during the subsequent years.
Table 3.
Annual prevalence of P. falciparum and P. vivax between 2019 and 2024 in Central Ethiopia Region
| Districts | Prevalences; n (%) annually | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | Total | |||||||||||||||
| S | P. f | P. v | S | P. f | P. v | S | P. f | P. v | S | P. f | P. v | S | P. f | P. v | S | P. f | P. v | S | P. f | P. v | |
| Analemo | 2042 | 71 (4) | 77 (4) | 2306 | 294 (13) | 160 (7) | 1584 | 251 (16) | 167 (11) | 2747 | 220 (8) | 207 (8) | 2549 | 332 (13) | 360 (14) | 1826 | 320 (18) | 307 (17) | 13,054 | 1488 (11) | 1278 (10) |
| Duna | 33 | 3 (9) | 8 (24) | 48 | 9 (19) | 13 (27) | 140 | 15 (11) | 17 (12) | 152 | 35 (23) | 20 (13) | 92 | 13 (14) | 30 (33) | 109 | 15 (14) | 21 (19) | 574 | 90 (16) | 109 (19) |
| E/Badawacho | 2531 | 413 (16) | 320 (13) | 9518 | 3370 (35) | 1361 (14) | 8423 | 2301 (27) | 1479 (18) | 10,811 | 2927 (27) | 1402 (13) | 9097 | 2928 (32) | 1353 (15) | 6671 | 1560 (23) | 647 (10) | 47,051 | 13,499 (29) | 6562 (14) |
| Ghibe | 85 | 3 (4) | 2 (2) | 608 | 65 (11) | 28 (5) | 1862 | 243 (13) | 102 (6) | 605 | 29 (5) | 32 (5) | 3052 | 515 (17) | 289 (9) | 4804 | 928 (19) | 674 (14) | 11,016 | 1783 (16) | 1127 (10) |
| Gombora | 2750 | 42 (2) | 39 (1) | 3382 | 211 (6) | 94 (3) | 5699 | 831 (15) | 286 (5) | 6605 | 1028 (16) | 503 (8) | 8987 | 1365 (15) | 1003 (11) | 6888 | 1116 (16) | 789 (11) | 34,311 | 4593 (13) | 2714 (8) |
| Lemo | 1589 | 41 (3) | 76 (5) | 2378 | 66 (3) | 121 (5) | 2113 | 24 (1) | 113 (5) | 4121 | 132 (3) | 247 (6) | 3920 | 119 (3) | 142 (4) | 2108 | 221 (10) | 178 (8) | 16,229 | 603 (4) | 877 (5) |
| Misha | 402 | 41 (10) | 30 (7) | 431 | 154 (36) | 29 (7) | 17 | 1 (6) | ––– | 22 | 1 (5) | 5 (23) | 304 | 33 (11) | 4 (1) | 408 | 51 (13) | 9 (2) | 1584 | 281 (18) | 77 (5) |
| Shashogo | 10,492 | 262 (2) | 238 (2) | 20,595 | 3638 (18) | 1778 (9) | 14,509 | 2118 (15) | 1660 (11) | 15,090 | 2371 (16) | 2151 (14) | 10,167 | 1378 (14) | 934 (9) | 9997 | 2047 (20) | 917 (9) | 80,850 | 11,814 (15) | 7679 (9) |
| Soro | 2097 | 101 (5) | 236 (11) | 9166 | 966 (11) | 1606 (18) | 3557 | 1042 (29) | 572 (16) | 1786 | 670 (38) | 311 (17) | 2387 | 733 (31) | 573 (24) | 5133 | 1796 (35) | 449 (9) | 24,126 | 5308 (22) | 3747 (16) |
| W/Badawacho | 2988 | 85 (3) | 160 (5) | 4039 | 578 (14) | 493 (12) | 2354 | 268 (11) | 178 (8) | 10,311 | 3659 (35) | 1382 (13) | 4716 | 938 (20) | 423 (9) | 2869 | 810 (28) | 308 (11) | 27,277 | 6338 (23) | 2944 (11) |
| Hossana town | 9875 | 10 (0.1) | 151 (2) | 4635 | 29 (0.6) | 68 (1) | 4701 | 93 (2) | 112 (2) | 2423 | 107 (4) | 137 (6) | 5451 | 293 (5) | 579 (11) | 2090 | 87 (4) | 89 (4) | 29,175 | 619 (2) | 1136 (4) |
| Shone town | 9773 | 85 (0.9) | 124 (1) | 6407 | 668 (10) | 163 (3) | 10,830 | 605 (6) | 374 (3) | 12,011 | 1074 (9) | 1017 (8) | 14,667 | 1295 (9) | 762 (5) | 9150 | 1048 (11) | 574 (6) | 62,838 | 4775 (8) | 3014 (5) |
| Enor | 2026 | 36 (2) | 56 (3) | 3154 | 88 (3) | 176 (6) | 1537 | 40 (3) | 67 (4) | 1259 | 22 (2) | 45 (4) | 1501 | 32 (2) | 72 (5) | 6013 | 210 (3) | 422 (7) | 15,490 | 428 (3) | 838 (5) |
| Yem | 301 | 11 (4) | 18 (6) | 512 | 22 (4) | 10 (2) | 469 | 17 (4) | 39 (8) | 287 | 22 (8) | 28 (10) | 1103 | 139 (4) | 593 (54) | 2243 | 714 (32) | 1270 (57) | 4915 | 925 (19) | 1958 (40) |
| Total | 46,984 | 1204 (2.6) | 1535 (3.3) | 67,179 | 10,158 (15) | 6100 (9) | 57,795 | 7849 (14) | 5167 (8) | 68,230 | 12,297 (18) | 7487 (11) | 67,993 | 10,113 (15) | 7117 (10) | 60,309 | 10,923 (18) | 6654 (11) | 368,490 | 52,544 (14) | 34,060 (9) |
S suspected, P.f Plasmodium falciparum, P.v Plasmodium vivax
Seasonal distribution of P. falciparum and P. vivax
Malaria cases were reported in all months (Fig. 2) and Ethiopian seasons (Fig. 3) from the 12 districts and two towns with some fluctuating trends. The number of cases peaked in May (13,811) and June (12,796) followed by October (11,908) and September (10,842) while the least was in March (6,288). A peak in numbers of cases were recorded during autumn (September–November) reaching 18,000 and 10,500 infected cases due to P. falciparum and P. vivax respectively followed by spring (March–May) reaching 16,000 and 9000 infected cases of P. falciparum and P. vivax respectively.
Fig. 2.
Trend of monthly P. falciparum and P. vivax infections over a period of previous six years (2019–2024) in Central Ethiopia Region
Fig. 3.
Seasonal variations of P. falciparum (p.f) and P. vivax (p.v) infections from 2019 to 2024 in Central Ethiopia Region
Differences in P. falciparum and P. vivax infections
The distribution of P. falciparum infections was significantly different between districts (P = 0.00), months (P = 0.00), Ethiopian seasons (P = 0.00), and years (P = 0.00). The positive rate of P. falciparum cases was significantly higher in West Badawacho district (Z-scores = 95.7), as were overall cases in May (Z-scores = 92), Autumn (Z-scores = 68.1), and 2024 (Z-scores = 31.3). Similarly, the distribution of P. vivax cases differed significantly by district (P = 0.00), months (P = 0.00), Ethiopian seasons (P = 0.00), years (P = 0.00) (Table 4).
Table 4.
Associations between confirmed P. falciparum and P. vivax infected individuals (2019–2024) and districts, months seasons and years
| Variable | Variable category | P. falciparum | P. vivax | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Number of positive cases | Number of negative cases | Z-scores | χ2 (P-value) | Number of positive cases | Number of negative cases | Z-scores | χ2 (P-value) | ||
| Districts and towns | Analemo | 1488 | 11,566 | − 9.6 | 20,259.102 (0.00) | 1278 | 11,776 | 2.2 | 11,159.002 (0.00) |
| Duna | 90 | 484 | 1 | 109 | 465 | 8.1 | |||
| E/Badawacho | 13,499 | 33,522 | 95.7 | 6562 | 40,489 | 37.8 | |||
| Ghibe | 1783 | 9233 | 5.8 | 1127 | 9889 | 3.7 | |||
| Gombora | 4593 | 29,718 | − 5 | 2714 | 31,597 | − 9 | |||
| Lemo | 603 | 15,626 | − 39.4 | 877 | 15,352 | − 17.3 | |||
| Misha | 281 | 1333 | 3.6 | 77 | 1507 | − 6.2 | |||
| Shashogo | 11,814 | 69,036 | 3 | 7679 | 73,171 | 2.8 | |||
| Soro | 5308 | 18,818 | 35.4 | 3747 | 20,379 | 34.9 | |||
| W/Badawacho | 6338 | 20,939 | 43.9 | 2944 | 24,333 | 9.2 | |||
| Hossana town | 619 | 28,556 | − 61.9 | 1136 | 28,036 | − 32.9 | |||
| Shone town | 4775 | 58,063 | − 52.6 | 3014 | 59,824 | − 42.3 | |||
| Enor | 428 | 15,062 | − 41.9 | 838 | 14,652 | − 16.8 | |||
| Yem | 925 | 3990 | 13.2 | 1958 | 2957 | 74.4 | |||
| Months | January | 2373 | 25,740 | − 9.4 | 64,455.378 (0.00) | 1924 | 26,189 | − 2.4 | 27,786.073 (0.00) |
| February | 1224 | 15,749 | − 24.5 | 1541 | 15,432 | − 17.2 | |||
| March | 3664 | 20,871 | − 22.5 | 2624 | 21,911 | − 12.5 | |||
| April | 4013 | 27,961 | 4 | 2043 | 29,931 | 7 | |||
| May | 8633 | 35,728 | 92 | 4578 | 39,783 | 67 | |||
| June | 7391 | 33,635 | 88 | 5405 | 35,621 | 71.3 | |||
| July | 2037 | 24,757 | 26.8 | 2139 | 24,655 | 19.8 | |||
| August | 2057 | 29,032 | 29.3 | 1171 | 29,918 | 15.3 | |||
| September | 6985 | 30,344 | 73 | 3857 | 33,472 | 43.7 | |||
| October | 7219 | 35,982 | 84.7 | 4089 | 39,112 | 37.7 | |||
| November | 3729 | 20,242 | − 3.8 | 2564 | 21,407 | − 1 | |||
| December | 3219 | 15,905 | − 7.1 | 2125 | 16,999 | − 2.1 | |||
| Seasons | Autumn | 17,933 | 86,568 | 68.1 | 10,433.099 (0.00) | 10,510 | 93,991 | 73.9 | 3470.490 (0.00) |
| Winter | 6816 | 57,394 | − 7.4 | 5590 | 58,620 | − 4.7 | |||
| Spring | 16,310 | 84,560 | 43.7 | 9245 | 91,625 | 51.7 | |||
| Summer | 11,485 | 87,424 | 13.7 | 8715 | 90,194 | 22 | |||
| Years | 2019 | 1204 | 45,780 | − 49.7 | 24,693.971 (0.00) | 1535 | 45,499 | − 29.2 | 7246.184 (0.00) |
| 2020 | 1015 | 57,021 | 23 | 6100 | 61,079 | 11.8 | |||
| 2021 | 7849 | 49,946 | 18.6 | 5166 | 52,629 | 8.6 | |||
| 2022 | 12,297 | 55,933 | 31.3 | 7487 | 60,743 | 21.9 | |||
| 2023 | 10,113 | 57,880 | 20.3 | 7117 | 60,876 | 14.3 | |||
| 2024 | 10,923 | 49,386 | 31.3 | 6654 | 53,655 | 21.9 | |||
Discussion
Plasmodium falciparum and P. vivax positive cases were reported from all the twelve districts and two towns of Central Ethiopia Region between 2019 and 2024, amounting to a total of 86,604 infected and 368,490 suspected with overall prevalence of 23.5%. This indicates that both P. falciparum and P. vivax malaria are co-endemic in the region. The co-endemicity of the two Plasmodial parasites creates difficulty in implementing effective malaria control strategies. This is due to the two parasites having different biological characteristics and transmission dynamics, which require distinct and more complex control measures. A single control strategy may not be effective for both, and interventions must be set to the local prevalence of each species to be successful. Implementing both P. falciparum and P. vivax focused interventions requires more resources and a thorough understanding of malaria epidemiology in the local context, which can be challenging for malaria control with limited resources [27, 28].
The majority of P. falciparum and P. vivax infected cases were reported from East Badawacho and Shashogo districts in Hadia zone. The significant variation in the number of cases between the majority of the districts entail difficulties in implementing control strategies. These challenges might include widespread resistance to insecticides in mosquito vectors, increased outdoor malaria transmission, a lack of vector monitoring and control tools appropriate for outdoor biting vectors, limitations in malaria surveillance, and a lack of trained healthcare professionals [29]. Ecological and epidemiological changes caused by environmental modifications caused by water resource efforts currently pose further barriers to malaria control [29, 30]. The difference in the numbers of cases among the districts could arise from local differences in climatic suitability for vector multiplication, quality of diagnosis and other vector control measures and malaria prevention practices [4, 13]. Furthermore, differences in malaria prevalence between the current research districts and towns could be attributed to variations in human activities, socioeconomic factors such as poverty and local population mobility, and micro-environmental conditions that influence mosquito breading habitat like proximity to water bodies that promote mosquito larval development and human-vector contact [31, 32]. Diversity in land use, housing quality, altitude, rainfall, intervention strategies and community awareness may also have resulted to significant variations in malaria prevalence between the study areas [31, 32]. However, in depth analytical studies such as ecological analysis, disease and vector clustering conditions and advanced methodologies are required to better understand the factors contribute to disproportionate distributions of malaria prevalence within these specific areas.
The total prevalence of malaria in the current study areas (23.5) was markedly higher than the report of previous similar studies conducted in several parts of the country and elsewhere such as in Mojo (4.2%) [15], Kombolcha (7.5%) [33], Halaba (9.5%) [34], Wolkite (8.6%) [14], Dembecha (16.3%) [35], Dembia (21.8%) [36] and Kissi County, Kenya (22.8%) [37]. The higher total prevalence of malaria recorded in the present study may be due to differences on the time of the study, as the malaria prevalence varies over time [38]. It could also be due to geographical difference because, the fact that different localities have different levels of population awareness on malaria and the implementation of intervention measures as shown by earlier studies elsewhere [39, 40]. The higher prevalence detected in the current study areas may be due to suitable geographical features and environmental conditions. All the study districts are characterized mostly by wet and warmer weather conditions, bimodal rainfall pattern, high vegetation density and bordered by the Ghibe river basins and several other small and large water bodies providing ideal breeding habitats for mosquitoes, and consequently increasing the risk of malaria transmission. This is supported by findings of similar previous studies [4, 15, 18]. In contrast to this, the total prevalence of malaria in the current study areas was markedly lower than the prevalence of malaria reported by previous studies in different parts of the country and elsewhere such as Guba district, Benishangul Gumuz region (51.0%) [22], Harari (46.9%) Oromia region (32%) [21] and Sennar state, Sudan (41.0%) [41]. The variations in results could be attributed to differences in environmental conditions and laboratory personnel performance in malaria parasite identification, as the quality of microscopic diagnosis is heavily impacted by slide preparation and staining methodology, microscopist skill, and microscope quality [15]. Another possible explanation is that the prevalence was underestimated due to a lack of mixed infection reports in the current study. Mixed infection not reported here could be because of the data used in the analysis of the current study was obtained from the district and zone level archives where mixed cases missed by the reporting system from health facilities to health offices in hierarchical manner similar to previous study [4]. However, mixed infection was reported in prior a facility based cross sectional study in Hadia zone [66]. Variations in the time and location of the investigations may also result in differences in malaria prevalence, as malaria fluctuates with time and place, as supported by several scientific international and national reports [13]. Furthermore, it could be related to geographical differences, as people's awareness of malaria transmission and the implementation of intervention activities differs by location. Variations in socio-demographic status and application of intervention in the same locality influenced the prevalence of malaria, according to results founded by several prior investigations in Ethiopia and elsewhere in the world [42–46].
The current study demonstrated that the highest prevalence of malaria was reported with more infections caused by P. falciparum 61% (52,544 confirmed cases) than infections caused by P. vivax 39% (34,060 confirmed cases). This result is similar to the national profile of Plasmodium species in which P. falciparum is a dominant species. Plasmodium falciparum was predominantly reported in the current study with some fluctuations among the study districts. For example, in Hossana town and Lemo district (Hadia zone), Yem zone and Enor district (Gurage zone), P. vivax was predominantly reported which is supported by some prior studies in Ethiopia [14, 15]; where as in the remaining districts, P. falciparum was predominantly reported which is in line with the previous studies conducted elsewhere in the country [18, 23, 47–49]. These differences in which P. falciparum was more prevalent compared to P. vivax may be due to the drug resistance fast life cycle and agro-climatic variations where it dominates in lower altitude and warm areas [18, 50].
The number of P. falciparum and P. vivax cases continued to increasing with some fluctuating trends from 2019 to 2024. A sharp increase in both P. falciparum and P. vivax infections occurred in 2020, 2022, and 2023/24. Infections of P. falciparum parasite reached its peak in 2024, whereas P. vivax infection was found to be highest in 2022. An increase in P. falciparum and P. vivax cases could be caused by factors such as drug resistance, declining immunity, vector resistance to insecticides and behavioral change, changing climate, and population movements [51, 52]. It implies the possibility of a malaria outbreak in the study areas, with persistent or increasing mortality and morbidity, higher demand on healthcare systems, and more challenges in achieving the malaria elimination goal [53]. For example, climate change and weather conditions could lead to the outbreak of malaria in Ethiopia [18, 54].
Previous records from malaria-endemic areas in Ethiopia demonstrated that malaria resurgence was commonly linked to weather-related conditions such as flooding and drought [54, 55]. Floods lower mosquito populations by destroying breeding grounds, but when the water recedes, stagnant pools form, allowing mosquitoes to breed and increasing malaria infection rate [56]. Furthermore, population immunity may be decreased during droughts, causing people to be more susceptible to malaria [57]. The findings of the current study highlighted the need for careful monitoring and surveillance of intervention measures to prevent potential malaria outbreaks and advance national targets of reducing malaria incidence and fatality to 0% by 2030. Extended indoor residual spraying, rapid diagnosis, increased access to insecticide-treated nets, and enhanced awareness may have contributed to the decrease in malaria prevalence during some years across the study periods particularly between 2020 and 2021 in the present study locations, which is in agreement with findings of other earlier studies [58–61]. Thus, there is still a growing need to develop and implement new tools for vector control and malaria management, such as novel insecticides.
Malaria transmission in the present study areas are holoendemic (year-round at intense levels) in which the disease is consistently present within the community. This indicates that vector control measures, such as indoor residual spraying and long-lasting insecticide treated mosquito nets must be implemented year-round rather than simply during seasonal peaks, and control strategies must be improved. Malaria cases have been reported in all months over the previous six years (2019–2024) despite peaked in the months of May, June, October and September in Central Ethiopia Region and during the Ethiopian spring and autumn seasons overlapping with the farming and harvesting seasons. The high infections cause deterimental effect on crop cultivation and harvesting as spring and autumn seasons has a detrimental socioeconomic impact on agricultural productivity and economic development in the country. This seasonal increases of malaria infection in the autumn season is assumed to be linked to the formation of stagnant water and increased relative humidity following a long rainfall period [62, 63]. It could be attributed to the creation of breeding sites following the heavy rain season, as well as the favorable temperature and high density of vegetation, which all provide an ideal breeding habitat for malaria-transmitting mosquitoes. The seasonality of malaria transmission revealed in this study is comparable to the findings in Dembia [36], Dembecha [35], Northwest Tigray [64], Guba [22], Harari [23], Modjo [15] and Ataye [65].
Limitations of the study
The retrospective data used in the current malaria trend analysis did not consider sociodemographic characteristics of the study population, such as gender and age categories limiting the ability to assess key risk groups. The data also lack information on the study participants' travel history to potentially malarious places, which may limit the relative insights that could have been acquired from analyzing these aspects. Furthermore, numbers of P. falciparum and P. vivax co-infected cases, details of individuals' clinical presentations, treatment situation, and diagnosis histories are unavailable, further limiting our understanding of malaria cases in the current study areas.
Conclusions
Plasmodium falciparum and P. vivax infections occured throughout the year in the Central Ethiopia Region. The highest numbers of infections were recorded in the months of May, June, October and September as well as during the autumn and spring Ethiopian seasons. Overall, the numbers of P. falciparum and P. vivax cases increased from 2019 to 2024 in the region with some fluctuations. Efforts are required to sustain and scale up the existing malaria control measures in order to reduce the cases in the areas and across the country. Furthermore, to more fully comprehend the influence of control measures on malaria transmission compared to natural cycles, climate data from these years might be included in the existing dataset and expand to cover more years.
Acknowledgements
We are most grateful to the Central Ethiopia Regional State public health institute for giving us permission to collect the data. We would like to thank the health offices (malaria management unit) of the three study zones for provision of the data. We also thank Addis Ababa University for providing financial support.
Abbreviations
- ALIPB
Aklilu Lemma Institute of Pathobiology
- P.f
Plasmodium falciparum
- P.v
Plasmodium vivax
- χ2
Pearson Chi-Square
Author contributions
Z.T. designed the research, conducted data collection and analysis and wrote the initial and final draft of the manuscript. A.A. designed the research, supervised the data collection and reviewed the manuscript. Y.N. reviewed the manuscript. M.G. designed the research, supervised the data collection and reviewed the manuscript. E.A. designed the research, supervised the data collection and reviewed the manuscript. All authors read and approved the final manuscript.
Funding
This study was financed by the Office of the Vice President for Research and Innovation, Addis Ababa University.
Data availability
The datasets used and/or analyzed during the current study may be obtained from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Prior to data collection, ethical clearance certificate was obtained from the Institutional Research Ethics Review Committee (ALIPB-IRERC) at Aklilu Lemma Institute of Health Research, Addis Ababa University, with reference number: ALIPB-IRERC/130/2016/24. Support and permission letter was obtained from the Institute of Public Health in the Central Ethiopia Regional State with reference number: PHI-6–19/457/2016/24.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study may be obtained from the corresponding author on reasonable request.