Detection of foci of residual malaria transmission through reactive case detection in Ethiopia

• Published in: Malaria Journal
• Main Authors: Endalew Zemene, Cristian Koepfli, Abebaw Tiruneh, Asnakew K. Yeshiwondim, Dinberu Seyoum, Ming-Chieh Lee, Guiyun Yan, Delenasaw Yewhalaw
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2018
• Subjects: Reactive case detection; Malaria; Residual malaria transmission; Low-transmission setting; Ethiopia; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-018-2537-5; https://doaj.org/article/3885ca4c4ca843ca9b9b2fae487a8fd1

Abstract Background Sub-microscopic and asymptomatic infections could be bottlenecks to malaria elimination efforts in Ethiopia. This study determined the prevalence of malaria, and individual and household-level factors associated with Plasmodium infections obtained following detection of index cases in health facilities in Jimma Zone. Methods Index malaria cases were passively detected and tracked in health facilities from June to November 2016. Moreover, family members of the index houses and neighbours located within approximately 200 m from the index houses were also screened for malaria. Results A total of 39 index cases initiated the reactive case detection of 726 individuals in 116 households. Overall, the prevalence of malaria using microscopy and PCR was 4.0% and 8.96%, respectively. Seventeen (43.6%) of the index cases were from Doyo Yaya kebele, where parasite prevalence was higher. The majority of the malaria cases (90.74%) were asymptomatic. Fever (AOR = 12.68, 95% CI 3.34–48.18) and history of malaria in the preceding 1 year (AOR = 3.62, 95% CI 1.77–7.38) were significant individual-level factors associated with detection of Plasmodium infection. Moreover, living in index house (AOR = 2.22, 95% CI 1.16–4.27), house with eave (AOR = 2.28, 95% CI 1.14–4.55), area of residence (AOR = 6.81, 95% CI 2.49–18.63) and family size (AOR = 3.35, 95% CI 1.53–7.33) were main household-level predictors for residual malaria transmission. Conclusion The number of index cases per kebele may enhance RACD efforts to detect additional malaria cases in low transmission settings. Asymptomatic and sub-microscopic infections were high in the study area, which need new or improved surveillance tools for malaria elimination efforts.