Travel to farms in the lowlands and inadequate malaria information significantly predict malaria in villages around Lake Tana, northwest Ethiopia: a matched case–control study

• Published in: Malaria Journal
• Main Authors: Asmamaw Malede, Kassahun Alemu, Mulugeta Aemero, Sirak Robele, Helmut Kloos
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2018
• Subjects: Locally acquired malaria; Malaria information; Travel; Matched case–control study; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-018-2434-y; https://doaj.org/article/7deaf3f3f72947919527d4c05c7ffea0

Abstract Background In Ethiopia, malaria has declined in the last decade; only a small number of cases have been reported, primarily from hotspots. The contribution of house proximity to water bodies and the role of migration in malaria transmission has not yet been examined in detail in northwest Ethiopia. Individual and household-level environmental and socio-demographic drivers of malaria heterogeneity were explored contextually in meso-endemic villages around Lake Tana, northwest Ethiopia. Methods A health facility-based paired age-sex matched case–control study involving 303 matched pairs was undertaken from 10 October 2016, to 30 June 2017. Geo-referencing of case households, control households, proximate water bodies, and health centres was carried out. A pretested and structured questionnaire was used to collect data on socio-demography, household assets, housing, travel history, and malaria intervention measures. Medians (interquartile range) were computed for continuous variables. Pearson’s Chi square/Fisher’s exact test was used to detect significant differences in proportions. Principal component analysis was performed to estimate household wealth. Stratified analysis was used to confirm confounding and interaction. A multivariable conditional logistic regression model was used to detect risk factors for malaria. Results Of 303 malaria cases, 59 (19.5% [15.4–24.3]) were imported malaria cases whereas 244 (80.5% [75.7–84.6]) were locally acquired malaria cases. In bivariate analysis, marital status, educational status, and bed net ownership were significantly associated with malaria cases. In multivariable adjustment, travel to malarious lowlands in the preceding month (adjusted mOR = 7.32; 95% CI 2.40–22.34), household member’s travel to malarious lowlands (adjusted mOR = 2.75; 95% CI 1.02–7.44), and inadequate health information on malaria (adjusted mOR = 1.57; 95% CI 1.03–2.41) were predictors of malaria. Stratified analysis confirmed that elevation of households and travel to malarious lowlands ...