Malaria outbreak investigation in Siraro District, Oromia Region, Ethiopia,2021

Malaria outbreak investigation in Siraro District, Oromia Region, Ethiopia,2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Malaria outbreak investigation in Siraro District, Oromia Region, Ethiopia,2021 Girma Mideksa, Takele Gezahegn This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3972780/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background In Ethiopia, malaria is highly seasonal in many communities with epidemic-prone transmission patterns and serious public health emergencies that have a major impact on health and the economy. This investigation aimed to assess malaria outbreaks, identify their risk factors and provide appropriate control & prevention measures of the infection in Siraro district,west Arsi,Oromia,Ethiopia. Methods A unmatched case-control study with a 1:1 case-to-control ratio was conducted in the Siraro District from 16 June 2021 to 03 August 2021. Seventy-four randomly selected cases and controls participated in this study. We reviewed the previous five year’s malaria data to establish a threshold level. Both descriptive and analytical statistical procedures were performed. The data were entered using Epi-Info version 7.2.4.0 software and analyzed by using SPSS version 25. Multivariable logistic regression analysis was conducted to identify independent factors associated with malaria infection. Results plasmodium Falciparum accounts for about 81.4%. Age group ≥ 5 years were the most affected with an attack rate (AR) of 2.04/1000. Multivariate analysis revealed the place of stay during night adjusted Odds Ratio (AOR) 5.62, 95% CI = 1.016–31.069, a person with malaria in the house with AOR 15.74,95% CI = 3.029–81.865, presence of stagnant water near to house AOR of 25.60, 95% CI = 4.696-139.649, availability of plants with temporary water pools in the compound an AOR of 90.94,95% CI = 9.019-917.012 and a person who does not hear about malaria prevention on insecticide-treated bed nets utilization adjusted Odds Ratios ( AOR) of 0.14,95% CI: 0.076, 1.061 were the main associated risk factors for the occurrence of the outbreak. Conclusions The main risk factors for the outbreak were people with malaria in the house, stagnant water, and plants with temporary water pools and it was positive for Anopheles larvae. We recommended identifying potential vector breeding sites and environmental management through community participation and redistribution of the ITN before malaria season and ITNs utilization gaps through health education. Investigation Malaria Outbreak Case-Control Response Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Background of the study Malaria is a life-threatening disease caused by the infection of red blood cells with protozoan parasites of the genus Plasmodium that are transmitted to people through the bites of infected female Anopheles mosquitoes. Four species of plasmodium ( P. falciparum, P.vivax, P.malariae , and P.ovale ) most commonly infect humans. P. falciparum and P.vivax are the most prevalent species and P. falciparum is the most dangerous. A fifth species, P.knowlesi (a species of Plasmodium that primarily infects non-human primates) is increasingly being reported in humans inhabiting forested regions of some countries of South-East Asia and the Western Pacific regions [ 1 – 3 ]. p. falciparum and p.vivax are the two most dominant malaria parasites in Ethiopia accounting for 60–70% and 30–40% of malaria cases, respectively. P. falciparum is the most dangerous species contributing to high malarial deaths in Africa, including Ethiopia. Anopheles Arabiensis, a member of the Anopheles Gambiae complex, is the primary vector of malaria in Ethiopia [ 4 ] . Children with severe malaria frequently develop one or more of the following severe symptoms: severe anemia, respiratory distress due to metabolic acidosis, or cerebral malaria. In adults, multi-organ involvement is also frequent. In malaria-endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur. Malaria is a preventable and treatable disease [ 5 ]. World Health Organization (WHO) recommends protection for all people at risk of malaria with effective malaria vector control method. Techniques of vector control include insecticide-treated mosquito nets, indoor residual spraying and in some specific settings, larval control is effective in a wide range of circumstances [ 2 ]. Malaria-Free World and World Health Organization’s (WHO) updated Global Technical Strategy 2016–2030. According to World Malaria Report 2018, Ethiopia has shown a 57 percent decline in incidence and a 54 percent reduction in malaria mortality between 2015 and 2018 [ 6 , 7 ]. Ethiopia became one of the president's malaria initiative (PMI) focus countries in Africa. Initially, the president's malaria initiative (PMI) resources for Ethiopia primarily targeted the Oromia Region, the country’s largest administrative region and home to the greatest number of people at risk for malaria. The overarching goals of the president's malaria initiative (PMI) Program in Ethiopia include, increasing support especially for vector control in high burden districts in high burden regions, continued insecticide-treated bed nets (ITN) procurement and distribution to support insecticide-treated bed net (ITN) universal coverage, continued procurement of antimalarial to address national gaps, and National level surveillance strengthening along with district-level support in low malaria burden districts to assist in achieving sub-national elimination [ 8 ]. In June 2021, Siraro District Health Office informed the West Arsi Zonal Health Department that there were suspected malaria cases identified in 16 Kebeles (villages) of the District. This study was intended to confirm the existence of an outbreak, describe the magnitude of the disease, identify risk factors and implement control measures. Methods Study Area and Period The study was conducted in Siraro District, West Arsi Zone, Oromia Region. This area is under the catchment of Biftu and Shasha Health centers. Siraro District is located in the Great Rift Valley of Southern, Oromia Region, Ethiopia.The administrative center of Siraro District is Loke, which is located about 304 kilometers to the South of Addis Ababa and 54 kilometers way from Shashamanne (Zonal town). The district borders Sidama Region to the southeast, Walayita zone to the southwest, Hadiya zone to the west, Halaba special zone to the north, and Shala District to the east ( Fig. 1 ) . Demographically speaking, a total of 207,541 people in which 10, 7921 were females and 30,410 were under-five children inhabit the District. The district is administratively organized into 28 rural kebeles, and 4 urban kebeles. The District had one primary hospital, 6 health centers (HCs), and 28 health posts (HPs) with primary health care coverage of 85.7% reported by Siraro district. The climate is 90% desertic. The mean annual temperature is between 18.5 to 25.5 degrees centigrade. The district generally lays at an altitude between 1500 and 2075 meters above sea level. These above districts' weather conditions, altitude, and temperature favor breeding of disease-causing vector-like anopheles mosquitoes. The district covers an area of 1312.855 square kilometers. The annual average rainfall is about 1650 milliliters, but inadequate and seasonal between 900 to 1500 milliliters per year. We conducted this study from 16 June to 03 August 2021. Study Design We used a community-based unmatched case-control study design with a 1:1 ratio of case and control to identify risk factors and cross-sectional study design to describe in terms of person,place and time for the occurrences of the malaria outbreak in the district. Population Source Population All populations living in the Siraro district of the West Arsi Zone were the source population for this study. Study Population All populations of Siraro district where Malaria outbreak occurred were the study population Study Subject Case Any person living in Siraro district during the study period with fever or fever with headache, rigor, back pain, chills, sweats, myalgia, nausea, vomiting and confirmed positive by microscopy or Rapid Diagnostic Test (RDT) for Plasmodium parasites and who agreed to participate in the study were included in the study. Controls Any resident of Siraro district during the study period who is a neighbor to a case and who did not develop signs and symptoms of malaria and confirmed negative by microscopy or Rapid Diagnostic Test (RDT) for plasmodium parasites. Eligibility criteria Inclusion Criteria For cases Any resident of the Siraro district where malaria outbreak occurred and who had symptoms of malaria and confirmed positive by microscopy or Rapid Diagnostic Test (RDT) for Plasmodium parasites and agree to participate were included from the study. For controls Any resident of Siraro district where malaria outbreak occurred, neighbor to a case and who did not develop signs and symptoms or free from malaria disease in the house and confirmed negative by microscopy or Rapid Diagnostic Test (RDT) for Plasmodium parasites and agree to participate. Exclusion Criteria For cases Any resident of Siraro district where malaria outbreak occurred, who had symptoms of malaria and confirmed positive by microscopy or Rapid Diagnostic Test (RDT) for Plasmodium parasites but who refused to participate were excluded from the study. For controls Those who refused to participate, were unavailable during the study period, and did not fulfill inclusion criteria were excluded from the study. Variables in the study Dependent variables Presence of malaria infection (case & control). The independent variables Socio-demographic factors Age, sex, occupation, religion, ethnicity, and educational status. Environmental factors Plant water pools, open deep well, broken materials, and stagnant water. Housing condition factors House screen, sprayed and bed net in household. Knowledge related factors Way of transmission, know symptoms of malaria, and way of prevention. Operational, case definitions and measurements Malaria A disease in an individual in which the presence of Plasmodium parasites in blood has been confirmed. Resident Individuals (workers) who had been living for more than 3 months and are normal residents of the study area. Cases Any person with fever or fever with headache, rigor, back pain, chills, sweats, myalgia, nausea, vomiting and confirmed positive by microscopy or RDT for plasmodium parasites. Controls Any person who is a neighbor to a case and who did not develop symptoms of malaria. Suspected Patient with fever or history of fever in the last 48 hours and who lives in malaria-endemic areas or has a history of travel within the past 30 days to malaria-endemic areas. Probable Any person with fever and one or more major signs such as headache, rigor, back pain, chills, sweats, myalgia, nausea, and vomiting are diagnosed clinically as malaria. Confirmed Any suspected case that is confirmed by microscopy or RDT for plasmodium parasites. Line-List Registrations of cases by place, person, and time. Knowledgeable If respondents answer > 60% correctly knowledge-related questions, then they are known to that question. Not Knowledgeable If respondents answer ≤ 60% correctly knowledge-related questions, then they are not known to that question. Sample size determination and sampling procedures Sample size determination For descriptive epidemiology Malaria was defined and identified as an acute febrile illness with blood smear positive for malaria in the Siraro District outbreak in 2021. During this outbreak investigation, the number of malaria cases and deaths were collected from health facilities on a daily and weekly basis. The magnitude of this outbreak was described by age, sex, and kebele, weekly, monthly, slide positivity rate was calculated as those positive for malaria among the total 183 confirmed cases examined from line list reported of Siraro district. For analytical epidemiology : The sample size for both cases and control was recruited by using a 1: 1 ratio of case and control. The assumption taken from a previous study indicates that the proportion of controls exposed was 55% for a power of 80% with an odds ratio (OR) of 2.90. (9). The sample size which was taken from each group was determined by Epi-Info version 7.2.4.0 and the final sample size generated was 74 malaria cases and 74 community controls total of 148 study participants. The significance of risk factors for the outbreak was determined through multivariate analysis by calculating Odds Ratio (OR) and 95% Confidence Interval (CI). Sampling technique and procedures The simple random sampling method was used at the places where the outbreak occurred and was selected randomly confirmed cases with the highest caseloads and community control interviewed from two affected kebeles. Data collection method, tools, and procedures Data was collected by using a structured questionnaire and by reviewing secondary data at the district after discussing with relevant bodies (task force), review of weekly Public Health Emergency Management (PHEM) reports at different levels ( zone health department, District health office, and Health facilities), health extension workers (HEWs), review on available data from line list, visiting of the affected village and interview of community members (patients) to collect risk factors for the malaria outbreak. Selected case patients and controls were interviewed about the presence of mosquito breeding sites in their compound and near to home within 500 meters or less than it. These sites include unprotected surface water, open deep well, solid and liquid waste collection, and disposal facilities. In addition, the availability of uncovered plastic water containers, old tires, and broken glasses in the home or outside the home was also critically assessed. Similarly, observation of these potential mosquito breeding sites and the presence of Anopheles larvae in stagnant water was conducted. Quantitative data that was addressed socio-demographic characteristics and potential exposures were collected. Laboratory technicians had conducted thick and thin smears with a 100 × oil immersion microscopy at Biftu Health Center of Siraro District. Additionally, Diagnostic Test (RDT) was also used in this health center whenever they faced a shortage of some reagents and during interruption electric power. Health extension workers also used Rapid Diagnostic Test (RDT) to identify confirmed malaria cases at the health post and community level during the outbreak investigation. A five-year (2017 to 2021), fiscal budget years recorded malaria data at the Siraro health office were reviewed. Daily data to weekly total cases in the affected localities in the previous weeks and months were compiled. By taking the second-largest malaria trend from the five-year reviewed malaria data as a threshold and comparing i t with the number of cases of the weeks and months of 2021, the malaria out-break was determined. Data Quality Assurance We used a line list for describing malaria cases in terms of time, place, and person. However, all data completeness was checked before analysis. Data processing and analyzing Data enter and summarizing were done using Epi- Info version 7.2.4.0 software. Then data were imported to Microsoft Excel and analyzed by SPSS version 25. We identified independent determinants by bivariate & multivariate logistic regression.Used a P-Value (< .05) and AOR with 95% CI to report significance and strength of association, respectively. Ethical considerations The supportive letter was written by St. Paul’s Hospital Millennium Medical College to Oromia Regional Health Bureau to get permission from the West Arsi Zonal Health department and Siraro district health office. Dissemination of results The study finding was prepared to share with St. Paul’s Hospital Millennium Medical College, School of public health of Field Epidemiology Training program Coordinators and mentors, Oromia Regional Health Bureau, and Siraro District Health Office in both hard copy and electronic soft copy. Results Descriptive epidemiology Description of a case by a person A total of 221 blood smear tests was done by Microscopy and Rapid Diagnostic Test (RDT) for suspected malaria cases at all health facilities of these 183 were confirmed cases from March to June 2021 in Siraro District. A total of 183 confirmed cases were treated and an 82.8% positivity rate. Total confirmed cases 104 (56.8%) were male. The proportion of suspected malaria cases was higher among males than females. Of the total positive cases, Plasmodium falciparum accounts for about 149(81.4%) followed by P. Vivax 34(18.6%) (Table 1 ). Table 1 Malaria Positivity rate by age, sex, and species in Siraro district, Oromia, 2021 Characteristics Total tested by RDT or Microscopy Total positive Positivity rate (%) Plasmodium species P. Falciparum N (%) P.Vivax N (%) Age <5 25 20 80% 16(10.7%) 4(11.8%) ≥ 5 196 163 83.1% 133(89.3%) 30(88.2%) Sex Male 125 104 83.2% 92(61.5%) 21(60.4%) Female 96 79 82.3% 57(38.5%) 13(39.6%) Total 221 183 82.8% 149(81.4%) 34(18.6%) Descriptive epidemiology by place Among the total confirmed malaria cases, 97(53%) were from Dongoro Bonkoya kebele.The populations in Dongoro Bonkoya kebele were the most affected by the malaria outbreak followed by Shasha Goyke kebele with an attack rate of 16.7/1000 and 1.9 /1000 population, respectively ( Table 2 ) . Table 2 Malaria attack rate by place in Siraro District, Oromia, 2021 S/N Name of Kebele Total Population Sex Total tested (RDT or Microscope) Total cases AR/1000 Male Female 1 Dongoro Bonkoya 5856 2869 2987 123 97 16.7 2 Shasha Goyke 6747 3340 3407 51 33 1.9 Total 12603 6209 6394 174 130 10.31 Distribution of malaria cases by kebele in Siraro District The malaria epidemic was detected & reported to Regional Health Bureau on June 10 of 2021. Malaria cases identified in 16 Kebeles among these most cases, 97(53%) Dongoro Bonkoya and 33(18%) cases Shasha Goyke while 53(29%) cases other (14) kebeles (Fig. 2 ). Descriptive epidemiology by time In the kebele, the malaria outbreak was verified by comparing the current year data with the second largest number during the previous 5 years (2017–2021). It was shown that the current case trend line crossed the threshold levels in the district and peaked in the 19th WHO week and started to decline after the 25th WHO week of May 2021 (WHO week 15 to 25/2021). Epi- curve showed that the district health office departed to the outbreak area early, as soon as the outbreak started (Fig. 3 ). The Epi-curve showed the outbreak was a propagated one with multiple peaks with a possibility of person-to-person transmission. The weeks when the epidemic started were on the first week of May 2021 and notified by the district health office (Fig. 4 ). Analytical epidemiology Socio-demographic characteristics of the study participants During this case-control study, 74 malaria case patients and 74 community controls were recruited. The mean age of study participants was 27.14 years with ± 14.042 standard deviations. They recruited study subjects (both cases and controls) all have participated in the study which gives a response rate of 100%. Among total study subjects, 47(63.5%) cases were male of which 39(52.7%) were controlled. Almost all (90.5%) of the respondents were Oromo by ethnicity and (94.6%) Muslim followers (Table 3 ). Table 3 Socio-demographic characteristics of study participant’s malaria outbreak of Siraro District, West Arsi Zone, Oromia, 2021 Variables Response Frequency (%) Cases(N = 74) Controls(N = 74) Age 55 3(4.1%) 3(4.1%) Sex of respondent Male 47(63.5%) 39(52.7%) Female 27(36.5%) 35(47.3%) Marital status Single 19(25.7%) 42(56.8%) Married 46(62.2%) 27(36.5%) Divorced 3(4.1%) 1(1.4%) Widowed 6(8.1%) 4(5.4%) Occupational status Employed 2(2.7%) 3(4.1%) Unemployed 18(24.3%) 24(32.4%) Student 14(18.9%) 21(28.4%) Farmer 40(54.1%) 26(35.1%) Religion Orthodox 1(1.4%) 3(4.1%) Protestant 6(8.1%) 4(5.4%) Muslim 67(90.5%) 67(90.5%) Ethnicity Oromo 70(94.6%0 70(94.6%) Sidama 4(5%) 4(5%) Educational status Illiterate 42(56.8%) 32(43.2%) Read and Write 17(23.0%) 3(4.1%) Under school age - 11(14.9%) Elementary 7(9.5%) 23(31.1%) Secondary 6(8.1%) 2(2.7%) Above secondary 2(2.7%) 3(14.9) Risk factors analysis study results Person with malaria in the house was 15 times higher among persons who reside with malaria-infected persons in the household than those who reside in households where there is no malaria-infected person an AOR of 15.74 [95% CI = 3.02–81.86, P = 0.001]. Staying outside the home during the night was 5 times higher of contracting malaria than staying inside the home AOR 5.62,95% CI = 1.01–31.06, P-value 048. Stagnant water near living areas was 25 times the risk of malaria contracting malaria when comparing the counterpart an AOR of 25.60,95% CI = 4.69-139.64, and at a p-value of 0.000. Availability of plants with temporary water pools in the compound was also found to be contributing risk factors for the occurrence of the outbreak with an AOR of 90.94 [95% CI = 9.01-917.01, P = 0.000]. A person who did not hear about malaria was AOR 0.14 [CI: 0.07, 1.06, P = 0.008] times less likely to have malaria than individuals who heard about malaria prevention on ITN utilization.Individuals who were not awareness about the transmission of malaria were 0.02 times (CI: 0.002–0.18) less likely to have malaria than individuals who know transmission of malaria ( Table 4 ) Table 4 Bi-variate Vs multivariate analysis of risk factors for malaria outbreak in Siraro, West Arsi Zone Oromia, Ethiopia, 2021 Risk factors Response Case status Crude OR(95%CI) Adjusted OR(95%CI) P-value Case (N = 74) Control (N = 74) Place of stay during night Inside house 53 64 2.53(1.09–5.85) 5.62(1.01–31.06) 0.048 Outside house 21 10 1 Person With malaria in the house With malaria in house 47 30 2.55 (1.31–4.95) 15.74(3.02–81.86) 0.001 With-out malaria in house 27 44 1 Plant with temporary water pools Yes 63 30 8.4(3.80-18.52) 90.94(9.01–91.01) 0.000 No 11 44 1 Stagnant water Near to house 46 21 4.15(2.08–8.26) 25.6(4.69-139.64) 0.000 Not near to the house 28 53 1 Hear about Malaria Heard 29 48 0.35(0.17–0.68) 0.14 (0.07–1.06) 0.008 Not heard 45 26 1 Having awareness transmission of malaria Yes 34 57 0.25(0.12–0.51) 0.02 (0.02–0.18) 0.000 No 40 17 1 Epidemic preparedness, response, and public health intervention There was a functional rapid response team to respond to the outbreak in the district. They had traveled almost about 46 km away from the district to investigate and respond to the outbreak. Case management/treatment of infected individuals was made in parallel with outbreak investigation. Awareness was created while collecting data and visiting the environment where the outbreak occurred ( Fig. 5 ) About 650 Insecticide-treated nes was distributed for 146 households including pregnant mothers in the affected Shasha Goyke kebele. About 2249 populations at risk were protected by the distribution of ITN. A total of 1220 households with 2862-unit structures were chemical sprayed at Dongoro Bonkoya kebele of the district. communities were mobilized and taught on prevention and control measures of malaria disease. Health professionals were mobilized and assigned to affected kebeles for active case search and early case management at the communities and health facility level. Awareness was also given to the affected communities on the prevention of the diseases concerning the way to avoid the breeding sites for malaria vectors, especially on environmental management. While distributing insecticide-treated nets, the affected communities were aware of using ITN properly by giving priority to pregnant women and children less than five years of age ( Fig. 6 ) Discussion Outbreaks of malaria are often complex, multi-factorial, and may have natural and human-made determinants. During this outbreak investigation time in the study area, it was found that health facilities were using Rapid Diagnostic Test (RDT) and microscopy to identified cases ,from 221 suspects tested 183(83%) confirmed cases without death were reported. Of total cases,male (AR = 2.2/1000) and age > 5 years (AR = 2.04/10,00) were more attacked in the District. The malaria outbreak was verified by comparing the current year data with the second largest number during the previous 5 years (2017–2021) in the district. It was shown that the current case trend line crossed the threshold levels in the district and peaked in the 19th WHO week and started to decline after the 25th week (WHO week 15 to 25/2021) with threshold line for monitoring malaria epidemic on the chart and confirmed. The overall attack rate of malaria infection in this study area was 10.31%, with a higher attack rate in the Dongoro Bonkoya kebele (16.7%) communities. This result was greater than reports from a study done in an institutional-based conducted at Dilla Town and the Surrounding Rural Areas, Gedeo Zone, Southern Ethiopia which is 16% [ 10 ] . The results of this study revealed that from malaria parasite species, P. falciparum accounts for 81.4% followed by P.vivax 18.6%. This finding was higher than that of a study on the analysis of malaria prevalence in Arsi Negelle health center, southern Ethiopia, that foound Plasmodium species, P. Vivax accounting for (74%), P. falciparum was (19.8%). This finding was similar with that of Amaya Woreda, southwest Shoa, Oromia, where 84% were P. falciparum and 16% were P. Vivax [ 11 , 12 ] . The transmission of malaria is determined by main factors such as human behavior and the existence of malaria parasite, as well as social and health facility factors such as housing condition, environmental management, KAPs of the community towards malaria causation, transmission, treatment-seeking behavior, and presence of mosquito control activities can affect malaria prevalence. The findings of this study revealed that living in the nearby stagnant water was identified as a risk factor. A significantly higher parasite rate was found among the individuals near stagnant water around their houses. The study conducted in Dilla Town and the surrounding rural areas, Gedeo Zone, the study showed that persons who live in an area where there is stagnant water were 34.26 times more likely to be exposed to malaria parasites than those who do not live in an area with stagnant water [ 13 ] . Availability of Plants with temporary water pools in the compound was also found to be contributing risk factor for the occurrence of the outbreak were more affected. It can be explained by the fact that they are more exposed to mosquito bites because these areas are suitable for the breeding of mosquitoes around their homes. This study agrees with a different study done at Afar Region on Malaria outbreak investigation, and also astudy conducted in Jimma town, south-west Ethiopia [ 4 , 10 ] . Persons who stay outside at night were 5.62 times more likely to develop malaria parasites than those who do not stay outside at night. Individuals with malaria patients in the house were 15.74 times more likely to develop malaria parasites than those who do not have malaria patients in their house. This result agrees with the study conducted in West Armachiho District, Northwest Ethiopia, that revealed that staying outside during the night is more likely to develop malaria than those who stay inside during the night [ 14 ] . Community knowledge on malaria prevention and control options is important and the effort is related to either environmental management, personal protection, or vector control. The results of this analytical epidemiological study showed that persons who have never heard about the transmission of malaria were significantly associated with the occurrence of this outbreak.The result of this study is similar to Malaria prevalence, knowledge, attitude, and practice among febrile patients attending Chagni health center, Northwest Ethiopia and a study also revealed that 97% of the respondents had ever heard about malaria and recognized it as a serious health problem [ 15 ] . Limitation of the study The main limitation was a shortage of medical entomologists to confirm the existence of anopheles mosquito larvae and measure their quantity in stagnant water. Late notification of the outbreak might show that there was weak monitoring of malaria trends at all levels. Conclusions There was a malaria outbreak in the Siraro district of West Arsi Zones. Of the 16 kebeles of the district malaria area Dongoro Bonkoya, Shasha Goyke, and Torba Hansawe kebeles were more affected by the malaria outbreak. Age five years and older were more affected by the disease,the presence of stagnant water,plants with temporary water pools in the compound, stay outside of their home during the night, the presence of malaria patients in the household, and persons who have never heard about malaria prevention on insecticide-treated bed nets (ITN) utilization were significantly contributed to the occurrence of the outbreak in this district. Abbreviations AR : - Attack Rate, AOR : -Adjusted Odds Ratios, CDC: - Center for Disease Control, CI: -Confidence Interval, EFETP : - Ethiopia Field Epidemiology Training Program, HC : - Health Center, HEW: - Health Extension worker, HF: - Health Facility, HHs : -Households, HPs: - Health Posts, IRS: -Indoor Residual Spray, ITN : -Insecticide-treated bed nets, OR: - Odds Ratio, PHCU: - Primary Health Care Unit, PHEM : -Public Health Emergency Management, RDT: -Rapid Diagnostic Test, SPHMMC : -ST. Paul’s Hospital Millennium Medical College, WHO: - World Health Organization Declarations Ethical Approval The study protocol was approved by the Institutional Review Board (IRB) of St. Paul’s Hospital Millennium Medical College and a letter of permission was obtained from the West Arsi zone health office. Then the letter was delivered to the Siraro District Health office and the respective villages. The rationale of the study was explained to the participants. In addition, oral consent was obtained from each study participant. Blood smears were taken by experienced laboratory technicians under an aseptic technique using sterile gloves and disposable sterile lancets. Codes were used to ensure the confidentiality of Laboratory results. Participants with positive for malaria parasites were linked to the nearest health facilities for treatment according to the national malaria guideline. Consent for publication Not applicable. Availability of data and materials The data upon which the result is based could be accessed as a reasonable request. Competing interests Both authors declared that they have no conflicts of interest for this work. Funding Not applicable. Authors’ Contributions Girma Mideksa designed the study, developed the proposal, participated in the data collection, performed analysis and interpretation of data, and drafted the paper. Takele Gezahegn contributed significantly from its beginning up to the manuscript preparation and its critical editing. Acknowledgments I would like to thank St. Paul’s Hospital Millennium Medical College School of Public Health for giving me the education opportunity. My thank is also for the Field Epidemiology Training Program Academic Coordinator (Dr. Samerawit Solomon, Mrs.Hayimanot Ewnetu, and Mrs.Jimmawork Wondimu) and instructors for their strict mentoring, advice, and comments during theoretical sessions and at fields. I would like to thank my mentor Mr.Takele Gezahegn (MPH, Assistant Professor) for his kindly and constructive inputs for this outbreak investigation right from advice and guidance. I would also Thank Mr. Gammachu Shume, Public Health Emergency Management Core-Process Manager at Oromia Regional Health Bureau, and my Field Supervisor for his facilitation of field works. I would also like to thank all staff of Siraro District Health Office, Public Health Emergency Management staff (PHEM), and community for their kindly assistance and cooperation during data collection. Furthermore, I would like to thank my lovely wife Sr.Motu File for her usual support and stand beside me in my all daily life. References Health W, Who O. WHO Guidelines for malaria - 16 February 2021. World malaria report 2019. 2019. Mishra N. Guidelines for diagnosis and treatment of malaria in india. 2018;(July 2014). Talie A. Prevalence of malaria and associated risk factors among asymptomatic migrant laborers in West Armachiho District , Northwest Ethiopia. 2018;95–101. Metanat M. Malaria in Children. 2015;2(1):4–5. Initiative M. PRESIDENT ’ S MALARIA INITIATIVE ETHIOPIA. 2018; President US, Initiative M. PRESIDENT ’ S MALARIA INITIATIVE ETHIOPIA. 2019; U . S . PRESIDENT ’ S MALARIA INITIATIVE ETHIOPIA Malaria Operational Plan FY 2020. 2020;1–107. Bayray A, Marama T. 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Malaria prevalence, knowledge, attitude, and practice among febrile patients attending Chagni health center, Northwest Ethiopia: a cross-sectional study. Trop Dis Travel Med Vaccines. 2021;7(1):1–10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 28 Mar, 2024 Reviews received at journal 27 Mar, 2024 Reviewers agreed at journal 19 Mar, 2024 Reviewers invited by journal 17 Mar, 2024 Editor assigned by journal 09 Mar, 2024 Submission checks completed at journal 06 Mar, 2024 First submitted to journal 20 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3972780","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":277614300,"identity":"f4902205-6529-4ac2-9f80-4a6f315367fb","order_by":0,"name":"Girma Mideksa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDACZghpwMDeAKQNLEjRwnMApEWCeLsMGCQSQAwitMi78z7d8DPH2lh+5vOrG34USDDwt3cn4NVieJjd7GbvtnQzg9s5ZTd7gA6TOHN2A34tzWxsN3i3HbYxkM5Ju8ED1GIgkUtYy82/QC3yM8+k3fxDjBZ5Zja220BbzBhusB+7TZQtBiAtstvSjQ3O5LDdljGQ4CHoF/n+Y2w3326zNpzffvzZzTd/bOT423sJ2HIAzuQxAJN4lYNtaYAz2R8QVD0KRsEoGAUjEwAAWCNFVzcjwi8AAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Girma","middleName":"","lastName":"Mideksa","suffix":""},{"id":277614301,"identity":"cf582978-24dd-44ff-bfc8-e79f479fd346","order_by":1,"name":"Takele Gezahegn","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Takele","middleName":"","lastName":"Gezahegn","suffix":""}],"badges":[],"createdAt":"2024-02-20 12:32:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3972780/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3972780/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52450078,"identity":"d2573e13-65e4-4a24-8a3c-308b22241930","added_by":"auto","created_at":"2024-03-11 19:03:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":334823,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Siraro District, West Arsi Zone, Oromia Ethiopia, 2021\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3972780/v1/98e230cc5efc296179ec677d.jpg"},{"id":52451062,"identity":"3f5dafc2-3b49-41e0-a493-9b5dd15403d5","added_by":"auto","created_at":"2024-03-11 19:11:31","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":207027,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of malaria cases by kebele in Siraro District, West Arsi Zone, 2021\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3972780/v1/1aa70798efbeaa458c07e138.jpg"},{"id":52450079,"identity":"5af1c894-ebce-4851-b7ed-590fcde3ffca","added_by":"auto","created_at":"2024-03-11 19:03:31","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":287778,"visible":true,"origin":"","legend":"\u003cp\u003eTrends of malaria cases crossing thresholds in Siraro district, West Arsi zone, Oromia, 2021\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3972780/v1/7d7f559aae0041f23e9f0bd0.jpg"},{"id":52450083,"identity":"eb861c00-ad90-47c0-ad87-3a7d90224f75","added_by":"auto","created_at":"2024-03-11 19:03:32","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":229226,"visible":true,"origin":"","legend":"\u003cp\u003eEpi-Curve confirmed Malaria cases by date of onset in Siraro district, 2021\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3972780/v1/cc4b0c289731a28ea2b21784.jpg"},{"id":52450082,"identity":"3380752b-8384-4cfd-9754-7b3081539f2e","added_by":"auto","created_at":"2024-03-11 19:03:32","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":313096,"visible":true,"origin":"","legend":"\u003cp\u003ePhoto taken while data collection, awareness creation, and case management at Dongoro Bonkoya kebele, Siraro district, West Arsi Zone, 2021\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3972780/v1/bfc15b6a4a6b3a1c0b5dec67.jpg"},{"id":52450081,"identity":"eb54b2d7-e11d-4ac9-81b1-7191435bd42d","added_by":"auto","created_at":"2024-03-11 19:03:32","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":371879,"visible":true,"origin":"","legend":"\u003cp\u003eA photo taken while awareness creation when ITN distribution at Shasha kebele, Siraro district, West Arsi Zone, 2021\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3972780/v1/193970eefb4dd32793e1f2cd.jpg"},{"id":52453113,"identity":"b919b1df-f2e1-40b2-a898-5704bb44c060","added_by":"auto","created_at":"2024-03-11 19:19:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1151361,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3972780/v1/91bb27ea-941e-4bc3-a275-aab375485616.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Malaria outbreak investigation in Siraro District, Oromia Region, Ethiopia,2021","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cstrong\u003eBackground of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMalaria is a life-threatening disease caused by the infection of red blood cells with protozoan parasites of the genus \u003cem\u003ePlasmodium\u003c/em\u003e that are transmitted to people through the bites of infected female \u003cem\u003eAnopheles\u003c/em\u003e mosquitoes. Four species of \u003cem\u003eplasmodium\u003c/em\u003e (\u003cem\u003eP. falciparum, P.vivax, P.malariae\u003c/em\u003e, and \u003cem\u003eP.ovale\u003c/em\u003e) most commonly infect humans. \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP.vivax\u003c/em\u003e are the most prevalent species and \u003cem\u003eP. falciparum\u003c/em\u003e is the most dangerous. A fifth species, \u003cem\u003eP.knowlesi\u003c/em\u003e (a species of \u003cem\u003ePlasmodium\u003c/em\u003e that primarily infects non-human primates) is increasingly being reported in humans inhabiting forested regions of some countries of South-East Asia and the Western Pacific regions [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. \u003cem\u003ep. falciparum\u003c/em\u003e and \u003cem\u003ep.vivax\u003c/em\u003e are the two most dominant malaria parasites in Ethiopia accounting for 60\u0026ndash;70% and 30\u0026ndash;40% of malaria cases, respectively. \u003cem\u003eP. falciparum\u003c/em\u003e is the most dangerous species contributing to high malarial deaths in Africa, including Ethiopia. Anopheles Arabiensis, a member of the Anopheles Gambiae complex, is the primary vector of malaria in Ethiopia [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e] .\u003c/p\u003e\n\u003cp\u003eChildren with severe malaria frequently develop one or more of the following severe symptoms: severe anemia, respiratory distress due to metabolic acidosis, or cerebral malaria. In adults, multi-organ involvement is also frequent. In malaria-endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur. Malaria is a preventable and treatable disease [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. World Health Organization (WHO) recommends protection for all people at risk of malaria with effective malaria vector control method. Techniques of vector control include insecticide-treated mosquito nets, indoor residual spraying and in some specific settings, larval control is effective in a wide range of circumstances [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]. Malaria-Free World and World Health Organization\u0026rsquo;s (WHO) updated Global Technical Strategy 2016\u0026ndash;2030. According to World Malaria Report 2018, Ethiopia has shown a 57 percent decline in incidence and a 54 percent reduction in malaria mortality between 2015 and 2018 [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. Ethiopia became one of the president's malaria initiative (PMI) focus countries in Africa. Initially, the president's malaria initiative (PMI) resources for Ethiopia primarily targeted the Oromia Region, the country\u0026rsquo;s largest administrative region and home to the greatest number of people at risk for malaria. The overarching goals of the president's malaria initiative (PMI) Program in Ethiopia include, increasing support especially for vector control in high burden districts in high burden regions, continued insecticide-treated bed nets (ITN) procurement and distribution to support insecticide-treated bed net (ITN) universal coverage, continued procurement of antimalarial to address national gaps, and National level surveillance strengthening along with district-level support in low malaria burden districts to assist in achieving sub-national elimination [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eIn June 2021, Siraro District Health Office informed the West Arsi Zonal Health Department that there were suspected malaria cases identified in 16 Kebeles (villages) of the District. This study was intended to confirm the existence of an outbreak, describe the magnitude of the disease, identify risk factors and implement control measures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Area and Period\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in Siraro District, West Arsi Zone, Oromia Region. This area is under the catchment of Biftu and Shasha Health centers. Siraro District is located in the Great Rift Valley of Southern, Oromia Region, Ethiopia.The administrative center of Siraro District is Loke, which is located about 304 kilometers to the South of Addis Ababa and 54 kilometers way from Shashamanne (Zonal town). The district borders Sidama Region to the southeast, Walayita zone to the southwest, Hadiya zone to the west, Halaba special zone to the north, and Shala District to the east \u003cstrong\u003e(\u003c/strong\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e. Demographically speaking, a total of 207,541 people in which 10, 7921 were females and 30,410 were under-five children inhabit the District. The district is administratively organized into 28 rural kebeles, and 4 urban kebeles. The District had one primary hospital, 6 health centers (HCs), and 28 health posts (HPs) with primary health care coverage of 85.7% reported by Siraro district. The climate is 90% desertic. The mean annual temperature is between 18.5 to 25.5 degrees centigrade. The district generally lays at an altitude between 1500 and 2075 meters above sea level. These above districts' weather conditions, altitude, and temperature favor breeding of disease-causing vector-like anopheles mosquitoes. The district covers an area of 1312.855 square kilometers. The annual average rainfall is about 1650 milliliters, but inadequate and seasonal between 900 to 1500 milliliters per year. We conducted this study from 16 June to 03 August 2021.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eWe used a community-based unmatched case-control study design with a 1:1 ratio of case and control to identify risk factors and cross-sectional study design to describe in terms of person,place and time for the occurrences of the malaria outbreak in the district.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003ePopulation\u003c/h2\u003e\n\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n\u003ch2\u003eSource Population\u003c/h2\u003e\n\u003cp\u003eAll populations living in the Siraro district of the West Arsi Zone were the source population for this study.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Population\u003c/h2\u003e\n\u003cp\u003eAll populations of Siraro district where Malaria outbreak occurred were the study population\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Subject\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny person living in Siraro district during the study period with fever or fever with headache, rigor, back pain, chills, sweats, myalgia, nausea, vomiting and confirmed positive by microscopy or Rapid Diagnostic Test (RDT) for \u003cem\u003ePlasmodium\u003c/em\u003e parasites and who agreed to participate in the study were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eControls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny resident of Siraro district during the study period who is a neighbor to a case and who did not develop signs and symptoms of malaria and confirmed negative by microscopy or Rapid Diagnostic Test (RDT) for \u003cem\u003eplasmodium\u003c/em\u003e parasites.\u003c/p\u003e\n\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n\u003ch2\u003eEligibility criteria\u003c/h2\u003e\n\u003cdiv id=\"Sec10\" class=\"Section4\"\u003e\n\u003ch2\u003eInclusion Criteria\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eFor cases\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny resident of the Siraro district where malaria outbreak occurred and who had symptoms of malaria and confirmed positive by microscopy or Rapid Diagnostic Test (RDT) for \u003cem\u003ePlasmodium\u003c/em\u003e parasites and agree to participate were included from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor controls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny resident of Siraro district where malaria outbreak occurred, neighbor to a case and who did not develop signs and symptoms or free from malaria disease in the house and confirmed negative by microscopy or Rapid Diagnostic Test (RDT) for \u003cem\u003ePlasmodium\u003c/em\u003e parasites and agree to participate.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eExclusion Criteria\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eFor cases\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny resident of Siraro district where malaria outbreak occurred, who had symptoms of malaria and confirmed positive by microscopy or Rapid Diagnostic Test (RDT) for \u003cem\u003ePlasmodium\u003c/em\u003e parasites but who refused to participate were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor controls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThose who refused to participate, were unavailable during the study period, and did not fulfill inclusion criteria were excluded from the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eVariables in the study\u003c/h2\u003e\n\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n\u003ch2\u003eDependent variables\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003ePresence of malaria infection (case \u0026amp; control).\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eThe independent variables\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-demographic factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAge, sex, occupation, religion, ethnicity, and educational status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnvironmental factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePlant water pools, open deep well, broken materials, and stagnant water.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHousing condition factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHouse screen, sprayed and bed net in household.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge related factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWay of transmission, know symptoms of malaria, and way of prevention.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eOperational, case definitions and measurements\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eMalaria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA disease in an individual in which the presence of \u003cem\u003ePlasmodium\u003c/em\u003e parasites in blood has been confirmed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResident\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndividuals (workers) who had been living for more than 3 months and are normal residents of the study area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCases\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny person with fever or fever with headache, rigor, back pain, chills, sweats, myalgia, nausea, vomiting and confirmed positive by microscopy or RDT for \u003cem\u003eplasmodium\u003c/em\u003e parasites.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eControls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny person who is a neighbor to a case and who did not develop symptoms of malaria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSuspected\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient with fever or history of fever in the last 48 hours and who lives in malaria-endemic areas or has a history of travel within the past 30 days to malaria-endemic areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProbable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny person with fever and one or more major signs such as headache, rigor, back pain, chills, sweats, myalgia, nausea, and vomiting are diagnosed clinically as malaria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny suspected case that is confirmed by microscopy or RDT for \u003cem\u003eplasmodium\u003c/em\u003e parasites.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLine-List\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegistrations of cases by place, person, and time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledgeable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIf respondents answer\u0026thinsp;\u0026gt;\u0026thinsp;60% correctly knowledge-related questions, then they are known to that question.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot Knowledgeable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIf respondents answer\u0026thinsp;\u0026le;\u0026thinsp;60% correctly knowledge-related questions, then they are not known to that question.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eSample size determination and sampling procedures\u003c/h2\u003e\n\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\n\u003ch2\u003eSample size determination\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eFor descriptive epidemiology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMalaria was defined and identified as an acute febrile illness with blood smear positive for malaria in the Siraro District outbreak in 2021. During this outbreak investigation, the number of malaria cases and deaths were collected from health facilities on a daily and weekly basis. The magnitude of this outbreak was described by age, sex, and kebele, weekly, monthly, slide positivity rate was calculated as those positive for malaria among the total \u003cstrong\u003e183\u003c/strong\u003e confirmed cases examined from line list reported of Siraro district.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor analytical epidemiology\u003c/strong\u003e: The sample size for both cases and control was recruited by using a 1: 1 ratio of case and control. The assumption taken from a previous study indicates that the proportion of controls exposed was 55% for a power of 80% with an odds ratio (OR) of 2.90. (9). The sample size which was taken from each group was determined by Epi-Info version 7.2.4.0 and the final sample size generated was 74 malaria cases and 74 community controls total of \u003cstrong\u003e148\u003c/strong\u003e study participants. The significance of risk factors for the outbreak was determined through multivariate analysis by calculating Odds Ratio (OR) and 95% Confidence Interval (CI).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003eSampling technique and procedures\u003c/h2\u003e\n\u003cp\u003eThe simple random sampling method was used at the places where the outbreak occurred and was selected randomly confirmed cases with the highest caseloads and community control interviewed from two affected kebeles.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eData collection method, tools, and procedures\u003c/h2\u003e\n\u003cp\u003eData was collected by using a structured questionnaire and by reviewing secondary data at the district after discussing with relevant bodies (task force), review of weekly Public Health Emergency Management (PHEM) reports at different levels ( zone health department, District health office, and Health facilities), health extension workers (HEWs), review on available data from line list, visiting of the affected village and interview of community members (patients) to collect risk factors for the malaria outbreak. Selected case patients and controls were interviewed about the presence of mosquito breeding sites in their compound and near to home within 500 meters or less than it. These sites include unprotected surface water, open deep well, solid and liquid waste collection, and disposal facilities. In addition, the availability of uncovered plastic water containers, old tires, and broken glasses in the home or outside the home was also critically assessed. Similarly, observation of these potential mosquito breeding sites and the presence of Anopheles larvae in stagnant water was conducted. Quantitative data that was addressed socio-demographic characteristics and potential exposures were collected. Laboratory technicians had conducted thick and thin smears with a 100 \u0026times; oil immersion microscopy at Biftu Health Center of Siraro District. Additionally, Diagnostic Test (RDT) was also used in this health center whenever they faced a shortage of some reagents and during interruption electric power. Health extension workers also used Rapid Diagnostic Test (RDT) to identify confirmed malaria cases at the health post and community level during the outbreak investigation.\u003c/p\u003e\n\u003cp\u003eA five-year (2017 to 2021), fiscal budget years recorded malaria data at the Siraro health office were reviewed. Daily data to weekly total cases in the affected localities in the previous weeks and months were compiled. By taking the \u003cstrong\u003esecond-largest\u003c/strong\u003e malaria trend from the five-year reviewed malaria data as a \u003cstrong\u003ethreshold\u003c/strong\u003e and \u003cstrong\u003ecomparing i\u003c/strong\u003et with the number of cases of the weeks and months of 2021, the malaria out-break was determined. Data Quality Assurance\u003c/p\u003e\n\u003cp\u003eWe used a line list for describing malaria cases in terms of time, place, and person. However, all data completeness was checked before analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003eData processing and analyzing\u003c/h2\u003e\n\u003cp\u003eData enter and summarizing were done using Epi- Info version 7.2.4.0 software. Then data were imported to Microsoft Excel and analyzed by SPSS version 25. We identified independent determinants by \u003cstrong\u003ebivariate \u0026amp; multivariate\u003c/strong\u003e logistic regression.Used \u003cstrong\u003ea P-Value (\u0026lt;\u0026thinsp;.05)\u003c/strong\u003e and \u003cstrong\u003eAOR\u003c/strong\u003e with 95% CI to report significance and strength of association, respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n\u003ch2\u003eEthical considerations\u003c/h2\u003e\n\u003cp\u003eThe supportive letter was written by St. Paul\u0026rsquo;s Hospital Millennium Medical College to Oromia Regional Health Bureau to get permission from the West Arsi Zonal Health department and Siraro district health office.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n\u003ch2\u003eDissemination of results\u003c/h2\u003e\n\u003cp\u003eThe study finding was prepared to share with St. Paul\u0026rsquo;s Hospital Millennium Medical College, School of public health of Field Epidemiology Training program Coordinators and mentors, Oromia Regional Health Bureau, and Siraro District Health Office in both hard copy and electronic soft copy.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n\u003ch2\u003eDescriptive epidemiology\u003c/h2\u003e\n\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n\u003ch2\u003eDescription of a case by a person\u003c/h2\u003e\n\u003cp\u003eA total of 221 blood smear tests was done by Microscopy and Rapid Diagnostic Test (RDT) for suspected malaria cases at all health facilities of these 183 were confirmed cases from March to June 2021 in Siraro District. A total of 183 confirmed cases were treated and an 82.8% positivity rate. Total confirmed cases 104 (56.8%) were male. The proportion of suspected malaria cases was higher among males than females. Of the total positive cases, \u003cem\u003ePlasmodium falciparum\u003c/em\u003e accounts for about 149(81.4%) followed by \u003cem\u003eP. Vivax\u003c/em\u003e 34(18.6%) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMalaria Positivity rate by age, sex, and species in Siraro district, Oromia, 2021\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eCharacteristics\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTotal tested by\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRDT or Microscopy\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003epositive\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePositivity rate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(%)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePlasmodium species\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP. Falciparum\u003c/p\u003e\n\u003cp\u003eN (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP.Vivax\u003c/p\u003e\n\u003cp\u003eN (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eAge\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16(10.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4(11.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e196\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e133(89.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30(88.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSex\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e92(61.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21(60.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e57(38.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13(39.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e221\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e183\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e149(81.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34(18.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\n\u003ch2\u003eDescriptive epidemiology by place\u003c/h2\u003e\n\u003cp\u003eAmong the total confirmed malaria cases, 97(53%) were from Dongoro Bonkoya kebele.The populations in Dongoro Bonkoya kebele were the most affected by the malaria outbreak followed by Shasha Goyke kebele with an attack rate of 16.7/1000 and 1.9 /1000 population, respectively \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMalaria attack rate by place in Siraro District, Oromia, 2021\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eS/N\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eName of Kebele\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePopulation\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSex\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTotal tested (RDT or Microscope)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTotal cases\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eAR/1000\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDongoro Bonkoya\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5856\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2869\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2987\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e2\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShasha Goyke\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6747\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3340\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3407\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e12603\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e6209\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e6394\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e130\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e10.31\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\n\u003ch2\u003eDistribution of malaria cases by kebele in Siraro District\u003c/h2\u003e\n\u003cp\u003eThe malaria epidemic was detected \u0026amp; reported to Regional Health Bureau on June 10 of 2021. Malaria cases identified in 16 Kebeles among these most cases, 97(53%) Dongoro Bonkoya and 33(18%) cases Shasha Goyke while 53(29%) cases other (14) kebeles (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\n\u003ch2\u003eDescriptive epidemiology by time\u003c/h2\u003e\n\u003cp\u003eIn the kebele, the malaria outbreak was verified by comparing the current year data with the second largest number during the previous 5 years (2017\u0026ndash;2021). It was shown that the current case trend line crossed the threshold levels in the district and peaked in the 19th WHO week and started to decline after the 25th WHO week of May 2021 (WHO week 15 to 25/2021). Epi- curve showed that the district health office departed to the outbreak area early, as soon as the outbreak started (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe Epi-curve showed the outbreak was a propagated one with multiple peaks with a possibility of person-to-person transmission. The weeks when the epidemic started were on the first week of May 2021 and notified by the district health office (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\n\u003ch2\u003eAnalytical epidemiology\u003c/h2\u003e\n\u003cdiv id=\"Sec30\" class=\"Section3\"\u003e\n\u003ch2\u003eSocio-demographic characteristics of the study participants\u003c/h2\u003e\n\u003cp\u003eDuring this case-control study, 74 malaria case patients and 74 community controls were recruited. The mean age of study participants was 27.14 years with \u0026plusmn;\u0026thinsp;14.042 standard deviations. They recruited study subjects (both cases and controls) all have participated in the study which gives a response rate of 100%. Among total study subjects, 47(63.5%) cases were male of which 39(52.7%) were controlled. Almost all (90.5%) of the respondents were Oromo by ethnicity and (94.6%) Muslim followers (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSocio-demographic characteristics of study participant\u0026rsquo;s malaria outbreak of Siraro District, West Arsi Zone, Oromia, 2021\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eResponse\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eFrequency (%)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCases(N\u0026thinsp;=\u0026thinsp;74)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eControls(N\u0026thinsp;=\u0026thinsp;74)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eAge\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(5.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u0026ndash;14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23(31.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(1.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(20.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20(27.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(17.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(33.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(14.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(18.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u0026ndash;54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(6.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(14.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(4.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(4.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSex of respondent\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47(63.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39(52.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(36.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35(47.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eMarital status\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19(25.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42(56.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46(62.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(36.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDivorced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(4.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(1.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWidowed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(8.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(5.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eOccupational status\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmployed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(2.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(4.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnemployed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(24.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24(32.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStudent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(18.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21(28.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFarmer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40(54.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26(35.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eReligion\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOrthodox\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(1.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(4.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProtestant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(8.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(5.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67(90.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67(90.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eEthnicity\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOromo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70(94.6%0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70(94.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSidama\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eEducational status\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIlliterate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42(56.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(43.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRead and Write\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(23.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(4.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnder school age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(14.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eElementary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(9.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23(31.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(8.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(2.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbove secondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(2.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(14.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\n\u003ch2\u003eRisk factors analysis study results\u003c/h2\u003e\n\u003cp\u003ePerson with malaria in the house was 15 times higher among persons who reside with malaria-infected persons in the household than those who reside in households where there is no malaria-infected person an AOR of 15.74 [95% CI\u0026thinsp;=\u0026thinsp;3.02\u0026ndash;81.86, P\u0026thinsp;=\u0026thinsp;0.001]. Staying outside the home during the night was 5 times higher of contracting malaria than staying inside the home AOR 5.62,95% CI\u0026thinsp;=\u0026thinsp;1.01\u0026ndash;31.06, P-value 048. Stagnant water near living areas was 25 times the risk of malaria contracting malaria when comparing the counterpart an AOR of 25.60,95% CI\u0026thinsp;=\u0026thinsp;4.69-139.64, and at a p-value of 0.000. Availability of plants with temporary water pools in the compound was also found to be contributing risk factors for the occurrence of the outbreak with an AOR of 90.94 [95% CI\u0026thinsp;=\u0026thinsp;9.01-917.01, P\u0026thinsp;=\u0026thinsp;0.000]. A person who did not hear about malaria was AOR 0.14 [CI: 0.07, 1.06, P\u0026thinsp;=\u0026thinsp;0.008] times less likely to have malaria than individuals who heard about malaria prevention on ITN utilization.Individuals who were not awareness about the transmission of malaria were 0.02 times (CI: 0.002\u0026ndash;0.18) less likely to have malaria than individuals who know transmission of malaria ( Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBi-variate Vs multivariate analysis of risk factors for malaria outbreak in Siraro, West Arsi Zone Oromia, Ethiopia, 2021\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eRisk factors\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eResponse\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eCase status\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eCrude OR(95%CI)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eAdjusted OR(95%CI)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCase (N\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eControl (N\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePlace of stay during night\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInside house\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.53(1.09\u0026ndash;5.85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.62(1.01\u0026ndash;31.06)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.048\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOutside house\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePerson With malaria in the house\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWith malaria in house\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.55 (1.31\u0026ndash;4.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.74(3.02\u0026ndash;81.86)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWith-out malaria in house\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePlant with temporary water pools\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.4(3.80-18.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90.94(9.01\u0026ndash;91.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eStagnant water\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNear to house\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.15(2.08\u0026ndash;8.26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.6(4.69-139.64)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot near to the house\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eHear about Malaria\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeard\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.35(0.17\u0026ndash;0.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.14 (0.07\u0026ndash;1.06)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.008\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot heard\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eHaving awareness transmission of malaria\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.25(0.12\u0026ndash;0.51)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02 (0.02\u0026ndash;0.18)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\n\u003ch2\u003eEpidemic preparedness, response, and public health intervention\u003c/h2\u003e\n\u003cp\u003eThere was a functional rapid response team to respond to the outbreak in the district. They had traveled almost about 46 km away from the district to investigate and respond to the outbreak. Case management/treatment of infected individuals was made in parallel with outbreak investigation. Awareness was created while collecting data and visiting the environment where the outbreak occurred ( Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eAbout 650 Insecticide-treated nes was distributed for 146 households including pregnant mothers in the affected Shasha Goyke kebele. About 2249 populations at risk were protected by the distribution of ITN. A total of 1220 households with 2862-unit structures were chemical sprayed at Dongoro Bonkoya kebele of the district. communities were mobilized and taught on prevention and control measures of malaria disease. Health professionals were mobilized and assigned to affected kebeles for active case search and early case management at the communities and health facility level. Awareness was also given to the affected communities on the prevention of the diseases concerning the way to avoid the breeding sites for malaria vectors, especially on environmental management. While distributing insecticide-treated nets, the affected communities were aware of using ITN properly by giving priority to pregnant women and children less than five years of age ( Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOutbreaks of malaria are often complex, multi-factorial, and may have natural and human-made determinants. During this outbreak investigation time in the study area, it was found that health facilities were using Rapid Diagnostic Test (RDT) and microscopy to identified cases ,from 221 suspects tested 183(83%) confirmed cases without death were reported. Of total cases,male (AR\u0026thinsp;=\u0026thinsp;2.2/1000) and age\u0026thinsp;\u0026gt;\u0026thinsp;5 years (AR\u0026thinsp;=\u0026thinsp;2.04/10,00) were more attacked in the District. The malaria outbreak was verified by comparing the current year data with the second largest number during the previous 5 years (2017\u0026ndash;2021) in the district. It was shown that the current case trend line crossed the threshold levels in the district and peaked in the 19th WHO week and started to decline after the 25th week (WHO week 15 to 25/2021) with threshold line for monitoring malaria epidemic on the chart and confirmed. The overall attack rate of malaria infection in this study area was 10.31%, with a higher attack rate in the Dongoro Bonkoya kebele (16.7%) communities. This result was greater than reports from a study done in an institutional-based conducted at Dilla Town and the Surrounding Rural Areas, Gedeo Zone, Southern Ethiopia which is 16% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eThe results of this study revealed that from malaria parasite species, \u003cem\u003eP. falciparum\u003c/em\u003e accounts for 81.4% followed by P.vivax 18.6%. This finding was higher than that of a study on the analysis of malaria prevalence in Arsi Negelle health center, southern Ethiopia, that foound Plasmodium species, \u003cem\u003eP. Vivax\u003c/em\u003e accounting for (74%), \u003cem\u003eP. falciparum was\u003c/em\u003e (19.8%). This finding was similar with that of Amaya Woreda, southwest Shoa, Oromia, where 84% were P. falciparum and 16% were P. Vivax [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eThe transmission of malaria is determined by main factors such as human behavior and the existence of malaria parasite, as well as social and health facility factors such as housing condition, environmental management, KAPs of the community towards malaria causation, transmission, treatment-seeking behavior, and presence of mosquito control activities can affect malaria prevalence.\u003c/p\u003e \u003cp\u003eThe findings of this study revealed that living in the nearby stagnant water was identified as a risk factor. A significantly higher parasite rate was found among the individuals near stagnant water around their houses. The study conducted in Dilla Town and the surrounding rural areas, Gedeo Zone, the study showed that persons who live in an area where there is stagnant water were 34.26 times more likely to be exposed to malaria parasites than those who do not live in an area with stagnant water [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eAvailability of Plants with temporary water pools in the compound was also found to be contributing risk factor for the occurrence of the outbreak were more affected. It can be explained by the fact that they are more exposed to mosquito bites because these areas are suitable for the breeding of mosquitoes around their homes. This study agrees with a different study done at Afar Region on Malaria outbreak investigation, and also astudy conducted in Jimma town, south-west Ethiopia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003ePersons who stay outside at night were 5.62 times more likely to develop malaria parasites than those who do not stay outside at night. Individuals with malaria patients in the house were 15.74 times more likely to develop malaria parasites than those who do not have malaria patients in their house. This result agrees with the study conducted in West Armachiho District, Northwest Ethiopia, that revealed that staying outside during the night is more likely to develop malaria than those who stay inside during the night [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eCommunity knowledge on malaria prevention and control options is important and the effort is related to either environmental management, personal protection, or vector control. The results of this analytical epidemiological study showed that persons who have never heard about the transmission of malaria were significantly associated with the occurrence of this outbreak.The result of this study is similar to Malaria prevalence, knowledge, attitude, and practice among febrile patients attending Chagni health center, Northwest Ethiopia and a study also revealed that 97% of the respondents had ever heard about malaria and recognized it as a serious health problem [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] .\u003c/p\u003e \u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003eLimitation of the study\u003c/h2\u003e \u003cp\u003eThe main limitation was a shortage of medical entomologists to confirm the existence of anopheles mosquito larvae and measure their quantity in stagnant water. Late notification of the outbreak might show that there was weak monitoring of malaria trends at all levels.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThere was a malaria outbreak in the Siraro district of West Arsi Zones. Of the 16 kebeles of the district malaria area Dongoro Bonkoya, Shasha Goyke, and Torba Hansawe kebeles were more affected by the malaria outbreak. Age five years and older were more affected by the disease,the presence of stagnant water,plants with temporary water pools in the compound, stay outside of their home during the night, the presence of malaria patients in the household, and persons who have never heard about malaria prevention on insecticide-treated bed nets (ITN) utilization were significantly contributed to the occurrence of the outbreak in this district.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAR\u003c/strong\u003e: - Attack Rate, \u003cstrong\u003eAOR\u003c/strong\u003e: -Adjusted Odds Ratios, \u003cstrong\u003eCDC:\u003c/strong\u003e - Center for Disease Control, \u003cstrong\u003eCI:\u003c/strong\u003e -Confidence Interval, \u003cstrong\u003eEFETP\u003c/strong\u003e: - Ethiopia Field Epidemiology Training Program, \u003cstrong\u003eHC\u003c/strong\u003e: - Health Center, \u003cstrong\u003eHEW:\u003c/strong\u003e - Health Extension worker, \u003cstrong\u003eHF:\u003c/strong\u003e - Health Facility, \u003cstrong\u003eHHs\u003c/strong\u003e: -Households, HPs: - Health Posts, \u003cstrong\u003eIRS:\u003c/strong\u003e -Indoor Residual Spray, \u003cstrong\u003eITN\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e-Insecticide-treated bed nets, \u003cstrong\u003eOR:\u0026nbsp;\u003c/strong\u003e- Odds Ratio, \u003cstrong\u003ePHCU:\u003c/strong\u003e- Primary Health Care Unit, \u003cstrong\u003ePHEM\u003c/strong\u003e: -Public Health Emergency Management, \u003cstrong\u003eRDT:\u003c/strong\u003e -Rapid Diagnostic Test, \u003cstrong\u003eSPHMMC\u003c/strong\u003e: -ST. Paul\u0026rsquo;s Hospital Millennium Medical College,\u0026nbsp;\u003cstrong\u003eWHO: -\u003c/strong\u003eWorld Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Institutional Review Board (IRB) of St. Paul\u0026rsquo;s Hospital Millennium Medical College and a letter of permission was obtained from the West Arsi zone health office. Then the letter was delivered to the Siraro District Health office and the respective villages. The rationale of the study was explained to the participants. In addition, oral consent was obtained from each study participant. Blood smears were taken by experienced laboratory technicians under an aseptic technique using sterile gloves and disposable sterile lancets. Codes were used to ensure the confidentiality of Laboratory results. Participants with positive for malaria parasites were linked to the nearest health facilities for treatment according to the national malaria guideline.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data upon which the result is based could be accessed as a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth authors declared that they have no conflicts of interest for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGirma Mideksa\u003c/strong\u003e designed the study, developed the proposal, participated in the data collection, performed analysis and interpretation of data, and drafted the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTakele Gezahegn\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003econtributed significantly from its beginning up to the manuscript preparation and its critical editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to thank St. Paul\u0026rsquo;s Hospital Millennium Medical College School of Public Health for giving me the education opportunity.\u003c/p\u003e\n\u003cp\u003eMy thank is also for the Field Epidemiology Training Program Academic Coordinator (Dr. Samerawit Solomon, Mrs.Hayimanot Ewnetu, and Mrs.Jimmawork Wondimu) and instructors for their strict mentoring, advice, and comments during theoretical sessions and at fields.\u003c/p\u003e\n\u003cp\u003eI would like to thank my mentor Mr.Takele Gezahegn (MPH, Assistant Professor) for his kindly and constructive inputs for this outbreak investigation right from advice and guidance.\u003c/p\u003e\n\u003cp\u003eI would also Thank Mr. Gammachu Shume, Public Health Emergency Management Core-Process Manager at Oromia Regional Health Bureau, and my Field Supervisor for his facilitation of field works.\u003c/p\u003e\n\u003cp\u003eI would also like to thank all staff of Siraro District Health Office, Public Health Emergency Management staff (PHEM), and community for their kindly assistance and cooperation during data collection. Furthermore, I would like to thank my lovely wife Sr.Motu File for her usual support and stand beside me in my all daily life.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHealth W, Who O. WHO Guidelines for malaria - 16 February 2021. \u003c/li\u003e\n\u003cli\u003eWorld malaria report 2019. 2019. \u003c/li\u003e\n\u003cli\u003eMishra N. Guidelines for diagnosis and treatment of malaria in india. 2018;(July 2014). \u003c/li\u003e\n\u003cli\u003eTalie A. Prevalence of malaria and associated risk factors among asymptomatic migrant laborers in West Armachiho District , Northwest Ethiopia. 2018;95\u0026ndash;101. \u003c/li\u003e\n\u003cli\u003eMetanat M. Malaria in Children. 2015;2(1):4\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eInitiative M. PRESIDENT \u0026rsquo; S MALARIA INITIATIVE ETHIOPIA. 2018; \u003c/li\u003e\n\u003cli\u003ePresident US, Initiative M. PRESIDENT \u0026rsquo; S MALARIA INITIATIVE ETHIOPIA. 2019; \u003c/li\u003e\n\u003cli\u003eU . S . PRESIDENT \u0026rsquo; S MALARIA INITIATIVE ETHIOPIA Malaria Operational Plan FY 2020. 2020;1\u0026ndash;107. \u003c/li\u003e\n\u003cli\u003eBayray A, Marama T. Malaria outbreak and contracting factors in Afar Region , Ethiopia , 2016. 2018;(July). \u003c/li\u003e\n\u003cli\u003eAreas R, Zone G, Molla E, Ayele B. Journal of Bacteriology and Parasitology Prevalence of Malaria and Associated Factors in Dilla Town and the Surrounding. 2015;6(5). \u003c/li\u003e\n\u003cli\u003eDefi GB, Belachew A, Addissie A, Hailemariam Z. A Malaria Outbreak in Ameya Woreda , South-West Shoa , Oromia , Ethiopia , 2012 : Weaknesses in Disease Control , Important Risk Factors. 2015;3(3):125\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLength F. Analysis of malaria prevalence in Arsi Negelle health. 2016;3(2):90\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eAccess O. Urban malaria and associated risk factors in. 2011;1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eAschale Y, Mengist A, Bitew A, Kassie B, Talie A. Prevalence of malaria and associated risk factors among asymptomatic migrant laborers in West Armachiho District, Northwest Ethiopia. Res Rep Trop Med. 2018;Volume 9:95\u0026ndash;101. \u003c/li\u003e\n\u003cli\u003eBelay B, Gelana T, Gebresilassie A. Malaria prevalence, knowledge, attitude, and practice among febrile patients attending Chagni health center, Northwest Ethiopia: a cross-sectional study. Trop Dis Travel Med Vaccines. 2021;7(1):1\u0026ndash;10. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-epidemiology-and-global-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Epidemiology and Global Health](https://www.springer.com/journal/44197)","snPcode":"44197","submissionUrl":"https://submission.nature.com/new-submission/44197/3","title":"Journal of Epidemiology and Global Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Investigation, Malaria, Outbreak, Case-Control, Response","lastPublishedDoi":"10.21203/rs.3.rs-3972780/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3972780/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn Ethiopia, malaria is highly seasonal in many communities with epidemic-prone transmission patterns and serious public health emergencies that have a major impact on health and the economy. This investigation aimed to assess malaria outbreaks, identify their risk factors and provide appropriate control \u0026amp; prevention measures of the infection in Siraro district,west Arsi,Oromia,Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA unmatched case-control study with a 1:1 case-to-control ratio was conducted in the Siraro District from 16 June 2021 to 03 August 2021. Seventy-four randomly selected cases and controls participated in this study. We reviewed the previous five year\u0026rsquo;s malaria data to establish a threshold level. Both descriptive and analytical statistical procedures were performed. The data were entered using Epi-Info version 7.2.4.0 software and analyzed by using SPSS version 25. Multivariable logistic regression analysis was conducted to identify independent factors associated with malaria infection.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e \u003cem\u003eplasmodium Falciparum\u003c/em\u003e accounts for about 81.4%. Age group\u0026thinsp;\u0026ge;\u0026thinsp;5 years were the most affected with an attack rate (AR) of 2.04/1000. Multivariate analysis revealed the place of stay during night adjusted Odds Ratio (AOR) 5.62, 95% CI\u0026thinsp;=\u0026thinsp;1.016\u0026ndash;31.069, a person with malaria in the house with AOR 15.74,95% CI\u0026thinsp;=\u0026thinsp;3.029\u0026ndash;81.865, presence of stagnant water near to house AOR of 25.60, 95% CI\u0026thinsp;=\u0026thinsp;4.696-139.649, availability of plants with temporary water pools in the compound an AOR of 90.94,95% CI\u0026thinsp;=\u0026thinsp;9.019-917.012 and a person who does not hear about malaria prevention on insecticide-treated bed nets utilization adjusted Odds Ratios \u003cb\u003e(\u003c/b\u003eAOR) of 0.14,95% CI: 0.076, 1.061 were the main associated risk factors for the occurrence of the outbreak.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe main risk factors for the outbreak were people with malaria in the house, stagnant water, and plants with temporary water pools and it was positive for Anopheles larvae. We recommended identifying potential vector breeding sites and environmental management through community participation and redistribution of the ITN before malaria season and ITNs utilization gaps through health education.\u003c/p\u003e","manuscriptTitle":"Malaria outbreak investigation in Siraro District, Oromia Region, Ethiopia,2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-11 19:03:26","doi":"10.21203/rs.3.rs-3972780/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-28T12:13:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-27T13:07:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"729be077-694b-4445-8937-5867808ca58d","date":"2024-03-19T13:16:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-17T09:17:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-09T07:14:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-06T13:48:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Epidemiology and Global Health","date":"2024-02-20T12:30:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-epidemiology-and-global-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Epidemiology and Global Health](https://www.springer.com/journal/44197)","snPcode":"44197","submissionUrl":"https://submission.nature.com/new-submission/44197/3","title":"Journal of Epidemiology and Global Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ec690ff9-7756-422a-b198-b9afc853198b","owner":[],"postedDate":"March 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-30T14:06:33+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-11 19:03:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3972780","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3972780","identity":"rs-3972780","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}