Trend analysis of malaria at Maraki Health Center, Gondar Town, Northwest Ethiopia: a ten-year retrospective study

Trend analysis of malaria at Maraki Health Center, Gondar Town, Northwest Ethiopia: a ten-year retrospective study | 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 Article Trend analysis of malaria at Maraki Health Center, Gondar Town, Northwest Ethiopia: a ten-year retrospective study Aberham Abere, Solomon Ayalew, Bealemlay Wondale, Fentahun Tigabu, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4281680/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Globally, malaria is the major public health disease caused by plasmodium species and it is a mosquito-borne disease caused by a protozoan parasite belonging to the genus Plasmodium . The largest number of malaria cases and deaths are reported from the WHO African region mainly, Sub-Saharan Africa, each year. The aim of the study was to assess the ten-year trend of malaria in Maraki Health Center, Gondar Town, northwest Ethiopia. Methods A retrospective study was carried out at Maraki Health Center. Ten-year (2012–2021) blood film results were extracted by reviewing the laboratory logbook. A chi-square test was used to describe associations between malaria cases and different variables. Result In a ten-year period, 15,978 blood films were requested for malaria diagnosis, of whom 57.5% were from males. About 68.0% fell under the age group of 15–45 years old. The overall prevalence of malaria was 25.2% (n = 4019) (95% CI: 23.83–26.59). Plasmodium falciparum was the dominant malaria species over the ten-year period. The highest peaks of total malaria cases were observed in 2012 and in October, and the lowest peaks were observed in 2016 and April (mean annual case = 401.9). The highest and lowest peaks of P. falciparum cases followed a similar pattern to the total malaria cases. The highest and lowest peaks of P. vivax cases were observed in 2012 and 2018, respectively. There was a statistically significant year and monthly variation of malaria cases ( P < 0:001). Malaria was reported in both sexes and all age groups, of which males and the age group 15–45 years old comprised the maximum number of malaria cases ( P < 0:001). Conclusion Malaria continues to be an important public health concern in the study area. A significant fluctuation was observed over the ten-year period. Plasmodium falciparum was the predominant species, despite some annual P. vivax dominance. Uninterrupted efforts are still essential to decrease the burden of malaria to a level that has no more public health effects. Biological sciences/Microbiology/Infectious disease diagnostics Biological sciences/Microbiology/Parasitology/Parasite biology Malaria Maraki Trend Northwest Ethiopia Figures Figure 1 Figure 2 Figure 3 Background Malaria is a mosquito-borne infectious disease that is responsible for a large number of morbidities and mortalities worldwide [ 1 ]. It is a serious global public health issue that affects several groups of the population, most notably pregnant women and under-5 children. In 2021, there were an estimated 247 million malaria cases (2.5% higher than 2020) and 619,000 deaths (1.29% lower than 2020) in 84 malaria-endemic countries worldwide, where 93% percent of malaria cases and 94% percent of malaria deaths occurred in the WHO African Region [ 2 ]. This region, mainly Sub-Saharan Africa, accounts for a disproportionately large share of the global malaria burden each year. Under-five children accounted for 80% of malaria deaths in the region [2, 3,]. Despite the fact that Africa bears over 90% of the malaria death burden, Southeast Asia nevertheless experiences significant mortality and morbidity [ 4 ]. The 2010 country specific-studies in some African countries revealed that the prevalence of malaria began to decline. In Uganda, the prevalence of malaria declined from 43% in 2004, to 23% in rural and 3.0% in urban areas in 2010 [ 5 ]. In Rwanda, malaria deaths and cases fell by 67% and 55% respectively among children under five years old in 2007. In Ethiopia, malaria cases and deaths fell by 73% and 62% respectively [ 6 ]. It is estimated that about 200 million people (24.6% of the total African population) live in urban settings where they are at risk of contracting the disease. The annual incidence is also estimated at 24.8-103.2 million cases of clinical malaria attacks among urban dwellers in Africa [ 7 ]. Approximately 74% of the population of African cities is at risk of malaria infection [ 8 ]. Malaria has also becomes a major public health problem in the urban populations of Eritrea and Ethiopia with 92% and 40% of their population, respectively, at risk [ 8 , 9 ]. Malaria is caused by protozoan parasites of the genus Plasmodium species, which are global pathogens with a complex life cycle. Infections can cause a wide range of symptoms, ranging from none to severe infections that can lead to life-threatening disorders such as cerebral malaria, severe anemia, hypoglycemia, organ failure, pulmonary edema, and even death [ 10 ]. Plasmodium falciparum and P. vivax are the most common and widely spread Plasmodium species in Ethiopia, accounting for 60% and 40% of malaria cases, respectively [ 11 , 12 ]. Plasmodium falciparum is the deadliest and most prevalent on the African continent, while P.vivax is dominant in countries outside Sub-Saharan Africa [ 3 ]. Malaria remains the largest cause of outpatient visits, health-care facility hospitalizations, and inpatient fatalities in Ethiopia, contributing to about 30 percent of overall disability-adjusted life years (DALYs), making it a substantial social and economic hindrance [ 13 ]. It continues to be a severe public health problem despite considerable progress in controlling and preventing the disease over the past decades. The number of malaria cases and deaths has increased dramatically during the last two decades [ 14 ]. It affects four to five million individuals each year, putting more than 50 million people at risk [ 15 ]. Reports indicated that clinical malaria accounts for 10%-40% of all outpatient consultations, with corresponding proportional morbidity among children under-5 years of age being 10%-20% [ 13 ]. According to a report from the Ethiopian Federal Ministry of Health, 25 percent of suspected malaria cases (410,409) tested positive; with P. falciparum accounting for 65% percent of positive cases and P. vivax accounting for the rest over the previous five years. Seasonal transmission and insufficient protective immunity put people of all ages at risk of contracting malaria. Seasonal and severely variable transmission is due to differences in topography and rainfall patterns [ 16 , 17 ]. Malaria has continued to be one of the major public health challenges in the Amhara region. A total of 1,127,241 cases of malaria were reported within the region in 2012. Out of eight zones in the region, only five of them accounted for 93.1% of the total malaria burden. The South Gondar zone accounted for the third-greatest number of cases in the region, next to the West Gojjam and North Gondar zones [ 18 ]. Epidemics due to seasonal transmission, a poor health-care system, such as low coverage of insecticide-treated nets (ITNs), drug-resistant Plasmodium parasites due to self-treatment or incorrect species identification by microscopists, asymptomatic malaria cases, and Anopheles mosquito resistance to pesticides and chemicals, are the main obstacles to controlling and preventing malaria [ 19 ]. Spatial and temporal analysis of malaria data is critical for developing area-specific evidence-based interventions, making informed decisions, tracking the efficacy of malaria control efforts, and preventing the burden of malaria and associated complications. Little is known regarding the trend of malaria in health institutions, and there is no published data in this regard in the study area. The present study was therefore aimed at assessing the ten-year trend of malaria. Methods Study area The study was conducted at Maraki Health Center, located in Maraki sub-city administration, Gondar town, Northwest Ethiopia. It is found in the middle part of Gondar town, the capital city of the central Gondar administrative zone, which is 738 Kilometers away from Addis Ababa (the capital of Ethiopia) to the northwest of Ethiopia and 180 kilometers away from Bahir Dar (the capital of Amhara Regional State). The estimated population of Maraki sub-city is 5000 people. It has a latitude and longitude of 10°27′N, 38°12′E, and an elevation of 2541 meters above sea level. Study Design and sampling method A retrospective study was conducted to assess the ten-year (2012–2021) trend of malaria by reviewing blood film reports in the Maraki Health Center laboratory logbook. The whole blood films examined over the ten-year period in the health centre that fulfilled the inclusion criteria were recorded and analyzed. Data collection Ten-year (2012–2021) data regarding malaria were compiled from the Maraki Health Center laboratory logbook from June 27, 2022 to September 30, 2022. In this health center, a well-prepared and well-stained blood film was used to confirm malaria parasites as recommended by the World Health Organization (WHO) [ 20 ]. Both microscopically confirmed positive and negative findings were collected by laboratory personnel. Data regarding the patient’s age, sex, date, month, and year of examination, blood film result, and Plasmodium species were collected using a checklist prepared for this purpose. Any incomplete and vague sociodemographic and malaria related data records were excluded. Data management and analysis Data were extracted from laboratory logbooks using a well-prepared checklist, entered into IBM SPSS Statistics (Version 23.0), checked for completeness, and analyzed accordingly. Descriptive statistics (frequency, percentage, mean, and range) were used to present the data and to evaluate malaria trends over the years and months. A chi-square test was used to describe the association of malaria cases with sex, age, month, and year. A statistically significant association was declared at a P value of < 0.05 at a 95% confidence interval. Data Quality Control Data were collected using a data extraction form. The completeness and consistency of the data was verified before analysis. To ensure the reliability and validity of the study, the generated data were rechecked by all investigators. Results Overall prevalence and annual trend of malaria In a ten-year period (2012–2021), 15,978 individuals were requested for malaria diagnosis at Maraki Health Center. Of whom, 9193 (57.5%) were from males, and 10,865 (68.0%) fell under the age group of 15–45 years old. Of the total diagnosed cases, malaria was reported in 25.2% (n = 4019) of individuals (95% CI: 23.83–26.59). Over the ten years, P. falciparum was the predominant malaria parasite identified, with an estimated overall prevalence of 13.4%, followed by P. vivax (10.6%). The remaining 1.2% of malaria cases were mixed infections. Their relative proportion was 53.4% (n = 2145), 42.0% ( n = 1688), and 4.6% (n = 186) respectively. Malaria cases were observed throughout the year, despite variation over a ten-year period. The prevalence ranged from 11.2% in 2016 (152 cases) to 66.4% in 2012 (952 cases), and there was a statistically significant year variation (P < 0.001). Plasmodium falciparum prevalence ranged from 6.9% in 2016 to 29.6% in 2012. Plasmodium vivax prevalence ranged from 4.3% in 2016 and 2018 to 32.4% in 2012 (Table 1 ). Table 1 Prevalence and annual trend of malaria at Maraki Health Center from 2012 to 2021, Gondar Town, northwest Ethiopia (n = 15978). Year Total number of blood films examined Total number of malaria cases (%) P. falciparum cases (%) P. vivax cases %) Mixed cases (%) P value 2012 1434 952(66.4) 425 (29.6) 464(32.4) 63(4.4) P < 0.001 2013 1295 569(43.9) 248(19.2) 248(19.2) 73 (5.6) 2014 1920 409(21.3) 192(10.0) 202(10.5) 15 (0.8) 2015 1411 312(22.1) 126(8.9) 181(12.8) 5(0.4) 2016 1361 152 (11.2) 94(6.9) 58(4.3) 0 (0) 2017 1529 189(12.2) 115(7.5) 73(4.8) 1(0.1) 2018 1222 190(15.5) 138(11.3) 52(4.3) 0(0) 2019 2160 440(20.4) 278(14.9) 144(6.7) 18(0.8) 2020 2287 523(22.9) 340(14.9) 175(7.7) 8(0.3) 2021 1359 283(20.8) 189(13.9) 91(6.7) 3(0.2) Total 15978 4019 (25.2) 2145(13.4) 1688(10.6) 186 (1.2) Insert Table 1 here On average, 401.9 (range: 152–952) microscopically confirmed malaria cases were recorded annually. The highest peak of total malaria cases was observed in 2012, and the lowest peak was observed in 2016. Similarly, the highest and lowest peaks of P. falciparum cases followed the same pattern. The highest and lowest peaks of P. vivax were observed in 2012 and 2018, respectively (Fig. 1 ). Insert Fig. 1 here Monthly variation of total malaria cases and Plasmodium species Malaria cases were observed throughout the 12 months, despite monthly fluctuations over a ten-year period in the study area. The total number of malaria cases varied among the 12 months, ranging from 118 (13.24% positivity rate) to 734 (39.15% positivity rate), and there was a statistically significant monthly variation of malaria cases ( P < 0:001). The highest peak of total malaria cases was observed during October, and the lowest peak was observed during April. The highest peaks of P. falciparum cases were observed during the months of October, and the lowest peaks were noticed in the months of February and April. Whereas, the highest peaks of P. vivax cases were observed during the months of August, October, November, and December, and the lowest peaks were observed in the months of February, April, and July. The highest peak for mixed infection was observed in September and lowest peak was noticed in March (zero record of mixed cases) (Fig. 2 ). Insert Fig. 2 here Distribution of malaria cases by sex and age group According to the ten-year record in the study area, malaria was reported in both sexes and all age groups. Individuals within the age group of 15–45 years old had the highest malaria cases (3132 out of the total 4019 malaria cases), whereas individuals within the age group of > 65 had the least number of malaria cases (42 out of the total 4019 malaria cases). Males (71.6%) were more affected than females (28.4%) in all age groups; malaria cases range from 27 to 2340 in males and 15 to 792 in females. There was a statistically significant difference in malaria cases among sex and age groups ( P < 0.001) (Table 2 ). Table 2 Malaria cases by sex and age in Maraki Health Center from 2012 to 2021, Gondar Town, northwest Ethiopia. Age group in years Malaria cases by sex P-value Male cases (%) Female cases (%) Total cases (%) < 5 134(54.3) 113(45.7) 247(6.1) P < 0.001 5 ≤ 14 284(63.3) 165(36.7) 449(11.2) 14 65 27(64.3) 15(35.7) 42(1.1) Total 2878(71.6) 1141(28.4) 4019(100) Insert Table 2 here Distribution of Plasmodium species by age group The distribution of Plasmodium species by age groups revealed that P. falciparum was the predominant species in all age groups except the age group < 5 years old ( P. vivax was dominant). Mixed ( P. falciparum and P. vivax ) cases were the least prevalent in all age groups compared to mono-infection cases. The highest and lowest P. falciparum cases were recorded in the age groups 15–45 and > 65 years old, respectively. Similarly, The highest and lowest P. vivax and mixed cases were recorded in the age group 15–45 and > 65 years old, respectively (Fig. 3 ). Insert Fig. 3 here Discussion In Ethiopia, zero malaria death in malaria-endemic localities and complete malaria elimination from hypo-endemic areas could not be achieved despite the WHO-recommended interventions targeted at mosquito vector control, rapid case detection, and treatment of symptomatic cases. According to this retrospective analysis, 15,978 blood films were requested over a ten-year period (2012–2021) to confirm Plasmodium parasites, and 25.2% (N = 4019) (95% CI: 23.83–26.59) of the examined individuals were infected with malaria parasites. This is lower than a study conducted in Adi-Arkay Health Center [ 21 ] and Ziquala district [ 22 ], and higher than a study conducted in Bichena primary hospital [ 23 ], University of Gondar [ 24 ], and Mojo Town [ 25 ]. This variation might be due to differences in community awareness about malaria transmission and prevention, study time frame, malaria endemicity of the study areas, and skill among laboratory professionals in detecting and identifying Plasmodium species correctly. The present study also demonstrated that P. falciparum and P. vivax were the species responsible for malaria in Maraki Sub-city and the surrounding population diagnosed at Maraki Health Center; the former accounted for most infections. The prevalence of P. falciparum , P. vivax , and mixed infections was 13.4%, 10.6%, and 1.2%, respectively. Plasmodium falciparum was the predominant species, comprising 53.37% of the total reported malaria cases, although there was a species fluctuation from year-to-year and month-to-month. Plasmodium vivax and mixed infections consisted of 42.0% and 4.63%, respectively. A retrospective study conducted in Bichena primary hospital reported a species composition of 51.18%, 41.78%, and 7.04% for P. falciparum , P. vivax , and mixed infections, respectively [ 23 ]. A study conducted in Ziquala district reported 59.7%, 37.0%, and 3.3%% for P.falciparum , P.vivax , and mixed infections respectively [ 22 ]. In contrast, studies conducted in Shewarobit [ 26 ], Mojo town [ 25 ], and at the University of Gondar [ 24 ] showed the dominance of P. vivax over P. falciparum despite year-to-year species fluctuation. The present finding is not also consistent with the national Plasmodium species distribution ( P. falciparum , 60%, and P. vivax , 40%), even if it indicates the mean distribution in all parts of Ethiopia [ 11 ]. Failure to correctly identify Plasmodium species and the possibility of relapse might explain the reason for the dominance of vivax malaria over falciparum malaria in the above-mentioned areas. In the current study, malaria cases were observed all over the years, with a significant year-to-year fluctuation ( P < 0:001). Both P. falciparum and P. vivax contributed to the overall year-to-year fluctuating trend of malaria cases. The highest peaks of total malaria cases were observed in 2012, and the lowest peaks were observed in 2016. There was a decreasing trend of malaria prevalence from 66.4% in 2012 to 11.2% in 2016, although a significant rise was observed in 2017, which continued up to 2020 and then dropped in 2021. Malaria cases dropped from 2012 to 2016 by 15.97% (952 cases in 2012 to 152 cases in 2016). The highest and lowest peaks of P. falciparum cases followed the same pattern. The highest and lowest peaks of P. vivax were observed in 2012 and 2018 respectively. This declined trend might be the outcome of the continuous national struggle made by stakeholders and their strong commitment to decrease malaria-related death and illness to a level that has no public health effect. The highest malaria case in 2020 might be the effect of the COVID-19 pandemic on malaria prevention measures. Less attention was given to malaria and HIV prevention during the COVID-19 pandemic. Similarly, a fluctuating trend of malaria cases was reported from studies conducted at University of Gondar [ 24 ], Ziquala district [ 22 ], and Bichena Primary Hospital [ 23 ], and fluctuation is a result of both P. vivax and P. falciparum. A five year (2016–2020) declining trend in malaria prevalence was reported from a study conducted in Mojo town, Central Ethiopia [ 25 ]. Malaria cases were observed in all months, regardless of variation. The prevalence varied among different months, ranging from 13.24–39.15%, and there was a statistically significant monthly variation ( P < 0:001). Relatively highest peaks of total malaria cases were observed during September to October, and the least peaks were observed during February to April. Similarly, P. falciparum cases followed the same pattern as the total malaria cases. The highest peak for P. vivax cases was observed during the months of October, November, and December. Whereas, the highest and least mixed cases were observed in September and March, respectively. This is consistent with studies conducted in Ziquala district [ 22 ], Guba district [ 14 ], and Bichena Primary Hospital [ 23 ]. A fluctuating monthly trend of malaria cases was also reported from studies conducted in Mojo town [ 25 ] and University of Gondar Specialized Referral Hospital [ 24 ], with maximum malaria cases reported from September to November and minimum cases reported from December to February. The possible reason for this type of malaria transmission pattern is that mosquito breeding and feeding cycles merely depend on rainfall and temperature. These factors contributed to the formation of favorable mosquito breeding sites and an increased rate of larval development. The present study also confirmed that malaria cases were reported in both sexes and all age groups. There was a higher positivity rate of malaria among males (18.05%) than females (7.15%). Individuals in the age group 15–45 years old accounted for the highest malaria cases across all years, followed by those in the age group 5–14 years old. Participants with the age of above 65 acconted the least malaria cases. Males were more affected than females in all age groups. There was a statistically significant difference in malaria cases among sex and age groups ( P < 0.001). The possible explanation for the dominance of male malaria cases over females and the age group 15–45 years old over other age groups is due to the fact that males in the age group 15–45 are usually involved in different outdoor activities and are traveling to malaria hotspot areas for work opportunities, which in turn increases their susceptibility to mosquito bites. Whereas females are less likely to perform such activities and are usually cookers at home, this might decrease the risk of infection with malaria parasites. Under-five children and people above the age of 65 showed relatively lower malaria cases because they are less likely to be exposed to mosquito bites as they usually sleep under bed nets. This finding agreed with a study reported in Adi-Arkay [ 21 ], Ziquala district [ 22 ], Bichena Primary Hospital [ 23 ], and Mojo Town [ 25 ], where males are more affected than females and the age group 15–45 years old consisted of the dominant malaria cases, followed by 5–14 and < 5 years old. Strengths and Limitations of the Study This retrospective study was the first survey conducted at Maraki Health Center since its establishment to assess the ten-year trend of malaria. The study manipulated a large amount of data from Maraki Health Centre Laboratory and allowed us to evaluate the ten-year trend of malaria prevalence. These findings might provide input for stakeholders to understand the obstacles to malaria elimination, future directions, and the need for further research. However, due to the nature of the study, we were unable to illustrate the possible risk factors that could have been predisposing to malaria in the area. Conclusions The mean annual positivity rate of malaria was 25.2% over the 10-year (2012–2021) period. This shows that malaria is still an important public health problem in the study area. A significant annual and monthly variation in malaria cases was noticed over a ten-year period. Successive effort and strong commitment are still required to eliminate malaria and/or reduce its burden to a level that has no more public health effects. Declarations Acknowledgements We would like to thank Maraki Health Center for allowing us to conduct this research. We are also grateful to all the data collectors. Authors’ contributions A.A, A.D, T.E, F.M, and M.T conceived and planed the study. B.W, F.T, N.G, S.A, and T.T collected the data, involved in data analysis and interpretation. AA, AD, BT, and GA wrote the first draft of the manuscript. A.A, A.D, T.E, Y.A, M.Y, and A.T participated in critical review of the manuscript. All authors read and approved the final version of the manuscript and agreed to be accountable for all parts of the work. Funding This research work was funded by the University of Gondar. The funder had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate Before starting the study, ethical clearance (Ref. N o . SBMLS/358; Dated: June 21, 2022) was obtained from the Research and Ethics Committee of the School of Biomedical and Laboratory Sciences, University of Gondar. A permission letter was obtained from the head of Maraki Health Center. Verbal consent was obtained from the head of Maraki Health Center Laboratory. All the information obtained from the participating study subjects was coded to maintain confidentiality. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Author’s information 1 Department of Medical Parasitology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia. 2 School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia. 3 Department of Microbiology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia. 4 Amhara Public Health Institute (APHI) Bahir Dar, Ethiopia. 5 Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia. 6 Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia References Deribew A, Dejene T, Kebede B, Tessema GA, Melaku YA, Misganaw A, Gebre T, Hailu A, Biadgilign S, Amberbir A, Yirsaw BD. 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Abere","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYDACCQYGZhBtwMDA+CChAshiZm4gWguzwYMzIC2MxGthk3zYBmIS0MI/u/nY54KabfLm7L0PJBLn1UbztwO1/KjYhtuSO8eSZ884dttwZ89xA4PEbcdzZxxmbGDsOXMbtzU3coyZedhuM264kcaQkLjtWG4DUAszYxtuLfI38j8z8/y7bb/h/jOGA4lzjuXOJ6TF4EYOMzNv2+3EDTfYGBsSG2pyNxDSYnjnmDEzb9/t5J09acwMCccO5G4EajmIzy9yt5sfM/N8u227nf0Y+88fNXW5884fPvjgRwUe76OBw2DyANHqgaCOFMWjYBSMglEwQgAAk2xhC35WK/QAAAAASUVORK5CYII=","orcid":"","institution":"University of Gondar","correspondingAuthor":true,"prefix":"","firstName":"Aberham","middleName":"","lastName":"Abere","suffix":""},{"id":327129049,"identity":"819c985a-25a6-4e20-95c7-5271df538f40","order_by":1,"name":"Solomon Ayalew","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Solomon","middleName":"","lastName":"Ayalew","suffix":""},{"id":327129053,"identity":"7b88a124-76a2-4351-896e-2f57edf3e9fb","order_by":2,"name":"Bealemlay Wondale","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Bealemlay","middleName":"","lastName":"Wondale","suffix":""},{"id":327129054,"identity":"653c5eb9-c9d8-4085-bd99-94a1fac90508","order_by":3,"name":"Fentahun Tigabu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Fentahun","middleName":"","lastName":"Tigabu","suffix":""},{"id":327129055,"identity":"ce312792-3dc6-4127-ab67-7df4f5721ce9","order_by":4,"name":"Nigus Gizachew","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Nigus","middleName":"","lastName":"Gizachew","suffix":""},{"id":327129056,"identity":"1ea7dfb4-3a12-4b8e-a1be-7a2d92f12e11","order_by":5,"name":"Takele Tesfaye","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Takele","middleName":"","lastName":"Tesfaye","suffix":""},{"id":327129057,"identity":"3f33018a-5bc3-4bf9-a85f-852a5ac38e61","order_by":6,"name":"Getnet Ayalew","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Getnet","middleName":"","lastName":"Ayalew","suffix":""},{"id":327129058,"identity":"62283e8d-03f1-4af2-b172-52c01b3d8738","order_by":7,"name":"Banchamlak Tegegne","email":"","orcid":"","institution":"Amhara Public Health Institute (APHI) Bahir Dar","correspondingAuthor":false,"prefix":"","firstName":"Banchamlak","middleName":"","lastName":"Tegegne","suffix":""},{"id":327129059,"identity":"639b83a7-3cab-4031-9f15-3c1b37326a77","order_by":8,"name":"Mulat Yimer","email":"","orcid":"","institution":"Bahir Dar University","correspondingAuthor":false,"prefix":"","firstName":"Mulat","middleName":"","lastName":"Yimer","suffix":""},{"id":327129060,"identity":"2b51ae1d-3c92-44aa-b484-e130c19bcd5e","order_by":9,"name":"Yibeltal Aschale","email":"","orcid":"","institution":"Debre Markos University","correspondingAuthor":false,"prefix":"","firstName":"Yibeltal","middleName":"","lastName":"Aschale","suffix":""},{"id":327129061,"identity":"4b962fb1-7c61-4654-9536-8c2f1dd4ea78","order_by":10,"name":"Adane Tilahun","email":"","orcid":"","institution":"Debre Markos University","correspondingAuthor":false,"prefix":"","firstName":"Adane","middleName":"","lastName":"Tilahun","suffix":""},{"id":327129062,"identity":"d65b1d39-3237-4536-93d9-85a7a1c35b4b","order_by":11,"name":"Mebratu Tamir","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Mebratu","middleName":"","lastName":"Tamir","suffix":""},{"id":327129063,"identity":"b1fa7194-0299-4233-9a45-db2e5cb6a9d0","order_by":12,"name":"Fentahun Megabiaw","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Fentahun","middleName":"","lastName":"Megabiaw","suffix":""},{"id":327129064,"identity":"ceb91a13-6719-400c-aa91-97263e4baf7b","order_by":13,"name":"Tegegne Eshetu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Tegegne","middleName":"","lastName":"Eshetu","suffix":""},{"id":327129066,"identity":"a51b859b-1878-45dd-a42a-1d9398ac3a2b","order_by":14,"name":"Adane Derso","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Adane","middleName":"","lastName":"Derso","suffix":""}],"badges":[],"createdAt":"2024-04-17 11:48:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4281680/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4281680/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61004810,"identity":"e282edc5-5225-4e82-8235-28ead6ee8687","added_by":"auto","created_at":"2024-07-24 13:40:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":130350,"visible":true,"origin":"","legend":"\u003cp\u003eSpecies trend of malaria at Maraki Health Center from 2012 to 2021, Gondar Town, northwest Ethiopia\u003c/p\u003e","description":"","filename":"Figure1..png","url":"https://assets-eu.researchsquare.com/files/rs-4281680/v1/ad8553d59e8cde685503f013.png"},{"id":61004812,"identity":"ed985054-8238-47b9-8f81-9c2f538603b8","added_by":"auto","created_at":"2024-07-24 13:40:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":127294,"visible":true,"origin":"","legend":"\u003cp\u003eMonthly variations of total malaria cases and species from in Maraki Health Center from 2012 to 2021, Gondar Town, northwest Ethiopia\u003c/p\u003e","description":"","filename":"Figure2..png","url":"https://assets-eu.researchsquare.com/files/rs-4281680/v1/6cb1faf54f130232ce2b52e6.png"},{"id":61004811,"identity":"1881aadf-5cd9-4eae-9282-6708a219f858","added_by":"auto","created_at":"2024-07-24 13:40:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":58260,"visible":true,"origin":"","legend":"\u003cp\u003eAge distribution of \u003cem\u003ePlasmodium \u003c/em\u003especies in Maraki Health Center from 2012 to 2021, Gondar Town, northwest Ethiopia.\u003c/p\u003e","description":"","filename":"Figure3..png","url":"https://assets-eu.researchsquare.com/files/rs-4281680/v1/1652dcae4a32db3b8b778a82.png"},{"id":77144628,"identity":"56f2252b-dbc6-4d5d-8461-6995ea1fbd6b","added_by":"auto","created_at":"2025-02-25 14:17:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1147332,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4281680/v1/0ce20a2d-55e1-4f37-b107-408fa4f3fe14.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trend analysis of malaria at Maraki Health Center, Gondar Town, Northwest Ethiopia: a ten-year retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMalaria is a mosquito-borne infectious disease that is responsible for a large number of morbidities and mortalities worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a serious global public health issue that affects several groups of the population, most notably pregnant women and under-5 children. In 2021, there were an estimated 247\u0026nbsp;million malaria cases (2.5% higher than 2020) and 619,000 deaths (1.29% lower than 2020) in 84 malaria-endemic countries worldwide, where 93% percent of malaria cases and 94% percent of malaria deaths occurred in the WHO African Region [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This region, mainly Sub-Saharan Africa, accounts for a disproportionately large share of the global malaria burden each year. Under-five children accounted for 80% of malaria deaths in the region [2, 3,]. Despite the fact that Africa bears over 90% of the malaria death burden, Southeast Asia nevertheless experiences significant mortality and morbidity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe 2010 country specific-studies in some African countries revealed that the prevalence of malaria began to decline. In Uganda, the prevalence of malaria declined from 43% in 2004, to 23% in rural and 3.0% in urban areas in 2010 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Rwanda, malaria deaths and cases fell by 67% and 55% respectively among children under five years old in 2007. In Ethiopia, malaria cases and deaths fell by 73% and 62% respectively [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is estimated that about 200\u0026nbsp;million people (24.6% of the total African population) live in urban settings where they are at risk of contracting the disease. The annual incidence is also estimated at 24.8-103.2\u0026nbsp;million cases of clinical malaria attacks among urban dwellers in Africa [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Approximately 74% of the population of African cities is at risk of malaria infection [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Malaria has also becomes a major public health problem in the urban populations of Eritrea and Ethiopia with 92% and 40% of their population, respectively, at risk [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalaria is caused by protozoan parasites of the genus \u003cem\u003ePlasmodium\u003c/em\u003e species, which are global pathogens with a complex life cycle. Infections can cause a wide range of symptoms, ranging from none to severe infections that can lead to life-threatening disorders such as cerebral malaria, severe anemia, hypoglycemia, organ failure, pulmonary edema, and even death [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. \u003cem\u003ePlasmodium falciparum\u003c/em\u003e and \u003cem\u003eP. vivax\u003c/em\u003e are the most common and widely spread \u003cem\u003ePlasmodium\u003c/em\u003e species in Ethiopia, accounting for 60% and 40% of malaria cases, respectively [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. \u003cem\u003ePlasmodium falciparum\u003c/em\u003e is the deadliest and most prevalent on the African continent, while \u003cem\u003eP.vivax\u003c/em\u003e is dominant in countries outside Sub-Saharan Africa [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eMalaria remains the largest cause of outpatient visits, health-care facility hospitalizations, and inpatient fatalities in Ethiopia, contributing to about 30 percent of overall disability-adjusted life years (DALYs), making it a substantial social and economic hindrance [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It continues to be a severe public health problem despite considerable progress in controlling and preventing the disease over the past decades. The number of malaria cases and deaths has increased dramatically during the last two decades [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It affects four to five million individuals each year, putting more than 50\u0026nbsp;million people at risk [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Reports indicated that clinical malaria accounts for 10%-40% of all outpatient consultations, with corresponding proportional morbidity among children under-5 years of age being 10%-20% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. According to a report from the Ethiopian Federal Ministry of Health, 25 percent of suspected malaria cases (410,409) tested positive; with \u003cem\u003eP. falciparum\u003c/em\u003e accounting for 65% percent of positive cases and \u003cem\u003eP. vivax\u003c/em\u003e accounting for the rest over the previous five years. Seasonal transmission and insufficient protective immunity put people of all ages at risk of contracting malaria. Seasonal and severely variable transmission is due to differences in topography and rainfall patterns [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalaria has continued to be one of the major public health challenges in the Amhara region. A total of 1,127,241 cases of malaria were reported within the region in 2012. Out of eight zones in the region, only five of them accounted for 93.1% of the total malaria burden. The South Gondar zone accounted for the third-greatest number of cases in the region, next to the West Gojjam and North Gondar zones [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Epidemics due to seasonal transmission, a poor health-care system, such as low coverage of insecticide-treated nets (ITNs), drug-resistant \u003cem\u003ePlasmodium\u003c/em\u003e parasites due to self-treatment or incorrect species identification by microscopists, asymptomatic malaria cases, and \u003cem\u003eAnopheles\u003c/em\u003e mosquito resistance to pesticides and chemicals, are the main obstacles to controlling and preventing malaria [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Spatial and temporal analysis of malaria data is critical for developing area-specific evidence-based interventions, making informed decisions, tracking the efficacy of malaria control efforts, and preventing the burden of malaria and associated complications. Little is known regarding the trend of malaria in health institutions, and there is no published data in this regard in the study area. The present study was therefore aimed at assessing the ten-year trend of malaria.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area\u003c/h2\u003e \u003cp\u003eThe study was conducted at Maraki Health Center, located in Maraki sub-city administration, Gondar town, Northwest Ethiopia. It is found in the middle part of Gondar town, the capital city of the central Gondar administrative zone, which is 738 Kilometers away from Addis Ababa (the capital of Ethiopia) to the northwest of Ethiopia and 180 kilometers away from Bahir Dar (the capital of Amhara Regional State). The estimated population of Maraki sub-city is 5000 people. It has a latitude and longitude of 10\u0026deg;27\u0026prime;N, 38\u0026deg;12\u0026prime;E, and an elevation of 2541 meters above sea level.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and sampling method\u003c/h2\u003e \u003cp\u003eA retrospective study was conducted to assess the ten-year (2012\u0026ndash;2021) trend of malaria by reviewing blood film reports in the Maraki Health Center laboratory logbook. The whole blood films examined over the ten-year period in the health centre that fulfilled the inclusion criteria were recorded and analyzed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eTen-year (2012\u0026ndash;2021) data regarding malaria were compiled from the Maraki Health Center laboratory logbook from June 27, 2022 to September 30, 2022. In this health center, a well-prepared and well-stained blood film was used to confirm malaria parasites as recommended by the World Health Organization (WHO) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Both microscopically confirmed positive and negative findings were collected by laboratory personnel. Data regarding the patient\u0026rsquo;s age, sex, date, month, and year of examination, blood film result, and \u003cem\u003ePlasmodium\u003c/em\u003e species were collected using a checklist prepared for this purpose. Any incomplete and vague sociodemographic and malaria related data records were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eData were extracted from laboratory logbooks using a well-prepared checklist, entered into IBM SPSS Statistics (Version 23.0), checked for completeness, and analyzed accordingly. Descriptive statistics (frequency, percentage, mean, and range) were used to present the data and to evaluate malaria trends over the years and months. A chi-square test was used to describe the association of malaria cases with sex, age, month, and year. A statistically significant association was declared at a \u003cem\u003eP\u003c/em\u003e value of \u0026lt;\u0026thinsp;0.05 at a 95% confidence interval.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Quality Control\u003c/h2\u003e \u003cp\u003eData were collected using a data extraction form. The completeness and consistency of the data was verified before analysis. To ensure the reliability and validity of the study, the generated data were rechecked by all investigators.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eOverall prevalence and annual trend of malaria\u003c/h2\u003e \u003cp\u003eIn a ten-year period (2012\u0026ndash;2021), 15,978 individuals were requested for malaria diagnosis at Maraki Health Center. Of whom, 9193 (57.5%) were from males, and 10,865 (68.0%) fell under the age group of 15\u0026ndash;45 years old. Of the total diagnosed cases, malaria was reported in 25.2% (n\u0026thinsp;=\u0026thinsp;4019) of individuals (95% CI: 23.83\u0026ndash;26.59). Over the ten years, \u003cem\u003eP. falciparum\u003c/em\u003e was the predominant malaria parasite identified, with an estimated overall prevalence of 13.4%, followed by \u003cem\u003eP. vivax\u003c/em\u003e (10.6%). The remaining 1.2% of malaria cases were mixed infections. Their relative proportion was 53.4% (n\u0026thinsp;=\u0026thinsp;2145), 42.0% (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1688), and 4.6% (n\u0026thinsp;=\u0026thinsp;186) respectively. Malaria cases were observed throughout the year, despite variation over a ten-year period. The prevalence ranged from 11.2% in 2016 (152 cases) to 66.4% in 2012 (952 cases), and there was a statistically significant year variation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). \u003cem\u003ePlasmodium falciparum\u003c/em\u003e prevalence ranged from 6.9% in 2016 to 29.6% in 2012. \u003cem\u003ePlasmodium vivax\u003c/em\u003e prevalence ranged from 4.3% in 2016 and 2018 to 32.4% in 2012 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence and annual trend of malaria at Maraki Health Center from 2012 to 2021, Gondar Town, northwest Ethiopia (n\u0026thinsp;=\u0026thinsp;15978).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal number of blood films examined\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal number of malaria cases (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP. falciparum\u003c/em\u003e cases \u003cem\u003e(%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP. vivax\u003c/em\u003e cases \u003cem\u003e%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMixed cases (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e952(66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e425 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e464(32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e569(43.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e248(19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e248(19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e409(21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e192(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e202(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e312(22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e126(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e181(12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e115(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e190(15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e138(11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e440(20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e278(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e144(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e523(22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e340(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e175(7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e283(20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e189(13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e91(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4019 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2145(13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1688(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e186 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003ehere\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOn average, 401.9 (range: 152\u0026ndash;952) microscopically confirmed malaria cases were recorded annually. The highest peak of total malaria cases was observed in 2012, and the lowest peak was observed in 2016. Similarly, the highest and lowest peaks of \u003cem\u003eP. falciparum\u003c/em\u003e cases followed the same pattern. The highest and lowest peaks of \u003cem\u003eP. vivax\u003c/em\u003e were observed in 2012 and 2018, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003ehere\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eMonthly variation of total malaria cases and\u003c/b\u003e \u003cb\u003ePlasmodium\u003c/b\u003e \u003cb\u003especies\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMalaria cases were observed throughout the 12 months, despite monthly fluctuations over a ten-year period in the study area. The total number of malaria cases varied among the 12 months, ranging from 118 (13.24% positivity rate) to 734 (39.15% positivity rate), and there was a statistically significant monthly variation of malaria cases (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0:001). The highest peak of total malaria cases was observed during October, and the lowest peak was observed during April. The highest peaks of \u003cem\u003eP. falciparum\u003c/em\u003e cases were observed during the months of October, and the lowest peaks were noticed in the months of February and April. Whereas, the highest peaks of \u003cem\u003eP. vivax\u003c/em\u003e cases were observed during the months of August, October, November, and December, and the lowest peaks were observed in the months of February, April, and July. The highest peak for mixed infection was observed in September and lowest peak was noticed in March (zero record of mixed cases) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003ehere\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDistribution of malaria cases by sex and age group\u003c/h2\u003e \u003cp\u003eAccording to the ten-year record in the study area, malaria was reported in both sexes and all age groups. Individuals within the age group of 15\u0026ndash;45 years old had the highest malaria cases (3132 out of the total 4019 malaria cases), whereas individuals within the age group of \u0026gt;\u0026thinsp;65 had the least number of malaria cases (42 out of the total 4019 malaria cases). Males (71.6%) were more affected than females (28.4%) in all age groups; malaria cases range from 27 to 2340 in males and 15 to 792 in females. There was a statistically significant difference in malaria cases among sex and age groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMalaria cases by sex and age in Maraki Health Center from 2012 to 2021, Gondar Town, northwest Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge group in years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMalaria cases by sex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale cases (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale cases (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal cases (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e134(54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113(45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e247(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e284(63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165(36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e449(11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u0026thinsp;\u0026lt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2340(74.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e792(25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3132(77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93(62.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56(37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27(64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2878(71.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1141(28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4019(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003ehere\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eDistribution of\u003c/b\u003e \u003cb\u003ePlasmodium\u003c/b\u003e \u003cb\u003especies by age group\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe distribution of \u003cem\u003ePlasmodium\u003c/em\u003e species by age groups revealed that \u003cem\u003eP. falciparum\u003c/em\u003e was the predominant species in all age groups except the age group\u0026thinsp;\u0026lt;\u0026thinsp;5 years old (\u003cem\u003eP. vivax\u003c/em\u003e was dominant). Mixed (\u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP. vivax\u003c/em\u003e) cases were the least prevalent in all age groups compared to mono-infection cases. The highest and lowest \u003cem\u003eP. falciparum\u003c/em\u003e cases were recorded in the age groups 15\u0026ndash;45 and \u0026gt;\u0026thinsp;65 years old, respectively. Similarly, The highest and lowest \u003cem\u003eP. vivax\u003c/em\u003e and mixed cases were recorded in the age group 15\u0026ndash;45 and \u0026gt;\u0026thinsp;65 years old, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003ehere\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn Ethiopia, zero malaria death in malaria-endemic localities and complete malaria elimination from hypo-endemic areas could not be achieved despite the WHO-recommended interventions targeted at mosquito vector control, rapid case detection, and treatment of symptomatic cases. According to this retrospective analysis, 15,978 blood films were requested over a ten-year period (2012\u0026ndash;2021) to confirm \u003cem\u003ePlasmodium\u003c/em\u003e parasites, and 25.2% (N\u0026thinsp;=\u0026thinsp;4019) (95% CI: 23.83\u0026ndash;26.59) of the examined individuals were infected with malaria parasites. This is lower than a study conducted in Adi-Arkay Health Center [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Ziquala district [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and higher than a study conducted in Bichena primary hospital [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], University of Gondar [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and Mojo Town [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This variation might be due to differences in community awareness about malaria transmission and prevention, study time frame, malaria endemicity of the study areas, and skill among laboratory professionals in detecting and identifying \u003cem\u003ePlasmodium\u003c/em\u003e species correctly.\u003c/p\u003e \u003cp\u003eThe present study also demonstrated that \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP. vivax\u003c/em\u003e were the species responsible for malaria in Maraki Sub-city and the surrounding population diagnosed at Maraki Health Center; the former accounted for most infections. The prevalence of \u003cem\u003eP. falciparum\u003c/em\u003e, \u003cem\u003eP. vivax\u003c/em\u003e, and mixed infections was 13.4%, 10.6%, and 1.2%, respectively. \u003cem\u003ePlasmodium falciparum\u003c/em\u003e was the predominant species, comprising 53.37% of the total reported malaria cases, although there was a species fluctuation from year-to-year and month-to-month. \u003cem\u003ePlasmodium vivax\u003c/em\u003e and mixed infections consisted of 42.0% and 4.63%, respectively. A retrospective study conducted in Bichena primary hospital reported a species composition of 51.18%, 41.78%, and 7.04% for \u003cem\u003eP. falciparum\u003c/em\u003e, \u003cem\u003eP. vivax\u003c/em\u003e, and mixed infections, respectively [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A study conducted in Ziquala district reported 59.7%, 37.0%, and 3.3%% for \u003cem\u003eP.falciparum\u003c/em\u003e, \u003cem\u003eP.vivax\u003c/em\u003e, and mixed infections respectively [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In contrast, studies conducted in Shewarobit [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], Mojo town [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and at the University of Gondar [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] showed the dominance of \u003cem\u003eP. vivax\u003c/em\u003e over \u003cem\u003eP. falciparum\u003c/em\u003e despite year-to-year species fluctuation. The present finding is not also consistent with the national \u003cem\u003ePlasmodium\u003c/em\u003e species distribution (\u003cem\u003eP. falciparum\u003c/em\u003e, 60%, and \u003cem\u003eP. vivax\u003c/em\u003e, 40%), even if it indicates the mean distribution in all parts of Ethiopia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Failure to correctly identify \u003cem\u003ePlasmodium\u003c/em\u003e species and the possibility of relapse might explain the reason for the dominance of vivax malaria over falciparum malaria in the above-mentioned areas.\u003c/p\u003e \u003cp\u003eIn the current study, malaria cases were observed all over the years, with a significant year-to-year fluctuation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0:001). Both \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP. vivax\u003c/em\u003e contributed to the overall year-to-year fluctuating trend of malaria cases. The highest peaks of total malaria cases were observed in 2012, and the lowest peaks were observed in 2016. There was a decreasing trend of malaria prevalence from 66.4% in 2012 to 11.2% in 2016, although a significant rise was observed in 2017, which continued up to 2020 and then dropped in 2021. Malaria cases dropped from 2012 to 2016 by 15.97% (952 cases in 2012 to 152 cases in 2016). The highest and lowest peaks of \u003cem\u003eP. falciparum\u003c/em\u003e cases followed the same pattern. The highest and lowest peaks of \u003cem\u003eP. vivax\u003c/em\u003e were observed in 2012 and 2018 respectively. This declined trend might be the outcome of the continuous national struggle made by stakeholders and their strong commitment to decrease malaria-related death and illness to a level that has no public health effect. The highest malaria case in 2020 might be the effect of the COVID-19 pandemic on malaria prevention measures. Less attention was given to malaria and HIV prevention during the COVID-19 pandemic. Similarly, a fluctuating trend of malaria cases was reported from studies conducted at University of Gondar [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], Ziquala district [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and Bichena Primary Hospital [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and fluctuation is a result of both \u003cem\u003eP. vivax\u003c/em\u003e and \u003cem\u003eP. falciparum.\u003c/em\u003e A five year (2016\u0026ndash;2020) declining trend in malaria prevalence was reported from a study conducted in Mojo town, Central Ethiopia [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalaria cases were observed in all months, regardless of variation. The prevalence varied among different months, ranging from 13.24\u0026ndash;39.15%, and there was a statistically significant monthly variation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0:001). Relatively highest peaks of total malaria cases were observed during September to October, and the least peaks were observed during February to April. Similarly, \u003cem\u003eP. falciparum\u003c/em\u003e cases followed the same pattern as the total malaria cases. The highest peak for \u003cem\u003eP. vivax\u003c/em\u003e cases was observed during the months of October, November, and December. Whereas, the highest and least mixed cases were observed in September and March, respectively. This is consistent with studies conducted in Ziquala district [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Guba district [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and Bichena Primary Hospital [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A fluctuating monthly trend of malaria cases was also reported from studies conducted in Mojo town [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and University of Gondar Specialized Referral Hospital [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], with maximum malaria cases reported from September to November and minimum cases reported from December to February. The possible reason for this type of malaria transmission pattern is that mosquito breeding and feeding cycles merely depend on rainfall and temperature. These factors contributed to the formation of favorable mosquito breeding sites and an increased rate of larval development.\u003c/p\u003e \u003cp\u003eThe present study also confirmed that malaria cases were reported in both sexes and all age groups. There was a higher positivity rate of malaria among males (18.05%) than females (7.15%). Individuals in the age group 15\u0026ndash;45 years old accounted for the highest malaria cases across all years, followed by those in the age group 5\u0026ndash;14 years old. Participants with the age of above 65 acconted the least malaria cases. Males were more affected than females in all age groups. There was a statistically significant difference in malaria cases among sex and age groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The possible explanation for the dominance of male malaria cases over females and the age group 15\u0026ndash;45 years old over other age groups is due to the fact that males in the age group 15\u0026ndash;45 are usually involved in different outdoor activities and are traveling to malaria hotspot areas for work opportunities, which in turn increases their susceptibility to mosquito bites. Whereas females are less likely to perform such activities and are usually cookers at home, this might decrease the risk of infection with malaria parasites. Under-five children and people above the age of 65 showed relatively lower malaria cases because they are less likely to be exposed to mosquito bites as they usually sleep under bed nets. This finding agreed with a study reported in Adi-Arkay [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], Ziquala district [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Bichena Primary Hospital [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and Mojo Town [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], where males are more affected than females and the age group 15\u0026ndash;45 years old consisted of the dominant malaria cases, followed by 5\u0026ndash;14 and \u0026lt;\u0026thinsp;5 years old.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations of the Study\u003c/h2\u003e \u003cp\u003eThis retrospective study was the first survey conducted at Maraki Health Center since its establishment to assess the ten-year trend of malaria. The study manipulated a large amount of data from Maraki Health Centre Laboratory and allowed us to evaluate the ten-year trend of malaria prevalence. These findings might provide input for stakeholders to understand the obstacles to malaria elimination, future directions, and the need for further research. However, due to the nature of the study, we were unable to illustrate the possible risk factors that could have been predisposing to malaria in the area.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe mean annual positivity rate of malaria was 25.2% over the 10-year (2012\u0026ndash;2021) period. This shows that malaria is still an important public health problem in the study area. A significant annual and monthly variation in malaria cases was noticed over a ten-year period. Successive effort and strong commitment are still required to eliminate malaria and/or reduce its burden to a level that has no more public health effects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe would like to thank Maraki Health Center for allowing us to conduct this research. We are also grateful to all the data collectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.A, A.D, T.E, F.M, and M.T conceived and planed the study. B.W, F.T, N.G, S.A, and T.T collected the data, involved in data analysis and interpretation. AA, AD, BT, and GA wrote the first draft of the manuscript. A.A, A.D, T.E, Y.A, M.Y, and A.T participated in critical review of the manuscript. All authors read and approved the final version of the manuscript and agreed to be accountable for all parts of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research work was funded by the University of Gondar. The funder had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBefore starting the study, ethical clearance (Ref. N\u003cu\u003eo\u003c/u\u003e. SBMLS/358; Dated: June 21, 2022) was obtained from the Research and Ethics Committee of the School of Biomedical and Laboratory Sciences, University of Gondar. A permission letter was obtained from the head of Maraki Health Center. Verbal consent was obtained from the head of Maraki Health Center Laboratory. All the information obtained from the participating study subjects was coded to maintain confidentiality.\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\u003eCompeting interests \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of\u003csup\u003e\u0026nbsp;\u003c/sup\u003eMedical Parasitology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia. \u003csup\u003e2\u003c/sup\u003eSchool of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.\u003csup\u003e\u0026nbsp;3\u003c/sup\u003eDepartment of Microbiology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.\u003csup\u003e\u0026nbsp;4\u003c/sup\u003eAmhara Public Health Institute\u0026nbsp;(APHI)\u0026nbsp;Bahir Dar, Ethiopia.\u003csup\u003e\u0026nbsp;5\u003c/sup\u003eDepartment of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia. \u003csup\u003e6\u003c/sup\u003eDepartment of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDeribew A, Dejene T, Kebede B, Tessema GA, Melaku YA, Misganaw A, Gebre T, Hailu A, Biadgilign S, Amberbir A, Yirsaw BD. 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Five-year trend of malaria prevalence in Mojo town, Central Ethiopia: shifting burden of the disease and its implication for malaria elimination: a retrospective study. Infect Drug Resist. 2022 Jan 1:455\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShiferaw TT, Desta AT. Five-year trend analysis of malaria prevalence in Shewarobit, Amhara Regional State, North-central Ethiopia. Pan Afr Med J. 2021; 40:237.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Malaria, Maraki, Trend, Northwest Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4281680/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4281680/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGlobally, malaria is the major public health disease caused by plasmodium species and it is a mosquito-borne disease caused by a protozoan parasite belonging to the genus \u003cem\u003ePlasmodium\u003c/em\u003e. The largest number of malaria cases and deaths are reported from the WHO African region mainly, Sub-Saharan Africa, each year. The aim of the study was to assess the ten-year trend of malaria in Maraki Health Center, Gondar Town, northwest Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective study was carried out at Maraki Health Center. Ten-year (2012\u0026ndash;2021) blood film results were extracted by reviewing the laboratory logbook. A chi-square test was used to describe associations between malaria cases and different variables.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eIn a ten-year period, 15,978 blood films were requested for malaria diagnosis, of whom 57.5% were from males. About 68.0% fell under the age group of 15\u0026ndash;45 years old. The overall prevalence of malaria was 25.2% (n\u0026thinsp;=\u0026thinsp;4019) (95% CI: 23.83\u0026ndash;26.59). \u003cem\u003ePlasmodium falciparum\u003c/em\u003e was the dominant malaria species over the ten-year period. The highest peaks of total malaria cases were observed in 2012 and in October, and the lowest peaks were observed in 2016 and April (mean annual case\u0026thinsp;=\u0026thinsp;401.9). The highest and lowest peaks of \u003cem\u003eP. falciparum\u003c/em\u003e cases followed a similar pattern to the total malaria cases. The highest and lowest peaks of \u003cem\u003eP. vivax\u003c/em\u003e cases were observed in 2012 and 2018, respectively. There was a statistically significant year and monthly variation of malaria cases (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0:001). Malaria was reported in both sexes and all age groups, of which males and the age group 15\u0026ndash;45 years old comprised the maximum number of malaria cases (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0:001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMalaria continues to be an important public health concern in the study area. A significant fluctuation was observed over the ten-year period. \u003cem\u003ePlasmodium falciparum\u003c/em\u003e was the predominant species, despite some annual \u003cem\u003eP. vivax\u003c/em\u003e dominance. Uninterrupted efforts are still essential to decrease the burden of malaria to a level that has no more public health effects.\u003c/p\u003e","manuscriptTitle":"Trend analysis of malaria at Maraki Health Center, Gondar Town, Northwest Ethiopia: a ten-year retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-24 13:40:12","doi":"10.21203/rs.3.rs-4281680/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0a56b021-5e6d-4980-977f-75212c97757c","owner":[],"postedDate":"July 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34617433,"name":"Biological sciences/Microbiology/Infectious disease diagnostics"},{"id":34617434,"name":"Biological sciences/Microbiology/Parasitology/Parasite biology"}],"tags":[],"updatedAt":"2025-02-25T14:08:53+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-24 13:40:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4281680","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4281680","identity":"rs-4281680","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}