Prevalence of malaria from blood smears examination: a seven-year retrospective study from metema hospital, northwest ethiopia

Hindawi Publishing CorporationMalaria Research and TreatmentVolume 2013 Article ID 704730 5 pageshttpdxdoiorg1011552013704730

Research ArticlePrevalence of Malaria from Blood Smears ExaminationA Seven-Year Retrospective Study from Metema HospitalNorthwest Ethiopia

Getachew Ferede Abiyu Worku Alemtegna Getaneh Ali Ahmed Tarekegn HaileYenus Abdu Belay Tessema Yitayih Wondimeneh and Abebe Alemu

School of Biomedical and Laboratory Sciences College of Medicine and Health Sciences University of GondarPO Box 196 Gondar Ethiopia

Correspondence should be addressed to Getachew Ferede get29fgmailcom

Received 23 September 2013 Revised 19 November 2013 Accepted 20 November 2013

Academic Editor Polrat Wilairatana

Copyright copy 2013 Getachew Ferede et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Background Malaria is a major public health problem in Ethiopia where an estimated 68 of the population lives in malariousareas Studying its prevalence is necessary to implement effective controlmeasuresTherefore the aim of this studywas to determineseven-year slide positive rate ofmalariaMethods A retrospective studywas conducted atMetemaHospital from September 2006 toAugust 2012 Seven-year malaria cases data had been collected from laboratory registration book Results A total of 55833 patientswere examined for malaria of these 9486 (17) study subjects were positive for malaria The predominant Plasmodium speciesdetected was P falciparum (8602) (907) followed by P vivax (852) (9) A slide positive rate of malaria within the last seven years(2006ndash2012) was almost constant with slight fluctuation The age groups of 5ndash14 years old were highly affected by malariainfection(1375) (201) followed by 15ndash29 years old (3986) (185) High slide positive rate of malaria occurred during spring (SeptemberndashNovember) followed by summer (JunendashAugust)Conclusion Slide positive rate of malaria was high in study areaTherefore healthplanners and administrators should give intensive health education for the community

1 Background

Malaria is a life-threatening infectious disease caused by theprotozoan parasite called Plasmodium It is a leading publichealth problem in Ethiopia where an estimated 68 of thepopulation lives in malarious areas and three-quarters of thetotal land mass is regarded as malarious [1] with two-thirdsof the countryrsquos population at risk [2]Thismakes malaria thenumber one health problem in Ethiopia with an average of 5million cases per year [3] The disease causes 70000 deathseach year and accounts for 17 of outpatient visits to healthinstitutions [4]

Four main species of malaria infect humans Plasmodiumfalciparum (P falciparum) P malariae P ovale and Pvivax P falciparum is the most highly virulent species andis responsible for almost all of the 17ndash25 million deathsworldwide caused by malaria [5 6] Malaria mostly affectschildren under the age of 5 years and pregnant women in

developing countries [7] Pregnant women are more vul-nerable because they experience depressed immunity duringpregnancy endangering the lives of both mother and thechild [8] A similar problemariseswith children below the ageof five as their immunity systems are not yet fully developedIt is estimated that every 45 seconds a child dies of malariaworldwide [9]

Malaria is seasonal in most parts of Ethiopia withvariable transmission and prevalence patterns affected by thelarge diversity in altitude and rainfall with a lag time varyingfrom a few weeks before the beginning of the rainy season tomore than a month after the end of the rainy season [10 11]Epidemics of malaria are relatively frequent [12] involvinghighland or highland fringe areas of Ethiopia mainly areas1000ndash2000m above sea level [1]Malaria transmission peaksbiannually from September to December and from April toMay coinciding with the major harvesting seasons

2 Malaria Research and Treatment

The main malaria control strategies in Ethiopia includeearly diagnosis and prompt treatment selective vector con-trol epidemic management and control environmentalmanagement and personal protection through the use ofinsecticide-treated bed nets [13] Despite recent efforts tocontrol the disease malaria remains the leading cause ofmortality andmorbidity in the country [1] Amajor challengefor malaria epidemiologists is to evaluate the strengths andweaknesses of both methods in estimating malaria incidenceand time trends especially as malaria control programmesare intensified worldwide [14]

Due to the difference in altitude and rainfall Ethiopia hasa varied pattern of malaria transmission with transmissionseason ranging from less than three months to more thansix months duration [10 11] Farming is extensive in studyarea due to the fact that many daily laborers move fromother areas to Metema Therefore this study was initiatedto analyse seven years hospital records which are importantsources of malaria data because they are readily availableand can provide useful indicators on the situation of malariaat lower cost Moreover they are useful to evaluate theimpact of the current national malaria control activities onmalaria prevalence in the study area If properly utilizedthis information will urge the decision makers to act timelyto strengthen malaria control interventions effectively andefficiently

2 Methods

21 Study Area The study was conducted at Metema Hos-pital which is located in the North Gondar on the borderwith Sudan Amhara region 897 km North of Addis Ababaand 197 km from the ancient city of Gondar and it has alatitude and longitude of 12∘581015840N 36∘121015840E with an elevation of685 meters above sea level Metema area is one of the areaswhere extensive farming is going on in Ethiopia This areais malarious and it has the only one primary hospital in thecommunity which provides inpatient and outpatient servicesfor more than 5581 populations surrounding it

22 Study Design A retrospective study was conducted todetermine the seven years (September 2006 to August 2012)slide positive rate of malaria by reviewing blood film malariareports at Metema Hospital

23 Study Population and Data Collection The study par-ticipants were all malaria suspected individuals who had acomplain of febrile illness at Metema Hospital during thestudy period Sociodemographic and laboratory data werecollected from patients registration book In this hospitalperipheral smear examination of a well-prepared and well-Giemsa stained blood film is used as the gold standard inconfirming the presence of the malaria parasite as WHOprotocol In Ethiopia the staining techniques and blood filmexamination for malaria parasite detection were conductedaccording to a standard operating procedure (SOP) in eachhospital and health center throughout the country

Table 1 Overall slide positive rate of malaria in relation to sex atMetema Hospital Northwest Ethiopia 2006ndash2012

Sex No screened No Positive Percentage () 119875 valueMales 30379 5470 18

0001Females 25454 4016 158Total 55833 9486 17

Table 2 Prevalence of Plasmodium species at Metema HospitalNorthwest Ethiopia 2006ndash2012

Plasmodium spps Frequency Percentage ()P falciparum 8602 907P vivax 852 9Mixed 32 03Total 9486 100

Table 3 Slide positive rate of malaria by age groups in patients whoattended at Metema Hospital Northwest Ethiopia 2006ndash2012

Age group inyear No screened Positive Percentage () 119875 value

lt1 4132 473 114

0001

1ndash4 9909 1630 1645ndash14 6847 1375 20115ndash29 21593 3986 18530ndash44 9645 1511 157ge45 3707 511 138

24 Data Analysis Data was entered and analyzed usingSPSS version 20 software Chi-square test was employed tocompare the proportion and 119875 value le 005 was consideredstatistically significant

25 Ethical Clearance The data was collected after ethicalclearance was obtained from the School of Biomedical andLaboratory Sciences College ofMedicine andHealth ScienceUniversity of Gondar After discussing the objective of thestudy written permission was obtained from Metema Hos-pital before the data collection

3 Results

During the study period a total of 55833 malaria suspectedpatients gave blood films for malaria diagnosis in MetemaHospital Of these 9486 (17) study subjects were positivefor malaria The predominant Plasmodium species was Pfalciparum 8602 (907) followed by P vivax 852 (9) andmixed infections of P falciparum and P vivax 32 (03)Gender had statistically significant association with malariainfection (Tables 1 and 2)

The age groups of 5ndash14 years old were highly affected bymalaria infection 1375 (201) followed by 15ndash29 years oldwith the slide positive rate of 3986 (185)Moreover malariainfection was statistically associated with ages (Table 3)

High slide positive rate of malaria occurred during spring(SeptemberndashNovember) 3118 (207) followed by summer

Malaria Research and Treatment 3

Table 4 Slide positive rate of malaria at different seasons in patientswho attended at Metema Hospital Northwest Ethiopia 2006ndash2012

Seasons No screened Positive Percentage () 119875 valueSpring(SepndashNov) 15039 3118 207

0001

Winter(DecndashFeb) 13310 2130 16

Autumn(MarndashMay) 13095 1853 142

Summer(JunndashAug) 14389 2385 166

Table 5 Slide positive rate of malaria from 2006ndash2012 in MetemaHospital Northwest of Ethiopia

Year MalariaNo screened Positive Percentage ()

2006 8412 1864 2222007 7318 1082 1482008 8600 1389 1622009 7700 1251 1622010 7695 1171 1522011 8248 1289 1562012 7860 1440 183

(JunendashAugust) 2385 (166) winter (DecemberndashFebruary)2130 (16) and autumn (MarchndashMay) 1853 (142) Seasonhad statistically significant association with malaria infection(Table 4)

Slide positive rate of malaria during the study period(2006ndash2012) was almost constant with slight fluctuation inthe study area A slightly increased number of microscopi-cally confirmedmalaria caseswere reported in 2006 followedby 2012 but relatively low number of cases was reported in2007 (Table 5)

4 Discussion

Malaria is a major public health problem in Ethiopia Overthe past years the disease has been consistently reported asthe first leading cause of outpatient visits hospitalizationand death in health facilities across the country [15] In thisstudy the overall slide positive rate ofmalaria was 9486 (17)This result was lower than similar studies done in Ethiopia[16 17] This difference might be due to altitude variationand climatological differences that may contribute to a greatrole for breeding of Anopheles vector The predominantPlasmodium species detected was P falciparum followed byP vivax This was in agreement with other previous studies[18ndash23] But other a studies reported that the most prevalentspecies was P vivax followed by P falciparum [24 25]

During the last seven years slide positive rate of malariawas almost constant in a study area with minor differenceA slight increase had started during 2006 but slightlydecreased and continuED almost constantly in 2007ndash2012The reduction of malaria cases from 2007 TO 2012 con-curS with the increased availability of the new effective

drug Coartem for the treatment of P falciparum malaria atnational and local levels [26] Other likely reasons formalariareduction during this period (2007ndash2012) might be due tothe increased attention to malaria control and preventiveactivities by different responsible bodies [1]

Males were more infected than females which wasstatistically significant (119875 lt 005) This is in line with theother previous studies [16 27 28] The higher prevalencerate might be due to the fact that males engage in activitieswhich make them more prone to infective mosquito bites ascompared to femalesrsquo counterparts which are mostly at homeand protected from such infective bites

In all age groups malaria was reported in the study areaHowever significantly (119875 lt 005) affected age groups were5ndash14 years old followed by 15ndash29 years old This might beassociated with their daily activities Farming is extensive inMetema due to the fact that young daily laborers move toMetema from different areas for application of herbicide andfor gathering of crops Because of high temperature in thisarea daily activities are accomplished especially during nightThis may expose them to the bite of mosquitoes

In the study area malaria was observed in almost everymonth of the year although there was significant (119875 lt 005)fluctuation in the number of malaria cases (Table 4) Thehighest prevalence of malaria cases was observed duringspring (SeptemberndashNovember) followed by summer (JunendashAugust) and winter (DecemberndashFebruary) while low slidepositive rate occurred during autumn (MarchndashMay) This isin agreement with other studies [16 29ndash31] The occurrenceof malaria depends on adequate rainfall and temperature Inareas with a temperate climate transmission of malaria iscommonly limited to months in which the average temper-ature is above the minimum required for sporogony [32]

In conclusion findings of this study showed that slidepositive rate of malaria was high and statistically signifi-cant with sex age and seasons Moreover its transmissionpeaks from September to December coinciding with themajor harvesting seasons This has serious consequences forEthiopiarsquos subsistence economy and for the nation in generalTherefore health planners and administrators need to giveintensive health education for the community and the dailylaborers thatmobilized aroundMetema about the control andprevention of malaria

This study is limited to the data obtained from thepatientsrsquo health records being a secondary data it is liable todisadvantages associated with any secondary data but we arefamiliar with the data set and the critical analysis in which thedata was subjected into make the conclusion valid

Conflict of Interests

All authors declare that they have no competing interests

Authorsrsquo Contribution

G Ferede participated in conception and design of the studydata analysis interpretation of the findings and drafting andwriting of the paper A Worku A Getaneh A Ahmed


T Haile and Y Abdu participated in conception and designof the study and data collection and reviewed the paper BTessema and Y Wondimeneh participated in data analysisand interpretations of the findings and reviewed the paper AAlemu participated in the design of the study data analysisand interpretations of the findings and reviewed the paperAll authors reviewed and approved the final paper

Acknowledgment

The authors thank with deep appreciation Metema HospitalLaboratory staffs for their consistent support during datacollection

References

[1] FMoH National Five Year Strategic Plan for Malaria Preventionand Control in Ethiopia 2006ndash2010 Ministry of Health AddisAbaba Ethiopia 2006

[2] N Kassahun ldquoEthiopia Roll Back Malaria Consultative Mis-sion Essential Actions to Support the attainment of the AbujaTargetsrdquo Ethiopia RBM Country Consultative Mission FinalReport 2004

[3] S Gabriel and V James ldquoDeveloping malaria earky warningsystem for Ethiopiardquo in 25th Annual ESRI International UserConference National Center for EROS San Diego Calif USAPaper no UC2409 2005

[4] Presidentrsquos Malaria Initiative Malaria Operational Plan (MOP)Ethiopia FY 2008

[5] M Aikawa ldquoHuman cerebral malariardquoTheAmerican Journal ofTropical Medicine and Hygiene vol 39 no 1 pp 3ndash10 1988

[6] R S Bray and R E Sinden ldquoThe sequestration of Plasmodiumfalciparum infected erythrocytes in the placentardquo Transactionsof the Royal Society of TropicalMedicine andHygiene vol 73 no6 pp 716ndash719 1979

[7] P Martens and L Hall ldquoMalaria on the move human popula-tion movement and malaria transmissionrdquo Emerging InfectiousDiseases vol 6 no 2 pp 28ndash45 2000

[8] J Sachs and P Malaney ldquoThe economic and social burden ofmalariardquo Nature vol 415 no 6872 pp 680ndash685 2002

[9] WorldHealthOrganization andUNICEFWorldMalaria Report2008 WHO Geneva Switzerland

[10] W Deressa A Ali and F Enqusellassie ldquoSelf-treatment ofmalaria in rural communities Butajira southern EthiopiardquoBulletin of theWorld Health Organization vol 81 no 4 pp 261ndash268 2003

[11] N A Tulu ldquoMalariardquo in The Ecology of Health and Disease inEthiopia H Kloos and A Z Zein Eds pp 341ndash352 WestviewPress Boulder Colo USA 2nd edition 1993

[12] G Zhou N Minakawa A K Githeko and G Yan ldquoAssociationbetween climate variability and malaria epidemics in the EastAfrician highlandsrdquo Proceedings of the National Academy ofSciences of the United States of America vol 101 no 8 pp 2375ndash2380 2004

[13] FMoH Guideline for Malaria Epidemic Prevention and Controlin Ethiopia Ministry of Health Addis Ababa Ethiopia 2ndedition 2004

[14] S CMurphy and J G Breman ldquoGAPS in the childhoodmalariaburden in Africa cerebral malaria neurological sequelae ane-mia respiratory distress hypoglycemia and complications of

pregnancyrdquo The American Journal of Tropical Medicine andHygiene vol 64 no 1-2 pp 57ndash67 2001

[15] W Deressa D Olana and S Chibsa ldquoTreatment seeking ofmalaria patients in east Shewa of Oromiardquo Ethiopian Journal ofHealth Development vol 17 pp 9ndash15 2003

[16] A Abebe M Dagnachew M Mikrie A Meaza and G Melk-amu ldquoTen year trend analysis of malaria prevalence in KolaDiba North Gondar Northwest Ethiopiardquo Parasites and Vec-tors vol 5 article 173 2012

[17] K Karunamoorthi and M Bekele ldquoPrevalence of malaria fromperipheral blood smears examination a 1-year retrospectivestudy from the Serbo Health Center Kersa Woreda EthiopiardquoJournal of Infection and Public Health vol 2 no 4 pp 171ndash1762009

[18] Federal Republic of EthiopiaMinistry ofHealthNational GuideLines Federal Republic of Ethiopia ministry of health AddisAbeba Ethiopia 3rd edition 2012

[19] K Y Asnakew G Sucharita T H Afework O D Dereje andP P Hrishikesh ldquoSpatial analysis of malaria incidence at thevillage level in areas with unstable transmission in EthiopiardquoInternational Journal of Health Geographics vol 8 pp 5ndash162009

[20] D Sintasath ldquoNational malaria survey (2000-2001)rdquo ActivityReport 134 The state of Ministry of Health of Eritrea 2004

[21] T AGhebreyesusMHaile KHWitten et al ldquoHousehold riskfactors for malaria among children in the Ethiopian highlandsrdquoTransactions of the Royal Society of Tropical Medicine andHygiene vol 94 no 1 pp 17ndash21 2000


[23] J M Ramos F Reyes and A Tesfamariam ldquoChange inepidemiology of malaria infections in a rural area in EthiopiardquoJournal of Travel Medicine vol 12 no 3 pp 155ndash156 2005

[24] T Solomon B Yeshambel T Takele M Girmay M Tesfayeand P Beyene ldquoMalaria pattern observed in the highland fringeof Butajira Southern Ethiopia a ten-year retrospective analysisfrom parasitological and metrological datardquo Malaria WorldJournal vol 3 article 5 2012

[25] A Woyessa T Gebre-Michael and A Ali ldquoAn indigenousmalaria transmission in the outskirts of Addis Ababa AkakiTown and its environsrdquo Ethiopian Journal of Health Develop-ment vol 18 pp 2ndash7 2004

[26] Ministry of Health Guideline for Malaria Vector Control inEthiopiaMalaria and other Vector BornDiseases Prevention andControl Team Diseases Prevention Control Department MOHAddis Ababa Ethiopia 2002

[27] B K Mandel E G L Wilkins E M Dunbar and R M WhiteLecture Notes on the Infective Disease Blackwell ScientificPublications 4th edition 1984

[28] World Health Organization World Malaria Report WHOGeneva Switzerland 2005

[29] S Tesfaye Y Belyhun T Teklu T Mengesha and B PetrosldquoMalaria prevalence pattern observed in the highland fringeof Butajira Southern Ethiopia a longitudinal study fromparasitological and entomological surveyrdquoMalaria Journal vol10 article 153 2011

[30] B Chala and B Petros ldquoMalaria in Finchaa sugar factory areain western Ethiopia assessment of malaria as public health


problem in Finchaa sugar factory based on clinical records andparasitological surveys western Ethiopiardquo Journal of Parasitol-ogy and Vector Biology vol 3 pp 52ndash58 2011

[31] T Adhanom Ghebreyesus W Deressa K H Witten AGetachew and T Seboxa Epidemiology and Ecology of Healthand Disease in Ethiopia Shama Books Addis Ababa Ethiopia1st edition 2006

[32] L Molineaux ldquoThe epidemiology of malaria as an explanationof its distribution including some implications for its controlrdquoinMalaria Principles and Practice of Malariology WWernsdor-fer Ed pp 913ndash998 Churchill Livingstone Great Britain UK1988

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Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


The main malaria control strategies in Ethiopia includeearly diagnosis and prompt treatment selective vector con-trol epidemic management and control environmentalmanagement and personal protection through the use ofinsecticide-treated bed nets [13] Despite recent efforts tocontrol the disease malaria remains the leading cause ofmortality andmorbidity in the country [1] Amajor challengefor malaria epidemiologists is to evaluate the strengths andweaknesses of both methods in estimating malaria incidenceand time trends especially as malaria control programmesare intensified worldwide [14]

Due to the difference in altitude and rainfall Ethiopia hasa varied pattern of malaria transmission with transmissionseason ranging from less than three months to more thansix months duration [10 11] Farming is extensive in studyarea due to the fact that many daily laborers move fromother areas to Metema Therefore this study was initiatedto analyse seven years hospital records which are importantsources of malaria data because they are readily availableand can provide useful indicators on the situation of malariaat lower cost Moreover they are useful to evaluate theimpact of the current national malaria control activities onmalaria prevalence in the study area If properly utilizedthis information will urge the decision makers to act timelyto strengthen malaria control interventions effectively andefficiently

2 Methods

21 Study Area The study was conducted at Metema Hos-pital which is located in the North Gondar on the borderwith Sudan Amhara region 897 km North of Addis Ababaand 197 km from the ancient city of Gondar and it has alatitude and longitude of 12∘581015840N 36∘121015840E with an elevation of685 meters above sea level Metema area is one of the areaswhere extensive farming is going on in Ethiopia This areais malarious and it has the only one primary hospital in thecommunity which provides inpatient and outpatient servicesfor more than 5581 populations surrounding it

22 Study Design A retrospective study was conducted todetermine the seven years (September 2006 to August 2012)slide positive rate of malaria by reviewing blood film malariareports at Metema Hospital

23 Study Population and Data Collection The study par-ticipants were all malaria suspected individuals who had acomplain of febrile illness at Metema Hospital during thestudy period Sociodemographic and laboratory data werecollected from patients registration book In this hospitalperipheral smear examination of a well-prepared and well-Giemsa stained blood film is used as the gold standard inconfirming the presence of the malaria parasite as WHOprotocol In Ethiopia the staining techniques and blood filmexamination for malaria parasite detection were conductedaccording to a standard operating procedure (SOP) in eachhospital and health center throughout the country

Table 1 Overall slide positive rate of malaria in relation to sex atMetema Hospital Northwest Ethiopia 2006ndash2012

Sex No screened No Positive Percentage () 119875 valueMales 30379 5470 18

0001Females 25454 4016 158Total 55833 9486 17

Table 2 Prevalence of Plasmodium species at Metema HospitalNorthwest Ethiopia 2006ndash2012

Plasmodium spps Frequency Percentage ()P falciparum 8602 907P vivax 852 9Mixed 32 03Total 9486 100

Table 3 Slide positive rate of malaria by age groups in patients whoattended at Metema Hospital Northwest Ethiopia 2006ndash2012

Age group inyear No screened Positive Percentage () 119875 value

lt1 4132 473 114

0001

1ndash4 9909 1630 1645ndash14 6847 1375 20115ndash29 21593 3986 18530ndash44 9645 1511 157ge45 3707 511 138

24 Data Analysis Data was entered and analyzed usingSPSS version 20 software Chi-square test was employed tocompare the proportion and 119875 value le 005 was consideredstatistically significant

25 Ethical Clearance The data was collected after ethicalclearance was obtained from the School of Biomedical andLaboratory Sciences College ofMedicine andHealth ScienceUniversity of Gondar After discussing the objective of thestudy written permission was obtained from Metema Hos-pital before the data collection

3 Results

During the study period a total of 55833 malaria suspectedpatients gave blood films for malaria diagnosis in MetemaHospital Of these 9486 (17) study subjects were positivefor malaria The predominant Plasmodium species was Pfalciparum 8602 (907) followed by P vivax 852 (9) andmixed infections of P falciparum and P vivax 32 (03)Gender had statistically significant association with malariainfection (Tables 1 and 2)

The age groups of 5ndash14 years old were highly affected bymalaria infection 1375 (201) followed by 15ndash29 years oldwith the slide positive rate of 3986 (185)Moreover malariainfection was statistically associated with ages (Table 3)

High slide positive rate of malaria occurred during spring(SeptemberndashNovember) 3118 (207) followed by summer




0001






2006 8412 1864 2222007 7318 1082 1482008 8600 1389 1622009 7700 1251 1622010 7695 1171 1522011 8248 1289 1562012 7860 1440 183



4 Discussion















Acknowledgment


References









































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















0001






2006 8412 1864 2222007 7318 1082 1482008 8600 1389 1622009 7700 1251 1622010 7695 1171 1522011 8248 1289 1562012 7860 1440 183



4 Discussion















Acknowledgment


References









































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of


















Acknowledgment


References









































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















Prevalence of malaria from blood smears examination: a seven-year retrospective study from metema hospital, northwest ethiopia

Documents