MAGNITUDE OF MALARIA AND ASSOCIATED FACTORS AMONG UNDER-

FIVE AGE CHILDREN IN EAST HARERGE ZONE ARROUND HARAMAYA.

DEPARTMENT COMPRESSIVE NURSE

4TH YEAR

Name of The Group ID No

1.Kadir Abrahim. 0549/14
2.Obsa Mohammed. 0566/14
3.Eniye Tashoma. 1183/14
4.Kalkidan Salamon. 1195/14
5.Kasahun suyum 1196/14
6.Hana Temesgen. 0541/14
 Content
Chapter1.Introduction
1.1background..................................................1.
1.2 statement of the problem..........................................2
1.3 significance of study...................................................3

Reference.............................................................................5

Chapter 2 Literature review

2.1 prevalence of Malaria.................,...............................5
2.2 Factors associated with the prevalence of

malaria.................................................................................6

2.3 Objective.......................................................................7

2.4 Conclusion.................,.................................................7

2.5 Reference....................................................................8
Introduction
Background

Malaria continues to be an important threat to public health and infects millions

of children under 5 years of age each year.Although Ethiopia has set targets for
at-risk group interventions to eradicate and manage malaria,the illness is still a
serious public health problem in areas where itis endemic, especially in the
unique low lands in Harerge Zone of Ethiopia.

It is particularly devastating among vulnerable populations, such as children under

five years of age, who are at the highest risk of severe illness and mortality due to
the disease. In this age group, malaria can lead to complications such as anemia,
respiratory distress, and cerebral malaria, making early diagnosis and treatment
crucial.

The East Hararge Zone is characterized by a diverse landscape that includes

highland and lowland areas, which influences the transmission dynamics of
malaria. Factors contributing to the magnitude of malaria in this region include
environmental conditions, socio-economic status, healthcare access, and
community awareness regarding malaria prevention and control measures.

Environmental factors such as stagnant water bodies, rainfall patterns, and

temperature significantly impact mosquito breeding sites and the lifecycle of the
malaria parasite. Additionally, socio-economic factors like poverty and lack of
education can hinder families' ability to access preventive measures such as
insecticide-treated nets (ITNs) and antimalarial medications. Furthermore,
cultural beliefs and practices may influence health-seeking behavior, affecting
timely diagnosis and treatment.

Statement of problem
Malaria,caused by the Plasmodium species,is one of the biggest threats to public
health and can be fatal.

According to WHO’s latest World malaria report, there were an estimated 263
million cases and 597 000 malaria deaths worldwide in 2023. This represents
about 11 million more cases in 2023 compared to 2022, and nearly the same
number of deaths. Approximately 95% of the deaths occurred in the WHO African
Region, where many at risk still lack access to the services they need to prevent,
detect and treat the disease.

Between 1 January and 20 October 2024, over 7.3 million malaria cases and 1157
deaths (CFR 0.02%) were reported in Ethiopia. Malaria poses a significant public
health challenge in Ethiopia, where approximately 75% of the land mass is
considered to be endemic to malaria. Around 69% of the population residing in
these areas face the risk of infection where periodic outbreaks contribute to up to
20% of deaths among children under the age of five.

Malaria is still a major challenge for public health and socio economic
development.In particular,in underdeveloped countries,malaria is one of the
leading causes of mortality among pregnant women and children under 5 years of
age,especially in sub-Saharan Africa,including Ethiopia.

Malaria is a major infection that affects resource-constrained

countries,particularly intropical regions around the world.Ethiopia is one of the
countries at high risk for malaria epidemics due to changes in climate and
topography that influence both vector and parasite populations.Climatic
fluctuations and drought-related nutritional emergencies cause a wide range of
epidemics to occur every 5 to 8 years in some areas.Plasmodium falciparum and
P.vivax are the two predominant species in the country,transmitted by the
inoculation of mosquitoes(Anopheles species).

Plasmodium falciparum(P.falciparum),P.vivax, and mixed infections account for an

estimated 65%,34%,and1%ofmalaria cases, respectively(Federal Ministry of
Health Ethiopia).
The impact of malaria also extends beyond the health center to families and every
day lives:children may developlong-term neurological sequelae following severe
malaria attacks and further subtle developmental and cognitive impairments as a
result of both severe and uncomplicated episodes,and families may also face
substantial economic consequences.It causes severe anemia,acute renal
failure(ARF),hypoglycemia,and severe complications.

Significance of study
This study aimed to determine the prevalence of malaria and associated factors
among children in East Hararge Zone pastoral communities,Oromia regional
state, Eastern Ethiopia in 2024.

Hararghe Zone administrative center is located in Harar, 525 km away from Addis
Ababa due east. The zone is one of the administrative zones in the Oromia
Regional State, bordered by West Hararghe due West and Somali Regional State
due east. The area of the zone is 24,247.66 sq. km. East Hararghe Zone consists of
21 administrative districts and four administrative towns, which further comprise
a total of about 548 kebeles (sub-districts). It is the most populated zone in
Oromia regional state with an estimated total population of 3.7 million.24
According to the current malaria stratification in the East Hararghe Zone, about
282 (52%) kebeles were endemic malaria areas by the level of malarial
endemicity, while the rest 20%, 30%, and 50% were categorized in high,
moderate, and low, respectively

Understanding these dynamics is essential for developing targeted interventions

to reduce malaria morbidity and mortality in this vulnerable population. By
addressing both environmental and socio-economic determinants, public health
strategies can be more effective in controlling malaria transmission and improving
health outcomes for children in the region.

In Ethiopia,a program is being carried out to eradicate malaria by 2030.The

prevalence and determinants of malaria among vulnerable groups should be
examined over time and in various locations to gauge the success (Federal
Ministry of Health Ethiopia,).Currently,rapid diagnostic tests (RDTs) are used to
diagnose malaria and treat patients.In door residual spraying (IRS) with
insecticides,promotion of community ownership,and long-lasting insecticide
nets(LLINs) are methods that have been scaled up to increase access to malaria
prevention and control.

References
√ Abossie,A.,Yohanes,T.,Nedu,A.,Tafesse,W.,and Damitie,M.(2020).Among febrile
children under-five years:Across-sectional study in Arba Minch Zuria district,
South Ethiopia.Infect.Drug Resist.13,363–372.doi:10.2147/IDR.S223873
Adugna,A.(2007).Malaria in Ethiopia.Available online at:www. ethiodemography
and health.org. Afoak wah,C.,Deng,X.,and Onur,L.(2018).Malaria infection among
children under five:theuseoflarge-scale interventions in Ghana.BM.

√Google

CHAPTER 2: LITERATURE REVIEW

2.1 Prevalence of Malaria

In Ethiopia, three-fourths of the areas are endemic to malaria and more than two-
thirds of its population (more than 55 million people) live in areas at risk for
malaria. Nevertheless, the distribution of malaria species differs across
geographical regions, and the associated risks have not been updated to reflect
recent changes such as urbanization and land use modifications. The incidence of
malaria cases was 28 per 1,000 people at risk in 2020, and the mortality rate of
children under 5 years of age per 1,000 live births was 59 in 2019 (U.S. President’s
Malaria Initiative Ethiopia

Malaria Operational Plan FY 2022; Adugna, 2007; Haji et al., 2016;

Tadesse.et al., 2018)

:The prevalence of malaria among children under 5 years of age was 27.8%
(95%CI=23.5–32.1), and the prevalence rates of Plasmodium falciparum,
Plasmodium vivax,and mixed malaria were 68.4%,25.6% ,and 6%,respectively.
Regarding the proportion of malaria among age groups,81% of children under5
years of age between 48 and 59 months were

malaria-positive.In this study,fever within the last week (AOR=13.34,95%CI=6.37–

27.95) and not sleeping under insecticide-treated nets (ITNs)
(AOR=3.10,95%CI=1.95–4.92) were significantly associated with malaria.The age
of the children was negatively associated with malaria

In terms of malaria within the age groups of children under 5 years of age, the
malaria proportion was higher among children who were in the age group of 48–
59 months (42, 80.8%), followed by children in the age groups of 24–35 months
and 36–47 months (34, 70.8% and 21, 44.8%, respectively). Plasmodium
falciparum was higher among the 24–35 and 48–59 age groups, with 27 (56.3%)
and 28 (53.8%), respectively (Table 1).www.frontiersin.org.
2.2 Factors associated with the prevalence of
malaria among children under 5 years of age
In the bivariate analysis, child age groups, sleeping under ITN, and child fever
history had a p-value of <0.25 and were considered candidates for multivariable
analysis. Multivariable analysis showed the factors that were significantly
associated with malaria among children under 5 years old. Children who were in

the 24 to 35 months age group (AOR = 0.29, 95% CI = 0.09–0.89), those who were
in the 36 to 47 months age group (AOR = 0.18, 95% CI = 0.06–0.52), those who
were in the 12 to 23 months age group (AOR = 0.01, 95% CI = 0.00–0.03), and
those who were in the 1 to 11 months age group (AOR = 0.01, 95% CI = 0.00–0.04)
were less likely to have positive test results for malaria than those in the 48 to 59
months age group. Children who had a fever within the last week were 13 times
more likely to be infected with malaria than those who did not have a fever (AOR
= 13.34, 95% CI = 6.37–27.95). Children who did not sleep under ITN were three
times more likely to be infected with malaria (AOR = 3.10, 95% CI = 1.95–4.92).

2.3 Objective
This study aimed to determine the prevalence of malaria and associated factors
among children in East Hararge Zone pastoral communities,Oromia regional
state, Eastern Ethiopia in 2024.

In addition, knowing the current prevalence of malaria among children under 5

years of age in pastoralist communities in Ethiopia and describing the factors
associated with the prevalence of malaria are of paramount importance to scaling
up and designing appropriate interventions for the remotest Eastern Ethiopian
pastoralists, who are vulnerable due to their mobility nature. Nevertheless, there
has been no prior research on the prevalence of malaria among children under 5
years old and the potential factors associated with it in East Hararge Zone
pastoral communities. Therefore, the present study aimed to assess the
prevalence of malaria and associated factors among children under 5 years of age
in pastoral communities

2.4 Conclusion
The prevalence of malaria among children under 5 years old was high during the
rainy season in this pastoral region of Ethiopia. Factors such as fever within the
last week and not sleeping in insecticide-treated nets were significantly
associated with malaria. Therefore, to reduce malaria-related infections and
deaths among children under 5 years of age, the government ought to enhance
the availability and utilization of insecticide-treated nets (ITNs

References

Abossie A., Yohanes T., Nedu A., Tafesse W., Damitie M. (2020). Among febrile
children under-five years: A cross-sectional study in Arba Minch Zuria district,
South Ethiopia. Infect. Drug Resist. 13, 363–372. doi: 10.2147/IDR.S223873

PubMed Abstract | CrossRef Full Text | Google Scholar

Adugna A. (2007). Malaria in Ethiopia. Available online at:

www.ethiodemographyandhealth.org.

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