Prevalence and associated factors of microscopy-confirmed malaria among the general population in Ethiopia: a systematic review and meta-analysis

Malaria remains a major public health problem in Ethiopia despite ongoing elimination efforts targeting interruption of local transmission by 2030. Reliable and up-to-date estimates of malaria burden in the general population are essential for guiding control strategies. However, there has been no comprehensive synthesis of microscopy-confirmed malaria prevalence and its determinants among the general population since 2020. This review aimed to estimate the pooled prevalence of microscopy-confirmed malaria and identify its determinants in Ethiopia. We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines, with the protocol registered in PROSPERO (CRD420251026861). Databases (PubMed, Scopus, ScienceDirect, HINARI, and AJOL) and gray literature sources were retrieved. Heterogeneity among studies was assessed using Higgins’s I2 statistic and visualized with forest plots. When substantial heterogeneity was detected, subgroup and sensitivity analyses were performed. A random-effects model with Knapp–Hartung adjustment was used to estimate pooled effect sizes. Publication bias was evaluated using funnel plots, Egger’s test, and trim-and-fill methods. Fourteen studies involving 8,762 participants were included. The pooled prevalence of microscopy-confirmed malaria was 7.1% (95% CI: 4.9–10.2%; I2 = 95.7%). Substantial regional variation was observed, with the highest prevalence in Amhara (10.7%) and the southwest (7.3%). Significant determinants included presence of stagnant water (OR = 6.71; 95% CI: 4.93–9.14), absence of indoor residual spraying (OR: 5.90, 95% CI: 3.40, 10.4), presence of mosquito breeding sites (OR: 6.13; 95% CI: 3.06–12.3), travel history to endemic areas (OR: 5.86; CI: 2.47–13.8), living in houses with eaves (OR: 4.5, 95% CI: 2.17–9.50), history of malaria infection (OR: 3.54; 95% CI: 1.79–6.98), and ITN non-use (OR: 4.8, 95% CI: 3.41–6.78). Trim-and-fill analysis for potential publication bias revealed an adjusted pooled prevalence of 8.2% (95% CI: 5.6%–11.7%). The pooled prevalence of malaria remains notable among the general population in Ethiopia. Strengthening community awareness on the regular use of insecticide-treated bed nets and better environmental management, such as getting rid of standing water, could help reduce the spread of malaria.