Prevalence of malaria and its determinants among urban residents in central Ethiopia: health center- and household-based study

Urban malaria has emerged as a growing public health concern. Malaria prevalence and its contributing factors were investigated in Akaki Kality Sub-City, Addis Ababa. From March to December 2024, a repeated cross-sectional study of malaria was conducted in health centers and households of malaria index cases. Plasmodium detection was performed using microscopy at health centers, BIOCREDIT Malaria Ag Pf/Pv (pLDH/pLDH) rapid diagnostic tests at households, and confirmation was achieved through quantitative PCR. Overall prevalence of Plasmodium infection among the study participants by qPCR diagnosis was 27.3% (253/928), of which 47.8% of the cases were infected with P. vivax , 36.8% P. falciparum, and 15.4% mixed infection. Plasmodium infection was 32.3% (226/700) among outpatients and 11.9% (27/228) among household members of index cases. Plasmodium infection among the non-travelled household members of index cases was 3.8% (9/238) by RDT and 8.3% (19/228) by qPCR. Asymptomatic infection among household members was 5.0% (12/238) by RDT and 10.1% (23/228) by qPCR. Microscopy demonstrated 81.2% sensitivity relative to qPCR, and RDT 81.3%. Specificity of the RDT was 93.4% compared to qPCR, and the microscopy was 83.2%. The median P. vivax density was 9.8 (IQR: 7.2–10.7)/µL and P. falciparum 8.5 (IQR: 5.1–10.6) p/µL. Being febrile and having a travel history contributed significantly to Plasmodium infection. P. falciparum and P. vivax prevailed among febrile patients of health centers and among household members of index cases. Plasmodium infection was identified among individuals who did not travel to malaria-endemic areas. There is a need to undertake sustainable malaria control in the sub-city by constructing mosquito-proof houses and undertaking regular larval source management.