Prevalence and associated risk factors of malaria in Amhara National Regional State: a systematic review and meta-analyses

Abstract

BACKGROUND: Malaria is a major parasitic infectious disease caused by Plasmodium species and remains a significant public health challenge in sub-Saharan African, including Ethiopia. The Amhara National Regional State is among the most malaria-affected region in Ethiopia. However, comprehensive evidence on the pooled prevalence of malaria and its associated risks in the region has been limited. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of malaria and identify its associated risk factors in Amhara National Regional State. METHODS: ) statistic, while publication bias was evaluated using Egger's regression test and funnel plot. RESULTS: Out of 2,743 records initially identified, 43 studies met the inclusion criteria. The pooled prevalence of malaria in the Amhara National Regional State was 14% (95% CI 12.0-17.0%). Subgroup analysis showed that the highest (17%, 95% CI 4.0-30.0%) pooled prevalence was from South and North Gonder Zones, whereas the lowest (8%, 95% CI 5.0-11.0%) prevalence was observed in East Gojjam Zone. Malaria prevalence estimate varied according to the diagnostic methods; with microscopy reporting a prevalence of 16%; 95% CI 13.0-18% and combination of microscopy with RDT reporting 9%; 95% CI 4.0-14.0%. The prevalence increased from 13% (95% CI 10.0-17%) before the onset of COVID-19 pandemic to 15% (95% CI 14.0-10.0%) after the onset. Plasmodium falciparum was the predominant species, accounting 9% (95% CI 6-11%) of the infection followed by P. vivax at 5% (95% CI 4-5%). Significant predictors of malarial infection included, the presence of stagnant water near residences (OR = 2.64; 95% CI 2.09-3.34), engagement in outdoor night activities (OR = 1.69; 95% CI 1.33-2.16), and lack of insecticide treated net (ITN) utilization (OR = 2.05; 95% CI 1.71-2.46). CONCLUSION: This systematic review and meta-analysis revealed that malaria remained a considerable public health burden in the Amhara National Regional State with Plasmodium falciparum as the dominant species. Malaria prevalence varied across administrative zones, diagnostic methods, study seasons, and study periods. Environmental and behavioural factors significantly contributed to malaria transmission, highlighting the need for a strengthened and targeted malaria prevention and controlled interventions in the region.