title: A Venue-Based Survey of Malaria, Anemia and Mobility Patterns among Migrant Farm Workers in Amhara Region, Ethiopia.
abstract: BACKGROUND
  Mobile populations present unique challenges to malaria control and elimination efforts. Each year, a large number of individuals travel to northwest Amhara Region, Ethiopia to seek seasonal employment on large-scale farms. Agricultural areas typically report the heaviest malaria burden within Amhara thereby placing migrants at high risk of infection. Yet little is known about these seasonal migrants and their malaria-related risk factors.
  
  
  RESULTS
  In July 2013, a venue-based survey of 605 migrant laborers 18 years or older was conducted in two districts of North Gondar zone, Amhara. The study population was predominantly male (97.7%) and young (mean age 22.8 years). Plasmodium prevalence by rapid diagnostic test (RDT) was 12.0%; One quarter (28.3%) of individuals were anemic (hemoglobin <13 g/dl). Nearly all participants (95.6%) originated from within Amhara Region, with half (51.6%) coming from within North Gondar zone. Around half (51.2%) slept in temporary shelters, while 20.5% regularly slept outside. Only 11.9% of participants had access to a long lasting insecticidal net (LLIN). Reported net use the previous night was 8.8% overall but 74.6% among those with LLIN access. Nearly one-third (30.1%) reported having fever within the past two weeks, of whom 31.3% sought care. Cost and distance were the main reported barriers to seeking care. LLIN access (odds ratio [OR] = 0.30, P = 0.04) and malaria knowledge (OR = 0.50, P = 0.02) were significantly associated with reduced Plasmodium infection among migrants, with a similar but non-significant trend observed for reported net use the previous night (OR = 0.16, P = 0.14).
  
  
  CONCLUSIONS
  High prevalence of malaria and anemia were observed among a young population that originated from relatively proximate areas. Low access to care and low IRS and LLIN coverage likely place migrant workers at significant risk of malaria in this area and their return home may facilitate parasite transport to other areas. Strategies specifically tailored to migrant farm workers are needed to support malaria control and elimination activities in Ethiopia.
authors.affiliation: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.|Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Rebekah Stewart
authors.initials: RS
authors.lastname: Schicker
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Neway
authors.initials: N
authors.lastname: Hiruy
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Berhanu
authors.initials: B
authors.lastname: Melak
authors.affiliation: Amhara Regional Health Research Laboratory Center, Bahir Dar, Ethiopia.
authors.forename: Woyneshet
authors.initials: W
authors.lastname: Gelaye
authors.affiliation: Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia.
authors.forename: Belay
authors.initials: B
authors.lastname: Bezabih
authors.affiliation: Department of Health Behavior and Biological Sciences, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America.|Agnes Scott College, Public Health Department, Decatur, Georgia, United States of America.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Patterson
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Zerihun
authors.initials: Z
authors.lastname: Tadesse
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America.|International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, United States of America.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America.
authors.forename: Frank O
authors.initials: FO
authors.lastname: Richards
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Noland
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D000067565:Farmers / Q000706:statistics & numerical data; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data; D008288:Malaria / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014171:Transients and Migrants / Q000706:statistics & numerical data; D055815:Young Adult