title: Analysis of asymptomatic and clinical malaria in urban and suburban settings of southwestern Ethiopia in the context of sustaining malaria control and approaching elimination.
abstract: BACKGROUND
  Malaria intervention in Ethiopia has been strengthened significantly in the past decade. The Ethiopian government recently stratified the country based upon annual parasite incidence into malaria free, low, moderate and high transmission strata. Districts with low transmission were targeted for indigenous transmission elimination. Surveillance on malaria disease incidence is needed for planning control and elimination efforts.
  
  
  METHODS
  Clinical malaria was monitored prospectively in health facilities in Jimma town, Oromia Region, southwestern Ethiopia from July 2014 to June 2015. Seasonal cross-sectional parasite prevalence surveys in local communities were conducted in 2014 and 2015 in eight kebeles. Case report forms were administered to obtain sociodemographic and epidemiological information from patients.
  
  
  RESULTS
  A total of 1434 suspected malaria cases were examined from the health facilities and 428 confirmed malaria cases were found. Among them, 327 (76.4 %) cases were Plasmodium vivax, 97 (22.7 %) were Plasmodium falciparum, and 4 (0.9 %) were mixed infection of P. vivax and P. falciparum. The annual malaria incidence rate was 1.7 cases per 1000 people at risk. Parasite prevalence in the community was less than 3 %. Household ownership of insecticide-treated nets (ITNs) was 47.3 % (1173/2479) and ITN usage was 37.9 %. All ITNs were long-lasting insecticidal nets, and repellent use was not found in the study area. Being male and traveling were the significant risk factors for P. falciparum malaria. For P. vivax malaria, risk factors included occupation and history of malaria illness during the preceding 30 days.
  
  
  CONCLUSIONS
  Epidemiological evidence suggested low clinical malaria incidence and prevalence in Jimma town. More aggressive measures may be needed to further suppress vivax transmission. Strategies should be planned targeting sustained control and elimination.
authors.affiliation: Program in Public Health, University of California, Irvine, CA, 92617, USA.
authors.forename: Guofa
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia.|Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia.
authors.forename: Delenasaw
authors.initials: D
authors.lastname: Yewhalaw
authors.affiliation: Program in Public Health, University of California, Irvine, CA, 92617, USA.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Lo
authors.affiliation: Program in Public Health, University of California, Irvine, CA, 92617, USA.
authors.forename: Daibin
authors.initials: D
authors.lastname: Zhong
authors.affiliation: Program in Public Health, University of California, Irvine, CA, 92617, USA.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Teshome
authors.initials: T
authors.lastname: Degefa
authors.affiliation: Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Endalew
authors.initials: E
authors.lastname: Zemene
authors.affiliation: Program in Public Health, University of California, Irvine, CA, 92617, USA.
authors.forename: Ming-chieh
authors.initials: MC
authors.lastname: Lee
authors.affiliation: Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Estifanos
authors.initials: E
authors.lastname: Kebede
authors.affiliation: Department of Health Management, College of Health Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Kora
authors.initials: K
authors.lastname: Tushune
authors.affiliation: Program in Public Health, University of California, Irvine, CA, 92617, USA. guiyuny@uci.edu.
authors.forename: Guiyun
authors.initials: G
authors.lastname: Yan
mesh_terms: D058345:Asymptomatic Infections / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D015994:Incidence; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control*; D016780:Malaria, Vivax / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control*; D015995:Prevalence; D014504:Urban Health / Q000706:statistics & numerical data
keywords: Ethiopia; Incidence; Malaria; Prevalence; Risk factor; Urban area