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      Incidence, prevalence and mortality rates of malaria in Ethiopia from 1990 to 2015: analysis of the global burden of diseases 2015

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          Abstract

          Background

          In Ethiopia there is no complete registration system to measure disease burden and risk factors accurately. In this study, the 2015 global burden of diseases, injuries and risk factors (GBD) data were used to analyse the incidence, prevalence and mortality rates of malaria in Ethiopia over the last 25 years.

          Methods

          GBD 2015 used verbal autopsy surveys, reports, and published scientific articles to estimate the burden of malaria in Ethiopia. Age and gender-specific causes of death for malaria were estimated using cause of death ensemble modelling.

          Results

          The number of new cases of malaria declined from 2.8 million [95% uncertainty interval (UI) 1.4–4.5 million] in 1990 to 621,345 (95% UI 462,230–797,442) in 2015. Malaria caused an estimated 30,323 deaths (95% UI 11,533.3–61,215.3) in 1990 and 1561 deaths (95% UI 752.8–2660.5) in 2015, a 94.8% reduction over the 25 years. Age-standardized mortality rate of malaria has declined by 96.5% between 1990 and 2015 with an annual rate of change of 13.4%. Age-standardized malaria incidence rate among all ages and gender declined by 88.7% between 1990 and 2015. The number of disability-adjusted life years lost (DALY) due to malaria decreased from 2.2 million (95% UI 0.76–4.7 million) in 1990 to 0.18 million (95% UI 0.12–0.26 million) in 2015, with a total reduction 91.7%. Similarly, age-standardized DALY rate declined by 94.8% during the same period.

          Conclusions

          Ethiopia has achieved a 50% reduction target of malaria of the millennium development goals. The country should strengthen its malaria control and treatment strategies to achieve the sustainable development goals.

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          Most cited references13

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          GBD 2010: design, definitions, and metrics.

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            Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study.

            To study the diagnosis and outcomes in people admitted to hospital with a diagnosis of severe malaria in areas with differing intensities of malaria transmission. Prospective observational study of children and adults over the course a year. 10 hospitals in north east Tanzania. 17,313 patients were admitted to hospital; of these 4474 (2851 children aged under 5 years) fulfilled criteria for severe disease. Details of the treatment given and outcome. Altitudes of residence (a proxy for transmission intensity) measured with a global positioning system. Blood film microscopy showed that 2062 (46.1%) of people treated for malaria had Plasmodium falciparum (slide positive). The proportion of slide positive cases fell with increasing age and increasing altitude of residence. Among 1086 patients aged > or = 5 years who lived above 600 metres, only 338 (31.1%) were slide positive, while in children < 5 years living in areas of intense transmission (< 600 metres) most (958/1392, 68.8%) were slide positive. Among 2375 people who were slide negative, 1571 (66.1%) were not treated with antibiotics and of those, 120 (7.6%) died. The case fatality in slide negative patients was higher (292/2412, 12.1%) than for slide positive patients (142/2062, 6.9%) (P < 0.001). Respiratory distress and altered consciousness were the strongest predictors of mortality in slide positive and slide negative patients and in adults as well as children. In Tanzania, malaria is commonly overdiagnosed in people presenting with severe febrile illness, especially in those living in areas with low to moderate transmission and in adults. This is associated with a failure to treat alternative causes of severe infection. Diagnosis needs to be improved and syndromic treatment considered. Routine hospital data may overestimate mortality from malaria by over twofold.
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              Multiple Insecticide Resistance: An Impediment to Insecticide-Based Malaria Vector Control Program

              Background Indoor Residual Spraying (IRS), insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are key components in malaria prevention and control strategy. However, the development of resistance by mosquitoes to insecticides recommended for IRS and/or ITNs/LLINs would affect insecticide-based malaria vector control. We assessed the susceptibility levels of Anopheles arabiensis to insecticides used in malaria control, characterized basic mechanisms underlying resistance, and evaluated the role of public health use of insecticides in resistance selection. Methodology/Principal findings Susceptibility status of An. arabiensis was assessed using WHO bioassay tests to DDT, permethrin, deltamethrin, malathion and propoxur in Ethiopia from August to September 2009. Mosquito specimens were screened for knockdown resistance (kdr) and insensitive acetylcholinesterase (ace-1R) mutations using AS-PCR and PCR-RFLP, respectively. DDT residues level in soil from human dwellings and the surrounding environment were determined by Gas Chromatography with Electron Capture Detector. An. arabiensis was resistant to DDT, permethrin, deltamethrin and malathion, but susceptible to propoxur. The West African kdr allele was found in 280 specimens out of 284 with a frequency ranged from 95% to 100%. Ace-1R mutation was not detected in all specimens scored for the allele. Moreover, DDT residues were found in soil samples from human dwellings but not in the surrounding environment. Conclusion The observed multiple-resistance coupled with the occurrence of high kdr frequency in populations of An. arabiensis could profoundly affect the malaria vector control programme in Ethiopia. This needs an urgent call for implementing rational resistance management strategies and integrated vector control intervention.
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                Author and article information

                Contributors
                amare.deribew@gmail.com
                tarikud@gmail.com
                biruck1@gmail.com
                agizachew@gmail.com
                adamayohannes@gmail.com
                awoket@uw.edu
                tgebre@taskforce.org
                hailu_a2004@yahoo.com
                sibhatu2010@gmail.com
                alamwo1@yahoo.com
                biruck471@yahoo.ca
                amanuel.abajobir@uq.net.au
                oumerjaji@gmail.com
                semawfer@yahoo.com
                nebiyu_negussu@yahoo.com
                belete19@yahoo.com
                azmerawtayelgn3@gmail.com
                abatem@who.int
                birhanmen@yahoo.com
                zerihun.tadesse@cartercenter.org
                mesfins@outlook.com
                eac27@uw.edu
                scottg16@uw.edu
                kebededeka@yahoo.com
                stanaway@uw.edu
                Journal
                Malar J
                Malar. J
                Malaria Journal
                BioMed Central (London )
                1475-2875
                4 July 2017
                4 July 2017
                2017
                : 16
                : 271
                Affiliations
                [1 ]St. Paul Millennium Medical College, Addis Ababa, Ethiopia
                [2 ]ISNI 0000 0004 1762 2666, GRID grid.472268.d, , Dilla University, ; Dilla, Ethiopia
                [3 ]Nutrition International (former Micronutrient Initiative), Addis Ababa, Ethiopia
                [4 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Center for Population Studies, , Addis Ababa University, ; Addis Ababa, Ethiopia
                [5 ]GRID grid.414835.f, , Federal Ministry of Health, ; Addis Ababa, Ethiopia
                [6 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, Department Reproductive Health, Institute of Public Health, , University of Gondar, ; Gondar, Ethiopia
                [7 ]ISNI 0000 0004 1936 7304, GRID grid.1010.0, School of Public Health, , The University of Adelaide, ; Adelaide, Australia
                [8 ]ISNI 0000 0004 1936 7304, GRID grid.1010.0, School of Medicine, , The University of Adelaide, ; Adelaide, SA Australia
                [9 ]ISNI 0000 0001 1539 8988, GRID grid.30820.39, School of Public Health, , Mekelle University, ; Mekelle, Ethiopia
                [10 ]ISNI 0000000122986657, GRID grid.34477.33, Institute of Health Metrics and Evaluation, , University of Washington, ; Seattle, USA
                [11 ]International Trachoma Initiative, The Task Force for Global Health, Addis Ababa, Ethiopia
                [12 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, School of Medicine, , Addis Ababa University, ; Addis Ababa, Ethiopia
                [13 ]World Health Organization, Kampala, Uganda
                [14 ]GRID grid.452470.0, , Dignitas International, Medical and Research Department, ; Zomba, Malawi
                [15 ]ISNI 0000 0000 8994 5086, GRID grid.1026.5, , University of South Australia, ; Adelaide, Australia
                [16 ]ISNI 0000 0000 9320 7537, GRID grid.1003.2, School of Public Health, , The University of Queensland, ; St Lucia, QLD Australia
                [17 ]GRID grid.449044.9, , Debremarkos University, ; Debremarkos, Ethiopia
                [18 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Rollins Schools of Public Health, , Emory University, ; Atlanta, USA
                [19 ]ISNI 0000 0001 2290 1502, GRID grid.9464.f, Institute of Biological Chemistry and Nutrition, , Hohenheim University, ; Stuttgart, Germany
                [20 ]ISNI 0000 0004 0439 5951, GRID grid.442845.b, College of Medicine and Health Sciences, , Bahir Dar University, ; Bahir Dar, Ethiopia
                [21 ]World Health Organization, Addis Ababa, Ethiopia
                [22 ]The Carter Centre, Addis Ababa, Ethiopia
                [23 ]ISNI 0000 0000 8853 076X, GRID grid.414601.6, Wellcome Trust Brighton and Sussex Centre for Global Health Research, , Brighton and Sussex Medical School, ; Falmer, Brighton, UK
                [24 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, School of Public Health, , Addis Ababa University, ; Addis Ababa, Ethiopia
                Article
                1919
                10.1186/s12936-017-1919-4
                5496144
                28676108
                dd939370-5ed9-485f-8bb4-98fa8f8063b0
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 April 2017
                : 27 June 2017
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                Research
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                © The Author(s) 2017

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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