Heterogeneity of Malaria in Urban Settings in Ethiopia: A Sero-prevalence and Risk Factor Study.

Malaria remains a significant public health concern in Ethiopia, affecting both rural and urban populations. This study aims to assess the seroprevalence of malaria and investigate associated risk factors among urban residents in three towns: Adama, Metehara, and Awash Sebat Kilo. A cross-sectional survey was conducted from January 30 to March 14, 2020, involving 912 individuals from 277 households. Malaria infection was diagnosed using rapid diagnostic tests (RDTs) and quantitative PCR (qPCR). Serological analyses were performed to determine exposure to Plasmodium falciparum and Plasmodium vivax. The study found a low malaria prevalence of 0.78% by RDT and 4% by qPCR, with 1.7% of cases due to P. falciparum and 2.3% due to P. vivax. Seroprevalence rates varied among towns, with Awash Sebat Kilo showing the highest exposure for recent markers (36.5% for P. falciparum; 28% for P. vivax) compared to lower rates in Adama (2.8% and 2.8%, respectively). Proximity to breeding sites and individuals aged over 15 years were significant risk factors for malaria exposure. This study highlights the heterogeneous nature of malaria transmission in urban settings in Ethiopia, indicating the lowest seroprevalence level in Adama and higher levels in Awash Sebat Kilo. These findings emphasize the need for targeted malaria control strategies and public health interventions tailored to the specific risks faced by urban populations as Ethiopia works toward malaria elimination.