BACKGROUND: Malaria epidemics due to Plasmodium falciparum are reported frequently in the East African highlands with high case fatality rates. There have been formal attempts to predict epidemics by the use of climatic variables that are predictors of transmission potential. However, little consensus has emerged about the relative importance and predictive value of different factors. Understanding the reasons for variation is crucial to determining specific and important indicators for epidemic prediction. The impact of temperature on the duration of a mosquito's life cycle and the sporogonic phase of the parasite could explain the inconsistent findings. METHODS: Daily average number of cases was modeled using a robust Poisson regression with rainfall, minimum temperature and maximum temperatures as explanatory variables in a polynomial distributed lag model in 10 districts of Ethiopia. To improve reliability and generalizability within similar climatic conditions, we grouped the districts into two climatic zones, hot and cold.

CONCLUSIONS The interaction between climatic factors and their biological influence on mosquito and parasite life cycle is a key factor in the association between weather and malaria. These factors should be considered in the development of malaria early warning system.

BACKGROUND: Although malaria is one of the most important causes of death in Ethiopia, measuring the magnitude of malaria-attributed deaths at community level poses a considerable difficulty. Nevertheless, despite its low sensitivity and specificity, verbal autopsy (VA) has been the most important technique to determine malaria-specific cause of death for community-based studies. The present study was undertaken to assess the magnitude of malaria mortality in a predominantly rural population of Ethiopia using VA technique at Butajira Rural Health Programme (BRHP) Demographic Surveillance Site (DSS). METHODS: A verbal autopsy was carried out for a year from August 2003 to July 2004 for all deaths identified at BRPH-DSS. Two trained physicians independently reviewed each VA questionnaire and indicated the most likely causes of death. Finally, all malaria related deaths were identified and used for analysis.

CONCLUSION: The results of this study suggest that malaria plays a considerable role as a cause of death in the study area. Further data on malaria mortality with a relatively large sample size for at least two years will be needed to substantially describe the burden of malaria mortality in the study area.

Plasmodium vivax accounts for about 40% of all malaria infection in Ethiopia. Chloroquine (CQ) is the first line treatment for confirmed P. vivax malaria in the country. The first report of CQ treatment failure in P. vivax was from Debre Zeit, which suggested the presence of chloroquine resistance. METHODS: An in vivo drug efficacy study was conducted in Debre Zeit from June to August 2006. Eighty-seven patients with microscopically confirmed P. vivax malaria, aged between 8 months and 52 years, were recruited and treated under supervision with CQ (25 mg/kg over three days). Clinical and parasitological parameters were assessed during the 28 day follow-up period. CQ and desethylchloroquine (DCQ) blood and serum concentrations were determined with high performance liquid chromatography (HPLC) in patients who showed recurrent parasitaemia.

CONCLUSION: Chloroquine-resistant P. vivax parasites are emerging in Debre Zeit, Ethiopia. A multi-centre national survey is needed to better understand the extent of P. vivax resistance to CQ in Ethiopia BACKGROUND: Plasmodium vivax malaria is the most geographically widespread and the second prevalent cause of malaria globally. Among 2.6 billion people at risk of malaria infection, annual estimates of P. vivax cases range from 130 to 435 million [1], 90% of these infections occur outside Africa [2]. Ethiopia has the highest proportion of P. vivax malaria on the continent, accounting for approximately 40% of all infection in the country [3]. Chloroquine (CQ) is the first line treatment for P. vivax malaria in most parts of the world. However, CQ resistance in P. vivax has compromised its use since the first reported cases from Papua New Guinea in 1989 [4]. Since then, cases of resistance have been reported from places such as Indonesia, island of Nias, in Papua and Irian Jaya in 1991 [5], Myanmar in 1993 and 1995 [6,7], India in 1995 [8], Borneo in 1996 [9], and in south America; Guyana in 1996 [10], and parts of the Amazon Brazil [11-13], Columbia in 2001 [14], Vietnam in 2002 [15], and Peru in 2003 [16]. Resistance has also been reported from two areas in Turkey in 2004 [17]. To date prevalence as high as 84% of CQ-resistant P. vivax has been reported from the north-eastern coast of Indonesian Papua in 2003 [18]. CQ has also been the first line drug in Ethiopia for uncomplicated malaria since 1950. Following the findings of CQ treatment failure as high as 65% for P. falciparum in studies conducted at 18 sites between 1997/98 [19], sulphadoxine/pyrimethamine (SP) was introduced as a first line drug treatment for uncomplicated falciparum malaria in 1999 [20]. SP was replaced by artemether/lumefantrine (AL) five years later after a study conducted in 2003 in 11 sites showed 35.9% treatment failure at day 7 and 71.7% on day 28. The efficacy of AL was reported to be 99.1% in 2004, when it replaced SP [21]. However, CQ continued to be in use as first line drug for vivax malaria. The first report of P. falciparun and P. vivax CQ treatment failure in Debre Zeit, was in 1995, when only 4 of 29 (14%) P. falciparum patients cleared their asexual parasites by day 7 and 2% of 225 P. vivax patients who were followed for seven days failed to respond to CQ treatment [22]. Malaria is one of the most frequently diagnosed acute illnesses and a principal cause of morbidity affecting all age groups in Debre Zeit. Transmission occurs throughout the year with P. vivax being more prevalent (70%) than P. falciparum (30%). Malaria transmission is generally more intense following the main rainy season, which occurs from September to December. The aim of the present study was to determine the rate of CQ treatment failure in P. vivax and confirm whether treatment failure is due to drug resistance or sub-therapeutic antimalarial drug concentrations.

Ethiopia plans to increase its electricity power supply by five-fold over the next five years to fulfill the needs of its people and support the economic growth based on large hydropower dams. Building large dams for hydropower generation may increase the transmission of malaria since they transform ecosystems and create new vector breeding habitats. The aim of this study was to assess the effects of Gilgel-Gibe hydroelectric dam in Ethiopia on malaria transmission and changing levels of prevalence in children. Methods A cross-sectional, community-based study was carried out between October and December 2005 in Jimma Zone, south-western Ethiopia, among children under 10 years of age living in three 'at-risk' villages (within 3 km from dam) and three 'control' villages (5 to 8 km from dam). The man-made Gilgel-Gibe dam is operating since 2004. Households with children less than 10 years of age were selected and children from the selected households were sampled from all the six villages. This included 1,081 children from 'at-risk' villages and 774 children from 'control' villages. Blood samples collected from children using finger prick were examined microscopically to determine malaria prevalence, density of parasitaemia and identify malarial parasite species.

CONCLUSION: This study indicates that children living in close proximity to a man-made reservoir in Ethiopia are at higher risk of malaria compared to those living farther away. It is recommended that sound prevention and control programme be designed and implemented around the reservoir to reduce the prevalence of malaria. In this respect, in localities near large dams, health impact assessment through periodic survey of potential vectors and periodic medical screening is warranted. Moreover, strategies to mitigate predicted negative health outcomes should be integral parts in the preparation, construction and operational phases of future water resource development and management projects.

Evaluation of Paracheck pf o and Parascreen pan/pf o tests for the diagnosis of malaria in an endemic area, South Ethiopia.Nigussie D, Legesse M, Animut A, H/Mariam A, Mulu A. College of Health Sciences, Hawassa University, P.O. Box 1388, Hawassa, Ethiopia. BACKGROUND: Laboratory diagnosis of malaria is limited in peripheral health care services and mainly depends on non-specific clinical examination until the advent of Rapid Diagnostic Tests. OBJECTIVE: Evaluation of the effectiveness of Paracheck pf and Parascreen pan/pf tests for the diagnosis of malaria. METHOD: A Health Center based cross-sectional study was conducted in Kella and Bussa Health Centers, Wondo-Genet area, South Ethiopia where malaria is endemic. Microscopy of Giemsa stained thick blood film was used as gold standard. RESULT: The sensitivity and specificity of Paracheck Pf test for the diagnosis of Plasmodium falciparum were 96.7% and 76%, respectively, with positive predictive value of 67.1% and negative predictive value of 97.9%. The sensitivity and specificity of the Parascreen Pan/pf test for the diagnosis of P. falciparum were 100% and 65.1%, respectively, while its positive and negative predictive values were 67.9 and 100% respectively. Its sensitivity and specificity for Plasmodium vivax were 100 and 42.3%, respectively, with a positive predictive value of 33.3% and a negative predictive value of 100%. CONCLUSION: Although further study is needed to evaluate their specificities, both tests were found to be effective for the diagnosis of falciparum malaria at peripheral health care unit where skilled personnel and laboratory facilities are not available for blood film examination.