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Title: Multiplex serology demonstrate cumulative prevalence and spatial distribution of malaria in Ethiopia
Authors: Ashenafi Assefa
Ahmed Ali Ahmed
Wakgari Deressa
Heven Sime
Hussein Mohammed
Amha Kebede
Hiwot Solomon
Hiwot Teka
Kevin Gurrala
Brian Matei
Brian Wakeman
G. Glenn Wilson
Ipsita Sinha
Richard J. Maude
Ruth Ashton
Jackie Cook
Ya Ping Shi
Chris Drakeley
Lorenz Von Seidlein
Eric Rogier
Jimee Hwang
Federal Ministry of Health - Ethiopia
Addis Ababa University
Harvard T.H. Chan School of Public Health
London School of Hygiene & Tropical Medicine
Centers for Disease Control and Prevention
Tulane University School of Public Health and Tropical Medicine
Syddansk Universitet
Mahidol University
Nuffield Department of Clinical Medicine
United States Agency for International Development
African Society for Laboratory Medicine
Ethiopian Public Health Institute
Keywords: Immunology and Microbiology;Medicine
Issue Date: 22-Jul-2019
Citation: Malaria Journal. Vol.18, No.1 (2019)
Abstract: © 2019 The Author(s). Background: Measures of malaria burden using microscopy and rapid diagnostic tests (RDTs) in cross-sectional household surveys may incompletely describe the burden of malaria in low-transmission settings. This study describes the pattern of malaria transmission in Ethiopia using serological antibody estimates derived from a nationwide household survey completed in 2015. Methods: Dried blood spot (DBS) samples were collected during the Ethiopian Malaria Indicator Survey in 2015 from malarious areas across Ethiopia. Samples were analysed using bead-based multiplex assays for IgG antibodies for six Plasmodium antigens: four human malaria species-specific merozoite surface protein-1 19kD antigens (MSP-1) and Apical Membrane Antigen-1 (AMA-1) for Plasmodium falciparum and Plasmodium vivax. Seroprevalence was estimated by age, elevation and region. The seroconversion rate was estimated using a reversible catalytic model fitted with maximum likelihood methods. Results: Of the 10,278 DBS samples available, 93.6% (9622/10,278) had valid serological results. The mean age of participants was 15.8 years and 53.3% were female. National seroprevalence for antibodies to P. falciparum was 32.1% (95% confidence interval (CI) 29.8-34.4) and 25.0% (95% CI 22.7-27.3) to P. vivax. Estimated seroprevalences for Plasmodium malariae and Plasmodium ovale were 8.6% (95% CI 7.6-9.7) and 3.1% (95% CI 2.5-3.8), respectively. For P. falciparum seroprevalence estimates were significantly higher at lower elevations (< 2000 m) compared to higher (2000-2500 m) (aOR 4.4; p < 0.01). Among regions, P. falciparum seroprevalence ranged from 11.0% (95% CI 8.8-13.7) in Somali to 65.0% (95% CI 58.0-71.4) in Gambela Region and for P. vivax from 4.0% (95% CI 2.6-6.2) in Somali to 36.7% (95% CI 30.0-44.1) in Amhara Region. Models fitted to measure seroconversion rates showed variation nationally and by elevation, region, antigen type, and within species. Conclusion: Using multiplex serology assays, this study explored the cumulative malaria burden and regional dynamics of the four human malarias in Ethiopia. High malaria burden was observed in the northwest compared to the east. High transmission in the Gambela and Benishangul-Gumuz Regions and the neglected presence of P. malariae and P. ovale may require programmatic attention. The use of a multiplex assay for antibody detection in low transmission settings has the potential to act as a more sensitive biomarker.
ISSN: 14752875
Appears in Collections:Scopus 2019

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