Infection, Disease & Health

Comparative Review on the Current Prevalence and Distribution of Malaria Cases in

Western Ethiopia: Hotspot Areas, Economic Burden, and Strategic Interventions.
--Manuscript Draft--

Manuscript Number:

Article Type: Review

Corresponding Author: Desalegn Amenu

Wollega University Department of Biology
ETHIOPIA

First Author: Desalegn Amenu

Order of Authors: Desalegn Amenu

Ayantu Nugusa

Temesgen Tefasse

Abstract: Background

Malaria remains a critical public health challenge in Western Ethiopia, particularly in

hotspot areas such as the Wollega Zones, Gambella, and

Benishangul-Gumuz

These regions experience high transmission rates due to favorable ecological and
climatic conditions for Anopheles mosquito breeding. This comparative review
examines the current prevalence and distribution of malaria in these hotspot areas,
assesses the economic burden of the disease, and evaluates the strategic
interventions implemented to combat it.

A systematic review of recent studies and epidemiological data was conducted to

analyze the prevalence and distribution of malaria cases in Western Ethiopia. The
economic impact was assessed through healthcare costs, productivity losses, and
household financial burden. Strategic interventions, including vector control,
community engagement, healthcare infrastructure, and research efforts, were
evaluated for their effectiveness in reducing malaria transmission and mitigating its
economic impact.

Results

The review found that malaria prevalence in Western Ethiopia remains high, with
significant seasonal variations and geographic disparities. Hotspot areas exhibit higher
transmission rates due to ecological conditions and socioeconomic factors. The
economic burden of malaria is substantial, affecting healthcare systems, workforce
productivity, and household finances. While vector control measures such as
insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS) have shown
positive outcomes, challenges such as insecticide resistance and logistical issues
persist. Community engagement and improvements in healthcare infrastructure have
enhanced the effectiveness of malaria control efforts, though further research and
development are necessary to address ongoing challenges.

Suggested Reviewers: Dr Reda Nem

redanemo@gmail.com

Dr Girmaye Kenasa
girmayek@gmail.com

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Title Page (with author details)

Comparative Review on the Current Prevalence and Distribution of Malaria Cases in

Western Ethiopia: Hotspot Areas, Economic Burden, and Strategic Interventions.
Desalegn Amenu1, Ayantu Nugusa1 and Temesgen Tefasse2
1. Wollega University, Natural sciences, Biology department, Nekemte, Ethiopia
2. Armauer Hansen Research Institute, Addis Ababa , Ethiopia
Conflict of Interest

The authors have no conflict of interest

1
Highlights (for review)

Malaria prevalence in Western Ethiopia remains high with notable seasonal variations and

geographic disparities.

Hotspot areas exhibit higher transmission rates due to ecological conditions and

socioeconomic factors.

The economic burden of malaria is substantial, impacting healthcare systems, workforce

productivity, and household finances.

Positive outcomes from vector control measures like insecticide-treated bed nets (ITNs) and

indoor residual spraying (IRS) were noted, though challenges like insecticide resistance and

logistical issues persist.

Community engagement and improved healthcare infrastructure have enhanced malaria

control efforts, but further research and development are necessary

Manuscript (without author details) Click here to view linked References

Abstract

Background: Malaria remains a critical public health challenge in Western Ethiopia, particularly
in hotspot areas such as the Wollega Zones, Gambella, and Benishangul-Gumuz. These regions
experience high transmission rates due to favorable ecological and climatic conditions for
Anopheles mosquito breeding. This comparative review examines the current prevalence and
distribution of malaria in these hotspot areas, assesses the economic burden of the disease, and
evaluates the strategic interventions implemented to combat it.

Methods: A systematic review of recent studies and epidemiological data was conducted to
analyze the prevalence and distribution of malaria cases in Western Ethiopia. The economic
impact was assessed through healthcare costs, productivity losses, and household financial
burden. Strategic interventions, including vector control, community engagement, healthcare
infrastructure, and research efforts, were evaluated for their effectiveness in reducing malaria
transmission and mitigating its economic impact.

Results: The review found that malaria prevalence in Western Ethiopia remains high, with
significant seasonal variations and geographic disparities. Hotspot areas exhibit higher
transmission rates due to ecological conditions and socioeconomic factors. The economic burden
of malaria is substantial, affecting healthcare systems, workforce productivity, and household
finances. While vector control measures such as insecticide-treated bed nets (ITNs) and indoor
residual spraying (IRS) have shown positive outcomes, challenges such as insecticide resistance
and logistical issues persist. Community engagement and improvements in healthcare
infrastructure have enhanced the effectiveness of malaria control efforts, though further research
and development are necessary to address ongoing challenges.

Conclusion: Malaria continues to impose a significant public health and economic burden in
Western Ethiopia, particularly in hotspot areas. A multifaceted approach that includes robust
vector control, community involvement, strengthened healthcare infrastructure, and ongoing
research and development is essential for sustainable malaria control. Effective implementation
of these strategies can reduce malaria prevalence, alleviate economic impacts, and improve health
outcomes for affected populations in Western Ethiopia.
Keywords: Malaria, Prevalence, Distribution, Economic Burden, Western Ethiopia, Hotspot
Areas, Vector Control, Strategic Interventions.
 1. Introduction

Malaria continues to pose a major public health threat across sub-Saharan Africa, with Western
Ethiopia being especially hard-hit(Benoist et al. 2008; WHO 2023).The Wollega Zones, Gambella,
and Benishangul-Gumuz regions are recognized as significant malaria hotspots(Adugna et al.,
2022). This is primarily due to their favorable ecological and climatic conditions, which provide
ideal environments for the breeding of Anopheles mosquitoes, the primary vectors of malaria.
These regions face exceptionally high malaria transmission rates, which have profound
implications for both public health and the local economy. The persistent presence of malaria
results in numerous health challenges, including high morbidity and mortality rates, particularly
among vulnerable groups such as children and pregnant women. The burden of frequent malaria
outbreaks places enormous strain on the healthcare systems, often leading to overcrowded health
facilities and a shortage of medical supplies and personnel(Meku 2017; Yimer et al. 2017)(Adugna
et al., 2022).

Recent research has underscored the severity of malaria in the Wollega Zones, particularly in East
Wollega, where the prevalence remains alarmingly high. Plasmodium falciparum and Plasmodium
vivax are the predominant species identified. The findings emphasize the urgent need for
continuous vector control measures and community-based interventions to mitigate transmission
rates (Alkadir,et al., 2020; Desalegn and Amenu, 2024; Duguma et al., 2022; Eshetu et al., 2022;
Midekisa et al., 2015; Temesgen et al., 2024; Temesgen et al. 2023).

In East Wollega, reported a high prevalence of 25.6% among young children, linked to factors
such as proximity to stagnant water and lack of insecticide-treated bed nets (ITNs)(Abate et al.,
2022). Taffese et al (2018) emphasized the need for timely vector control measures, especially
during the rainy season. In West Wollega, high rate of malaria prevalence were
reported(Gemechu et al., 2015; Olani et al. 2023; Tesfaye and Yesuf 2024a, 2024b), this alarming
rate of malaria prevalence were assspcoiited with practices and implementation of indoor residual
spraying (IRS) has led to significant reductions in malaria cases; however, challenges such as
insecticide resistance. In Kellem Wollega, agricultural practices that create water pools have
exacerbated mosquito breeding and pointed out gaps in community knowledge regarding malaria
prevention. The economic impact of malaria is substantial, straining productivity and pushing
families into poverty due to the high costs associated with treatment and prevention. Addressing
malaria effectively requires improvements in healthcare infrastructure, better access to diagnostic
tools and antimalarial drugs, and ongoing research to tackle emerging challenges such as drug
resistance and environmental changes.

Gambella, located in Western Ethiopia, is one of the regions most affected by malaria due to its
favorable ecological and climatic conditions for Anopheles mosquito breeding. The region's
proximity to water bodies and its seasonal rainfall patterns create ideal breeding grounds for
mosquitoes, making it a malaria hotspot. Recent research studies and reports have provided
valuable insights into the prevalence, distribution, and economic burden of malaria in various areas
within Gambella. Despite significant advances in malaria control in the Horn of Africa, Ethiopia
continues to face high rates of morbidity and mortality from the disease. Lare, a district in the
Gambella region near the Ethio-South Sudan border, has the highest malaria prevalence in the
country.

Benishangul-Gumuz has also been a focal point of malaria research. According to a survey by
Deribew et al. (2020), the prevalence of malaria in this region is influenced by agricultural
practices that create breeding grounds for mosquitoes. The study called for integrated pest
management strategies and improved agricultural practices to mitigate malaria transmission. The
economic burden of malaria in Western Ethiopia is substantial. Healthcare systems are strained by
the high demand for diagnosis, treatment, and hospitalization. Additionally, malaria significantly
affects productivity, particularly in the agricultural sector, which is a primary source of livelihood
in these regions. Households bear considerable financial burdens due to out-of-pocket expenses
for malaria treatment and prevention, often pushing families into poverty.

Malaria remains a major public health challenge in sub-Saharan Africa, with Western Ethiopia
being particularly affected. The Wollega Zones, Gambella, and Benishangul-Gumuz are key
malaria hotspots due to their favorable ecological and climatic conditions that support Anopheles
mosquito breeding. These regions experience high malaria transmission rates, leading to severe
health and economic impacts. Malaria causes high morbidity and mortality, especially among
vulnerable groups like children and pregnant women, straining healthcare systems with
overcrowded facilities and shortages of medical supplies and personnel.
Economically, malaria's impact is profound. Frequent illness among the working population
results in significant productivity losses, affecting subsistence and commercial farming, which is
crucial in these agrarian communities. Families also face considerable out-of-pocket expenses for
medical treatment and preventive measures like insecticide-treated bed nets (ITNs) and indoor
residual spraying (IRS).

In the Wollega Zones, studies reveal high prevalence of both Plasmodium falciparum and
Plasmodium vivax, with transmission rates peaking during the rainy season due to increased
mosquito breeding sites. Similarly, in Gambella, seasonal rains boost mosquito populations and
malaria cases, compounded by inadequate access to healthcare and preventive measures.
Benishangul-Gumuz also struggles with malaria, exacerbated by agricultural practices that create
standing water, thus enhancing mosquito breeding. Suggested strategies include integrated pest
management and improved agricultural practices to reduce breeding sites and transmission rates.

Efforts to control malaria, such as ITNs and IRS, have had some success but face challenges like
insecticide resistance and distribution difficulties. Community engagement and education are
crucial for promoting preventive measures, but ongoing efforts are necessary to sustain these
initiatives. Effective malaria management requires continuous investment in healthcare
infrastructure, including diagnostic tools, antimalarial drugs, and trained professionals. Ongoing
research is essential to address emerging challenges such as drug resistance and climate change
impacts on malaria transmission.

In summary, malaria poses a significant health and economic challenge in Western Ethiopia.
Addressing it effectively requires a comprehensive approach involving robust vector control,
community engagement, healthcare infrastructure improvement, and continuous research. This
review provides an in-depth analysis of the current malaria situation in Western Ethiopia,
examining prevalence, distribution, economic impact, and the effectiveness of strategic
interventions based on recent research.

Understanding local variations in malaria prevalence and impact is crucial for developing effective
malaria control strategies. Local differences in transmission are influenced by factors such as
climate, ecology, and socio-economic conditions. Recognizing these variations allows for the
design of targeted interventions that address the specific needs and challenges of each area,
ensuring that resources are allocated efficiently. This tailored approach helps in reducing malaria
cases and associated morbidity, particularly among vulnerable groups like children and pregnant
women. Additionally, localized data enhances surveillance and monitoring, enabling better
tracking of malaria patterns and adaptation of strategies to emerging trends or resistance. It also
supports informed policymaking by providing context-specific insights for developing effective
policies. Furthermore, understanding local impacts aids in addressing the economic consequences
of malaria, such as lost productivity and treatment costs, and helps in constructing targeted
economic support programs. Overall, grasping local variations is essential for constructing
sustainable malaria control efforts that improve health outcomes and community engagement.

Western Ethiopia, particularly the Wollega zones, is a significant hotspot for malaria transmission
due to a confluence of environmental, socioeconomic, and epidemiological factors. The region’s
warm and humid climate, combined with seasonal rainfall, creates optimal breeding conditions for
Anopheles mosquitoes, the primary vectors of malaria(Jama et al. 2020). The area’s diverse
topography, including lowland valleys and highland plateaus, contributes to varying mosquito
activity levels, with lowland areas offering abundant breeding sites due to stagnant
water(Haileselassie et al. 2023). Socioeconomic factors also play a role; limited access to
healthcare and malaria prevention tools exacerbates transmission, especially in remote areas with
inadequate health infrastructure (Solomon et al., 2020). Additionally, high levels of migration and
mobility related to agricultural work facilitate the spread of malaria across different areas( Beyene
et al. 2015). Insecticide resistance among malaria vectors presents a significant challenge to
effective vector control, diminishing the efficacy of traditional methods(Bekele et al. 2016).
Malaria remains endemic in Western Ethiopia, with seasonal peaks typically occurring after the
rainy season, reflecting the ongoing public health challenge in managing and reducing malaria
transmission in this region(Duguma et al., 2022). Malaria prevalence and transmission dynamics
in the Wollega zones of Western Ethiopia are influenced by various environmental, socio-
economic, and vector-related factors. This region, characterized by its high altitude and variable
topography, experiences seasonal fluctuations in malaria transmission.
1.1.Prevalence of Malaria

Malaria is endemic in the Wollega zones, with prevalence rates often peaking following the rainy
season. Studies have shown that the incidence of malaria in this region is closely linked to seasonal
rainfall patterns, which create abundant breeding sites for Anopheles mosquitoes(Demilew et al.,
2017; Duguma et al., 2022). The prevalence is typically higher in lowland areas compared to
highland regions due to more favorable conditions for mosquito breeding in the former. The
transmission dynamics of malaria in Wollega are shaped by several key factors:

Vector Species and Behavior: The primary malaria vectors in the Wollega zones are Anopheles
gambiae and Anopheles arabiensis. These species are highly adapted to the local environmental
conditions, with An. gambiae being more prevalent in the lowland areas and An. arabiensis in both
highland and lowland regions (Eligo et al. 2024). The mosquitoes exhibit peak feeding activity
during the evening and night, which coincides with the increased human activity in the region.

Climate and Seasonal Variation: The region experiences a bimodal rainfall pattern, with two
main rainy seasons creating ideal conditions for mosquito breeding. The high temperatures and
increased humidity during these periods enhance vector survival and malaria transmission(Jama
et al. 2020).

Socioeconomic Factors: Agricultural practices, including irrigation for crops, create additional
mosquito breeding sites. Limited access to healthcare and malaria prevention tools, such as
insecticide-treated bed nets, contributes to higher transmission rates(Alemu et al. 2014; Jaleta et
al. 2013). Migration and mobility associated with seasonal agricultural work further facilitate the
spread of malaria

Vector Control Measures: Efforts to control malaria in Wollega include the use of insecticide-
treated bed nets and indoor residual spraying. However, insecticide resistance among local
mosquito populations (Bekele et al., 2023) challenges the effectiveness of these measures(Okumu
and Moore 2011).
1.2.Public Health Implications

Malaria in the Wollega zones poses significant public health challenges, including high morbidity
and occasional mortality. The disease burden is exacerbated by the region’s remote and
underserved areas, where healthcare access is limited. Effective malaria control strategies in
Wollega require a multifaceted approach, including improved vector control, enhanced
surveillance, and community-based interventions(Temesgen et al. 2024). The Gambella Region of
Western Ethiopia presents unique epidemiological factors influencing malaria transmission and
patterns of occurrence. This region is notable for its tropical climate, proximity to major rivers,
and other environmental and socio-economic features that affect malaria dynamics(Haileselassie
et al. 2021).

Unique Epidemiological Factors

1. Tropical Climate

Temperature and Humidity: Gambella's tropical climate, characterized by high temperatures and
humidity, provides a conducive environment for the breeding and survival of Anopheles
mosquitoes. The consistent warmth throughout the year supports year-round mosquito activity and
malaria transmission (Agyekum et al. 2021; Atnafu et al. 2020).

2. Proximity to Rivers

Breeding Sites: The region's numerous rivers and floodplains create ideal breeding conditions for
malaria vectors. Seasonal flooding and river overflow lead to the formation of temporary stagnant
water bodies, which are perfect breeding sites for Anopheles mosquitoes (Jama et al. 2020).These
conditions increase the mosquito population and, consequently, malaria transmission rates.

3. Vegetation and Land Use

Forests and Agriculture: Gambella's extensive forested areas and agricultural activities further
affect malaria dynamics. Forests provide resting sites for mosquitoes, while agricultural practices,
including irrigation, contribute to the creation of additional breeding sites(Haileselassie et al.
2021).
Patterns of Malaria Occurrence
1. Seasonal Variability

Rainy Seasons: Malaria transmission in Gambella exhibits strong seasonal patterns, with peak
transmission occurring shortly after the rainy seasons. The region typically experiences two main
rainy periods: one from March to May and another from September to November. These periods
contribute to the proliferation of mosquito breeding sites(File and Dinka 2020; Jaleta et al. 2013).

2. Dry Seasons

Reduced Transmission: During the dry seasons, from December to February and June to August,
the number of breeding sites diminishes as river levels drop and temporary water bodies dry up.
Consequently, malaria transmission tends to decrease, although it does not stop completely
(Duguma et al., 2022).

3. Year-Round Transmission

Endemic Nature: Despite seasonal fluctuations, malaria remains endemic in Gambella, with
transmission occurring throughout the year due to the region's persistent warm and humid
conditions. The consistent presence of mosquito breeding sites ensures that malaria transmission
does not cease completely even during drier periods(Haileselassie et al. 2021).

Public Health Implications

1. Vector Control Challenges

Resistance and Coverage: Efforts to control malaria in Gambella face challenges related to vector
resistance to insecticides and difficulties in reaching remote areas. Comprehensive vector control
strategies, including the use of insecticide-treated bed nets and indoor residual spraying, are critical
but require adaptation to local conditions(Gari and Lindtjørn 2024; Okumu and Moore 2011).
2. Health Infrastructure

Access to Care: Limited healthcare infrastructure in remote areas of Gambella complicates the
management of malaria. Improving healthcare access and strengthening malaria surveillance are
essential for effective control and treatment(Gindola et al. 2022; Haileselassie et al. 2021)

3. Community Engagement

Prevention Education: Increasing community awareness about malaria prevention and promoting
the use of preventive measures are crucial for reducing transmission. Public health campaigns and
education can help mitigate the impact of malaria in the region(Jama et al. 2020). The Benishangul-
Gumuz Region of Western Ethiopia experiences varied malaria transmission dynamics across its
districts, influenced significantly by environmental factors. Here's a detailed overview:

Transmission Dynamics across Different Districts

1. District Variation:

Lowland Districts: Districts such as Metekel and Asosa are characterized by lowland areas with
abundant riverine systems and seasonal flooding. These conditions favor extensive mosquito
breeding sites, resulting in higher malaria transmission rates. Seasonal peaks in transmission are
often observed shortly after the rainy seasons, when water bodies are most prevalent (Gari and
Lindtjørn 2024; Haileselassie et al. 2021)

Highland Districts: Districts such as Bambasi, which are situated at higher elevations, typically
experience lower malaria transmission rates due to cooler temperatures that are less conducive to
mosquito breeding. However, even in these areas, malaria transmission can still occur, particularly
in the lower parts of the districts where temperatures are warmer(Haileselassie et al. 2021).

2. Seasonal Patterns:

Rainy Seasons: The Benishangul-Gumuz Region generally experiences two main rainy seasons:
the long rains from March to May and the short rains from September to November. Malaria
transmission tends to peak shortly after these periods due to the creation of new mosquito breeding
sites from increased rainfall(Jama et al. 2020). Dry Seasons: During the dry seasons, from June to
August and December to February, the number of breeding sites decreases as water bodies dry up.
Consequently, malaria transmission tends to decline, though transmission rates can remain
significant in certain lowland areas where water sources persist(Deribe et al. 2018).

Impact of Environmental Factors on Malaria Prevalence

1. Climate and Temperature:

The region’s diverse climate, ranging from tropical in lowlands to more temperate in highlands,
influences malaria prevalence. Warmer temperatures in lowland areas promote higher mosquito
activity and faster development of malaria parasites within mosquitoes, leading to increased
transmission rates(File and Dinka 2020; Gemechu, Samuel, and Yewhalaw 2015).High humidity
levels in the region support mosquito survival and proliferation. Areas with high humidity,
particularly in the lowlands, see more persistent mosquito populations and higher malaria
prevalence(Haileselassie et al. 2021).

2. Water Bodies and Flooding:

Major rivers such as the Baro and the Dabus create numerous breeding sites for mosquitoes,
particularly during the rainy seasons. Seasonal flooding can lead to widespread mosquito breeding,
significantly affecting malaria transmission(Jama et al. 2020) . Agricultural practices, especially
irrigation, also contribute to malaria risk by creating additional mosquito breeding sites. Irrigated
fields can retain water and foster mosquito populations, impacting local malaria dynamics(Gari
and Lindtjørn 2024; Okumu and Moore 2011).

3. Vegetation and Land Use:

Dense forested areas provide shelter for mosquitoes, while agricultural activities, such as rice
paddies and irrigation, create favorable conditions for mosquito breeding. The interplay between
these environmental factors influences malaria transmission across different districts (Beke et al.
2023).
4. Human Settlements and Migration:

Population Density: Districts with higher population densities, particularly in lowland areas, often
experience higher malaria transmission rates due to increased human-mosquito contact. Migration
patterns related to agricultural work and other economic activities can influence malaria
spread(Bekele et al. 2016).

Public Health Implications

1. Targeted Interventions:

Tailored Strategies: Effective malaria control strategies need to be tailored to the specific
environmental and epidemiological conditions of each district. For example, highland districts may
benefit more from targeted surveillance and community education, while lowland districts may
require enhanced vector control measures(Zhou et al. 2020)(Zhou et al. 2020).

2. Surveillance and Monitoring:

Enhanced Surveillance: Implementing robust surveillance systems to monitor malaria incidence

and vector populations is crucial for managing malaria in diverse environments. Continuous
monitoring can help adapt control measures to changing environmental conditions(Jama et al.
2020).

3. Community Engagement:

Awareness Programs: Engaging local communities in malaria prevention efforts, such as using
insecticide-treated bed nets and improving sanitation to reduce mosquito breeding sites, is essential
for controlling malaria(Gindola et al. 2022).
5. Mitigation Strategies and Interventions

Vector Control

In the Wollega Zones Gambella and Asossa regions, vector control strategies, such as the
implementation of insecticide-treated nets (ITNs) and indoor residual spraying (IRS), are crucial
for reducing malaria transmission(Okumu and Moore 2011). ITNs provide a protective barrier
against mosquito bites during the night, while IRS targets adult mosquitoes resting indoors.
Despite their effectiveness, achieving high coverage poses several challenges. Similarly, IRS
programs face difficulties related to insecticide resistance, logistical constraints, and maintaining
consistent spraying schedules. Addressing these challenges requires strengthening supply chains,
enhancing local coordination, and exploring alternative insecticides to combat resistance(Dusfour
et al. 2019).

Healthcare Strengthening

Improving healthcare infrastructure in the Wollega Zones Gambella and Asossa regions involves
enhancing the availability and accessibility of diagnostic tools such as rapid diagnostic tests
(RDTs). RDTs offer a quick and reliable means of diagnosing malaria, which is essential for
prompt treatment and reducing transmission(Gari and Lindtjørn 2024; Okumu and Moore 2011).
Alongside diagnostics, treatment protocols need to be updated regularly based on current malaria
strains and resistance patterns. Strengthening health system capacity includes training healthcare
personnel, expanding health facilities, and ensuring a steady supply of antimalarial drugs. Effective
management of these aspects is vital for improving malaria case detection, treatment, and overall
health system resilience(Gari and Lindtjørn 2024; Gindola et al. 2022).

Community Engagement

Community engagement plays a significant role in malaria control within the Wollega Zones
Gambella and Asossa regions, education campaigns aimed at increasing awareness about malaria
prevention and treatment are essential for changing behaviors and promoting the use of ITNs and
IRS. Local participation in malaria prevention efforts, including community-led initiatives and
involvement in vector control activities, enhances the effectiveness of these strategies. By fostering
community ownership and collaboration, interventions are more likely to succeed and be sustained
over time. Empowering communities through education and active participation helps in
overcoming barriers to malaria prevention and treatment, ultimately leading to a reduction in
malaria burden in the region.

In the Wollega Zones, Gambella and Asossa regions, effective malaria mitigation strategies and
interventions are crucial for controlling the disease. The approach includes vector control
measures, healthcare strengthening, and community engagement. Here’s a comprehensive look at
these strategies:

Implementation of ITNs and IRS Programs:

Insecticide-Treated Nets (ITNs): ITNs are a key component of malaria control efforts in
Gambella. The nets are designed to protect individuals from mosquito bites during the night, when
the Anopheles mosquitoes are most active. The distribution of ITNs is typically carried out through
health campaigns and routine services(Wubishet et al. 2021). Indoor Residual Spraying (IRS):
IRS involves spraying the interior walls of homes with insecticides that kill mosquitoes. This
method targets mosquitoes resting indoors, providing another layer of protection against malaria.
IRS programs are often implemented on a rotational basis, targeting areas with high malaria
transmission(Ibrahim et al. 2023)

Effectiveness and Challenges in Achieving High Coverage:

Effectiveness: Both ITNs and IRS have been shown to significantly reduce malaria transmission
by decreasing mosquito populations and human exposure to bites. Studies in Gambella have
demonstrated reductions in malaria incidence following widespread distribution and use of these
interventions(Jama et al. 2020). Challenges: Achieving high coverage can be challenging due to
factors such as logistical issues in distributing ITNs to remote areas, resistance of mosquito
populations to insecticides, and variability in IRS application. Insecticide resistance reduces the
effectiveness of IRS, while maintenance and proper use of ITNs require continuous community
education and support (Haileselassie et al. 2021).
2. Healthcare Strengthening

Availability and Accessibility of Diagnostic Tools:

Rapid Diagnostic Tests (RDTs): RDTs are crucial for the timely diagnosis of malaria. They allow
for quick and accurate detection of malaria parasites, which is essential for effective treatment.
RDTs are distributed through health facilities and community health workers, but accessibility can
be limited in remote areas (Omondi et al. 2023). Microscopy: While microscopy remains the gold
standard for malaria diagnosis, it requires trained personnel and well-equipped laboratories, which
may be lacking in some areas of Gambella.

Treatment Protocols and Health System Capacity:

Treatment Protocols: The standard treatment for uncomplicated malaria includes artemisinin-
based combination therapies (ACTs). Ensuring that these medications are available and used
correctly is vital for reducing malaria morbidity and mortality(Pousibet-Puerto et al. 2016). Health
System Capacity: Strengthening health systems involves improving the availability of diagnostic
tools and medications, training healthcare workers, and enhancing healthcare infrastructure. In
Gambella, challenges include inadequate health facilities in remote areas and a shortage of trained
personnel(Teklehaimanot, 2013).

3. Community Engagement

Role of Community Education and Behavior Change:

Education Campaigns: Community education plays a significant role in malaria prevention.

Awareness campaigns about the use of ITNs, the importance of IRS, and symptoms of malaria can
help change behaviors and increase the uptake of preventive measures. Education programs are
often conducted through local health centers, schools, and community gatherings (Jama et al.
2020). Behavior Change: Efforts to promote behavior change include encouraging the consistent
use of ITNs, adherence to malaria treatment protocols, and seeking timely medical care. Behavior
change communication strategies aim to address misconceptions and promote practices that reduce
malaria risk (Haileselassie et al. 2021).
Local Participation in Malaria Prevention Efforts:

Community Involvement: Local participation is critical for successful malaria prevention.

Engaging community members in planning and implementing malaria control activities helps
ensure that interventions are culturally appropriate and effectively address local needs. Community
health workers play a vital role in mobilizing local support and facilitating access to prevention
and treatment services (Haileselassie et al. 2021). Partnerships: Collaborations with local
organizations, leaders, and stakeholders can enhance the reach and impact of malaria interventions.
Building partnerships helps to leverage resources and expertise for more effective malaria
control(File and Dinka 2020; Okumu and Moore 2011; Temesgen et al., 2023).

Vaccine Development

The development of malaria vaccines represents a critical frontier in combating the disease.
Significant progress has been made in vaccine research, with candidates such as the RTS,S/AS01
vaccine showing promise in clinical trials. This vaccine, targeted primarily at Plasmodium
falciparum, has demonstrated moderate efficacy in reducing malaria incidence in young children.
However, challenges persist, including the need for more effective vaccines with longer-lasting
protection, adaptation to various malaria strains, and scaling up production and distribution. The
potential impact of successful malaria vaccines could be transformative, significantly reducing
transmission rates and decreasing the overall malaria burden, particularly in high-prevalence areas
like the Wollega Zones, Gambela Region, and Benishangul-Gumuz.

Surveillance and Response

Effective malaria control relies heavily on robust surveillance and response systems. In the
Wollega Zones, Gambela Region, and Benishangul-Gumuz, surveillance systems are essential
for tracking malaria cases, identifying hotspots, and assessing trends. Improved data collection
and analysis enable timely and targeted interventions. During outbreaks and seasonal peaks,
rapid response strategies are crucial for controlling the spread of malaria. These strategies may
include enhanced case detection, expedited distribution of insecticide-treated nets (ITNs) and
indoor residual spraying (IRS), and the deployment of mobile health teams to affected areas.
Strengthening surveillance and response capabilities ensures that public health authorities can
quickly adapt to changing patterns of malaria transmission, effectively manage, and mitigate
outbreaks.
Conclusion and Future Perspective

The Gambella and Benishangul-Gumuz regions of Western Ethiopia face significant challenges in
malaria control due to their unique environmental conditions, including tropical climates,
extensive river systems, and seasonal flooding. Effective mitigation strategies have been
implemented, focusing on vector control, healthcare strengthening, and community engagement.
However, achieving sustainable malaria control requires addressing ongoing challenges and
adapting strategies to evolving conditions. The future of malaria control in the Gambella and
Benishangul-Gumuz regions hinges on integrating innovative technologies, strengthening health
systems, engaging communities, and fostering collaboration. By addressing current challenges and
embracing new approaches, it is possible to achieve more sustainable and effective malaria control,
ultimately reducing the burden of this disease and improving public health outcomes in these
regions.
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Manuscript (without author details)

Authorship Statement

We, the undersigned, have participated in the creation of the manuscript titled [“Title of the
Manuscript”]. Our specific contributions are detailed below:

Desalegn Amenu
Contributed to the conception and design of the study, acquisition of data, analysis and
interpretation of data, drafting the manuscript, and approving the final version to be published.

Ayantu Nugusa
Contributed to the conception and design of the study, acquisition of data, analysis and
interpretation of data, revising the manuscript critically for important intellectual content, and
approving the final version to be published.

Temesgen Tafesse
Contributed to the acquisition of data, analysis and interpretation of data, drafting the
manuscript, and approving the final version to be published.

We hereby declare that all listed authors meet the criteria for authorship as defined by the
[relevant guidelines, e.g., ICMJE, COPE, etc.], and that no deserving authors have been omitted.
Each author has read and approved the final version of the manuscript and agrees to be
accountable for all aspects of the work.

Conflict of Interest Statement:

The authors declare that there are no conflicts of interest

Funding Statement:
This research did not receive any specific grant from funding agencies in the public, commercial,
or not-for-profit sectors