An overall malaria positivity rate of 7.3% was recorded in the current study area. This figure is comparable with the result of the study done in Kombolcha health facility, north-central Ethiopia that reported a prevalence of 7.52% [15]. Similarly, a study conducted in Nigeria among pregnant women in an antenatal care program reported a prevalence of 7.7% [16]. However, the finding of this study contradicts with previous studies from southern and northern Ethiopia, reported overall malaria positivity rates between 11.5% and 28.1% among patients visited health facilities [17–19]. Possible factors for observed variations might be differences in the time of studies, microclimate, altitude, community awareness about malaria bed net application, its transmission, and health seeking behavior, and malaria intervention practices.
The predominant Plasmodium species detected among the current study participants was P. falciparum. This finding is congruent with national figures and other similar studies in parts of Ethiopia that reported preponderance of P. falciparum than P. vivax [2, 20–21]. However, this is in disagreement with the previous report from Jimma Town which reported a higher prevalence of P. vivax than P. falciparum [23]. The reason why P. falciparum dominated over P. vivax in the study area could be due to the severity of disease, drug resistance, and gap of program performance.
In the present study, more males (55.4%) were affected by malaria than females (44.6%). This finding is concurrent with studies from several localities in Ethiopia that reported higher malaria burden among males than females [15, 21–22]. The higher prevalence rate in males might be due to the fact that males are usually engaged in outdoor activities at dusks and dawns, coinciding with the peak biting hours of the exophagic mosquito species [24]. In addition, males often travel as seasonal migrant laborers to different malarious parts of Ethiopia to perform agricultural activities, thereby exposing them to the higher risk of contracting malaria infection. Conversely, this was not similar with a study conducted in Amhara region where the prevalence of malaria was relatively higher among females (60%) than males (40%) [25].
Regarding the age groups, the burden of malaria morbidity was more concentrated in the adults of age 15 and above. Studies in Ethiopia have also shown that the risk of malaria infection varied by sex with some reporting males at higher risk than females [15, 21–22, 26–27]. The contributing factors for such higher burden of disease among adults might be due to their frequent engagement in different activities like agriculture, trade and other occupational risks that increase the exposure to infective mosquito bites. Lower cases of malaria in children under 5 years of age was detected, which could be linked to their reduced exposure to infected mosquito bite due to good malaria awareness and control and prevention practices by their guardians.
The results revealed that most of the respondents (97%) had ever heard about malaria and similar number of respondents believed that malaria is one of the serious diseases of the community, affecting both sex and all age groups, which is in line with previous reports on Ethiopia and elsewhere [13, 28]. Respondents also mentioned that the most common source of information about malaria was mass media (86.1%) followed by health facility (13.9%), suggesting that they are essential channels to deliver malaria-related information to the community. This is congruent with those previously reported results from Africa, in which over 90% of individuals in malaria endemic areas are aware of malaria and that media (television and radio) and health education by health facilities are the most commonly cited source of malaria information sources [29, 30].
Mosquito bite has been identified as the principal malaria transmission as shown in some studies in Ethiopia and elsewhere in Africa [11, 13, 29, 31–32]. In Ethiopia, regular practice of awareness creation in the communities about health issues through health extension workers and mass media has brought remarkable behavioral change in the control and prevention of communicable diseases. We also presume that this factor has contributed to the high level of awareness observed in the study participants regarding the causes and transmission of malaria in the area.
Fever, head ache, chills and shivering, loss of appetite and vomiting were mentioned as sign and symptoms of malaria. Similar results were found from different KAP studies in other regions of Ethiopia [11, 13, 31, 33]. Interestingly, large majority of subjects linked mosquito biting time during night time and their main breed sites to stagnant water, which is comparable with previous studies in Ethiopia and elsewhere [29, 33–34]. This correct understanding of mosquito behavior among participants of the present study is encouraging to implement appropriate malaria preventive measures and for the proper utilization of ITNs.
Similar to other studies in Amhara region and other parts of Ethiopia [11–13, 35], great majority (97%) of participants believed that malaria is preventable and curable disease. Taking drug, use of mosquito nets, drain stagnated water (mosquito breeding sites), and house spay with insecticides were the main types of malaria preventive measures frequently reported by the present study participants. This is in line with previous reports from Tanzania [30] and Iran [36].
Around 91.4% of participants go to the nearest health service within the 24 h upon the occurrence of the first malaria symptoms. This was further substantiated by the observation that about 91.4% of participants sought treatment at health facilities, suggestive of a good practice of treatment-seeking behavior at health structures. The same has been reported in Ethiopia and elsewhere [29, 37, 38], with majority of studies relating high malaria treatment-seeking behavior at health facilities. Yet, few subjects responded that they rely on the use of self-administered drugs and traditional medicines, common practices in parts of Africa [11, 30, 39]. Treatment seeking behavior is important for early case detection and management so that transmission would be reduced. Therefore, awareness creation is very crucial to direct the wider community to seek timely treatments at the health structures earlier upon the occurrence of malaria symptoms.
This study also demonstrated that around 98% of participants had least one ITN, of which 75% of them claimed that they slept under a bed net the previous night, which is consistent with previous studies elsewhere in Ethiopia [12, 14, 33, 40]. About 90% of responders also associated benefits of ITNs with the reduction of the bite of mosquitoes and other insect pests. Meanwhile, quarter of the respondents did not use bed net the previous night, suggesting the necessity of health education to raise awareness of the community about proper and consistent use of ITNs. Prominently, some of the reasons mentioned for not properly using bed net were fear of burning sensation, and lack of awareness about its benefit and getting substitutes for worn out ones. The study further showed that most of the communities give priority for pregnant mother and children to sleep under bed net, which is comparable with results reported from other studies elsewhere in Ethiopia [13, 31].
Our data also showed that IRS is one of the most important malaria prevention methods practiced in the locality with the overall coverage of 99%. Houses of more than 77% of the respondents get sprayed during spraying campaign, result that is comparable with the reports from Jiga area and Shewa Robit district of north-western Ethiopia [11, 42]. This result asserts the demand to expand the coverage and frequency of IRS in malaria endemic areas in order to achieve an already targeted plan of 100% spraying of households before and throughout the transmission for effective prevention and control of malaria [43].
As institutional based cross-sectional study design was employed, the results may not be generalized to the general population. In addition, we have not recruited the required sample size so that it might have compromised the power of our study. Finally, lack of direct observation of ITNs usage among the study subjects may preclude generalizing this trend to the general community in the area. Thus, these could constitute the limitations of the study.