Chapter 2 The data
2.2 Baseline characteristics of the study population
The data analyzed consisted of malaria rapid diagnosis tests of respondents in the rural parts of Amhara, Oromiya and SNNP regions of Ethiopia. During the study period, 5,708 households that were located in 224 clusters, covered in the survey. From the total 5,708 households, Amhara, Oromiya and SNNP regions covered 4,101 (71.85%), 809 (14.17%) and 798 (13.98%) households respectively. The distribution of toilet facility, source of drinking water and time to collect water is presented in Table 2.2. The table shows that in Amhara and Oromiya regions, the majority of people most frequently used unprotected water supplies with percentage equal to 66.30% and 79.70% respectively. In contrast to these regions, in SNNP, the use of unprotected water was found to be slightly over half (56%). On the other hand, 25.4% of the people in SNNP region used protected water followed by those in Amhara (17.8%) and Oromiya (8.8%) regions. From the total households, 18.6% in SNNP, 16% in Amhara and 11.5% in Oromiya regions use tap water for drinking. Unprotected water includes, unprotected spring, unprotected dug well (use bucket and rope) and surface water (river/dam/lake/pond/stream). Similarly, protected water includes, capped spring, protected dug well (use hand pump), tube well or borehole and cart with small Tank. Furthermore, the tap water also includes public tap or standpipe, piped into yard and piped into dwelling.
The total time taken to collect water is also presented in Table 2.2. Based on the result, more households in Amhara region (72.3%) than in the other two regions (62.6 – 64.6%) had to travel less than 30 minutes on average to get their water. Furthermore, 8.6% of the households in Oromiya region travel more than 90 minutes to collect water. But, in Amhara and SNNP regions 2.9%
and 3.6% of their residents respectively took more than 90 minutes to collect water.
19 Table 2. 2: Distribution of toilet facility, source of drinking water and
time to collect water by region
Socio-economic variables Region
Amhara Oromiya SNNPR
Toilet facility
No facility 73.40% 72.60% 40.90%
Pit latrine 26.60% 26.00% 59.10%
Toilet with flush 0.00% 1.40% 0.00%
Source of drinking water
Unprotected water 66.30% 79.70% 56.00%
Protected water 17.80% 8.80% 25.40%
Tap water 16.00% 11.50% 18.60%
Time to get water
Less than 30 minute 72.30% 62.60% 64.60%
Between 30 - 90 minutes 24.90% 28.80% 31.80%
Greater than 90 minutes 2.90% 8.60% 3.60%
The great majority of households, namely 73.4% in Amhara, 72.6% in Oromiya and 40.9% in SNNP regions had no access to toilet facility (Table 2.2). Again, Amhara and Oromiya lagged behind SNNP in the use of pit latrine includes pit latrine with no cement slab, pit latrine with slab and pit latrine with cement slab and vent pipe toilet. Table 2.2 shows that more than half of houses in SNNP (59.1%) having a latrine toilet.
Furthermore, the distribution of positive RDT results by toilet facility, source of drinking water and distance to get water is presented in Figure 2.2. In the figure, it is clear that respondents with no toilet facility (11%) had more positive RDT results, followed by pit latrine (5.9%) and toilet with flush (4.3%).
Similarly, households who travelled long distance (5.8%) have a high percentage of positive RDT results than those travelling shorter distances.
Persons who have unprotected water (6.5%) as source of drinking water have greater chance to be RDT positive compared to those using protected and tap waters.
20 Figure 2. 2: Distribution of positive RDT result by toilet facility, source of
drinking water and distance to get water
More than 90% of households in all regions have house walls made of wood.
Similarly, more than 90% of the households for all regions have earth or local dung floor. However, the roof material varied across regions, with the majority of houses in Oromiya (67.3%) and SNNP (74%) regions having corrugated iron roofs compared to Amhara (39.8%). On the other hand, where 59.3% had thatch roofs in Amhara, followed by 23.1% in Oromiya and 0.5% in the SNNP region.
Table 2. 3: Ditribution of material for house construction by region Socio-economic variables Region
Amhara Oromiya SNNP
Wall material
Cement block 0.3% 2.9% 0.2%
Mud block/stick/wood 99.6% 90.1% 99.8%
Corrugated metal .1% 7.0% 0.0%
Roof material
Thatch 59.3% 23.1% 0.5%
Stick and mud 0.9% 9.6% 25.5%
Corrugate 39.8% 67.3% 74.0%
Floor material
Earth/Local dung plaster 96.2% 92.6% 96.98%
Wood 2.0% 6.9% 1.02%
Cement 1.8% .5% 2.0%
5.0%
6.0%
6.5%
2.9%
4.6%
5.8%
11.0%
5.9%
4.3%
0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%
Tap water Protected water Unprotected water Less than 30 minute Between 30 - 90 minutes Greater than 90 minutes No facility Pit latrine Toilet with flush
Source of drinking waterDistance to get waterToilet facility
21 The distribution of positive RDT result by wall, roof and floor materials of the house is presented in Figure 2.3. The figure shows that the percentage of positive RDT results in cemented floors was 0.9%, 7.7% in wooden floor and 5.9% in earth or local dung plastered. On the other hand, the percentage of RDT result in corrugate roof was 5.4%, 17.3% in stick and mud roof and 5.8%
in thatch roofs. The percentage of positive RDT in corrugated metal wall was found to be 5.9%, 7.3% in mud/stick/wood wall and 3.2% in cement block (Figure 2.3).
Figure 2. 3: Distribution of positive RDT result by wall, roof and floor materials of the house
In the survey, representative household heads were asked if they had access to radio, television and electricity. From the result it was found that electricity and televisions were very rare in the surveyed households. In Amhara, Oromiya and SNNP regions 94.3%, 97.9% and 94.1% of the households did not have
3.2%
7.3%
5.9%
5.8%
17.3%
5.4%
5.9%
7.7%
0.9%
0.0% 5.0% 10.0% 15.0% 20.0%
Cement block Mud block/stick/wood Corrugated metal Thatch Stick and mud Corrugate Earth/Local dung plaster Wood Cement
Wall materialRoof materialFloor material
22 access to electricity respectively. Similarly, more than 97% of the households in the three regions have no television. Unlike television access, radios were more common. The data show that 75.2%, 62.9% and 58.7% of the households in Amhara, Oromiya and SNNP regions have access to radio respectively (Table 2.4).
Table 2. 4: Ditribution of availability of radio, television and electricity by region
Socio-economic variables Region
Amhara Oromiya SNNP Availability of radio
Yes 24.80 37.10 41.30
No 75.20 62.90 58.70
Availability of Television
Yes 1.20 2.47 0.74
No 98.80 97.53 99.26
Availability of electricity
Yes 5.70 2.10 5.90
No 94.30 97.90 94.10
Use of mosquito nets and indoor residual spraying drugs in the last twelve months were included in the survey. The use of mosquito nets was derived by direct questioning about who slept in each net in the household, and who slept without a net. The results show that 38.3% in Amhara, 43.7% in oromiya and 48.2% in SNNP regions use mosquito nets. Besides the use of mosquito nets, information on the use of indoor residual spraying in the last twelve months was collected. The result revels that those households who live in SNNP region use more indoor residual spraying (30.9%) compared to Amhara (29.6%) and Oromiya (27.4%) regions (Figure 2.4).
23 Figure 2. 4: Distribution of use of mosquito nets and indoor residual
spraying by RDT result
Figure 2.5 shows the distribution of age group and family size by malaria RDT result. Most houses, i.e., age group 31-45 accounts for 72.9% of all positive malaria RDTs and 72.6% of all negative malaria RDTs. Similarly, family size 5–
10 persons accounts for 58.7% of all positive malaria RDTs and 53.2% of all negative malaria RDTs.
Figure 2. 5: Distribution of age group and family size by RDT result
38.30%
61.70%
29.60%
70.40%
43.70%
56.30%
27.40%
72.60%
48.20%
51.80%
30.90%
69.10%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00%
Yes No Yes No
Use of mosquito netsUse of Indoor residual spray
SNNP Oromiya Amhara
28.3%
53.2%
18.6%
0.0%
.6%
72.6%
26.8%
25.2%
58.7%
16.1%
3.3%
1.2%
72.9%
22.6%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%
1 - 4 5 - 10
> 10 0 - 15 16 - 30 31 - 45
> 45
Family sizeAge Group
Positive Negative
24 Table 2.5 shows descriptive characteristics of total rooms and total number of persons in the household. Most houses in Amhara (90.25%), Oromiya (71.2%) and SNNP (74.56%) regions had only one sleeping room. A very small proportion of people (<1%) reported having more than three sleeping rooms.
Furthermore, the average number of rooms in Amhara, Oromiya and SNNP regions was found to be 1.15, 1.3 and 1.3 respectively. Furthermore, the average number of persons per household ranged from 4.7 to 5.6 by region and was 4.9 overall. In Amhara the median household size was five whereas in both Oromiya and SNNPR it was six persons.
Table 2. 5: Distribution of total number of rooms and total number of members of the household by region
Region
Amhara Oromiya SNNP
Total Number of Rooms
1 90.25% 71.20% 74.56%
2 8.83% 22.62% 21.93%
3 0.85% 4.70% 3.01%
4 0.05% 0.99% 0.25%
5+ 0.02% 0.49% 0.25%
Family size
1 2.34% 1.36% 0.75%
2 10.59% 6.67% 4.01%
3 16.90% 13.10% 12.91%
4 17.32% 14.46% 15.91%
5 17.88% 16.69% 20.05%
6 15.22% 20.40% 20.18%
7 9.93% 10.75% 11.15%
8 5.27% 6.67% 5.64%
9+ 4.56% 9.89% 9.40%
The age and gender-specific malaria prevalence, by region is shown in Table 2.6. This table demonstrates that there is no significant difference in prevalence by age group as well as by region. Moreover, the pattern of malaria prevalence by age is not homogeneous across the study regions. In addition, Table 2.6 shows that there is no difference in prevalence between males 4.05%
and females 4.55%.
25 Table 2. 6: Malaria prevalence by region, age group and gender
Age group Male Female Total
Tested +ive % Tested +ive % Tested +ive % Amhara
<5 643 28 4.35 603 31 5.14 1,246 59 4.74 5-14 1,144 43 3.76 1,240 49 3.95 2,384 92 3.86 15-49 1,316 55 4.18 1,998 94 4.70 3,314 149 4.50
>=50 426 17 3.99 375 18 4.80 801 35 4.37 Total 3529 143 4.05 4216 192 4.55 7745 335 4.33
Oromiya
<5 225 1 0.44 213 2 0.94 438 3 0.68
5-14 293 1 0.34 368 4 1.09 661 5 0.76
15-49 342 2 0.58 420 4 0.95 762 6 0.79
>=50 66 2 3.03 69 0 0.00 135 2 1.48
Total 926 6 0.65 1,070 10 0.93 1,996 16 0.80 SNNPR
<5 142 11 7.75 134 6 4.48 276 17 6.16
5-14 346 23 6.65 326 20 6.13 672 43 6.40
15-49 332 16 4.82 443 20 4.51 775 36 4.65
>=50 78 5 6.41 59 4 6.78 137 9 6.57
Total 898 55 6.12 962 50 5.20 1,860 105 5.65 Three regions
<5 1,010 40 3.96 950 39 4.11 1,960 79 4.03 5-14 1,783 67 3.76 1,934 73 3.77 3,717 140 3.77 15-49 1,990 73 3.67 2,861 118 4.12 4,851 191 3.94
>=50 570 24 4.21 503 22 4.37 1,073 46 4.29 Total 5353 204 3.81 6,248 252 4.03 11,601 456 3.93 The prevalence of malaria by altitude is given in Tables 2.7. For each surveyed household the altitude was determined at the time of the survey. Based on the values of altitude for the households, Amhara had the greatest range of altitudes. For Oromiya and SNNPR the altitude for households is below 1000 meters or above 2500 meters. The majority of households (93.4%) in all regions were found at altitudes between 1000 to 2500 meters. Moreover, there were a significant number of malaria cases detected at altitudes above 2000 meters.
Unlike Oromiya and SNNP regions, there was an expected decline in prevalence by altitude up to 3000 meters in Amhara (Table 2.7). But, the prevalence of malaria above 2500 meters was found to be 8.3%. For persons who lived above 3000 meters, the prevalence of malaria was 1.33%. No positive malaria cases
26 were detected above 2000 meters for Oromiya region (Table 2.7), but in SNNPR there was a high prevalence of 72.6% for households who lived at 1500-2000 meters.
Table 2. 7: Malaria prevalence by altitude and region
Altitude class Amhara Oromiya SNNP Total
Tested % Tested % Tested % Tested % <=1000m 125 1.61 0 0.00 0 0.00 125 1.08 1000-1500m 859 11.09 343 17.18 327 17.58 1529 13.18 1500-2000m 2973 38.39 1316 65.93 1351 72.63 5640 48.62 2000-2500m 3142 40.57 337 16.88 182 9.78 3661 31.56 2500-3000m 543 7.01 0 0.00 0 0.00 543 4.68
>3000m 103 1.33 0 0.00 0 0.00 103 0.89
Total 7745 1996 1860 11601
According to the result in Figure 2.6, there was a declining trend in percentage of malaria prevalence from 48.6% at 1500-2000m to 31.6% at 2000-2500m.
Highland or highland fringe areas, mainly those at 1000 – 2000 meters are often described as the limit of transmission of malaria in Ethiopia. But, there are some cases found above 2000 meters. These cases may have resulted from local epidemics or from movement of people from lower altitudes.
Figure 2. 6: Distribution of altitude by positive malaria RDT result
1.08 13.18
48.62 31.56
4.68 0.89
<=1000m 1000-1500m 1500-2000m 2000-2500m 2500-3000m >3000m
27