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Meta-Analysis
. 2021 Sep 15;15(9):e0009781.
doi: 10.1371/journal.pntd.0009781. eCollection 2021 Sep.

Plasmodium vivax epidemiology in Ethiopia 2000-2020: A systematic review and meta-analysis

Tsige Ketema  1   2 , Ketema Bacha  1 , Kefelegn Getahun  3 , Hernando A Del Portillo  2   4   5 , Quique Bassat  2   5
Affiliations
Meta-Analysis

Plasmodium vivax epidemiology in Ethiopia 2000-2020: A systematic review and meta-analysis

Tsige Ketema et al. PLoS Negl Trop Dis. .

Abstract

Background: Ethiopia is one of the scarce African countries where Plasmodium vivax and P. falciparum co-exist. There has been no attempt to derive a robust prevalence estimate of P. vivax in the country although a clear understanding of the epidemiology of this parasite is essential for informed decisions. This systematic review and meta-analysis, therefore, is aimed to synthesize the available evidences on the distribution of P. vivax infection by different locations/regions, study years, eco-epidemiological zones, and study settings in Ethiopia.

Methods: This study was conducted in accordance with Preferred Reposting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Studies conducted and published over the last two decades (2000 to 2020) that reported an estimate of P. vivax prevalence in Ethiopia were included. The Cochrane Q (χ2) and the I2 tests were used to assess heterogeneity, and the funnel plot and Egger's test were used to examine publication bias. A p-value of the χ2 test <0.05 and an I2 value >75% were considered presence of considerable heterogeneity. Random effect models were used to obtain pooled estimate of P. vivax infection prevalence. This study is registered with PROSPERO (International Prospective Register of Systematic Reviews): ID CRD42020201761.

Results: We screened 4,932 records and included 79 studies that enrolled 1,676,659 confirmed malaria cases, from which 548,214 (32.69%) were P. vivax infections and 1,116,581 (66.59%) were due to P. falciparum. The rest were due to mixed infections. The pooled estimate of P. vivax prevalence rate was 8.93% (95% CI: 7.98-9.88%) with significant heterogeneity (I2 = 100%, p<0.0001). Regional differences showed significant effects (p<0.0001, and I2 = 99.4%) on the pooled prevalence of P. vivax, while study years (before and after the scaling up of interventional activities) did not show significant differences (p = 0.9, I2 = 0%). Eco-epidemiological zones considered in the analysis did show a significant statistical effect (p<0.001, I2 = 78.5%) on the overall pooled estimate prevalence. Also, the study setting showed significant differences (p = 0.001, and I2 = 90.3%) on the overall prevalence, where significant reduction of P. vivax prevalence (4.67%, 95%CI: 1.41-7.93%, p<0.0001) was observed in studies conducted at the community level. The studies included in the review demonstrated lack of publication bias qualitatively (symmetrical funnel plot) and quantitatively [Egger's test (coefficient) = -2.97, 95% CI: -15.06-9.13, p = 0.62].

Conclusion: The estimated prevalence of P. vivax malaria in Ethiopia was 8.93% with P. vivax prevailing in the central west region of Ethiopia, but steadily extending to the western part of the country. Its distribution across the nation varies according to geographical location, study setting and study years.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow diagram.
Fig 2
Fig 2. Map showing estimates of P. vivax prevalence from the 72 study sites according to geographical distribution in Ethiopia.
The size of the purple dots is proportional to the prevalence estimates reported. The map was sketched by one of the authors using ArcGIS software.
Fig 3
Fig 3. Individual and pooled estimates of the prevalence of P. vivax (mono-infection and mixed infection with P. falciparum) in Ethiopia.
Fig 4
Fig 4. Individual and pooled estimates of the prevalence of P. vivax mono-infection in Ethiopia, 2000–2020.
Fig 5
Fig 5. Individual and pooled estimates of the prevalence of mixed infection (P. vivax and P. falciparum) in Ethiopia, 2000–2020.
See this image and copyright information in PMC

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