Abstract:
Background: Despite significant progress in malaria control efforts, the disease continues to
pose a major public health challenge in Ethiopia due to its complex epidemiological landscape.
A critical concern is the presence of a large proportion of the population, such as
schoolchildren, who have asymptomatic malaria infections that go undiagnosed and untreated.
This, coupled with a dearth of evidence on the performance of new, highly-sensitive histidine-
rich protein-2 (HRP-2)-based malaria rapid diagnostic tests (hsRDTs), such as the NxTek™
Eliminate Malaria-Pf test, in detecting Plasmodium falciparum (P. falciparum) infections in
asymptomatic schoolchildren, hinders accurate diagnosis and treatment. This contributes to the
persistence of asymptomatic infections, which act as a silent reservoir, fueling ongoing
transmission and thwarting the ambitious goal of malaria elimination.
Furthermore, a comprehensive examination of the spatiotemporal clustering of malaria
incidence through modeling a decade of epidemiological data from the Jimma Zone is critical
for informing resource allocation and targeted, locally effective intervention strategies. Taken
together, this PhD project was aimed to investigate the epidemiology of malaria and evaluate
the performance of a novel, highly-sensitive malaria diagnostic tool within the Jimma Zone of
Southwest Oromia, Ethiopia.
Methods: To achieve this aim, a school-based cross-sectional study was conducted from
September 2021 to January 2022, involving 994 healthy schoolchildren aged 6–15 years. A
multi-stage sampling technique was employed to select schools and participants, with sample
allocation done proportionally to each school and grade. Participants were randomly chosen
from student records using a lottery method. Finger-pricked blood samples were collected for
various diagnostic tests: microscopy, conventional rapid diagnostic test (cRDT) (SD Bioline
Malaria Ag Pf/Pv), and the hsRDT. Additionally, dry blood spots (DBSs) were prepared on
filter papers for quantitative real-time polymerase chain reaction (qPCR) assay. For the
prevalence study, all diagnostic methods except hsRDT were utilized. Data on demographic
and risk factors for asymptomatic malaria were collected through face-to-face interviews with
the child’s head of household by trained data collectors. The hsRDT was then compared to
cRDT and microscopy. qPCR and microscopy were used as reference methods. Furthermore,
to understand the broader epidemiological context, a decade of retrospective malaria data
(2012-2021) from 15 districts in the Jimma Zone was analyzed. District-level annual parasite
incidence (API) and standardized incidence ratio (SIR) were calculated, and malaria risk maps
