A Venue-Based Survey of Malaria, Anemia and Mobility Patterns among Migrant Farm Workers in Amhara Region, Ethiopia

• Type of Material: Article
• Authors: Rebekah Stewart Schicker, Emory University; Neway Hiruy, The Carter Center, Addis Ababa, Ethiopia; Berhanu Melak, The Carter Center, Addis Ababa, Ethiopia; Woyneshet Gelaye, Amhara Regional Health Research Laboratory Center, Bahir Dar, Ethiopia; Belay Bezabih, Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia; Robert Stephenson, Emory University; Amy Patterson, Emory University; Zerihun Tadesse, The Carter Center, Addis Ababa, Ethiopia; Paul Emerson, Emory University; Frank O. Richards, Emory University; Gregory S. Noland, Emory University
• Language: English
• Date: 2015-11-30
• Publisher: Public Library Science
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Schicker et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0143829
• Title of Journal or Parent Work: PLoS ONE
• Volume: 10
• Issue: 11
• Start Page: e0143829
• End Page: e0143829
• Grant/Funding Information: This research was supported in part by graduate student funding grants from the Institute for Developing Nations at Emory University and by the Global Field Experience fund of the Rollins School for Public Health at Emory University (RSS).
• Keywords: Risk factors; Sex; Population; Multidisciplinary Sciences; Transmission; Prevention; Science & Technology - Other Topics; Elimination; Prevalence; Science & Technology; Impact; Hemoglobin levels; Men
• Research Categories: Biology, Parasitology; Health Sciences, Occupational Health and Safety; Health Sciences, Public Health

Abstract

Background: Mobile populations present unique challenges to malaria control and elimination efforts. Each year, a large number of individuals travel to northwest Amhara Region, Ethiopia to seek seasonal employment on large-scale farms. Agricultural areas typically report the heaviest malaria burden within Amhara thereby placing migrants at high risk of infection. Yet little is known about these seasonal migrants and their malaria-related risk factors. Methods and Findings: In July 2013, a venue-based survey of 605 migrant laborers 18 years or older was conducted in two districts of North Gondar zone, Amhara. The study population was predominantly male (97.7%) and young (mean age 22.8 years). Plasmodium prevalence by rapid diagnostic test (RDT) was 12.0%; One quarter (28.3%) of individuals were anemic (hemoglobin <13 g/dl). Nearly all participants (95.6%) originated from within Amhara Region, with half (51.6%) coming from within North Gondar zone. Around half (51.2%) slept in temporary shelters, while 20.5% regularly slept outside. Only 11.9% of participants had access to a long lasting insecticidal net (LLIN). Reported net use the previous night was 8.8% overall but 74.6% among those with LLIN access. Nearly one-third (30.1%) reported having fever within the past two weeks, of whom 31.3% sought care. Cost and distance were the main reported barriers to seeking care. LLIN access (odds ratio [OR] = 0.30, P = 0.04) and malaria knowledge (OR = 0.50, P = 0.02) were significantly associated with reduced Plasmodium infection among migrants, with a similar but non-significant trend observed for reported net use the previous night (OR = 0.16, P = 0.14). Conclusions: High prevalence of malaria and anemia were observed among a young population that originated from relatively proximate areas. Low access to care and low IRS and LLIN coverage likely place migrant workers at significant risk of malaria in this area and their return home may facilitate parasite transport to other areas. Strategies specifically tailored to migrant farm workers are needed to support malaria control and elimination activities in Ethiopia.