Prevalence and risk factors of human brucellosis and malaria among patients with fever in malaria-endemic areas, attending health institutes in Awra and Gulina district, Afar Region, Ethiopia

Background Brucellosis is an important neglected bacterial zoonotic disease that has been affecting animals and humans for decades. Malaria has been considered major cause of illness in tropical areas, including Ethiopia. This study aimed to identify prevalence and risk factors of human brucellosis and malaria among patients with fever in malaria-endemic areas attending health institutes in Awra and Gulina district, Afar Region, Ethiopia. Methods A purposive cross-sectional study was conducted among febrile patients who attended health institutes in Awra and Gulina district of Afar region from February to May 2019. 3-5 ml blood samples were collected, thick and thin blood films were prepared and examined for malaria; serum was separated and tested for anti-Brucella using Rose Bengal Plate Test, and the seropositives were subjected to ELISA. Data were entered using EpiData3.1 and analyses were performed using Stata SE 14. Results A total of 444 febrile individuals (59.5% female) of age ranging from 2 to 83 years (mean = 26.1, SD = +/- 11.8) were participated in this study. The overall seroprevalence of brucellosis was 31.5% (95% CI; 27.4-36.0%) by RBPT and 15.8% (95% CI; 12.7-19.7%) by ELISA, as well as the prevalence of malaria (P. falciparum) was 4.3% (95% CI; 2.7-6.6%) among febrile patients. Malaria was more common in males (7.2% 95% CI; 4.2-12.1%) than in female (2.3% 95% CI; 1.0-5.0%, p = 0.01) and in non-married than in married (7.6% 95% CI; 4.1-13.6% vs. 2.9% 95% CI; 1.5-5.4%, p = 0.02). Being male (AOR = 2.41, 95%CI: 1.36-4.26, p < 0.002), drinking raw milk (AOR = 26.68, 95%CI: 3.22- 221.13, p = 0.002) and boiled milk (AOR = 17.52, 95%CI: 2.06-149.04, p = 0.009) and touching aborted fetus/discharges without protective (AOR = 2.56, 95%CI: 1.01-6.528.50, p = 0.048) were independently associated with brucellosis among febrile patients. Conclusion The prevalence of brucellosis in fever patients in this study area is higher than malaria. Consumption of raw milk and contact with animal discharge can cause significant risk of Brucella infection. So, brucellosis disease must be sought in the differential diagnosis, like ELISA test that can be used to differentiate from other febrile diseases like malaria.

Automated summary

This study investigated the prevalence and risk factors of human brucellosis and malaria among fever patients in malaria-endemic areas in the Afar Region of Ethiopia. The results showed a higher prevalence of brucellosis compared to malaria, with consumption of raw milk and contact with animal discharge identified as significant risk factors for Brucella infection.