ADDIS ABABA UNIVERSITY

SCHOOL OF GRADUATE STUDIES

DEPARTMENT OF EARTH SCIENCES

VULNERABILITY ANALYSIS AND MALARIA RISK MAPPING IN AWASSA

AND WONDOGENET WOREDAS.

A THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES OF ADDIS

ABABA UNIVERSITY IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE (M.SC) IN
REMOTE SENSING AND GIS.

AREGA DEGIFE GURMU

JUNE 2009

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 ADDIS ABABA UNIVERSITY
SCHOOL OF GRADUATE STUDIES
DEPARTMENT OF EARTH SCIENCES

VULNERABILITY ANALYSIS AND MALARIA RISK MAPPING IN AWASSA

AND WONDOGENET WOREDAS.

A THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES OF ADDIS

ABABA UNIVERSITY IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE (M.SC) IN
REMOTE SENSING AND GIS.

BY:
AREGA DEGIFE GURMU

ADVISOR:
Dr. K.V. SURYABHAGAVAN

JUNE 2009

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 To
The late Dadhi Lugo and Askalech Mergiya

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 ACKNOWLEDGMENTS

First and foremost I would like to thank the almighty Lord, my savior, who has been with me in
all of the ups and downs from the beginning to the end of my study.

My sincere thanks goes to my advisor Dr Surya for his valuable comments, unreserved
encouragement and guidance. I am also greatly indebted to RS and GIS stream for their kindness
to facilitate the use of the laboratory for extra times including Saturday and Sunday. Here the
contribution of Eskedar, the GIS Lab Attendant, will not be forgettable.

I am extremely grateful to Shumet with whom I passed the ups and downs of the year 2008/09
and his wife, my sister, Buze for their encouragement and moral support.

It is hardly possible to find appropriate words to express my gratefulness to Frezer and her
mother, Genet for what they did for me.

I am grateful to Wondogenet Wereda Health office for providing me the socio-economic data
needed for this thesis.

Finally, I wish to thank my sincere friends Engidawork, Emebet, John, Behailu, Solomon, Asebe
and Tigineh, for their continuous moral support and encouragement.

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 ABSTRACT

Malaria is one of the high priority tropical diseases in Tropical Countries. Although, there have
been many efforts to eradicate malaria from the world over a long period of time, yet it remains a
complex disease. Among the efforts made so far, the main intervention area has been targeting at
the ecology of the Mosquito. This study is aimed at first mapping malaria hazard areas and then
the malaria risk areas at Awassa and Wondongenet Woredas. For mapping malaria hazard areas
five parameters were selected. The parameters include elevation, slope, distance from rivers,
distance from wetlands and drainage density. The elevation, slope, and river net works were
derived from SRTM satellite data and the wet land layer was extracted from land use/land cover
map. These layers were combined by using weighted multi criteria evaluation. Similarly, risk
map was developed depending on the malaria hazard layer, land use/land cover, distance from
health stations layer and population density layer of the study area. The landuse/ landcover layer
was obtained from Landsat ETM+ imagery of the year 2005. The resulting malaria hazard map
depicts that 184.7Km2, 76.3 Km2, 37.4 Km2, 26.9 Km2, and 24.1 Km2 representing 48.6%,
19.9%, 9.7%, 7%, and 6.3%, of the total area is subject to very high, high, moderate, low, and
very low level of malaria hazard. The remaining 32.0 Km2 (8.4%) of the total area is free from
malaria. Yuwa, Aruma, Edo, Busa, Chuko, Entaye, Kela, Wetera, Shasha Kakale, Gotu Anuma,
Abaye and Baja Fabrica kebeles were found to be under high malaria hazard. The risk map
produced from the overlay analysis of the four parameters also showed that 122Km2(32%),
117Km2(30.7%), 60Km2(15.7%), 31Km2(8.1%) 19Km2 (5%), and 32Km2(8.4%) of the total
area is subject to very high, high, moderate, low, very low and is free from malaria risk
respectively. Part of Abaye, Yuwo, Aruma, Tllu, Chefe Kotegebesa, Swampy area, Shashsa
Kakalo, Washa Soyama, and Gamato are subject to very high risk of malaria. In conclusion, 68%
of the total area is highly exposed to malaria hazard and more than 60% is under high risk of
malaria. It is also suggested that it will be cost effective and time as well as energy saving if the
results of this study will be incorporated into the ongoing malaria eradication programs.

Key words: GIS, Remote Sensing, MCE, malaria hazard, malaria risk

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 Table of Contents
Acknowledgements…………………………..………………………...…….….……..……….....i
Abstract…………………………………………………………………………………….…......ii
Table of Contents…………………………………………………….……….……….……...….iii
List of Tables …………….………………….………….………..….……….….…….……….....v
List of Figures…………………….………….………..….………….…………………..…….....vi
List of Abbreviations…………………………………………………………………..…...……vii
1. Introduction …………………………….…………….…………………………..…………1
1.1. Background and Problem statement….…………………….………..….……….…….....1
1.2. Objectives of the Study……………….……………….………………….…….………..2
1.3. Organization of the Thesis………………………………...…………….…………….....3
1.4. Significance of the Study..………….………………………………….….………….….3
1.5. Limitation of the Study…………………………………………………….….…..……..4
2. Review of Related Literature…………………………………………………..…….…......4
2.1. Some Concepts: Malaria and its Behavior…………………………….……….………....4
2.2. Using RS/GIS Technology to Study and Control Malaria…………….….…..…….…...4
2.3. Importance of Landuse / Landcover Classification for Malaria Study…….……..……...5
2.4. The Relationship between Major Climatic Variables and Malaria Incidence………........6
2.5. Factors Affecting the Emergence of Malaria…………………………………….…….....7
2.6. Anthropogenic Factors Affecting Malaria Transmission…………..…………………...10
2.7. Global Malaria Distribution and Burden………………………………………………..11
2.8. The Situation of Malaria in Ethiopia………………………………………….………...14
2.9. Potential Applications of GIS in Public Health…………………………………………15
3. Methodology………………………………………………………………………………...16
3.1. Description of the Study Area………………………………………………….…....….16
3.1.1. Location, Size and Accessibility…………………………………………..………..16
3.1.2. Topography………………………………………………………………..…….….16
3.1.3. Drainage Pattern………………………………………………….……....……….17

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 3.1.4. Landuse and Landcover……………………………………………………….......18
3.1.5. Population Distribution… …………………………………………………..……20
3.1.6. Climate (Temperature and Rainfall)………………………………………………20
3.1.7. Malaria Trend and Major Climatic Variables……………………………………..21
3.1.7.1. Malaria and Temperature……………………………………………………21
3.1.7.2 Malaria and Rainfall……………………………………………………….…23
3.2. Data Sources and Methodology………………………………...……………………..25
3.2.1. Data Sources…………………………………………………………………….…25
3.2.2. Research Methodology…………………………………………………...……..…26
3.2.3. Mapping Parameters…………………………………………………………….…27
3.3. Data Analysis.…..……………………………………………………………………..28
3.3.1. Environmental Factors for Identifying Malaria Hazard Areas…………………….28
3.3.1.1. Altitude ……………………....…………………………….…………..……28
3.3.1.2. Slope …………………………………………………………….…….……..31
3.3.1.3. Distance from Wet Lands …………………………….………….……..……32
3.3.1.4. Distance from River………………………………….…………….…………33
3.3.1.5. Drainage Density…………………………………….……………………….35
3.3.2. Socio-Economic Factors for Identifying Malaria Risk Areas ……………………...36
3.3.2.1. Distance from Medical Facilities………………….…..……………..……….36
3.3.2.2. Landuse/ Landcover……………………….…….…….…………..………….37
3.3.2.3. Population Density……………………………………….………………...…39
4. Results and Discussion…………………………………..….................................................41
4.1. Identifying Areas of Malaria Hazard….………………….……….…….……..………...41
4.2. Identifying Areas of Malaria Risk ……………………….………..…………….............43
4.3. Comparing Malaria Hazard Map with Kebeles Which were Labeled as Malarious….....46
5. Conclusion and Recommendations………………………………….………….………......47
5.1. Conclusion……………........................................................................................………47
5.2. Recommendations………………………………………….….……………….…..…....48
References………………………………………………………….….……………….………...49

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 List of Tables

Table 3.1. Average Monthly Temperature Values of Awassa (1993-2001)………….….…..…21

Table 3.2. Average Monthly Rainfall Values of Awassa and Wondo Genet (1993-2001)….…21
Table 3.3: Data Used for Analysis………………………………………………………….….26
Table 3.4. Mapping Parameters and their Use in the Analysis…………………………….…...28
Table 4.1. Weight of Malaria Hazard Factors…………………………………………………..41
Table 4.2. Weight of Malaria Risk Factors………………………….…………………….…....44

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 List of Figures

Fig.2.1.The Malaria Belt of the World……………………………………..…………………....11

Fig.3.1. Location of the Study Area…………………………………….………………............16
Fig.3.2. Topographic Structure and Elevation of the Study Area……………………………….17
Fig.3.3. Drainage Pattern of the Study Area…………………………….……….…...................18
Fig.3.4. True Color Composite Landsat ETM+ Image of the year 2005 at Bands 6, 4 and 2…...19
Fig.3.5. Landuse/ Landcover of the Study Area…………………..……….…………………....19
Fig.3.6. Population Density of the Study Area…………………………….….…….…………..20
Fig.3.7. Temporal Patterns of Malaria Cases and Temperature at Awassa Health Center ……..22
Fig.3.8. Temporal Patterns of Malaria Cases and Temperature at Bushilo Health Center ……..22
Fig.3.9.Temporal Patterns of Malaria Cases and Rainfall at Awassa Health Center …………..23
Fig.3.10.Temporal Patterns of Malaria Cases and Rainfall at Bushilo Health Center …………24
Fig.3.11. Temporal Patterns of Malaria Cases and Rainfall at Wondogenet Health Center …...25
Fig.3.12. Procedural Flow Chart of Methodology…………………………….……..…….…....27
Fig.3.13. Elevation ………………………………………………………………………………30
Fig.3.14. Reclassified Elevation ………………………………..….………………...……….....30
Fig.3.15. Reclassified Slope ………………………………………….….………….....………..31
Fig.3.16. Reclassified Distance from Wetlands …………………….…….…….…....…………33
Fig.3.17. Reclassified Distance from Rivers ……………………………………..…..................34
Fig.3.18. Reclassified Drainage Density ……………………………….……..……...…………35
Fig.3.19. Reclassified Distance from Health Facilities …………………..…..…….……………36
Fig.3.20. Landuse/ Landcover ………………………………………………..…………………38
Fig.3.21. Reclassified Landuse/Landcover …………………………………….….…................38
Fig.3.22. Reclassified Population Density …………………………………….……………….40
Fig.4.1. Malaria Hazard ………………………………………..……………………………….42
Fig.4.2. Malaria Risk ………………………………………………………………….….…….45
Fig.4.3. Malaria Hazard Map Showing Malarious and Non-Malarious Kebeles……………….46

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 List of Abbreviations

AAU Addis Ababa University

AVHRR Advanced Very High Resolution Radiometer
BOFED Bureau of Finance and Economic Development
CDC Centers for Disease Control and Prevention
DEM Digital Elevation Model
ERDAS Earth Resources Data Analysis System
ETM+ Enhanced Thematic Mapper Plus
FAO Food and Agricultural Organization
GIS Geographic Information System
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
GPS Global Positioning System
m.a.s.l meter above sea level
MCE Multi Criteria Evaluation
MDGs Millennium Development Goals
MFI Malaria Foundation International
MOWR Ministry Of Water Resources
MSS Multispectral Scanner
NDVI Normalized Difference Vegetation Index
NMA National Meteorological Agency
NOAA National Oceanic and Atmospheric Administration
RBM Roll Back Malaria
RS Remote Sensing
SNNPR Southern Nations, Nationalities and Peoples Region
SRTM Shuttle Radar Thematic Mapper
SWIR Short Wave Infrared
TM Thematic Mapper
WHO World Health Organization
WMR World Malaria Record

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 1. INTRODUCTION

1.1. Background and Problem Statement

Malaria is one of the high priority tropical diseases in Tropical Countries. Although, there have
been many efforts to eradicate malaria from the world over a long period of time, yet it remains a
complex disease. It affects human health and continues to be one of the most serious vector-
borne diseases world-wide. Malaria transmits through 3 possible mediums; malaria parasite,
human hosts, and Anopheles mosquito. The way to solve the malaria problem is to intervene
these mediums. One of the interventions mechanisms includes identifying possible potential
malaria prone areas. The suitable environmental conditions for various behaviors of Anopheles
mosquito such as resting, swarming, oviposition, biting, and feeding can easily be examined by
first predicting and analyzing potential mosquito reproduction areas. The characteristic of
heterogeneous space is an important factor to predict the mosquito densities. The heterogeneous
space is called “land cover” (Abose et al., 2003).

Every year nearly 350-500 million clinical disease episodes are caused by malaria parasites and
3.2 billion people in the world are living under the risk of malaria (WHO, 2005). Malaria is
essentially an environmental disease since the vectors require specific habitats with surface water
for reproduction, humidity for adult mosquito survival and the development rates of both the
vector and parasite populations are influenced by temperature (Ashenafi, 2003). Although it is
preventable, Malaria is a leading cause of morbidity and mortality in the developing world,
especially sub-Saharan Africa where the transmission rates are highest and where it is considered
to be a major impediment to economic development (Robert et al., 2003).

In Sub-Saharan Africa the pattern of malaria transmission varies markedly from region to region,
depending on climate and biogeography, and broad ecological categories have been widely used
to describe variations in the observed epidemiological patterns (MFI, 1997). One of the new
approaches to better understand the variability in the epidemiology of the disease depends on
knowledge of biodiversity. Specifically, the distribution and ecology of the vectors and the
parasites are considered within a context of a climatic and anthropogenic environment which is
in perpetual evolution.

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This biodiversity is determined by many factors:
o Environmental: rainfall, temperature, vegetation;
o Biological: competence of the vectors (transmission), biology of each species of
Plasmodium; and susceptibility of the host to disease;
o Anthropogenic: deforestation, irrigation, urbanization, movements of populations and
economic changes.

During the last twenty years, the development of Geographical Information Systems (GIS) and
satellites for earth observation have made it possible to make important progress in the
monitoring of the environmental and anthropogenic factors which influence the reduction or the
re-emergence of the disease. Analyses resulting from the combination of GIS and Remote
Sensing (RS) have improved knowledge of the biodiversity influencing malaria. This knowledge
can help decision-makers to better allocate limited resources in the fight against the disease
(Robert et al., 2003).

Thus, remote sensing and geographic information systems (GIS) technologies have been used to
describe local and landscape-level features that influence the patterns and prevalence of disease
and then model the occurrence of the health event in space and time (Ashenafi, 2003; Bose,
2003). In the study area although malaria is prevalent, risk analysis is not yet done and
potentially prone areas are not delineated based on environmental factors. This has created a
problem to target at high risk areas and has substantial increased costs of prevention.

This study therefore apply the combined use of GIS and remote sensing which provides a strong
tool for monitoring environmental conditions that are conducive to malaria and mapping the
disease risk. GIS and remote sensing tools are used to analyze and integrate the spatial
component of vector-borne disease situation in the study.

1.2 Objectives
o General Objective
The objective of this study is to use GIS and Remote Sensing to investigate the area that is
suitable for the breeding of malaria vectors and map malaria risk areas.

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 o Specific Objectives
The specific objectives of the study include:
1. To identify environmental factors that contribute for malaria incidence in the study
area;
2. To investigate malaria hazard;
3. To identify priority areas for taking mitigation measures against the problem by
mapping areas of population at risk of malaria;
4. To compare the malaria risk map with kebeles which were labeled as malarious so as
to verify study results based on health bureau data;

1.3 Organization of the Thesis

This thesis is organized in five chapters. Chapter one provides research background, problem
statement, Objectives and the like. Chapter two provides a literature review of application of
RS/GIS technology to the study and control of malaria, including the environmental factors like
climate, temperature, humidity, land cover, etc. Chapter three provides the background of the
study area and describes methodology. Chapter four describes analysis, result and discussion and
finally chapter five is about conclusion and Recommendations.

1.4 Significance of the Study

This research is aimed at using GIS and RS tools for identification of malaria prone areas. The
ability of identifying risk areas will greatly enhance the effectiveness of prevention efforts and
will substantially reduce costs of prevention with efficient targeting of high risk areas. Applying
GIS and RS for visualizing and analyzing epidemiological data, revealing trends, dependencies
and interrelationships will provide valuable information for evaluation and monitoring.

1.5 Limitation of the Study

The main limitation of the study was the unavailability of well documented monthly medical
data at kebele level over extended years, and lack of a detailed population distribution data of the
study area. There was also lack of satellite images taken at different seasons for some years
which can help to map seasonal variation of climatic variables in relation with malaria
epidemics.

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 2 REVIEW OF RELATED LITERATURE

2.1. Some Concepts: Malaria and its Behavior

Malaria is a mosquito-borne disease caused by a parasite. The geographic distribution of malaria

depends mainly on climatic factors such as temperature, humidity, and rainfall. It is transmitted
in tropical and subtropical areas. Malaria is responsible for over 300 to 500 million clinical cases
and more than one million deaths each year. Approximately 20% of the world population is
living under risk of malaria, mainly in tropical areas and in the poorest countries of the world
(CDC report, 2007). Scientists have observed significant correlations between malaria epidemics
and seasonally warm semi-arid and highland areas. Several tools, such as, GIS, GPS, remote
sensing and spatial statistics were used for malaria surveillance and malaria control programs.

2.2. Using RS and GIS Technology to Study and Control Malaria

Historically several attempts have been done to study and control malaria by using different
technologies and ideas that the body of knowledge has produced. Satellite sensors developed in
US, Europe, Canada, and India have contributed to a better understanding of malaria vector
ecology. The history of RS and its application to malaria and other vector-borne diseases has
been recorded over time in a series of review papers (Hay et al., 2000). Yet, despite 30 years of
research on the potential applicability of remote sensing technologies to malaria control, these
tools are only now beginning to have an impact on policy and practice in operational control of
malaria in affected countries.

In 1971, NASA scientists first identified larva habitat sites using CIR photography. Manually
they identified forest coverage, open wetlands, marshy lands and residential areas from CIR
photography and, by calculating mosquito flight range from settlements, produced a risk map for
malaria control. Pope et al. (1992) used Landsat TM imagery over the Pacific coastal plain of
Chiapas, Mexico and by integrating GIS, RS and field research tried to predict Anopheles
mosquito population dynamics.

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TM proved it’s usefulness by identifying Anopheles larva habitat sites in California (Wood et al.,
1992) and mapping rift valley fever vectors in Kenya, East Africa (Pope et al., 1992). In that
study, they classified TM image and identified roads, water and vegetation. They also colour
coded the homogeneous vegetation types and water bodies on classified TM images. Their study
result revealed that habitat types were divided in low, medium and high larva producing groups.
Many disease vectors cannot be observed directly.

Wood et al. (1992) identified high mosquito producing fields in California using GIS and
Landsat TM imagery. They also detected the reflectance of canopy growth in early season and
correlated with Anopheles larva density. Distances between rice fields and source of blood meal
for mosquitoes, i.e. pastures with livestock, were measured using GIS. Their study result
revealed that rice fields situated very close near pastures had more larva production compare
with rice fields far from pastures.

Rahman et al. (2006) carried out another study in Bangladish. They used GIS technology to
understand the spatial distribution of houses and incidence rates. In that study, GIS was used to
generate the nearest distance between houses, water bodies and forest edges, and to create a
buffer zone around water bodies. Finally, the findings were used to estimate the impact of
malaria risk reducing interventions. In order to identify the environmental risk factors associated
with malaria risk, a study was carried out by Kaya et al. (2001) in coastal Kenya. In that study
risk areas were identified based on the highest mosquito flight carrying capacity from breeding
sites. Wetlands were considered suitable for larva breeding sites and a two-kilometer buffer zone
was created around mosquito breeding sites. With that information a risk map was generated that
showed which settlements were situated very close and within the buffer zones. That study
demonstrated the potential of using SAR images for identification of land cover types that may
be associated with malaria carrying mosquito breeding.

2.3 Importance of Landuse / Landcover Classification for Malaria Study

In different parts of the world different landscape elements were identified for different types of
malaria breeding. Beck et al. (1997) demonstrated how landscape elements can be used to predict
mosquito availability and subsequently malaria outbreaks in Mexico. Land cover maps were
produced from Landsat imagery to identify different classes of land. Land type was then

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correlated with malaria incidence to identify the landscape elements that are most suitable for
mosquito breeding.

Research was carried out by Bian et al. (2003) in the Kenyan highlands to understand mosquito
larval habitats. Remote sensing images were classified for land cover types using a supervised
classification method. A total of seven land cover classes were used: farmland, pasture, natural
swamp, forest, river/stream, road and suburbs. DEM was used to investigate topographic
parameters that can be related with mosquito larva habitat sites such as elevation, wetness index,
and distance from stream, land surface and curvature. They used Landsat TM images and their
study results revealed that transitional swamps and unmanaged pastures were the most suitable
land types for mosquito larva breeding.

To see the spatial distribution of Plasmodium Vivax in Afghanistan a study was carried out by
Broker et al. (2002). Afghanistan is divided into four ecologic zones on the basis of differences
in elevation, temperature and land cover type. Epidemiologic data were obtained from a nation
wide survey of 269 villages. They used logistic regression analysis to investigate the relationship
between environmental variables and the probability of transmission. No transmission occurred
in those villages higher than 2000 meter above sea level because of variation of temperature.
Prevalence rate was higher in river valleys and no transmission occurred in settlements farther
than 10 km away from rivers.

2.4 The relationship Between Major Climatic Variables and Malaria Incidence

Rainfall in tropical areas creates an opportunity for anopheles mosquitoes to lay eggs, which can
reach adulthood. 9-12 days are needed for that process. The anopheles mosquito transmits the
causative agent, plasmodium species, when the environmental parameters (such as water
availability, temperature and humidity) permit. In many parts of the world where temperature is
not a limiting factor, seasonal malaria transmission takes place during peak rainfall periods
(Daniel, 1999). It is already established that vector abundance, distribution and pattern of vector
behaviours changes because of climate change. In order to develop malaria early warnings based
on seasonal climate forecasts in Botswana, research was carried out in 1996. Malaria incidence
data, precipitation data, DEMETER (Development of European Multi-Model Ensemble System

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for Seasonal to Interannual Climate Prediction) climate predictions were used for probability
forecasts. Study result revealed that high incidence malaria years were associated with above
average precipitation, while the lowest malaria years were associated with below average
precipitation (Thomson et al., 2006).

To understand climate change and its relation to vector borne disease a review was carried out by
Githeko et al. (2000) on the whole world. Literature suggests inter-annual and interdecadal
climate variability has a direct influence on vector-borne disease epidemics. Broker et al. (2001)
studied to see the spatial distributions of Helminthes (one type of parasites) in Cameroon. They
collected epidemiological and population data. Land surface temperature was derived from
NOAA-AVHRR. They used a Logistic regression model to identify significant environmental
variables which affect the transmission of infection. The variables used in the regression analysis
were mean, minimum and maximum land surface temperature; total annual rainfall and altitude.
The result revealed that maximum temperature was an important variable in determining
Helminthes distribution.

2.5 Factors Affecting the Emergence of Malaria

The severity of malaria is a function of the interaction between the parasite, the Anopheles
mosquito vector, the human host and the environment. Vector abundance, duration of the
extrinsic incubation period and survival rate of the vector, combined with the probability of the
vector feeding off a susceptible human host determine the risk of malaria infection, the stability
of disease transmission, and seasonal patterns. Many factors are involved in determining the
evolution of the parasite, the vector, the human and the environment (WHO, 2005). Hackett
wrote ‘Everything about malaria is so molded by local conditions that it becomes a thousand
epidemiological puzzles’. Like chess, it is played with few pieces, but is capable of an infinite
variety of situations’. If we are to see order within the chaos we must consider that most of the
factors are interrelated and it is necessary to take into account these inter-relationships in a
holistic approach to understand the components which influence the development of malaria; we
must also understand the differing scales at which each factor play out its influence on the
overall game. According to many researchers including WHO (2005), Githeko et al. (2000), and

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Broker (2002), the natural principle that govern malaria emanate from the natural conditions that
are favorable to it.

Rainfall
Different malaria vectors use a variety of sites in which to lay their eggs (irrigation canals, tire
ruts, mangrove swamps, pools, etc.) as long as the water is clean, not too shaded and, for most
species, relatively still. In many semi-arid areas these sites are only widely available with the
onset of the seasonal rains unless dry season irrigation is undertaken. The association between
rainfall and malaria epidemics has been recognized for many decades (WHO, 2005) but while
increasing precipitation may increase vector populations in many circumstances by increasing
available anopheles breeding sites, excessive rains may also have the opposite effect by flushing
out small breeding sites, such as ditches or pools (Fox, 1957) or by decreasing the temperature,
which in regions of higher altitude can stop malaria transmission.

Temperature
Temperature has an effect on both the vector and the parasite. For the vector, it affects the
juvenile development rates, the length of the gonotrophic cycle and survivorship of both juvenile
and adult stages with an optimal temperature and upper and lower lethal boundaries. For the
parasite it effects the extrinsic incubation period (Lactin et al., 1995). Plasmodium falciparum
(the dominant malaria parasite in Africa) requires warmer minimum temperatures than
Plasmodium vivax. This helps account for the geographic limits of falciparum malaria
transmission in Africa (Bruce and Chwatt, 1991). At 26ºC the extrinsic incubation period of this
malaria species is about 9-10 days whereas at 20- 22ºC it may take as long as 15-20 days. In
highland areas, where cold temperatures preclude vector and/or parasite development during
part/or all of the year, increased prevalence rates may be closely associated with higher than
average minimum temperatures (Bouma et al., 1994).

Humidity
The survival rate of adult insects is often thought to increase or decrease in relation to a factor
called saturation deficit. Saturation deficit is derived by subtracting the actual water vapor
pressure from the maximum possible vapor pressure at a given temperature. Evidence for other

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vectors (tsetse, ticks, culicoides) suggests that saturation deficit is an important environmental
variable in larval and adult survivorship.

Surface Water
Surface water provides the habitat for the juvenile stages (egg, larvae, and pupae) of malaria
vectors. Monitoring the state of small water bodies and wetlands using satellite data is therefore
very useful to identify the source of malaria vectors. The Short Wave Infrared (SWIR) is a
wavelength (1.55-1.75 µm) absorbed by water and therefore can be used to retrieve information
on the presence of water bodies and vegetation water content (Gond et al., 2004)

Vegetation
Vegetation type and growth stage may play an important role in determining vector abundance
irrespective of their association with rainfall. The type of vegetation which surrounds the
breeding sites, and thereby provides potential resting, sugar feeding supplies for adult
mosquitoes, and protection from climatic conditions, may also be important in determining the
abundance of mosquitoes associated with the breeding site (Broker 2002). Furthermore,
vegetation type may influence mosquito abundance by affecting the presence or absence of
animal or human hosts and thereby affecting the availability of blood meals.

Seasonality of Climate
The combined influence of rainfall, temperature and humidity, re-grouped underneath weather
(short-term) and climate (long-term) on malaria is very complex, especially for extreme weather
conditions. Direct effects of climate on vector and parasite development are easy to see but
indirect effects may also be important such as the effects of previous exposure (related to direct
effects), nutritional status, and co-infection may help determine the disease outcome. Just as
climate is one of the determinants of malaria endemicity, climate variability is one of the main
factors behind inter-annual fluctuations of malaria. Literature abounds with examples of how
unusual, anomalous or extreme weather conditions have led directly and indirectly (through
destructive crop pests and diseases) to human malnutrition and in turn to health problems or to
both at the same time (Ashenafi, 2003).

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In recent years there have been significant scientific advances in our ability to predict climate on
the seasonal timescale (Goddard et al., 2001). The skill associated with these predictions varies
from region to region, but is generally higher within the tropics. The World Health Organizations
Technical Support Network for Malaria Epidemic Prevention and Control has suggested that
such forecasts may be relevant to malaria early warning (WHO, 2005). Recently, the information
provided by regional forecasters in Southern Africa has been presented and used by decision-
makers to forecast an increase in malaria risk in epidemic prone areas during seasonal Outlook
Forums (Daniel, 1999). The importance of the factors influencing malaria is not only limited to
climatic factors. Anthropic changes in the environment, in land use, deforestation, in hydraulic
network, also induce continuous changes in the intensity of malaria transmission.

2.6 . Anthropogenic Factors Affecting Malaria Transmission

Consequences of demographic and technological developments during the last century have
considerably modified the environment. Forest and swamp regions were shifted to agriculture to
feed an ever-increasing population. Water requirements for many crops have led to modifications
of surface waters. Development of urban areas has also modified the spatial distribution of
populations and lead to high concentrations of population in restricted areas. Already more than
50% of the total global population lives in cities. These demographic changes in cities can
impact malaria, either by increasing the potential for malaria transmission where the
development of irrigated cultures surrounding the city increases the vector population or by
decreasing it, if adequate measures are taken to reduce the vector and parasite population in the
cities. In some countries, and in particular in Africa, movements of population for political or
economical reasons create another risk factor to the spread of malaria.

Migrants and refugees may bring new parasites (including drug resistant parasites) to an area and
increase transmission in the settled population, or because they come from a low, no
transmission area migrants and refugees may be highly vulnerable to severe disease when the
enter a malaria endemic area (Giada et al., 2003). Development of urban cities (Small, 2003) can
be monitored with high spatial resolution images such as Ikonos and QuickBird (respectively,
1m and 0.61m for the panchromatic channel).

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2.7 Global Malaria Distribution and Burden

Malaria has been recorded as far North 64ºN latitude and as far South 32ºS latitude and in
altitude ranges of 400m below sea level up to 2800m above sea level. Within these limits of
latitude and altitude, there are large areas free of malaria (figure: 1), which is essentially a focal
disease, since the transmission of malaria depends greatly on local environment and other
conditions (Gilles and Warrell, 1993). The World Health Organization estimates that 300 to 500
million people are diagnosed with malaria annually, causing 1.1 to 2.7 million deaths (WHO,
2000; WHO, 2003).

Fig 2.1. The Malaria Belt of the world Source: WHO, 2005

Malaria has a major place among the endemic tropical diseases (Gilles and Warrell, 1993).
Reports as for 2004 indicate that 107 countries and territories have reported as areas at risk of
transmission. This number is considered less than the 1950s report where 140 endemic countries
and territories were accounted, but still in these 107 countries there are 3.2 billion people at risk
of infection (WMR, 2005). Around 60 % of the cases of clinical malaria and over 80% of deaths
occur in Africa, south of the Sahara. In addition to acute disease episode and deaths in Africa,
malaria also contributes significantly to anemia in children and pregnant women, adverse birth
outcome and overall child mortality. Financially, it is estimated to be responsible for 3% in

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average annual reduction of economic growth in countries with high disease burden (WMR,
2005).

Malaria extracts an enormous toll in lives, medical costs, and days of labor lost. Educational
systems also suffer as large numbers of children miss several weeks of school each year in
endemic regions (MFI, 1997). In addition to the direct economic cost of malaria such as costs
related to transportation to health service facility, consultation fee, laboratory test fee, and more
importantly, drug cost, malaria mortality and morbidity sluggish economic growth by reducing
the capacity, and efficiency of the labor force. The economic loss due to malaria is very high,
with an annual loss of growth estimated at 1.3% and loss of approximately 12 billion US dollars
every year in Africa (WHO, 2005).

The wide variation seen in the burden of malaria between different regions of the world is driven
by several factors (WMR, 2005). The presence of the most serious parasite, accompanied by the
potent vector species and vulnerable human population (Parasitevector- human transmission
dynamics) is the one amongst the factors that favor or limit the transmission of malaria and the
associated risk of disease and death (Gilles and Warrell, 1993; Konradsen et al., 1990; cited by
Joshi et al., 2005). The severe malaria parasite P. falciparum and the most efficient malaria
vector mosquitoes Anopheles gambiae occur exclusively in tropical and sub tropical part of the
world, especially in Africa (Gilles and Warrell, 1993; WMR, 2005). Tropical areas of the world
have the best combination of adequate rainfall, temperature and human host allowing for
breeding and survival of malaria vector mosquitoes (WMR, 2005).

The other major factor contributing to regional and local variability in malaria burden is
differences in level of socio-economic development. Determinants include general poverty,
quality of housing and access to health care and health education, as well as existence of active
malaria control programmes providing access to malaria prevention and treatment measures
(Gilles and Warrell, 1993; WMR, 2005). The poorest nations generally have the least resource
for adequate control efforts (WMR, 2005). The combination of all these factors put down a
heavy toll on malaria burden in Africa. In fact, the population groups at risk of malaria also
differ between regions. The majority of death in tropical Africa occurs in areas of stable
transmission of falciparum malaria (WMR, 2005). In these areas the two groups at high risk are

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the very young children, who have not yet acquired clinical immunity (Gilles and Warrell, 1993),
and pregnant women, whose immunity to malaria is temporarily impaired (WMR, 2005).
Whereas in areas of unstable or highly seasonal falciparum malaria transmission, which is
mostly common outside Africa, the lack of frequent exposure to malaria infection early in life
delay the acquisition of clinical immunity, and thus older age groups remain at relatively higher
risk for malaria disease when exposed (WMR, 2005).

More recently, there is evidence that compared with the 1980’s, the burden of malaria increased
during the 1990s in several areas in terms of population at risk, the severity of infection and the
number of deaths (WMR, 2005). Malaria re-emerged in several countries of central Asia with an
increased frequency of epidemics and with the re-establishment of stable endemic transmission.
Factors contributing to the increase in malaria include (i) resistance of parasite to commonly
used anti-malaria drugs; (ii) breakdown of control programs; (iii) complex emergencies; (iv)
collapse of local primary health services; (v) resistance of mosquito vectors to insecticides
(WMR, 2005). In addition, there are other variables that expand malaria endemicity such as,
deforestation, introduction of different irrigation schemes, swamp drainage and specific crop
intensification (Patz and Lindsay, 1999; Boelee et al, 2002; ICMR, 2002; Kebede et al, 2005).
Within the same period, however, malaria was well controlled in the five northern African
countries and elimination or a very low level of transmission was maintained in some of the
islands of the cost of Africa. Throughout the decades, malaria was generally less intense in
central and South America than in Africa and South East Asia (WMR, 2005).

From the available information, it is not yet possible to determine with sufficient confidence
whether the global burden of malaria has changed substantially, for better or worse, since 2000
when Roll Back Malaria (RBM) implementation began in many countries. In some areas,
fluctuations in malaria transmission from year to year potentially confound evaluation of broader
trends. Therefore, a final conclusion typically requires analysis of epidemiological data over
multiple years. For the high burden in Africa, reliable data will only become available after a
time lag of several years. Nevertheless, for some countries and areas throughout the world, there
is evidence that successful control has got an impact on malaria disease burden (WMR, 2005).

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2.8 .The Situation of Malaria in Ethiopia

Malaria is a major public health problem in Ethiopia (Abose et al., 1998). Its occurrence in most
parts of the country is unstable mainly due to the country's topographical and climatic features
(Abose et al., 2003). Although the two epidemiologically important malaria parasite species in
the country are P. falciparum and P. vivax, the other two species, P. malariae and P. ovale, are
also reported to occur. Anopheles arabiensis is the major malaria vector; An. pharoensis, An.
funestus and An. nili are deemed as secondary vectors (Abose et al., 1998). Approximately 4-5
million cases of malaria are reported annually in Ethiopia (in a normal transmission year) (WHO,
2005). Malaria is found in about 75% of the total area of the country, and 40-50 million (>65%)
of the total population is at risk of infection (Tulu, 1993; WHO, 2005). Malaria accounts for
seven per cent of outpatient visits and represents the largest single cause of morbidity. It is
estimated that only 20 per cent of children less than five years of age that contract malaria are
treated at existing health facilities. Large-scale epidemics occur every 5-8 years in certain areas
due to climatic fluctuations and drought-related nutritional emergencies. There are also areas of
stable transmission in some low-lying western regions of the country (WHO, 2005).

Transmission usually occurs at altitudes <2000 meters above sea level. The two main seasons for
transmissions of malaria in Ethiopia are September–December, after the heavy summer rains,
and March–May, after the light rains. P. falciparum and P. vivax are the dominant human
malaria parasites, which account for about 60% and 40% of cases, respectively (Tulu, 1993).
Malaria epidemics are frequent and widespread in the country. Most of the areas affected by
epidemics are highland or highland fringe areas (mainly areas 1000–2000m above sea level), in
which the population lacks immunity to malaria (Tulu, 1993). Occasionally, transmission of
malaria occurs in areas previously free of malaria, including areas >2000m above sea level, in
which the microclimate and weather conditions are favorable for malaria. According to Negash
et al. (2005) true explosive epidemic malaria was recorded at exceptionally high altitude (around
2500 m above sea level). Resulting from human activities, aggravated transmission in the
country was also observed (Negatu et al., 1992).

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 2.9. Potential Applications of GIS in Public Health:

The recognition and employ of GIS technology in public health is significantly growing. GIS is
gradually being accepted & used by public health administrators & professionals, including
policy makers, statisticians, epidemiologists, regional & district medical officers. Some of its
potential applications in public health are listed below:
1. Determine the geographical distribution & variation of diseases.
2. Analyze spatial & temporal trends of diseases.
3. Identify gaps in immunizations.
4. Map populations at risk & stratify risk factors.
5. Document community health care needs & assess resource allocations.
6. Forest epidemics.
7. Plan & target interventions.
8. Monitor diseases & interventions over time.
9. Manage patient care environments, materials, supplies & human resources.
10. Monitor the utilization of health centers.
11. Route health workers, equipments & supplies to service locations.
12. Publish health information maps on the internet.
13. Locate the nearest health facility.
(Negash et al., 2005; Tulu, 1993)

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 3. METHODOLOGY

3.1. Description of the Study Area

3.1.1. Location, Size and Accessibility

The study area is found in the main Ethiopian rift extending up to the eastern escarpment. It is
located in SNNPR, South Ethiopia, in and around Awassa town, which is located at 275 Km
south of Addis Ababa. The study area includes Kebeles which are found under the administration
of Awassa and Wondo Genet Weredas. Most of these kebeles were labeled as malarious. The
total area of these study kebeles is 381.1296km2 (see figure 3.1). The surrounding area is
accessible by all weather road and seasonal gravel roads (Awassa Town Municipality, 2009).

Fig 3.1. Location of the Study Area

3.1.2. Topography

The study area is situated in a large volcano-tectonic collapse at the eastern margin of the Main
Ethiopian Rift, Woldegabriel et al., (1986). As it is indicated in figure 3.2, the area is
characterized by flat lying topography with some scattered hills, like Mount Tabor (1800m), and

16
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Mount Alamura (2019m). The depression is bounded by remnants of the caldera wall and some
regional and local faults. The eastern scarp forms the edge of the rift whose average throw is
about 500 m, whereas the southern and western scarps of the caldera which roughly form an arc
of a circle are relatively lower with a 250 m elevation difference from the floor.

Water bodies, swampy areas and small volcanic hills such as Lake Awassa, Chefe, and Mt.
Tabor and Mt. Alamura characterize the floor of the depression, (Awassa Town Municipality,
2009).

Fig.3.2. Topographic Structure and Elevation of the Study Area

3.1.3. Drainage Pattern

The study area is found in a poorly drained catchment. It is drained by ephemeral and perennial
rivers radiating from the eastern escarpment of the rift valley, flowing to the swampy area and
then to lake Awassa (Figure 3.3). The former Lake Cheleleka is now converted to swamp since
sediments that are coming from the eastern side of the scarp are partly deposited in this area.

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 Fig.3.3. Drainage Pattern of the Study Area

3.1.4. Landuse/ Landcover

As far as the land use is concerned, as it is indicated in figure 3.4 and figure 3.5, the main land
use of the area is dominated by rain fed agriculture and irrigation based agro-forestry practices
like coffee, enset, avocado and banana, sugarcane and chat plantations. The escarpment on the
eastern part of the area is covered by agro forestry and the lower flat lands are used for
mechanized farms, although these farms are shrinking due to urban expansion. Private small
holding farms also occupy a considerable large portion on this area. A swampy area is found and
serves as a very important grazing land. Since, the capital town of the SNNPR is found within
this area, settlement areas are found to be another significant land use type. At higher altitudes
especially in the north east side of the area dense forests on which the Wondogenet Forestry
College depends is found.

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 Fig.3.4. True Color Composite Landsat ETM+ Image of the year 2005 at Bands 6, 4 and 2.

Fig.3.5. Landuse/ Landcover of the Study Area

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3.1.5. Population Distribution

The population data used for this study area is the 2009’s population data which is obtained from
BOFED. As it is indicated in figure 3.6, areas colored red are areas of high population density.
These areas are dense because they are areas of urban settlement. The second dense areas are
areas surrounding the urban areas. The next dense areas are areas of agro forestry and areas
where irrigation practices are conducted. Finally, areas of higher altitude where there is dense
forest coverage and areas of wet lands are very sparsely populated (see figure 3.5 and figure 3.6).

Fig.3.6. Population Density of the Study Area

3.1.6. Climate (Temperature and Rainfall)

Awassa area is affected by the north-south movement of ITCZ (Inter Tropical Convergence
Zone) almost through out the year, MOWR, (2000). The area has a sub-humid climate, FAO,
(1984). Awassa area, according to table 3.2, has a mean annual precipitation of about 1062mm.
The mean minimum precipitation is 21 mm in December during the dry season and the mean

20
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 maximum precipitation is 128mm in July, during the rainy season. Temperatures vary between
19ºC in July and 22ºC in April as it is indicated in table 3.1. The daily sunshine hours ranges
between 4 hours during the rainy season and 9 hours during the dry season and the relative
humidity varies between 48% and 73% over the year at 1800 local station. The average wind
speed recorded is between 0.7 and 1.3m/second at 2m elevation with dominant direction from
northeast to southwest (NMA, 2009). Regarding Wondogenet area, the mean annual precipitation
is about 1122mm. The mean minimum precipitation is 15 mm in December during the dry
season and the mean maximum precipitation is 144mm in July, during the rainy season.

Table 3.1. Average Monthly Temperature Values of Awassa (1993-2001)

Station Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Awassa 20.0 20.65 21.22 20.98 20.35 19.75 19.05 19.40 19.39 19.43 19.27 19.4

Table 3.2. Average Monthly Rainfall Values of Awassa and Wondogenet (1993-2001)

Station Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Awassa 39.07 54.25 73.58 97.66 96.36 113.51 128.43 112.58 105.65 101.80 35.86 21.62

W /G 22.26 32.98 110.48 137.62 123.47 112.21 144.20 138.66 136.22 115.68 33.73 15.20

3.1.7. Malaria Trend and Major Climatic Variables

3.1.7.1. Malaria and Temperature

Temperature is an important factor that determines the distribution of mosquitoes. It has an effect
on both the vector and the parasite. For the vector, it affects the juvenile development rates, and
survivorship of both juvenile and adult stages. For the parasite it affects the extrinsic incubation
period (Lactin et al., 1995).

Temperature also increases transmission of malaria by increasing the frequency with which the
vector takes blood meals, which increases the growth rate of vector populations through
shortening of the generation time. However, the temperature should be combined with the

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availability of rainfall for this to be effective. The following graphs illustrate the relationship
between malaria incidence and temperature of the study area.

Malaria Cases and Tem prature (Aw assa)

21.5 700
21 600

No. of Malaria Cases

C)

20.5 500
O

20
Tem perature(

400 Temp.
19.5
300 Malaria
19
200
18.5
18 100
17.5 0
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Fig.3.7. Temporal Patterns of Malaria Cases and Temperature at Awassa Health Center (1993-2001)

Malaria Cases and Temprature (Bushilo)

21.5 600

21
500
20.5
No. of malaria cases

400
Av. T ( C)

20
0

19.5 300
o

Temp.
19
200 Malaria
18.5
100
18

17.5 0
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Fig.3.8. Temporal Patterns of Malaria Cases and Temperature at Bushilo Health Center (1993-2001)

Bushilo and Awassa health centers are found in Awassa town. They have similar climatic
situation. As the above graphs in figure 3.7 and figure 3.8 show that, there is negative
relationship between malaria case and temperature for most months except during and
immediately after the main rainy season of the area. During and immediately after the rainy

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season the temperature is relatively constant. However, the malaria case showed increment and
become the highest at the month of November. This implies that temperature alone is not a
sufficient condition for the occurrence of malaria epidemics. It means that the seasonality of
temperature should be combined with other climatic variables especially with rainfall as most of
the time malaria epidemics are related to the seasonal pattern of rainfall in Ethiopia.

3.1.7.2 Malaria and Rainfall

Preliminary data analysis of 11-woredas in Ethiopia showed a strong seasonal pattern of malaria
transmission rate being related to the seasonal pattern of rainfall with a lag time varying from a
few weeks at the beginning of the rainy season to more than a month at the end of the rainy
season. In most of the 11 Woredas, the malaria transmission rate peaks occurs in May/June at the
beginning of the “kiremet” rainy season and in October /November after the “kiremet” rains have
stopped in mid September.

Concerning the relationship between rainfall and malaria epidemics of the study area, the
following graphs in figure 3.9 and figure 3.10 show the monthly average rainfall and malaria
cases of Awassa, and Bushilo health centers for the years between 1993 and 2001.

Malaria cases and Rainfall (Aw assa)

140 700

120 600

100 500
RF
80 400
Malaria
60 300

40 200

20 100

0 0
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Fig.3.9.Temporal Patterns of Malaria Cases and Rainfall at Awassa Health Center (1993-2001)

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 Malaria and Rainfall (Bushulo)
140 600

120 500

No. Malaria Cases

Railfall (mm) 100
400
80 RF
300
60 Malaria
200
40

20 100

0 0
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Fig.3.10.Temporal Patterns of Malaria Cases and Rainfall at Bushilo Health Center (1993-2001)

Figure 3.9 and 3.10 Show similar temporal patterns of malaria cases in relation with rainfall as
the two areas are located at the same city. There is positive relationship between rainfall and
malaria case from March up to October. However, the relationship becomes negative between
November and February. There is a peak malaria epidemic immediately after rainy season at
November. Once the main rainy season declines in intensity and frequency in November, the
increasing average daily temperature and progressive dryness beginning mid-October creates a
conducive environment for mosquito breeding in areas where water has been accumulating from
the main rain season. The lag time between the end of the main rainy season and peak malaria
transmission can be explained by the inherent lag time in mosquito breeding and parasite life
cycle inside the mosquito, which are dependent on air temperature and humidity (Zucker, 1996,
Malakooti et al, 1998). In addition, the appearance of a malaria patient to the clinic will play role
in the observed lag time.

The case of malaria seasonality of Wondogenet area is relatively different from Awassa area. It
shows lower seasonal variation as it is indicated in the following figure 3.11.

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 Malaria Cases and Rainfall (Wondogenet)
160 80
140 70

No. of Malaria Cases

120 60

Rainfall (mm) 100 50

Rainfall
80 40
Malaria
60 30 cases
40 20

20 10
0 0
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Fig.3.11. Temporal Patterns of Malaria Cases and Rainfall at Wondogenet Health Center (1993-2001)

Figure 3.11 indicates the presence of a lower seasonal variation of malaria epidemics as
compared to Awassa area. However, there is some increment of malaria cases after the two
rainfall seasons in May and November. The lower seasonal variability of malaria epidemics
might be due to the availability of irrigation practices around Wondogenet area. Irrigation
structures in the area might have provided suitable breeding sites for mosquitoes during the dry
season. Since mosquito-breeding sites are equally available both in the dry and rainy season,
such a very high increase in malaria prevalence was not observed during and after the rainy
season. The humid environment, which is created through irrigation during the dry season, might
have enhanced vector longevity and resulted in lower seasonal variation of malaria epidemics.
Likewise, Robert (2004) observed, the increase in the density of foliage of plants will provide
more shelter and sites for resting for adult mosquitoes, extending their longevity. This can
explain the higher adult density of mosquito in irrigated areas during the dry season (Abose et al.
1998).

3.2. Data Sources and Methodology

3.2.1. Data Sources

The input data were taken from various offices where relevant information was expected to be
available. Accordingly, the following data shown in table 3.3 were obtained from the respective
offices.

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 Table 3.3. Data used for Analysis
Item Data type Source Remarks
1 SRTM data GSOE 30m
2 Land Sat ETM+ AAU GIS Stream 2005 data
3 To, RF NMA 10 Years Data
4 Medical Data Health Bureau 10 Years Data
5 Health Facility Location BOFED Shapefile
6 Study Woredas Boundary BOFED Shapefile

Data about malaria patient cases were collected from the health bureau of Awassa and
Wondogenet Weredas. Patient cases of 3 health centers were included for the study. In addition,
the point location of 6 health facilities was obtained from the SNNPR BOFED. Detailed
information about the land use/cover was extracted from the Landsat ETM+ of the year 2005
imagery by using the supervised classification technique. The topography patterns were was
extracted 30m SRTM data. Besides, population data of each kebele within the study area was
obtained from BOFED of SNNPR. Moreover, rainfall and temperature data were received from
NMA and included for analyzing the relationships between malaria epidemics and rainfall and
temperature. Finally, for limiting the area extent of the study, a shape file showing the
administrative boundary of the study area was received from the BOFED of SNNPR.

3.2.2. Research Methodology

The study is aimed at first identifying malaria hazard (infected) areas and then malaria risk areas.
For mapping malaria hazard five parameters were selected by consulting a malaria expert and
depending on related previous works. The factors include elevation, slope, distance from rivers,
distance from wetlands, and drainage density. The malaria hazard areas mapping was done using
MCE. To carry out the MCE, weight for the factors depending on their suitability for malaria
incidence was given in IDRISI software. Then the overly analysis was conducted using ArcGIS
9.2 spatial analyst extension. Finally, the malaria hazard map was produced. Using similar
procedures, the malaria risk map was produced by including population density, distance from
health facilities, land use/land cover and malaria hazard layer. For the purpose of depicting the

26
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trend of malaria epidemics and climatic variables, graphs showing the patterns of malaria cases
and rainfall and temperature were produced (see figure 3.12).

Landsat ETM+ Location of Health SRTM Data Population

Facilities

Landuse River Slope Elevation Population

Density

Wetland Distance from

Health Facilities
Distance Drainage
from River Density
Distance from
Wetland

Reclassify Reclassify Reclassify Reclassify

Vulnerability Malaria Hazard Map Element at Risk

Malaria Risk Map

Fig.3.12. Procedural Flow chart of Methodology

3.2.3. Mapping Parameters

From the collected data, relevant parameters which can be used for mapping malaria prone areas
were extracted. Their relevance for the mapping is described in table 3.4.

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Table 3.4. Mapping parameters and their use in the analysis

Parameter/Map Relevance for mapping

Distance from rivers, and wet lands For identifying surface waters and swamps as they
are related to vector breeding.
Slope, and Drainage Density For identifying of areas receptive to water logging

Landuse/ Landcover For identifying vulnerable and receptive areas for

malaria
Location of health facilities To determine areas that are far away from health
service
Elevation To stratify the elevation according to its suitability
to malaria
Population Density To determine the degree of proneness of the
population to malaria risk

3.3. Data Analysis

3.3.1 Environmental Factors for Identifying Malaria Hazard Areas

Malaria transmission is strongly associated with environmental conditions, which control

mosquito maturity and parasite development. According to a study conducted in Kenyan
highlands, malaria is associated with ecological risk factors. Higher elevation, increased distance
from swamp and increased population density were associated with decreased malaria risk (Kaya
et al., (2001); Bose, 2003 and Negasi, 2007).

Based on literature search, previous works, and interviews with malaria experts; the following
environmental factors that greatly influence on malaria prevalence were identified.

3.3.1.1 Altitude

Altitude has long been recognized as an important determinant of malaria endemicity. It affects
various transmission factors which are epidemiologically significant. Probably the most
important of these factors is temperature, which affects longevity of vectors and the process of
parasite development. In simple terms, the duration of sporogony increases hyperbolically with

28
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decreasing environmental temperatures to a point where parasite development ceases altogether.
(Bouma et al., 1994).

Temperature affects malaria transmission for two reasons: either the minimum temperature is so
low that it prevents parasite and vector development or else the temperature is too high resulting
in increased mortality of the vector. A minimum temperature of 160C restricts parasite
development and also prevents the development of the vector in its aquatic stages. At 170C
parasites develop but not rapidly enough to cause an epidemic (Lindsay et al., 1998). Maximum
temperatures in the neighborhood of 400C have been found to seriously reduce the daily survival
probability of the mosquito (Martens et al., 1995). Temperature is an important factor when
determining the distribution of mosquitoes since research has made it quite apparent that regions
with temperatures dropping to 160C are rarely at risk for malaria epidemics and can be
disregarded.

In Ethiopia malaria epidemics tend to occur in areas which are found below 2,200m a.m.s.l.
Areas above 2,200 m were considered to be malaria free (UNICEF, 2008). However, most of the
areas affected by epidemics are areas located between 1000–2000 m. (Tulu, 1993). Now,
transmission of malaria is expanding in to areas which were previously free of malaria. It was
revealed that the limit has moved up to 2,500 m. (Negash et al., 2005). In this study, altitude of
up to 2,500 m, above which due to low temperature mosquito survival is greatly reduced and
malaria transmission does not occur, is taken for the analysis.

The elevation layer was reclassified based on the extent of malaria prevalence at different
altitudes given by UNICEF (2008) and Tulu (1993). The layer was reclassified in to five classes
and new values were assigned to each class and based on this classification, 5, 4, and 3, values
were given to elevation ranges of 1664-2000m, 2000-2200m, and 2200-2500m, respectively and
the elevation above 2500m was given no value as malaria can not survive beyond this elevation.
Accordingly, the classes were labeled in the figure 3.14 as very high, moderate, very low and
malaria free based on the level of vulnerability of those areas to malaria incidence.

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 Fig.3.13. Elevation

Fig.3.14. Reclassified Elevation

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3.3.1.2. Slope

Slope is also one of the topographic parameters that can determine the existence of mosquito larval
habitat. It is the measurement of the rate of change of elevation of the land per unit distance. It affects
the stability of aquatic habitats (Munga, 2000) as steeper slopes are slopes that allow the fast
movement of water. Hence, they restrain the development of stagnant aquatic bodies which can
be conducive for breeding of mosquito. Relative to steeper slopes, gentler slopes are slopes
where surface water movement is stagnant and this creates fertile situation for mosquito
breeding. Therefore, identifying gentler slopes can help to detect the relative importance of areas
for mosquito breeding.

Fig.3.15 Reclassified Slope

The slope of the study Area was derived from 30 meter SRTM data and reclassified in to five
classes like the other parameters using natural break standard reclassification technique. The new
classes (0-5°, 5-12°, 12-22°, 22-36°, 36-69°) in the reclassified slop layer shown in figure 3.15

31
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were ranked to 5, 4, 3, 2, and 1 and described as very high, high, moderate, low, and very low
respectively based on the relative degree of suitability of the slope class for malaria incidence.
This means that relatively, gentler slopes are better suitable for malaria incidence and steeper
slopes are less suitable.

3.3.1.3 Distance from Wetlands

Wetlands provide habitats for the juvenile (immature) stages (egg, larvae, pupae) of malaria
vectors. Monitoring the state of small water bodies and wetlands using satellite data is therefore
very useful to identify the source of malaria vectors. Since the fly range of mosquitoes is limited
and breeding should be done in water, the abundance of mosquitoes can be found around the
places where there are patches of still waters and wetlands (Gond et al., 2004). The premise for
assessing areas at risk of malaria infection is based on the maximum distance a malaria-carrying
mosquito can travel from its breeding ground to infect human hosts. For this study, the wetland
factor was considered to be the most conducive to mosquito larval breeding. A two-kilometer
distance around wetlands larval breeding grounds were taken as an area with high malaria
transmission with increasing transmission near wetlands. According to Kaya et al. (2001) a two-
kilometer distance around wetlands is considered to be the maximum flying distance for
mosquito. With this information, new classes of the wet land layer were generated to show the
highest mosquito density near wetlands.

The wetlands layer was extracted from land use land cover map of the study area. Then, distance
calculation and reclassification was done on the layer. The reclassified sub groups of distance
from wetlands were ranked according to mosquitoes flying distance threshold value. Areas out of
the maximum flying distance threshold were considered to be less malaria prone. Areas found
within the two kilometer distance was reclassified in two four classes as all the area can not have
equal and uniform distribution of mosquitoes. Hence, new values as it is indicated in figure 3.16.
were re-assigned as 5, 4, 3, 2, and 1 in order to show the relative susceptibility of the class ranges
of 0-500m, 500-1000m, 1000m-1500m, 1500m-2000m and > 2000m which indicate very high,
high, moderate, low, and very low susceptibility to malaria respectively.

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 Fig.3.16. Reclassified Distance from Wetlands

3.3.1.4 Distance from River

Breeding and early prevalence of anopheles mosquito is done in water basins. Since the fly range
of mosquitoes is limited, the abundance of mosquitoes can be found around rivers where there
are still waters. Conducting irrigation practices and developing agricultural projects around rivers
can produce still water and as a result, the changing ecosystem can cause an increase in
abundance of mosquitoes. As to Bradley (1995) cited in Boelee (2003), irrigation often facilitates
double or even triple cropping of crops; here the irrigation system can lead to continuous
availability of surface water where vectors can breed without restraint. In the irrigated fields
mosquito abundance will increase and if these mosquitoes have enough food source in the
breeding sites, the resulting adults may live longer and allow malaria parasites to complete their
developmental cycle so that they can be passed on to another host. This allows year round
transmission of disease. Moreover, according to Maihotro and Srivastave (2005), the abundance
of water in irrigated areas due to seepage, silting, and stagnation, creates innumerable sites for
malaria vector breeding. In the study area, specifically around Wondogenet area, small scale

33
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irrigation practices are conducted by farmers. According to Malaria expert of the area, it is these
practices and the abundance of wet lands that makes malaria to be prevalent through out the year
in the area.

For the purpose of identifying the abundance of mosquitoes around rivers, the river network was
derived from the 30 meter SRTM satellite data. Distance was computed from every river. The
computed distance was reclassified based on the maximum distance that mosquitoes can fly.
Different literatures indicate that mosquitoes have typical flight ranges up to 2 kms depending
upon species (Kaya et al., 2001). Therefore, for this study, similar to the distance calculated
around wetlands, new classes of 0-500m, 500-1000m, 1000-1500m, 1500-2000m, and
above2000m were computed and assigned values of 5, 4, 3, 2, and 1 respectively. Then, each
class shown in figure 3.17, beginning from the class with the highest value, was labeled as very
high, high, moderate, low, and very low based on the degree of vulnerability of the area to
malaria. In other words, this means that areas near to river(s) are highly vulnerable to malaria
and those areas far from river(s) are less vulnerable.

Fig.3.17 Reclassified Distance from Rivers

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3.3.1.5 Drainage Density

Drainage density refers to the average length of streams within each unit area. A number of
factors influence drainage density. It tends to be highest in areas where the land surface is
impermeable, where slopes are steep, and where rainfall is heavy and prolonged (Waugh, 1996).
Steeper slopes inhibit the development of still aquatic body; thereby inhibiting mosquito
breeding habitats. In addition, heavy rains may have a flushing effect, cleaning breeding sites of
mosquitoes. Therefore, calculating drainage density helps to identify the potential areas for
mosquito breeding by identifying areas of water-logging. A.W. Sweeney (1999) stated that, there
is a negative correlation between mosquito habitat and drainage density. This means that the
lower the drainage density, the higher an area is suitable for water logging and the better suitable
the area is for mosquito breeding. To this effect, classes of 0-0.28, 0.28-0.56, 0.56-0.84, 0.84-
1.12, and 1.12-1.40 were formed and ranked as 5, 4, 3, 2, and 1 respectively. The values were
described in figure 3.18 as very high, high, moderate, low, and very low in correspondence with
the values beginning from the highest value representing degree of malaria proneness.

Fig.3.18. Reclassified Drainage Density

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3.3.2. Socio-Economic Factors for Identifying Malaria Risk Areas

In assessing an the area in urgent need of attention to fight against malaria, mapping which is
based solely on natural conditions is not sufficient but socio-economic factors, such as
population distribution, health facility distribution and land use should also be included. Because
it is then that one can better site the area where there is high risk of Malaria and can at the same
time locate people at risk.

3.3.2.1. Distance from Medical Facilities

Assessing the location of health facilities is important, because it is necessary not only to map
risky areas but also to uncover the potential needs and the location of existing medical facilities
so that allocation of the new facilities can be done effectively.

Fig.3.19. Reclassified Distance from Health Facilities

The location map of medical facilities of the study area is obtained from SNNPR BOFED. The
map below illustrates the sphere of influence of medical facilities in the study area. This was

36
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done by calculating distance from each health facility and by reclassifying the distances in to 5
classes based on the lowest easily accessible distance set by WHO.

According to WHO (2003), areas found within 3 Km radius from a health facility is assumed to
be less risky than areas found beyond this distance. Hence, classes of distances; 0-3000m, 3000-
6000m, and >6000m were computed in figure 3.19. The classes were given values of 1, 3, and 5
and scaled as low, moderate and very high respectively based on the degree of vulnerability to
the risk of malaria.

3.3.2.2 Landuse/ Landcover

Ecological disturbances are unavoidable as humans are changing the environment in which they
and other biological systems exist. The creation of new habitat for mosquitoes is observed when
changes in landuse, such as forest clearance and irrigation agriculture are part of a region.
Irrigated areas are ideal places for mass production of mosquitoes (Beck et al., 1997). As to
Bradley (1995) cited in Boelee (2003), irrigation system can lead to continuous availability of
surface water where vectors can breed without restraint. In the irrigated fields mosquito
abundance will increase and if these mosquitoes have enough food source in the breeding sites.
The resulting adult mosquitoes may live longer and allow malaria parasites to complete their
developmental cycle so that they can be passed on to another host. As a result, there can be more
human-vector interactions, which cause an increase in malaria incidence in the human population
there by allowing year round transmission of disease.

Curran et al. (2005), provide an excellent overview of the use of remote sensing data for health
applications. They indicate that a complex set of inter-relationships exist between land surface
characteristics, as perceived by remote sensing, and disease risk spatially distributed on the
earth’s surface. In the malaria-mosquito disease-vector combination, there is a link between land
cover and vector density on the one hand, and vector density and disease risk on the other. In the
case of the landcover and mosquito population, it is generally understood that proximity to water
is important, particularly in the breeding phase. However, there are many other factors that
intervene, such as internal vector population dynamics, interrelations between the vector and
vertebrate populations, and environmental influences such as microclimate.

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 Fig.3.20. Landuse/Landcover

Fig.3.21. Reclassified Landuse/ Landcover

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In the study area, in order to identify aquatic habitats and landcover types that affect the
survivorship of anopheline mosquito, Landsat ETM+ satellite image of the year 2005 was
classified using a supervised classification method. A total of seven land-cover classes were
identified: farmland; grazing land, natural swamp, dense forest, settlement, lake, and agro-
forestry. Ground truthing was conducted by direct field inspection of 50 points randomly, which
assesses the accuracy of landuse and landcover classification. Moreover, the landuse/ landcover
map in figure 3.20 was reclassified in to five sub-groups in order of susceptibility and suitability
for malaria risk. Thus, the reclassified version in figure 3.21 implies 1 to 5 values, where 1
stands for less prone land use land cover and 5 for highly prone landuse / landcover for malaria.

Due to their suitability for malaria, wetland & agro-forestry landuse/ landcovers were considered
as high risk in terms of malaria breeding and resting sites. Robert (2004) observed that the
increase in the density of foliage of plants provide more shelter for adult mosquitoes. The
irrigated farming in the study area, where different crops were grown and other trees planted for
fencing, provided ideal sites for resting and enhancing longevity of vectors. In addition,
settlement areas open doors to new habitats for the malaria vector, because not only are there
more people in the city, but also there are more places to breed in the city as well (Broker et al.,
2005).
3.3.2.3 Population Density

The growth of population and urbanization is another factor in the determination of health events
such as epidemics of malaria. Issues related with urbanization include open water storage and the
inadequate disposal of water (Reiter, 2001). When population is rapidly expanding, it opens
doors to new habitats for the malaria vector, because not only are there more people in the city,
but there are more places to breed in the city as well. Also of importance is the movement of
people, infected people traveling to non-endemic areas can introduce disease where it would not
normally occur. Conversely non-immune people are at a high risk if they move to a region where
transmission is high.

Malaria as a disease is closely bound to conditions which favour the survival of the anopheles
mosquito. For malaria to occur in a person, Anopheles mosquitoes must be present, which are in
contact with humans, and in which the parasites can complete the "invertebrate host" half of their

39
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life cycle. In addition, humans must be present, who are in contact with Anopheles mosquitoes,
and in whom the parasites can complete the "vertebrate host" half of their life cycle. Finally,
malaria parasites must be present.

For Anopheles mosquito to survive, it has to feed on human blood. The frequency with which the
vector takes blood meals is directly related with rising temperature at optimal range of
temperature (20-300c) and the presence of people exposed to Anopheles mosquitoes. The larger
the population, the greater it is exposed to the risk of malaria in areas where malaria hazard is
prevalent. Because, it increases the human-vector interactions, and enhances transmission by
increasing the frequency with which the vector takes blood meals. This causes an increase in
malaria incidence in the human population.

Therefore, for the purpose of mapping the population at risk of malaria, population density of
each kebele was computed. The population density at kebele level was used because there is no
detail population data or map that can depict the detail spatial distribution of the population in an
area less than kebele level. Then, the population density map is reclassified in to 5 classes and
the densely populated areas were labeled as highly susceptible in figure 3.22.

Fig.3.22. Reclassified Population Density

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 4. RESULTS AND DISCUSSION

4.1. Identifying Areas of Malaria Hazard

Hazard is the probability of occurrence of damaging natural phenomenon within specified period
of time. As a hazard, malaria incidence is mapped by depending on some of the environmental
factors which contribute for the survival of Anopheles mosquitoes.

Table 4.1. Weight of Malaria Hazard Factors

Factors Weight Class Ranking Susceptibility References

Altitude 0.50 1664-2000m 5 Very High UNICEF (2008)
2000-2200m 3 Moderate Tulu (1993)
2200-2500m 1 Very Low
>2500m Malaria Free
Distance from wet lands 0.30 0-500m 5 Very High Kaya et al.
500-1000m 4 High (2001)
1000-1500m 3 Moderate Gond et al.
1500-2000m 2 Low (2004)
> 2000m 1 Very Low
Slope 0.10 0-5° 5 Very High Munga
5-12° 4 High (2000)
12-22° 3 Moderate Negasi
22-36° 2 Low (2007)
36-69° 1 Very Low
Distance from river 0.04 0-500m 5 Very High Kaya et al.
500-1000m 4 High (2001)
1000-1500m 3 Moderate Negasi
1500-2000m 2 Low (2007)
> 2000m 1 Very Low
Drainage Density 0.06 0-0.28 5 Very High Sweeney
0.28-0.56 4 High (1999)
0.56-0.84 3 Moderate Negasi
0.84-1.12 2 Low (2007)
1.12-1.40 1 Very Low

For the purpose of identifying areas of malaria hazard, this study focused on elevation, slope,
distance from rivers, distance from wetlands, and drainage density as the factors of malaria

41
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incidence in the study area. The malaria incidence and transmission requires the environment
with lower elevation (higher temperature), abundance of wet lands, occurrence of gentle slopes,
availability of still waters around rivers, and areas of lower drainage density (Kaya et al., (2001);
Bose, 2003 and Negasi, 2007). It is by overlaying these factors that areas vulnerable to malaria
were identified. The overlay analysis was done after each factor was given the appropriate
weight. The factors were ranked in Table 4.1, according to the degree of importance that they
have for the incidence of malaria in this research. This was done based on the previous studies,
by consulting the malaria expert of Wondogenet woreda, and by using weighted linear
combination method in IDRISI software. Pair wise Comparison of the five parameters was
carried out to develop the pair wise comparison matrix. Accordingly, the above weights of
factors in table 4.1. was computed.

After the overlay analysis of the five factors namely; elevation, slope, distance from rivers,
distance from wetlands, and drainage density, the following malaria hazard map in figure 4.1
was produced.

Fig.4.1. Malaria Hazard

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The Malaria hazard map in Figure.4.1 depicts that 184.7Km2, 76.3 Km2, 37.4 Km2, 26.9 Km2,
and 24.1 Km2 representing 48.6%, 19.9%, 9.7%, 7%, and 6.3%, of the total area is subject to
very high, high, moderate, low, and very low level of malaria vulnerability. The remaining 32.0
Km2 (8.4%) of the total area is a free from malaria. Hence, from these figures it is possible to
conclude that about 68% of the total area is highly exposed to malaria hazard. This is mainly due
to the excessive availability of aquatic bodies and irrigation practices in the study area.

4.2. Identifying Areas of Malaria Risk

In assessing the area in urgent need of attention to fight against Malaria, hazard mapping which
is based solely on natural conditions is not sufficient but socio-economic factors, such as
population density, distribution of health facilities, and land use land cover should also be
included. Because, it is only then that one can site the area where there’s high risk of malaria.
The malaria hazard map, Population distribution map, health facilities map, and land use land
cover map were multiplied and malaria risk indicator map which is shown in figure 4.2 was
created. The basis for the calculation of the map was the risk computation model developed by
shook (1999). According to (shook, 1999):

Risk = Hazard * Element at Risk * Vulnerability

“Hazard (H) is the probability of occurrence of a potential damaging phenomenon within a

specified period of time and within a given area”

“Vulnerability (V) is the degree of loss to a given element or set of elements at risk resulting
from the occurrence of a damaging phenomenon of a given magnitude”

“Element at risk (E) includes the population, buildings, and civil engineering works, economic
activities, public services, utilities and infrastructures, etc., at a given area.”

“Risk (R) is the expected degree of loss due to a particular natural phenomenon. It may be
expressed as the product of hazard (H), vulnerability (V), and element at risk”

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As it is indicated above, the mapping of malaria risk includes hazard, element at risk, and
vulnerability. The malaria hazard layer was computed by overlaying the five selected causative
factors which includes wet lands, elevation, slope, drainage density and distance to streams. The
element at risk layer was developed by reclassifying population density layer. Moreover,
vulnerability layer was developed by reclassifying land use/ land cover layer on the basis of the
degree of susceptibility of each landuse/ landcover to malaria and by computing and
reclassifying distance from the existing health facilities layers. The layers were prioritized
according to their degree of influence. Pair wise comparison of the four parameters was carried
out to develop the following weights in Table 4.2. Based on these weights, the map in Figure 4.2
showing areas of malaria risk was produced.

Table 4.2. Weight of Malaria Risk Factors

Factor Class Rank Susceptibility Weight

Malaria Hazard 5 Very High 40%
4 High
3 Moderate
2 Low
1 Very Low
Land Use Wet Land 5 Very High 30%
Agro forest & Grazing 4 High
Settlement 3 Moderate
Cultivated Land 2 Low
Dense Forest & Lake 1 Very Low

Health Facility 0-3000m 5 Very High 20%

3000-6000m 4 High
>6000m 1 Very Low

Population 0-358 1 Very Low 10%

Density 358-748 2 Low
748-1061 3 Moderate
1061-1752 4 High
1752-11245 5 Very High

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 Fig.4.2. Malaria Risk

In this study, for the purpose of identifying areas of malaria risk; population density, distribution
of health facilities, malaria hazard and land use land cover were used as input factors for malaria
risk mapping. As a result, the risk map in figure 4.2 showed 122Km2(32%), 117Km2(30.7%),
60Km2(15.7%), 31Km2(8.1%) 19Km2 (5%), and 32Km2(8.4%) of the total area is subject to very
high, high, moderate, low, very low and is free from malaria risk respectively. Hence, it is
possible to conclude that the majority of the area (more than 60%) is under high risk of malaria.
Part of Abaye, Yuwo, Aruma, Tllu, Chefe Kotegebesa, Swampy area, Shashsa Kakalo, Washa
Soyama, and Gamato are subject to very high risk of malaria. This seems due to the humid
environment, which is created by irrigation and the wet land, and the availability of large number
of people with lower health facility. Moreover, the existence of the agroforestry might have
provided more shelter and sites for resting for adult mosquitoes, which extends their longevity
and density.

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4.3. Comparing Malaria Hazard Map with Kebeles Which Were Labeled as Malarious

The entire kebeles under Awassa woreda and part of kebeles under Wondogenet woreda (Yuwa,
Aruma, Edo, Busa, Chuko, Entaye, Kela, Wetera, Shasha Kakale, Gotu Anuma, Abaye and Baja
Fabrica) were labeled as malarious by health bureaus of the respective woredas. Similarly, these
kebeles were labeled and mapped under high and moderate hazard areas in the hazard map (see
fig 4.3). The main difference is that Kebeles under Awassa woreda are labeled as areas of
seasonal malaria prevalence and malarious kebeles of Wondogenet woreda are labeled as areas
of permanent malaria prevalence. This is mainly attributed to the presence of wet lands, rivers,
agro forests and irrigation practices around Wondogenet area.

Fig.4.3. Malaria Hazard Map Showing Malarious and Non-Malarious Kebeles

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5. CONCLUSIONS AND RECOMMENDATIONS

5.1. Conclusions

This study was aimed at producing malaria hazard and risk maps of Awassa and Wondogenet
Weredas so that it can help to improve the management and control of malaria vector. Although
the environmental drivers that determine the life cycles of both the vector and the parasite are
complex, they can be monitored and analyzed using newly available technologies of RS and GIS.
This research has shown that GIS and remote sensing is important to create operational maps
which could help the vector control agencies to identify hazard and priority areas for disease
control.

The hazard map was produced depending upon the physical parameters which are capable of
providing fertile environmental situations for mosquito breading. The study focused on
elevation, slope, distance from rivers, distance from wetlands, and drainage density as the factors
of malaria incidence having 50%, 10%, 4%, 30% and 6% weights respectively in the overlay
analysis. The malaria incidence and transmission requires the environment with lower elevation
(higher temperature), abundance of wet lands, occurrence of gentle slopes, availability of still
waters around rivers, and areas of lower drainage density. Hence, from the result of the overlay
analysis of the physical parameters, it is possible to conclude that about 68% of the total area is
highly exposed to malaria hazard. In addition, Yuwa, Aruma, Edo, Busa, Chuko, Entaye, Kela,
Wetera, Shasha Kakale, Gotu Anuma, Abaye and Baja Fabrica kebeles were highly found to be
under malaria hazard. This is mainly due to the greater availability of aquatic bodies and
irrigation practices in the study area.

Similarly, the malaria risk map was produced depending upon the overlay analysis of the malaria
hazard map and some socio-economic parameters like landuse/ landcover, distance from health
facility services location and population density. The factors had 40%, 30%, 20% and 10%
weights in the overlay analysis respectively. The result indicated that the majority of the area
(more than 60%) is under high risk of malaria. Part of Abaye, Yuwo, Aruma, Tllu, Chefe
Kotegebesa, Swampy area, Shashsa Kakalo, Washa Soyama, and Gamato are subject to very

47
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high risk of malaria. This is not only due to the physical parameters but also the poor heath
facility for the existing large number of people in the study area and the existence of suitable
landuses and landcovers for mosquito breading.

Hence, the maps were constructed to allow targeting intervention within kebeles according to the
risk gradient. Thus, vector control mechanisms like indoor insecticide spraying could be limited
to these priority zones.

Recommendations

Based the findings of this study the following recommendations were given as follows:
1. The Woredas should develop the capacity to use GIS and remote sensing technology for
the effective identification of ecologies of mosquito and other vector borne diseases;
2. It will be cost effective if the woredas will incorporate the malaria hazard and malaria
risk maps of the results of this study in the current ongoing health development activates
so as to target on the priority areas identified by the study;
3. The establishment of health centers should be made at high and very high risk areas at
reasonable distance away from the existing health facilities so that people at a distance
can easily access the service.
4. Proper data bases about detail patient data, the seasonal incidence of epidemics and about
other related aspects of the malarious kebeles should be made using GIS ;

48
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Declaration

I, the undersigned declare that this thesis is my work and that all sources of material used for the
thesis have been correctly acknowledged.
Name: ________________________________
Signature: ____________________________
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