The Persistent Threat of Urban Malaria in Bishoftu Town: Twelve-Year Trends and Their Implications for Addis Ababa

Ethiopia aims to eliminate malaria in low transmission areas by 2030; however, the threat of malaria is growing, particularly in urban areas due to rapid urbanization, climate change, and increased population movements. Bishoftu is a significant concern, posing substantial risks to Addis Ababa, a city currently classified as malaria-free and located just 40 km away. The interconnectedness of these rapidly growing urban centers heightens the risk of transmission. Bishoftu's vulnerability to malaria is exacerbated by several factors, including numerous water bodies that provide optimal breeding sites for mosquitoes and an influx of visitors, especially during cultural events like the Irreechaa festival, which increases human exposure to malaria. The recent introduction of the urban malaria vector Anopheles stephensi to East Africa further complicates control efforts. Future surges in malaria cases in Bishoftu may be driven by the impending construction of Africa's largest airport, facilitating increased visitor traffic and mobility. Thus, timely and proactive measures are necessary to closely monitor the disease trends in Bishoftu to safeguard both the town and Addis Ababa before it is too late. To address these pressing issues, this study conducts a twelve-year trend analysis of malaria in Bishoftu. A retrospective analysis was performed using data from the Bishoftu Town Health Office, examining 252,610 blood films collected between January 2011 and December 2022. The study revealed 5,696 confirmed malaria cases, resulting in a slide positivity rate of 2.3%. Plasmodium vivax was the predominant species (63.8%), followed by P. falciparum (31.0%), with the highest incidence recorded in 2017 (804 cases). Individuals over 15 years old constituted 66.3% of cases, stressing the need for targeted interventions for high-risk populations. Remarkably, the trend of malaria cases in Bishoftu has been fluctuating, making it challenging to predict and reliably identify the determinants of transmission. The findings have significant implications not only for Bishoftu but also for Addis Ababa, as increased mobility and environmental changes heighten the risk of malaria re-emerging in previously non-endemic regions. Given these interconnected risks, aggressive surveillance and targeted control measures are essential to mitigate the threats posed by urbanization, climate change, and demographic shifts. This study provides critical insights for public health authorities to develop effective strategies to combat the rising threat of malaria in Bishoftu and prevent its spread to Addis Ababa, thereby safeguarding public health in these rapidly evolving urban environments.