Malaria is a protozoan infection of red blood cells transmitted by the bite of a female anopheles mosquito and causes massive morbidity and mortality. More than 90% of the malaria burden occurs in sub-Saharan Africa (SSA), mainly affecting young children in rural areas with limited access to health services. It also affects the poorest and most vulnerable communities due to their lack of access to effective services for prevention, diagnosis, and treatment. Of the five most common species of Plasmodium that infect humans, the vast majority of deaths in SSA are caused by Plasmodium falciparum, while Plasmodium vivax, Plasmodium malaria, Plasmodium ovale, and Plasmodium knowlesi generally cause milder forms of the disease (World malaria report, 2018; Herrador et al., 2019).

In Ethiopia, malaria is a major challenge for both public health and socio-economic development. Three-quarters of its landmass is considered endemic for malaria, putting 68% of the total population more at risk of the infection (EPHI (Ethiopian Public Health Institute), 2016). This protozoan infection (by Plasmodium species) was responsible for 14% of outpatient visits and 9% of admissions in the country in 2009/2010 (FMOH, 2011). In 2016, there were an estimated 2,927,266 new malaria cases and 4,782 deaths (Girum et al., 2019). Varying topographical and climatic features of the country contribute to the seasonal and unstable malaria transmission pattern which is usually characterized by frequent focal and cyclical widespread epidemics.

The transmission of malaria peaks biannually from September to December and April to May, coinciding with the major harvesting seasons (FMOH, 2010). P. falciparum and P. vivax are the two dominant species in Ethiopia, which account for 60% and 40% of malaria cases, respectively. However, the proportion varies among geographical settings and seasons. In the lowlands and during the major malaria transmission season, P. falciparum is much more common while P. vivax is more common at higher altitudes and during the dry season. The disease primarily occurs at altitudes below 2,000 meters above sea level in the country (Hailu et al., 2017).

Different studies have tried to assess knowledge, perceptions, and behaviors toward malaria among communities in different parts of the country. These studies have demonstrated the communities’ level of understanding and revealed some misconceptions related to signs and symptoms, mode of transmission, treatment, and prevention control of malaria. In a study from the Tigray region, Ethiopia, nearly half of the respondents (48.8%) recognized mosquitoes as a cause of malaria (Paulander et al., 2009). It was also observed that misconceptions about the causes and transmissions of malaria were very common, where exposure to cold weather, hunger, and drinking dirty water were mentioned as causes of malaria (Aderaw and Gedefaw, 2013). In contrast, findings of a study conducted on two indigenous populations of Bangladesh revealed superficial knowledge of malaria transmission, prevention, and treatment by the respondents (Ahmed et al., 2009).

Studies showed that each year, more than 300 million malaria cases and up to 3 million deaths occur throughout the world. Of these, over 80% of malaria deaths occur in Africa, with Asia and Eastern Europe accounting for less than 15% (World Health Organization, 2015). Although the climatic conditions of Jawi and its surroundings are suitable for mosquito breeding, Plasmodium infection around the town is not known. Thus, this study was conducted to assess the trend of malaria and patients’ awareness of the disease in selected health centers in the Jawi District, Northwest Ethiopia.

The study indicated that 40.9% of the blood films evaluated over 7 years for the presence of malaria parasites were positive. This outcome was similar to a study carried out in the Kola Diba Health Center (40.9%) (Alelign et al., 2018). It was also observed that the overall malaria prevalence was much lower (82.4%) compared to Hallaba (Tefera, 2014) and the East Shewa Zone (82.8%) in the Oromia Region (Gemechu et al., 2015). In contrast, this study showed a higher infection rate (16.34%) than studies carried out in the Dembecha Health Center, Northwest Ethiopia (Haile et al., 2020), Metema Hospital (17%), Ataye (8.4%) in North Shoa (Feleke et al., 2018), and Felegehiwot Referral Hospital (5.0%) in Bahir Dar (Yimer et al., 2017). Such discrepancies might be due to differences in malaria detection methods and laboratory staff members’ abilities to find and identify malaria parasites. Additionally, malaria prevention and control operations may vary from one region to another. Differences in the demography, economic activity, altitude variation, study period, health institute accessibility, community awareness of vector control, and insecticide-treated net (ITN) and indoor residual spraying (IRS) coverage might have an impact on the prevalence of the disease.

The difference in the average annual prevalence of malaria within the study period might be due to differences in climatic conditions. A greater focus on malaria prevention and control measures by various responsible bodies, increased community awareness on the use of ITNs, insecticide spraying, drainage systems for mosquito breeding sites, and global climate change may all be contributing factors to the variation in malaria prevalence.

The highest number of malaria cases coming after heavy rainfall (from June to September) might be due to the rainfall creating a suitable environment for the breeding of Anopheles mosquitoes which transmit the disease. Those differences in malaria prevalence based on seasonality are in line with studies conducted in different parts of Ethiopia (Gemechu et al., 2015; Legesse et al., 2015; Hawaria et al., 2019). It has also been underlined that climatic variables such as rainfall, temperature, and altitude are important drivers of malaria dynamics by affecting both malaria parasites and vectors directly or indirectly (FMOH, 2010; Alemu et al., 2011; Sena et al., 2014).

The greater prevalence of P. falciparum in this study agreed with the national data and other related research conducted in Ethiopia (FMOH, 2010; Alemu et al., 2012; Amenu, 2014; Ali and Animut, 2019). However, this outcome disagrees with a prior report from Jimma Town that stated that P. vivax is more common (Alemu et al., 2011). This study also found that male patients had a greater positivity rate for malaria (54.2%) than female patients in our retrospective study, which is in line with studies conducted in many Ethiopian localities (Alemu et al., 2012; Amenu, 2014; Hawaria et al., 2019; Dabaro et al., 2020). Such a higher incidence rate in male patients may be due to the fact that men frequently engage in outside activities where the risk of mosquito bites is high (Kenea et al., 2016). On the contrary, in the case of the 4-month prospective study (March to June 2022), female patients were more affected (55.1%) than male patients which is similar to a study conducted in the Bahir Dar Health Center (Derbie and Mekonnen, 2017). The difference might be due to variations in sample number between the retrospective and 4-month prospective data.

The prevalence of malaria was also influenced by age. Compared to older age groups, it was higher in younger age groups in the retrospective study. The greater prevalence of malaria in children under 5 years old might be due to these patients having less immune system development than the other age groups. Furthermore, its lower prevalence in the older age group (greater than 90 years old) might be due to less engagement in outdoor activities and a low number of participants which reduces the risk of infection.

The analysis of the 4-month study revealed definite monthly variation in the prevalence of malaria. P. falciparum infection in the prospective 4-month study was consistent with the findings of the retrospective investigation. The greater understanding (87%) of malaria prevention techniques is due to better information sources about the disease from health professionals and discussions among family members, which is similar to a study conducted in a malaria-endemic area (Amusan et al., 2017). The majority of the respondents (80.9%) stated that malaria spreads through mosquito bites, which was consistent with research from Ghana (Laar et al., 2013) and India (Forero et al., 2014). This is in contrast to a study conducted in the Shashogo District, Ethiopia, which showed that participants had very little understanding of the method of malaria transmission, with only 15.6% of the participants associating mosquitoes with the disease (Fuge et al., 2015). This study showed more awareness (80.9%) of the association of mosquitoes with the disease.

Nearly all the participants correctly identified the major signs and symptoms of malaria, which is similar to a study carried out in Karachi (Arshia et al., 2013) and additional investigations carried out in Ethiopia (Legesse et al., 2007; Andargie et al., 2013). It is crucial to know mosquito habits, resting and breeding locations, and feeding times to utilize ITNs correctly and avoid malaria. According to the research participants’ observations of mosquito breeding grounds, 266 (64.3%) of them connected mosquitoes to standing water, marshy areas (110, 26.6%), discarded items (23, 5.6%), and discarded materials (23, 5.6%) which is similar to a study conducted in the Shashogo District, Southern Ethiopia (Fuge et al., 2015). Nevertheless, a study conducted in Tepi, southwest Ethiopia, showed that the majority of the community members (96.4%) were aware that mosquitoes breed in stagnant water (Fuge et al., 2015).

Regarding knowledge of interventions for indoor and outdoor prevention and vector control, there was more awareness than the reported rates from Myanmar (Zay and Shwe, 2013). The percentage of respondents who believed that using ITN aids in malaria prevention was lower than in other studies conducted in Ethiopia (Abrar et al., 2017; Flatie and Munshea, 2021). This might be due to the shortage of available ITNs and the economic problems of the people in the study area. Although 96.9% of the total respondents agreed that malaria is a major concern in the study area, only 58.5% sleep under a mosquito net during the night as a method of preventing themselves from mosquito bites. Despite knowledge of ITNs as a protective measure, several participants did not know that fully covering the body at night can prevent the transmission of malaria. Similar findings were reported from a study conducted in Nigeria but the prevalence of wearing of long-sleeved clothes was higher in the Nigerian study than in our study (Amusan et al., 2017). This could be due to a lack of awareness about the importance of wearing long-sleeved clothing to protect against Anopheles mosquito bites.

The majority of the participants correctly identified children and pregnant women as the two groups of people the most susceptible to malaria. This is consistent with research from related studies carried out in Kenya (Atieli et al., 2011) and Southwestern Ethiopia (Hawaria et al., 2019). In both cases, a significant number of the participants identified children and pregnant women as the most vulnerable population groups to malaria. This is mostly because pregnant women have immune systems that are partially weakened and children have immune systems that are underdeveloped and weak, making them more susceptible to the disease than adults.

This study was conducted in the spatially limited geographical settings of the selected health centers in the Jawi District. The prospective data collection was only over 4 months (March to June 2022) and that of the retrospective study was only 7 years of recorded data.

The prevalence of malaria in the retrospective study of 7 consecutive years (2015 to 2021) was found to be high. The trend of infection rate was not consistently increasing or decreasing within the study period but it was varied. Higher malaria prevalence was recorded in the less than 5 years age group. P. falciparum was recorded as the main parasite infecting the patients in the month of October and was the lowest in April. The prevalence of malaria in the 4-month prospective study (March to June 2022) was also found as high. Female patients and younger age groups were infected more often and the peak of malaria cases was recorded in June. In this study, the overall knowledge, attitude, and practice level of the study population towards malaria were relatively good. However, a substantial proportion of the participants still had misconceptions about the cause, signs and symptoms, modes of transmission, and practices for prevention methods of malaria. Environmental, biological, socioeconomic, and policy changes may have contributed to the fluctuating trend of malaria prevalence seen in the area. In general, to minimize the prevalence of malaria in the Jawi District, the health office should place more emphasis on preventive measures such as health education, primarily regarding the mode of transmission and prevention and control mechanisms.