Malaria is a vector borne disease caused by plasmodium parasites which are transmitted by the bite of infected female Anopheles mosquitoes. The plasmodium parasites implicated in malaria include P. falciparum, P. vivax, P. ovale, P. malariae, P. knowlesi. Malaria parasite trophozoites are generally ringed shaped 1 - 2 μ in size, although other forms (ameboid and band) may also exist [1] . The sexual forms of the parasites (gametocytes) are much larger and 7 - 14 microns in size [2] .

Malaria is a serious threat to human health. The disease has had a great impact on human populations affecting 3.3 billion people worldwide in at least 106 countries [2] [3] . However, it is both preventable and curable. In 2019 alone, 229 million malaria cases were detected globally with 409,000 estimated deaths. Children under five years were particularly susceptible to malaria, which accounted for 67% (274,000) of all malaria deaths worldwide [3] . Presently, malaria parasite still poses a major global public health concern, with sub-Saharan Africa bearing the most burden of the disease [3] . Malaria transmission and severity within this part of Africa varies greatly from region to region, village to village and even from person to person [3] [4] . The impact of the disease is, however, greater in rural areas where the disease is common during periods of agricultural activity [3] .

Nigeria accounts for 27% of the global malaria burden and 32% of malaria deaths globally [4] . Malaria poses a risk of about 97% to the Nigerian population and contributes about 11% of maternal mortality. The result of 2021 Nigeria Malaria Indicator Survey (NMIS), however, shows a decline in national prevalence of malaria to 22% from 23% in 2018 and 42% in 2010 [4] [5] .

The 2021 World Malaria Report from World Health Organization (WHO) also showed that 9 - 10 persons die every hour due to malaria, or malaria-related issues in Nigeria, with Osun state, recording the highest prevalence (11.85%) [5] .

Since understanding where infection prevalence and transmission potentials are highest in a population is very key in developing targeted control interventions, the prevalence of malaria parasites has long been observed and researched globally, continentally, nationally, and even sub-nationally.

In Nigeria, for instance, a series of studies have been carried out on the prevalence of malaria parasite in Ebonyi State in Southeastern part of Nigeria [5] . These studies have traversed various demographics spanning various areas like Afikpo North Local Government Area, Ezza North Local Government Area, and Onicha Local Government Area, between 2010 and 2022. Ezza North Local Government Area had the highest prevalence of 13.4% while Izzi Local Government Area had the lowest prevalence of 12.5%. However, as can be gleaned from Figure 1 , no study has been done for Uburu community in Ohaozara Local Government Area.

Generally, symptoms of malaria include fever, flu-like illness, chills, headache, muscle aches, tiredness, nausea, vomiting, and diarrhea [5] . Other symptoms are elevated body temperature ≥ 37.5˚C, enlarged spleen or liver (especially in children), pallor in children or pregnant women.

The national guideline for diagnosis and treatment of malaria (2020) recommends parasitological diagnosis for all suspected malaria cases. The guideline states that the signs and symptoms of malaria are non-specific. However, clinical suspicion is primarily based on fever or a history of fever in the last 24 hours and/or the presence of anemia [6] [7] .

Fever has been defined as “a state of elevated core temperature, which is often, but not necessarily, part of the defensive response of multicellular organisms to invasion by live microorganisms or inanimate matter recognized as pathogenic or alien by the host [8] .

The objective of this study was to determine the prevalence of malaria parasites among febrile patients in a teaching hospital in Southeast Nigeria, using David Umahi Federal Teaching Hospital, Uburu, Ebonyi State, Nigeria, as a case study.

The study was approved by the Research and Ethics Committee of David Umahi Federal University Teaching Hospital Uburu, Ebonyi State, Nigeria. The implications of the study were clearly explained to the participants before they were recruited. In other words, informed consent was obtained from them, before starting the study. Data collected were kept confidential and privacy was ensured; and they did not bear the cost of the study.

Globally, malaria infects between 300 - 500 million people annually, with a major contribution to public health problems affecting all, including children, under 5 years and pregnant women in Africa. Malaria fever is endemic in sub-Saharan Africa and one of the most affected countries around the sub-Saharan African region is Nigeria, having 25% disease burden [9] - [11] . Southeastern Nigeria has dense tropical rain forest vegetation with many pools of surface water reserves that serve as breeding grounds for malaria vectors (anopheles mosquitoes).

This study confirmed the endemicity of malaria fever in south east region with overall prevalence of 78%. Similar study was done by Agboeze et al., and Adefioye et al. in Oshogbo and Ebonyi before now recorded 79%, and 72% respectively [6] [11] , this further buttresses the endemicity and disease burden of malaria parasite among the populace of Nigeria and south east as well. In Nigeria, malaria prevalence is as high as 80% to 85% and at some point, 96.1% with a 1.3 million affectation on the populace and is the most common cause of outpatient visits to health facilities all year round [5] [12] .

In this study, malaria affected across all age groups ranging from ages 0 - 100 years. However, the ages 31 - 40 years were the most affected, even among the female patients who were present.

The reason for the higher prevalence in the age group 31 - 40 is unknown; however, it is suggested that the higher prevalence could be due to the fact that young adults have a high mobility rate and, in most cases, are the breadwinners of their homes, frequently engaging in farming and all other agro-allied related jobs and outdoor activities. These occupations/activities are known exposures to mosquito bites, which eventually lead to the transmission of malaria parasites.

Although the prevalence rates of 18.5% recorded as the highest in the age group 31 - 40 years and 14.8% in the age group 0 - 10 years, may appear low when compared with other findings, the findings in the present study are, however, supported by Adefioye et al., with 88.2% as the highest frequency of prevalence in the age group 36 - 39 years followed by age group 32 - 35 years 76% prevalence rate in their independent study [6] . The same goes for Ibeneme et al., who documented 36 - 48 years 50 (39%) as the highest prevalence, followed by 26 - 35 years 45 (35%) in their studies [9] .

Another variable study recorded the highest prevalence among children 1 - 10 years (28.9%) and the lowest in 91 - 100 and above in prevalence of malaria by age group studies using RDT examination [12] .

We recorded the lowest prevalence among ages > 91 years of age (1.7%), a finding that corresponds with findings above displaying low malaria frequency affectation among the elderly. Although there is a global acceptance of increased prevalence of malaria among children with its attendant increase in under 5 mortality, various findings across the globe as well as this research have a convincing fact that malaria is equally a burden with a high prevalence amongst adults, especially, young adult within age range of 30 - 45 years.

Although malaria was present across all the studied months of the year, the most affected months were January, February, March and September with the highest prevalence in January 22.5% and the lowest in April with 4.2.%. Months like February and March also recorded reasonable spikes in frequency for both male and female patients. Studies done by Adefioye in 2007 and Nwagha (2009) have shown a higher seasonal prevalence of 72% in the months December/January between 2015 and 2020. More cases of malaria were previously recorded between April and September [6] [13] , in Ebonyi by Joseph et al. In another study by Andrew et al., on spatial pattern of malaria affectation in Nigeria, the recorded highest periods were in the months of January, February, March, October, November and December in Ebonyi state as well. Other months like April, May, June, July and August and September also have their own fair share of the frequencies that are worthy of note [6] - [10] . It is, therefore, safe to conclude that due to the endemicity of malaria in Nigeria and Southeast region especially Ebonyi state, malaria parasite infection can occur in any month of the year. This knowledge is necessary for prevention and planning for prevention and other relevant public health purposes.

In most studies, malaria is characteristically common among females. Malaria is a known deadly disease among pregnant women. For instance, in a study done in Enugu State, by Enoch and Priscilla (2015) a prevalence of 40.6% was shown among females [11] – a prevalence much higher than that of males. Similarly, the present study has shown a higher prevalence of malaria among female patients, with a value as high as 61.9% (297), while 38.1% (183) was found in males.

The cause of the high prevalence of malaria in female patients is equally generally unknown.

However, malaria is characteristically high among pregnant women and as some studies have suggested, a possible reason for the increased risk could be due to the increased attractiveness of pregnant women to mosquitoes, as suggested by Nwagha et al., 2010 [7] . They also noted that cellular immune response changes believed to result from the increased level of circulating maternal steroids in pregnancy could also be a factor, which makes pregnant women attract twice the number of anopheles mosquitoes compared to their non-pregnant counterparts [14] .

Of all the variables tested, only the period, age group and gender showed significant associations with malaria prevalence. However, other sociodemographic factors such as—patient’s pregnancy-status, lifestyle, and even occupation and educational status—are also important and relevant variables which could also be compared.

The results of this study suggest that malaria prevalence amongst febrile patients attending David Umahi Teaching Hospital from September 2023 to April 2024 was higher amongst female patients; and amongst patients within the age group 31 - 40 years, while the disease burden was highest in the month of January 2024. It is recommended that a malaria surveillance unit which will help standardize data collection and monitoring of malaria patients in the hospital, be established, while Molecular Malaria Surveillance (MMS) also needs to be introduced in teaching hospitals in Nigeria and in Southeast hospitals, in line with international best practices.

There is need to step up efforts in malaria surveillance, through the establishment of a dedicated malaria surveillance unit across teaching hospitals in Nigeria including David Umahi Federal University Teaching Hospital Uburu. This will help to standardize data collection and monitoring of malaria patients, which is in line with international best practices.

In addition, since according to the World Health Organisation, the highest malaria burden is now found in those countries with the weakest malaria surveillance [15] , there may be a need to also introduce Molecular Malaria Surveillance (MMS) in the hospitals. This is more so because, according to a recent report from the U.S. President’s Malaria Initiative for Nigeria, more robust malaria surveillance systems have been known to help countries design effective health interventions and evaluate the impact of their malaria control programs [16] .

The authors are grateful to the management of David Umahi Federal University Teaching Hospital, Uburu, for granting approval to conduct this research.