Background: In Ethiopia, malaria has declined in the last decade; only a small number of cases have been reported, primarily from hotspots. The contribution of house proximity to water bodies and the role of migration in malaria transmission has not yet been examined in detail in northwest Ethiopia. Individual and household-level environmental and socio-demographic drivers of malaria heterogeneity were explored contextually in meso-endemic villages around Lake Tana, northwest Ethiopia.

Methods: A health facility-based paired age-sex matched case–control study involving 303 matched pairs was undertaken from 10 October 2016, to 30 June 2017. Geo-referencing of case households, control households, proximate water bodies, and health centres was carried out. A pretested and structured questionnaire was used to collect data on socio-demography, household assets, housing, travel history, and malaria intervention measures. Medians (interquartile range) were computed for continuous variables. Pearson’s Chi square/Fisher’s exact test was used to detect significant differences in proportions. Principal component analysis was performed to estimate household wealth. Stratified analysis was used to confirm confounding and interaction. A multivariable conditional logistic regression model was used to detect risk factors for malaria.

Results: Of 303 malaria cases, 59 (19.5% [15.4–24.3]) were imported malaria cases whereas 244 (80.5% [75.7–84.6]) were locally acquired malaria cases. In bivariate analysis, marital status, educational status, and bed net ownership were significantly associated with malaria cases. In multivariable adjustment, travel to malarious lowlands in the preceding month (adjusted mOR=7.32; 95% CI 2.40–22.34), household member’s travel to malarious lowlands (adjusted mOR=2.75; 95% CI 1.02–7.44), and inadequate health information on malaria (adjusted mOR=1.57; 95% CI 1.03–2.41) were predictors of malaria. Stratified analysis confirmed that elevation of households and travel to malarious lowlands were not effect modifiers. Travel to malarious lowlands had a confounding effect on malaria but elevation of households did not.

Conclusions: In this study, travel to farms in the lowlands and inadequate health information on malaria were risk factors for malaria in villages around Lake Tana. This evidence is critical for the design of improved strategic interventions that consider imported malaria cases and approaches for accessing health information on malaria control in northwest Ethiopia.

Keywords: Locally acquired malaria, Malaria information, Travel, Matched case–control study