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Background  Measures of malaria burden using microscopy and rapid diagnostic tests (RDTs) in cross-sectional household surveys may incompletely describe the burden of malaria in low-transmission settings. This study describes the pattern of malaria transmission in Ethiopia using serological antibody estimates derived from a nationwide household survey completed in 2015.    Methods  Dried blood spot (DBS) samples were collected during the Ethiopian Malaria Indicator Survey in 2015 from malarious areas across Ethiopia. Samples were analysed using bead-based multiplex assays for IgG antibodies for six  Plasmodium  antigens: four human malaria species-specific merozoite surface protein-1 19kD antigens (MSP-1) and Apical Membrane Antigen-1 (AMA-1) for  Plasmodium falciparum  and  Plasmodium vivax . Seroprevalence was estimated by age, elevation and region. The seroconversion rate was estimated using a reversible catalytic model fitted with maximum likelihood methods.    Results  Of the 10,278 DBS samples available, 93.6% (9622/10,278) had valid serological results. The mean age of participants was 15.8 years and 53.3% were female. National seroprevalence for antibodies to  P. falciparum  was 32.1% (95% confidence interval (CI) 29.8–34.4) and 25.0% (95% CI 22.7–27.3) to  P. vivax . Estimated seroprevalences for  Plasmodium malariae  and  Plasmodium ovale  were 8.6% (95% CI 7.6–9.7) and 3.1% (95% CI 2.5–3.8), respectively. For  P. falciparum  seroprevalence estimates were significantly higher at lower elevations (< 2000 m) compared to higher (2000–2500 m) (aOR 4.4; p < 0.01). Among regions,  P. falciparum  seroprevalence ranged from 11.0% (95% CI 8.8–13.7) in Somali to 65.0% (95% CI 58.0–71.4) in Gambela Region and for  P. vivax  from 4.0% (95% CI 2.6–6.2) in Somali to 36.7% (95% CI 30.0–44.1) in Amhara Region. Models fitted to measure seroconversion rates showed variation nationally and by elevation, region, antigen type, and within species.    Conclusion  Using multiplex serology assays, this study explored the cumulative malaria burden and regional dynamics of the four human malarias in Ethiopia. High malaria burden was observed in the northwest compared to the east. High transmission in the Gambela and Benishangul-Gumuz Regions and the neglected presence of  P. malariae  and  P. ovale  may require programmatic attention. The use of a multiplex assay for antibody detection in low transmission settings has the potential to act as a more sensitive biomarker.    Electronic supplementary material  The online version of this article (10.1186/s12936-019-2874-z) contains supplementary material, which is available to authorized users.

Multiplex serology demonstrate cumulative prevalence and spatial distribution of malaria in Ethiopia