Analysis of Malaria Surveillance Data in the Southwest Ethiopia Peoples' Regional State, 2018-2024

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We analyzed malaria surveillance data to describe its distribution and to provide insights to support public health planning and decision-making. Method We conducted a cross-sectional study design to analyze six-year malaria surveillance data from 2018 to 2024 in the Southwest Ethiopia Peoples' Regional State (SWEPRS). The malaria data were collected from regional Public Health Institute database, cleaned, compiled and analyzed using Microsoft Excel 19. Results During 2018–2024, a total of 3,888,670 suspected fever cases were tested for malaria, of which 2,117,347 (54.4%) were treated and 2,085,824 were parasitologically confirmed (slide positivity rate: 53.6%). Among confirmed cases, PF accounted for 64.3%. Malaria case fatality rate was 0.03% and a mortality rate of 26.3 per 1,000,000 population. Malaria incidence increased markedly from 2018 to 2024, with incidence of 12.1 to 274.7 per 1,000 population respectively. The overall incidence of malaria in the region was 92.6 cases per 1,000 population. Bench Sheko zones reported the highest number of cases, while Konta zone had the highest incidence (170.1 per 1,000 population). The peak month were August followed-by June, whereas the peak week were epi-week 27. Conclusion Malaria remains a major and increasing public health burden in SWEPRS, characterized by a sharp rise in incidence from 2018 to 2024, predominance of PF, and marked spatial and seasonal variations. Strengthening malaria prevention and control measures, surveillance, and targeting high-burden districts and peak transmission seasons are essential to reduce malaria morbidity and mortality in the region. Malaria Surveillance Data Analysis incidence trend Ethiopia Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Malaria is a life-threatening disease caused by Plasmodium parasites, transmitted by infected female Anopheles mosquitoes ( 1 ). Malaria cause high levels of cases and death in the world. Globally in 2022, there were an estimated 249 million malaria cases and 608,000 deaths occurred where African accounted for about 93.6% of malaria cases and 95.4% of malaria deaths; Followed by South-East Asia by 2% of malaria cases and deaths and the rest World Health Organization (WHO) Regions shares the remaining malaria cases and deaths ( 2 ). Sub-Saharan Africa accounted the heaviest burden of malaria infection. Persistent endemic transmission across sub-Saharan Africa is common where Anopheles mosquito vectors and favorable climatic conditions support sustained malaria transmission ( 3 ). Seasonal peaks often follow rainy seasons, and transmission intensity varies with altitude and rainfall patterns ( 3 , 4 ). In Ethiopia between 2010 and 2019, malaria cases decreased from 3.8 million to 993,999 and malaria deaths decreased from 261 to 132 ( 5 ). However, the number of malaria cases and deaths in Ethiopia rose to 1.6 million and 180 respectively in 2022 ( 6 ). About 75% of the country's land is favorable for malaria breeding and Around 52% of population resides in this malarious area ( 7 , 8 ). In Ethiopia, PF and PV were the two most common plasmodium species, with frequencies of 70% and 30%, respectively, with varying proportions from location to location and season to season ( 9 , 10 ) In Ethiopia, malaria transmission mainly occurs below 2000 meters and occasionally up to 2300 meters, with unstable epidemics posing public health emergencies. Transmission varies seasonally, peaking between July and September, though the south and southwest parts of Ethiopia experience undefined rainfall seasons conducive to year-round breeding. Despite community-based interventions like indoor residual spraying, insecticide-treated bed nets, and improved diagnosis and treatment, malaria incidence is significantly increasing ( 11 , 12 ). The SWEPRS is a newly established region where malaria surveillance data analysis has not been previously conducted. Such analysis is essential for early detection of case surges, monitoring trends, and evaluating control program effectiveness within the public health surveillance system. The aim of this surveillance data analysis (2018–2023) was to assess the burden, distribution and trends of malaria and to identify gaps for public health planning and further study in southwest Ethiopia regional state. Methods Study area The study was conducted in Southwest Ethiopia Peoples’ Regional State (SWEPRS), located approximately 531 km southwest of Addis Ababa. The region borders Oromia and Central Ethiopia regions in the north, Southern Ethiopia in the east and south, and Gambella and South Sudan in the west. The region was established as the 11th regional state of the Federal Democratic Republic of Ethiopia in Nov.2021 with 6 Zonal structures and 57 woredas. As its name indicates, the region is located in South Western Ethiopia. Of the 57 total woredas, (33 agrarian, 8 pastoralists and sixteen are administrative Towns). SWEPRS has an estimated population of 3,400,012 million, of which 2,958,010 rural and 442,002 are urban, with 47% of the population being under the age of 15 years. The total area of the region is about 39,400 km2. The region is found at a latitude of 4°52’N- 8°47’N and longitude of 34°85’-38°71'E and altitude of 300–4200 meters above sea level. Study design and period A descriptive cross-sectional study was conducted using routine malaria surveillance data collected between January 2018 and December 2024. Data analysis was performed from February to April 2025. Data source The study used secondary malaria surveillance data obtained from the Public Health Emergency Management (PHEM) database of the Southwest Ethiopia Peoples’ Regional State Public Health Institute. Source population included all individuals who sought malaria testing in public and private health facilities in SWEPRS during the study period. Study population - consisted of all reported malaria cases recorded in the surveillance database between 2018 and 2024. Sample size and sampling technique A complete enumeration approach was used. All malaria cases reported during the study period were included in the analysis. Inclusion and exclusion criteria All confirmed and clinical malaria cases reported during the study period were included. Records with missing or duplicate data were excluded. Data collection method: - First, an official letter was issued from Addis Ababa University to the SWEPRS-PHI. Subsequently, permission was obtained from the Director General of Public Health Institute. Secondary weekly malaria surveillance data for the period 2018–2024 were then obtained from the SWEPRS-PHI database, reviewed, filtered, and used for analysis. Data quality control, processing and analysis Before analysis, the dataset was examined to verify completeness and consistency. Data verification and validation were carried out by a team of analysts at several points during the analytical process. Descriptive summaries were produced and presented using tables and graphical representations. Data cleaning, entry into Microsoft Excel, and analytical procedures were undertaken to enhance the accuracy, reliability, and overall quality of the data compiled from the weekly malaria surveillance report spreadsheets. Dissemination of results Results of this malaria surveillance data analysis were summited to AAU College of Health Science /School of Public Health and SWEPRS-PHI. Results Data Analysis by person Malaria Morbidity and Mortality Over the seven years period, total number of 3,888,670 Suspected Fever cases examined for malaria and about 2,117,347(54.4%) cases treated for malaria. Of treated 2,085,824 cases were parasitological confirmed with slide positivity rate of (53.6%). Of confirmed cases, PF accounted for 64.3%, PV for 32.3%, and while the remainder mixed malaria infections. Out of treated malaria cases, about 2,078,991 (98.2%) cases treated at outpatient and 38,357 (1.8%) at inpatient. A total of 601 malaria-related deaths were reported during the study period, corresponding to a case fatality rate of 0.03% and a mortality rate of 26.3 per 1,000,000 population. Trends of Malaria cases and incidence Malaria cases increased dramatically over the study period. The number of cases rose from 34,907 in 2018 to 1,108,570 in 2024. Similarly, malaria incidence increased from 12.1 per 1,000 population in 2018 to 274.7 per 1,000 population in 2024. The overall malaria incidence during the seven-year period was 92.6 cases per 1,000 population. The incidence of P. falciparum increased from 6.8 per 1,000 population in 2018 to 170.4 per 1,000 population in 2024 (Table 1 ). Table 1 total malaria cases and incidence by species types for the period 2018–2024, SWEPRS, Ethiopia, 2025 years total population by year (a) Total Malaria cases (b) Incidence of malaria per population (b/a*1000) Number of PF* cases (d) Incidence of PF malaria per population (d/a*1000) Number of PV** cases (e) Incidence of pv malaria per population (e/a*1000) 2018 2,891,222 34,907 12.1 19,701 6.8 14,918 5.2 2019 2,986,491 47,916 16.0 29,445 9.9 18,222 6.1 2020 3,084,898 57,356 18.6 47,215 15.3 9,992 3.2 2021 3,186,551 81,000 25.4 64,237 20.2 16,406 5.1 2022 3,291,550 272,155 82.7 173,694 52.8 97,270 29.6 2023 3,400,012 515,443 151.6 319,972 94.1 178,882 52.6 2024 4,035,688 1,108,570 274.7 687,799 170.4 337,910 83.7 Grand Total 22,876,412 2,117,347 92.6 1,342,064 58.7 673,600 29.4 * plasmodium falsiparum , ** plasmodium vivax Data analysis by place Distribution of malaria cases and incidence by place Bench Sheko Zone reported the highest number of malaria cases (568,592), followed by Dawuro (467,360) and Kaffa (387,463). In contrast, Konta Zone reported the lowest number of cases (152,238) but had the highest malaria incidence (170.1 per 1,000 population) while Kaffa Zone had the lowest incidence (45.9 per 1,000 population). Sheka and West Omo zones reported intermediate case numbers but relatively high incidence rates of 130.8 and 148.1 per 1,000 population (Fig. 1 ). Trends of Malaria by Zone in each Year Overall, malaria incidence remained relatively lower in all zones between 2018 and 2021. From 2022 onward, a marked increase in malaria incidence is observed across all zones. The rise became more pronounced in 2023 and peaked in 2024 (Fig. 2 ). Top-20 District level distribution of malaria cases and incidence per 1,000 population Among top-20 Districts, Mizan Aman Town (101,426) followed by Gurafarda (78,869), Loma Bossa (73,234), and Tarcha Zuriya (62,374) reported relatively high numbers of malaria cases. However, Jemu Town experienced the highest malaria incidence of 434 cases per 1000 populations followed by Bero district (344 cases per 1000 populations), Tarcha Town (308 cases per 1000 populations) and Chida Town (305 cases per 1000 populations) (Fig. 3 ). Data Analysis by Time Trends of malaria transmission by month Malaria transmission showed a clear seasonal pattern. Cases were relatively low between January and March, increased gradually from April, and peaked during June and August. Transmission remained moderately high during October and November before declining toward the end of the year (Fig. 4 , 5 ). Trends of malaria by epidemiological weeks In all years, malaria transmission follows a similar temporal pattern, with relatively low case numbers during the early epi-weeks (approximately weeks 1–12), followed by a gradual increase beginning around weeks 15–18 and reaching peak levels during the main malaria transmission season. The year 2024 experienced a substantially higher malaria burden than all previous years throughout all epi-weeks. A sharp rise is observed from around week 20, culminating in a pronounced peak between weeks 26 and 28, after which cases declined but remained persistently higher than all previous years (Fig. 6 ). Discussion In this malaria surveillance data analysis result, among suspected fever cases screened for malaria, about 54.4%, which is much higher than a Study conducted in Thailand-Myanmar border (11%) ( 13 ), Amhara (11.03%) ( 14 ), SNNPRS (16.1%) ( 15 ), Oromia special zone in Amhara (12.5%) ( 16 ), Oromia region (12%) ( 17 ), kaffa zone 13.6% ( 18 ), Bale (17.6%) ( 12 ), zukuala district 31.1% ( 19 ) and Menge district 38.9% ( 20 ) but lower than Kaduna state in Nigeria ( 21 ). This may be due to most areas in SWEPRS are malaria endemic, with multiple favorable breeding sites that facilitate intense malaria transmission. It may also reflect appropriate malaria testing practices in health facilities, where health workers prioritize testing individuals with strong clinical suspicion according to national malaria guidelines. The mortality rate of this study is 26.3/1,000,000 population, which is lower than worldwide report malaria deaths ( 22 ). The case fatality rate of this result is CFR of 0.03%, which is lower than study conducted in SNNPR with CFR of 2.1%, India 1.27% ( 23 ) and higher than study conducted in Benishangul Gumuz with CFR of 0.013% ( 20 ). This may be due to better health seeking behavior compared to SNNPR and delayed treatment compared to that of Menge district that lead to disease complications and ultimately increase the risk of death. This result showed among parasitologically confirmed malaria cases, PF accounted for 64.3% while PV 32.3%, which is comparable to a Study in SNNPRS ( 15 ), west shewa zone ( 24 ) and that of zukuala district ( 19 ) but different from study in Bale zone ( 12 ) and Amhara region ( 14 ). The observed variation may be due most of the SWEPRS areas are lower altitude and warmer climate where PF dominates whereas P. vivax is relatively more common in areas of cooler and higher altitude due to its ability to form dormant liver stages that can relapse even under less favorable transmission conditions. This data analysis indicated a substantial increase in malaria incidence across the years, rising from 12 cases per 1,000 population at risk in 2018 to 274.7 per 1,000 in 2024. This finding is higher than the studies from the Amhara Region ( 14 ), West Shewa ( 24 ), West Wellega ( 1 ), urban settings in Ethiopia ( 25 ), and Oromia ( 17 ). The higher incidence may be attributed to the presence of suitable malaria breeding sites, such as stagnant water and swampy areas, along with warmer climatic conditions in SWEPRS. Additionally, The Region is a new region and faces shortages of malaria control resources, such as IRS chemicals and financial support. Although Bench sheko and Dawuro zone reported the highest number of malaria cases; Konta, followed by West Omo Zone, showed the highest malaria incidence. These findings are higher than World Malaria Report 2023 ( 2 ), study in Ethiopia ( 4 ), North Shewa ( 26 ) and SNNPRS ( 15 ). This may be due to the predominance of lowland and warmer environments in Konta Zone, which favor mosquito breeding. Furthermore, many communities in West Omo are pastoralists and frequently move from place to place within the zone, making malaria control measures implementation more challenging. Similarly, marked spatial differences in malaria burden across districts in SWEPRS. Mizan Aman Town, Gurafarda, Loma Bossa and Tarcha Zuriya District reported the highest numbers of malaria cases, while the highest incidence rates were observed in Jemu Town, Bero District, Tarcha and Chida Town. The difference between numbers of malaria case and incidence rates may be explained by variations in population size and malaria transmission intensity. Similar spatial variations in malaria distribution have been reported in Ethiopia and other countries, where environmental factors such as rainfall, humidity, temperature, altitude, and the presence of vector breeding sites influence transmission intensity ( 23 , 26 – 28 ). This data analysis showed a clear seasonal pattern, with malaria transmission increasing from April and peaking in June and August. This pattern is consistent with previous studies conducted in Ethiopia and India, which showed that malaria transmission typically peaks following the rainy season due to increased mosquito breeding sites and favorable climatic conditions for vector survival ( 1 , 12 , 14 , 29 , 30 ). The persistence of moderate transmission during October and November also aligns with the major transmission season documented in Ethiopia ( 8 ). Malaria transmission exhibited consistent seasonal pattern across all years of the study period. Malaria Case remained relatively low during the early epidemiological weeks ( 1 – 12 ). However, gradual increase was observed starting around epi-weeks 15–18, eventually reaching peak levels during the main malaria transmission season. The observed seasonal pattern is consistent with previous studies in Ethiopia and other countries ( 17 , 26 , 28 , 29 , 31 ) where transmission high following the rainy season due to increased malaria vector breeding. This temporal trend likely reflects the influence of climatic and environmental factors, which create favorable breeding conditions for Anopheles mosquitoes and subsequently enhance malaria transmission variability. Limitations of the Study This surveillance data lacks personal variables such as age, sex and pregnancy status so unable to analyze with this variables. Conclusion Malaria remains a major and increasing public health burden in SWEPRS, characterized by a sharp rise in incidence from 2018 to 2024, predominance of PF, and marked spatial and seasonal variations. Strengthening malaria prevention and control measures, surveillance, and targeting high-burden districts and peak transmission seasons are essential to reduce malaria morbidity and mortality in the region. Recommendation Based on the surveillance data analysis we would like to recommend the following points to EPHI, SWEPRS-PHI and other respective stakeholders. Malaria prevention and vector control measures should be strengthened in the region. Malaria surveillance and early response systems should also be enhanced to closely monitor the increasing incidence and ensure timely detection of outbreaks. In addition, targeted seasonal malaria interventions should be implemented before the main transmission period. Better to include key variables like age, sex and pregnancy in surveillance data for detail analysis. Abbreviations AAU Addis Ababa University CFR Case Fatality Rate IRS Indoor Residual Spraying PF Plasmodium falciparum PHEM Public Health Emergency Management PV Plasmodium vivax SNNPRS Southern Nation Nationalities People Regional State SWEPRS Southwest Ethiopia Peoples' Regional State SWEPRS-PHI Southwest Ethiopia Peoples' Regional State Public Health Institute Declarations Ethical approval and consent to participate Ethical clearance was obtained from Addis Ababa University through a formal support letter submitted to the SWEPRS-PHI and the PHEM Directorate, and official permission was granted by the PHEM Director to access and analyze malaria surveillance data. Surveillance officers and relevant health professionals were informed about the study objectives to facilitate cooperation during data collection and analysis. As the study used secondary malaria surveillance data with no direct contact with human participants, informed consent was not required. All data were anonymized before analysis, confidentiality was strictly maintained, and all methods were conducted in accordance with national public health research guidelines and Regulations. Consent for publication Not applicable Clinical trial number Not applicable. Competing interests: The authors declare no competing interests. Funding No funding Author Contribution AM designed the study, carried-out the statistical analysis, and drafted the manuscript. GT, MG, AA, TT, EK and EZ critically reviewed the manuscript for important intellectual content and provided technical guidance on the statistical analysis. All authors read and approved the final manuscript. Acknowledgement The authors would like to express their sincere gratitude to the SWEPRS-PHI and its staff for their kind cooperation in providing the necessary data. We also acknowledge the support received from the AAU Department of Epidemiology and Biostatistics and the Ethiopian Field Epidemiology and Laboratory Training Program. Data Availability All relevant data are included within the manuscript. Additional data supporting the findings of this study are available from the corresponding author upon reasonable request. References Tesfaye S, Yesuf A. Trend analysis of malaria surveillance data in West Wallaga, West Oromia, Ethiopia: a framework for planning and elimination. Malar J. 2024;23(1):1–8. World Health Organization. World Malaria Report. Vol. WHO/HTM/GM, World Health Organization. 2023. 238 p. Ltd, EL on behalf of IPG. Increasing challenges of malaria control in sub-Saharan Africa: Priorities for public health research and policymakers. 2022;81(July). Dabaro D, Birhanu Z, Negash A, Hawaria D, Yewhalaw D. Effects of rainfall, temperature and topography on malaria incidence in elimination targeted district of Ethiopia. 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Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 Apr, 2026 Reviewers invited by journal 31 Mar, 2026 Editor invited by journal 30 Mar, 2026 Editor assigned by journal 28 Mar, 2026 Submission checks completed at journal 28 Mar, 2026 First submitted to journal 25 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9219157","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":615058472,"identity":"6d70d1c9-0abf-4979-9899-efcb47fd3885","order_by":0,"name":"Ayele 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06:53:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9219157/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9219157/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106070611,"identity":"a0f84029-5cdd-4320-9617-0118d1b9f6f3","added_by":"auto","created_at":"2026-04-03 06:28:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74841,"visible":true,"origin":"","legend":"\u003cp\u003eAggregate distribution of malaria cases and incidence by zones for the period 2018–2024, SWEPRS, 2025\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9219157/v1/d75dbf05d53e6bed0d04e5b6.png"},{"id":106414670,"identity":"373b76ee-0943-4f1f-9bff-46c76a9370b9","added_by":"auto","created_at":"2026-04-08 10:21:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":65042,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eYearly trends of malaria incidence rate by zones from 2018-2024 periods, SWEPRS, 2025\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9219157/v1/68aa8e10403b9950f31684cb.png"},{"id":106070612,"identity":"373d3da4-5fba-4ab9-888e-cf8bef7091ae","added_by":"auto","created_at":"2026-04-03 06:28:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":103555,"visible":true,"origin":"","legend":"\u003cp\u003eShowing Top-20 District level distribution of malaria cases and incidence from 2018-2024, SWEPRS, 2025\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9219157/v1/39c688d414aa050e0dcb85a8.png"},{"id":106095386,"identity":"44cc286d-3734-415f-9af5-a85baee65bbc","added_by":"auto","created_at":"2026-04-03 11:47:47","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":74118,"visible":true,"origin":"","legend":"\u003cp\u003eAggregate trends of malaria cases by months from 2018-2024 periods in SWEPRS, Ethiopia, 2025\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9219157/v1/cb5217ad873216d32555e198.png"},{"id":106070614,"identity":"a7a40081-3c10-4d6c-bbf5-cd966aaa4ca0","added_by":"auto","created_at":"2026-04-03 06:28:54","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":80828,"visible":true,"origin":"","legend":"\u003cp\u003eYearly trends of malaria cases by months from 2018-2024 periods in SWEPRS, Ethiopia, 2025\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-9219157/v1/3721c90ae97475ba6fb06f69.png"},{"id":106070616,"identity":"80e9b9e5-0907-417c-83ed-1c5d5953e62d","added_by":"auto","created_at":"2026-04-03 06:28:54","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":68875,"visible":true,"origin":"","legend":"\u003cp\u003eYearly trends of malaria cases by WHO epi-weeks in the 2018-2024 periods SWEPRS, Ethiopia, 2025\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-9219157/v1/c71ee40c1e337cda2c1bff36.png"},{"id":106416171,"identity":"445b7dba-7e88-4973-a6b0-02767b6dbdd5","added_by":"auto","created_at":"2026-04-08 10:43:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1205096,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9219157/v1/456c2d78-5483-4f78-95f0-dda20061c4c4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of Malaria Surveillance Data in the Southwest Ethiopia Peoples' Regional State, 2018-2024","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalaria is a life-threatening disease caused by Plasmodium parasites, transmitted by infected female Anopheles mosquitoes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Malaria cause high levels of cases and death in the world. Globally in 2022, there were an estimated 249\u0026nbsp;million malaria cases and 608,000 deaths occurred where African accounted for about 93.6% of malaria cases and 95.4% of malaria deaths; Followed by South-East Asia by 2% of malaria cases and deaths and the rest World Health Organization (WHO) Regions shares the remaining malaria cases and deaths (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Sub-Saharan Africa accounted the heaviest burden of malaria infection. Persistent endemic transmission across sub-Saharan Africa is common where \u003cem\u003eAnopheles\u003c/em\u003e mosquito vectors and favorable climatic conditions support sustained malaria transmission (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Seasonal peaks often follow rainy seasons, and transmission intensity varies with altitude and rainfall patterns (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Ethiopia between 2010 and 2019, malaria cases decreased from 3.8\u0026nbsp;million to 993,999 and malaria deaths decreased from 261 to 132 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, the number of malaria cases and deaths in Ethiopia rose to 1.6\u0026nbsp;million and 180 respectively in 2022 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). About 75% of the country's land is favorable for malaria breeding and Around 52% of population resides in this malarious area (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In Ethiopia, PF and PV were the two most common plasmodium species, with frequencies of 70% and 30%, respectively, with varying proportions from location to location and season to season (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn Ethiopia, malaria transmission mainly occurs below 2000 meters and occasionally up to 2300 meters, with unstable epidemics posing public health emergencies. Transmission varies seasonally, peaking between July and September, though the south and southwest parts of Ethiopia experience undefined rainfall seasons conducive to year-round breeding. Despite community-based interventions like indoor residual spraying, insecticide-treated bed nets, and improved diagnosis and treatment, malaria incidence is significantly increasing (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe SWEPRS is a newly established region where malaria surveillance data analysis has not been previously conducted. Such analysis is essential for early detection of case surges, monitoring trends, and evaluating control program effectiveness within the public health surveillance system. The aim of this surveillance data analysis (2018\u0026ndash;2023) was to assess the burden, distribution and trends of malaria and to identify gaps for public health planning and further study in southwest Ethiopia regional state.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area\u003c/h2\u003e \u003cp\u003eThe study was conducted in Southwest Ethiopia Peoples\u0026rsquo; Regional State (SWEPRS), located approximately 531 km southwest of Addis Ababa. The region borders Oromia and Central Ethiopia regions in the north, Southern Ethiopia in the east and south, and Gambella and South Sudan in the west. The region was established as the 11th regional state of the Federal Democratic Republic of Ethiopia in Nov.2021 with 6 Zonal structures and 57 woredas. As its name indicates, the region is located in South Western Ethiopia. Of the 57 total woredas, (33 agrarian, 8 pastoralists and sixteen are administrative Towns). SWEPRS has an estimated population of 3,400,012\u0026nbsp;million, of which 2,958,010 rural and 442,002 are urban, with 47% of the population being under the age of 15 years. The total area of the region is about 39,400 km2. The region is found at a latitude of 4\u0026deg;52\u0026rsquo;N- 8\u0026deg;47\u0026rsquo;N and longitude of 34\u0026deg;85\u0026rsquo;-38\u0026deg;71'E and altitude of 300\u0026ndash;4200 meters above sea level.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design and period\u003c/h3\u003e\n\u003cp\u003eA descriptive cross-sectional study was conducted using routine malaria surveillance data collected between January 2018 and December 2024. Data analysis was performed from February to April 2025.\u003c/p\u003e\n\u003ch3\u003eData source\u003c/h3\u003e\n\u003cp\u003eThe study used secondary malaria surveillance data obtained from the Public Health Emergency Management (PHEM) database of the Southwest Ethiopia Peoples\u0026rsquo; Regional State Public Health Institute.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSource population\u003c/strong\u003e \u003cp\u003eincluded all individuals who sought malaria testing in public and private health facilities in SWEPRS during the study period.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy population\u003c/strong\u003e \u003cp\u003e- consisted of all reported malaria cases recorded in the surveillance database between 2018 and 2024.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eSample size and sampling technique\u003c/h3\u003e\n\u003cp\u003eA complete enumeration approach was used. All malaria cases reported during the study period were included in the analysis.\u003c/p\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eAll confirmed and clinical malaria cases reported during the study period were included. Records with missing or duplicate data were excluded.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection method: -\u003c/b\u003e First, an official letter was issued from Addis Ababa University to the SWEPRS-PHI. Subsequently, permission was obtained from the Director General of Public Health Institute. Secondary weekly malaria surveillance data for the period 2018\u0026ndash;2024 were then obtained from the SWEPRS-PHI database, reviewed, filtered, and used for analysis.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData quality control, processing and analysis\u003c/h2\u003e \u003cp\u003eBefore analysis, the dataset was examined to verify completeness and consistency. Data verification and validation were carried out by a team of analysts at several points during the analytical process. Descriptive summaries were produced and presented using tables and graphical representations. Data cleaning, entry into Microsoft Excel, and analytical procedures were undertaken to enhance the accuracy, reliability, and overall quality of the data compiled from the weekly malaria surveillance report spreadsheets.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDissemination of results\u003c/h3\u003e\n\u003cp\u003eResults of this malaria surveillance data analysis were summited to AAU College of Health Science /School of Public Health and SWEPRS-PHI.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis by person\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eMalaria Morbidity and Mortality\u003c/h2\u003e \u003cp\u003eOver the seven years period, total number of 3,888,670 Suspected Fever cases examined for malaria and about 2,117,347(54.4%) cases treated for malaria. Of treated 2,085,824 cases were parasitological confirmed with slide positivity rate of (53.6%). Of confirmed cases, \u003cem\u003ePF\u003c/em\u003e accounted for 64.3%, \u003cem\u003ePV\u003c/em\u003e for 32.3%, and while the remainder mixed malaria infections. Out of treated malaria cases, about 2,078,991 (98.2%) cases treated at outpatient and 38,357 (1.8%) at inpatient. A total of 601 malaria-related deaths were reported during the study period, corresponding to a case fatality rate of 0.03% and a mortality rate of 26.3 per 1,000,000 population.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTrends of Malaria cases and incidence\u003c/h2\u003e \u003cp\u003eMalaria cases increased dramatically over the study period. The number of cases rose from 34,907 in 2018 to 1,108,570 in 2024. Similarly, malaria incidence increased from 12.1 per 1,000 population in 2018 to 274.7 per 1,000 population in 2024. The overall malaria incidence during the seven-year period was 92.6 cases per 1,000 population. The incidence of \u003cem\u003eP. falciparum\u003c/em\u003e increased from 6.8 per 1,000 population in 2018 to 170.4 per 1,000 population in 2024 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003etotal malaria cases and incidence by species types for the period 2018\u0026ndash;2024, SWEPRS, Ethiopia, 2025\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyears\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003etotal population by year (a)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal Malaria cases (b)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncidence of malaria per population (b/a*1000)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNumber of PF* cases (d)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncidence of PF malaria per population (d/a*1000)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNumber of PV** cases (e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIncidence of pv malaria per population (e/a*1000)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,891,222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34,907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e 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align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9,992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,186,551\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e64,237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e16,406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,291,550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272,155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e173,694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e97,270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,400,012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e515,443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e151.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e319,972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e94.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e178,882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,035,688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,108,570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e274.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e687,799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e170.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e337,910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e83.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrand Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22,876,412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,117,347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,342,064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e673,600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*\u003cem\u003eplasmodium falsiparum\u003c/em\u003e, ** \u003cem\u003eplasmodium vivax\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData analysis by place\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eDistribution of malaria cases and incidence by place\u003c/h2\u003e \u003cp\u003eBench Sheko Zone reported the highest number of malaria cases (568,592), followed by Dawuro (467,360) and Kaffa (387,463). In contrast, Konta Zone reported the lowest number of cases (152,238) but had the highest malaria incidence (170.1 per 1,000 population) while Kaffa Zone had the lowest incidence (45.9 per 1,000 population). Sheka and West Omo zones reported intermediate case numbers but relatively high incidence rates of 130.8 and 148.1 per 1,000 population (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTrends of Malaria by Zone in each Year\u003c/h2\u003e \u003cp\u003eOverall, malaria incidence remained relatively lower in all zones between 2018 and 2021. From 2022 onward, a marked increase in malaria incidence is observed across all zones. The rise became more pronounced in 2023 and peaked in 2024 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTop-20 District level distribution of malaria cases and incidence per 1,000 population\u003c/h2\u003e \u003cp\u003eAmong top-20 Districts, Mizan Aman Town (101,426) followed by Gurafarda (78,869), Loma Bossa (73,234), and Tarcha Zuriya (62,374) reported relatively high numbers of malaria cases. However, Jemu Town experienced the highest malaria incidence of 434 cases per 1000 populations followed by Bero district (344 cases per 1000 populations), Tarcha Town (308 cases per 1000 populations) and Chida Town (305 cases per 1000 populations) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis by Time\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003eTrends of malaria transmission by month\u003c/h2\u003e \u003cp\u003eMalaria transmission showed a clear seasonal pattern. Cases were relatively low between January and March, increased gradually from April, and peaked during June and August. Transmission remained moderately high during October and November before declining toward the end of the year (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTrends of malaria by epidemiological weeks\u003c/h2\u003e \u003cp\u003eIn all years, malaria transmission follows a similar temporal pattern, with relatively low case numbers during the early epi-weeks (approximately weeks 1\u0026ndash;12), followed by a gradual increase beginning around weeks 15\u0026ndash;18 and reaching peak levels during the main malaria transmission season. The year 2024 experienced a substantially higher malaria burden than all previous years throughout all epi-weeks. A sharp rise is observed from around week 20, culminating in a pronounced peak between weeks 26 and 28, after which cases declined but remained persistently higher than all previous years (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this malaria surveillance data analysis result, among suspected fever cases screened for malaria, about 54.4%, which is much higher than a Study conducted in Thailand-Myanmar border (11%) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Amhara (11.03%) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), SNNPRS (16.1%) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), Oromia special zone in Amhara (12.5%) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Oromia region (12%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), kaffa zone 13.6% (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), Bale (17.6%) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), zukuala district 31.1% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Menge district 38.9% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) but lower than Kaduna state in Nigeria (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This may be due to most areas in SWEPRS are malaria endemic, with multiple favorable breeding sites that facilitate intense malaria transmission. It may also reflect appropriate malaria testing practices in health facilities, where health workers prioritize testing individuals with strong clinical suspicion according to national malaria guidelines.\u003c/p\u003e \u003cp\u003eThe mortality rate of this study is 26.3/1,000,000 population, which is lower than worldwide report malaria deaths (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The case fatality rate of this result is CFR of 0.03%, which is lower than study conducted in SNNPR with CFR of 2.1%, India 1.27% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and higher than study conducted in Benishangul Gumuz with CFR of 0.013% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This may be due to better health seeking behavior compared to SNNPR and delayed treatment compared to that of Menge district that lead to disease complications and ultimately increase the risk of death.\u003c/p\u003e \u003cp\u003eThis result showed among parasitologically confirmed malaria cases, PF accounted for 64.3% while PV 32.3%, which is comparable to a Study in SNNPRS (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), west shewa zone (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and that of zukuala district (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) but different from study in Bale zone (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and Amhara region (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The observed variation may be due most of the SWEPRS areas are lower altitude and warmer climate where \u003cem\u003ePF dominates\u003c/em\u003e whereas \u003cem\u003eP. vivax\u003c/em\u003e is relatively more common in areas of cooler and higher altitude due to its ability to form dormant liver stages that can relapse even under less favorable transmission conditions.\u003c/p\u003e \u003cp\u003eThis data analysis indicated a substantial increase in malaria incidence across the years, rising from 12 cases per 1,000 population at risk in 2018 to 274.7 per 1,000 in 2024. This finding is higher than the studies from the Amhara Region (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), West Shewa (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), West Wellega (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), urban settings in Ethiopia (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), and Oromia (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The higher incidence may be attributed to the presence of suitable malaria breeding sites, such as stagnant water and swampy areas, along with warmer climatic conditions in SWEPRS. Additionally, The Region is a new region and faces shortages of malaria control resources, such as IRS chemicals and financial support.\u003c/p\u003e \u003cp\u003eAlthough Bench sheko and Dawuro zone reported the highest number of malaria cases; Konta, followed by West Omo Zone, showed the highest malaria incidence. These findings are higher than World Malaria Report 2023 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), study in Ethiopia (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), North Shewa (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and SNNPRS (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This may be due to the predominance of lowland and warmer environments in Konta Zone, which favor mosquito breeding. Furthermore, many communities in West Omo are pastoralists and frequently move from place to place within the zone, making malaria control measures implementation more challenging.\u003c/p\u003e \u003cp\u003eSimilarly, marked spatial differences in malaria burden across districts in SWEPRS. Mizan Aman Town, Gurafarda, Loma Bossa and Tarcha Zuriya District reported the highest numbers of malaria cases, while the highest incidence rates were observed in Jemu Town, Bero District, Tarcha and Chida Town. The difference between numbers of malaria case and incidence rates may be explained by variations in population size and malaria transmission intensity. Similar spatial variations in malaria distribution have been reported in Ethiopia and other countries, where environmental factors such as rainfall, humidity, temperature, altitude, and the presence of vector breeding sites influence transmission intensity (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis data analysis showed a clear seasonal pattern, with malaria transmission increasing from April and peaking in June and August. This pattern is consistent with previous studies conducted in Ethiopia and India, which showed that malaria transmission typically peaks following the rainy season due to increased mosquito breeding sites and favorable climatic conditions for vector survival (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The persistence of moderate transmission during October and November also aligns with the major transmission season documented in Ethiopia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMalaria transmission exhibited consistent seasonal pattern across all years of the study period. Malaria Case remained relatively low during the early epidemiological weeks (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, gradual increase was observed starting around epi-weeks 15\u0026ndash;18, eventually reaching peak levels during the main malaria transmission season. The observed seasonal pattern is consistent with previous studies in Ethiopia and other countries (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) where transmission high following the rainy season due to increased malaria vector breeding. This temporal trend likely reflects the influence of climatic and environmental factors, which create favorable breeding conditions for \u003cem\u003eAnopheles\u003c/em\u003e mosquitoes and subsequently enhance malaria transmission variability.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eThis surveillance data lacks personal variables such as age, sex and pregnancy status so unable to analyze with this variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMalaria remains a major and increasing public health burden in SWEPRS, characterized by a sharp rise in incidence from 2018 to 2024, predominance of PF, and marked spatial and seasonal variations. Strengthening malaria prevention and control measures, surveillance, and targeting high-burden districts and peak transmission seasons are essential to reduce malaria morbidity and mortality in the region.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eRecommendation\u003c/h2\u003e \u003cp\u003eBased on the surveillance data analysis we would like to recommend the following points to EPHI, SWEPRS-PHI and other respective stakeholders.\u003c/p\u003e \u003cp\u003eMalaria prevention and vector control measures should be strengthened in the region. Malaria surveillance and early response systems should also be enhanced to closely monitor the increasing incidence and ensure timely detection of outbreaks. In addition, targeted seasonal malaria interventions should be implemented before the main transmission period. Better to include key variables like age, sex and pregnancy in surveillance data for detail analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":" \u003cp\u003eAAU Addis Ababa University\u003c/p\u003e \u003cp\u003eCFR Case Fatality Rate\u003c/p\u003e \u003cp\u003eIRS Indoor Residual Spraying\u003c/p\u003e \u003cp\u003ePF Plasmodium falciparum\u003c/p\u003e \u003cp\u003ePHEM Public Health Emergency Management\u003c/p\u003e \u003cp\u003ePV Plasmodium vivax\u003c/p\u003e \u003cp\u003eSNNPRS Southern Nation Nationalities People Regional State\u003c/p\u003e \u003cp\u003eSWEPRS Southwest Ethiopia Peoples' Regional State\u003c/p\u003e \u003cp\u003eSWEPRS-PHI Southwest Ethiopia Peoples' Regional State Public Health Institute\u003c/p\u003e "},{"header":"Declarations","content":" \u003ch2\u003eEthical approval and consent to participate\u003c/h2\u003e \u003cp\u003eEthical clearance was obtained from Addis Ababa University through a formal support letter submitted to the SWEPRS-PHI and the PHEM Directorate, and official permission was granted by the PHEM Director to access and analyze malaria surveillance data. Surveillance officers and relevant health professionals were informed about the study objectives to facilitate cooperation during data collection and analysis. As the study used secondary malaria surveillance data with no direct contact with human participants, informed consent was not required. All data were anonymized before analysis, confidentiality was strictly maintained, and all methods were conducted in accordance with national public health research guidelines and Regulations.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAM designed the study, carried-out the statistical analysis, and drafted the manuscript. GT, MG, AA, TT, EK and EZ critically reviewed the manuscript for important intellectual content and provided technical guidance on the statistical analysis. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to express their sincere gratitude to the SWEPRS-PHI and its staff for their kind cooperation in providing the necessary data. We also acknowledge the support received from the AAU Department of Epidemiology and Biostatistics and the Ethiopian Field Epidemiology and Laboratory Training Program.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll relevant data are included within the manuscript. Additional data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTesfaye S, Yesuf A. Trend analysis of malaria surveillance data in West Wallaga, West Oromia, Ethiopia: a framework for planning and elimination. Malar J. 2024;23(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. World Malaria Report. Vol. WHO/HTM/GM, World Health Organization. 2023. 238 p.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLtd, EL on behalf of IPG. Increasing challenges of malaria control in sub-Saharan Africa: Priorities for public health research and policymakers. 2022;81(July).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDabaro D, Birhanu Z, Negash A, Hawaria D, Yewhalaw D. Effects of rainfall, temperature and topography on malaria incidence in elimination targeted district of Ethiopia. Malar J. 2021;1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalaria Operational Plan (MOP). U. S. PRESIDENT \u0026rsquo; S MALARIA INITIATIVE Ethiopia Malaria Operational Plan FY 2022. 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Trans R Soc Trop Med Hyg. 2025;119(July):1335\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNigussie TZ, Zewotir TT, Muluneh EK. Detection of temporal, spatial and spatiotemporal clustering of malaria incidence in northwest Ethiopia, 2012\u0026ndash;2020. Sci Rep. 2022;12(1):3635.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaniel Dansa Dana1, Tadele Shiwito Ango2* SG and WD. Retrospective analysis of malaria surveillance data in the former Southern Nations. Ethiopia: Nationalities, and peoples \u0026rsquo; region; 2025.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Malaria, Surveillance, Data Analysis, incidence trend, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-9219157/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9219157/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eMalaria is a major global health challenge caused by Plasmodium parasites, significantly affects Ethiopia, particularly the Southwest Ethiopia Peoples' Regional State Trend analysis of malaria data is crucial to comprehend patterns of transmission and implement appropriate malaria control measures. We analyzed malaria surveillance data to describe its distribution and to provide insights to support public health planning and decision-making.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study design to analyze six-year malaria surveillance data from 2018 to 2024 in the Southwest Ethiopia Peoples' Regional State (SWEPRS). The malaria data were collected from regional Public Health Institute database, cleaned, compiled and analyzed using Microsoft Excel 19.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDuring 2018\u0026ndash;2024, a total of 3,888,670 suspected fever cases were tested for malaria, of which 2,117,347 (54.4%) were treated and 2,085,824 were parasitologically confirmed (slide positivity rate: 53.6%). Among confirmed cases, \u003cem\u003ePF\u003c/em\u003e accounted for 64.3%. Malaria case fatality rate was 0.03% and a mortality rate of 26.3 per 1,000,000 population. Malaria incidence increased markedly from 2018 to 2024, with incidence of 12.1 to 274.7 per 1,000 population respectively. The overall incidence of malaria in the region was 92.6 cases per 1,000 population. Bench Sheko zones reported the highest number of cases, while Konta zone had the highest incidence (170.1 per 1,000 population). The peak month were August followed-by June, whereas the peak week were epi-week 27.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMalaria remains a major and increasing public health burden in SWEPRS, characterized by a sharp rise in incidence from 2018 to 2024, predominance of PF, and marked spatial and seasonal variations. Strengthening malaria prevention and control measures, surveillance, and targeting high-burden districts and peak transmission seasons are essential to reduce malaria morbidity and mortality in the region.\u003c/p\u003e","manuscriptTitle":"Analysis of Malaria Surveillance Data in the Southwest Ethiopia Peoples' Regional State, 2018-2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-03 06:28:49","doi":"10.21203/rs.3.rs-9219157/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"145780607668427628441345718040003915602","date":"2026-04-16T16:27:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-31T06:46:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T12:19:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-28T07:12:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T07:12:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2026-03-25T06:42:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f3b2681f-3460-4e66-8141-dc5d47b788e5","owner":[],"postedDate":"April 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-03T06:28:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-03 06:28:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9219157","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9219157","identity":"rs-9219157","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}