Malaria Cases Research Articles

Malaria notifications in Legal Amazon, Brazil (2003-2022): A Comprehensive Dataset for research & surveillance

Malaria, a life-threatening disease, is preventable and curable. However, the World Health Organization reported alarming statistics for the year 2021, estimating 247 million cases of malaria worldwide, resulting in 619,000 deaths. In Brazil, cases of malaria are concentrated in the region of the Amazon rainforest, known as the Legal Amazon. In response to calls for more research to adapt malaria mitigation and eradication strategies to local conditions, this article presents a dataset based on data collected from the Malaria Epidemiological Surveillance Information System (SIVEP-Malaria) for the period from January 2003 to December 2022 on patients diagnosed with malaria. The pre-processed data set is composed of 1,251,309 records of confirmed malaria cases and included four attributes (Date, Municipality, Test results, and Notifications), attributes considered essential for the development and application of series modeling techniques temporal. By making this dataset available, it is intended to provide researchers with the necessary tools to develop effective strategies for mitigating and eradicating malaria in the region.

Determinants of persistent malaria transmission in the Arjo-Didessa farm area in Ethiopia

Background: In tropical and subtropical areas of the world, malaria is still a serious public health concern. Activities related to agricultural development that involve irrigation schemes likely increase the risk of malaria in tropical and sub-Saharan African regions. Ethiopia is a sub-Saharan country where malaria is endemic.Objectives: The aim of the study was to investigate the determinants related to the persistence of malaria transmission in the Arjo-Didessa sugarcane farm area in southwest Ethiopia.Method: The study employed a quantitative survey design. Quantitative data were collected from 397 households using structured questionnaires. SPSS Statistics version 26 was used to analyse the data. Z- and Chi-square tests were applied, and the data were analysed using logistic regression.Results: The determinants that were identified included variation in land use, water management practices, socioeconomic status and knowledge about the use of anti-malaria treatment. These were shown to contribute to increased malaria transmission and the rise in malaria cases in agricultural areas.Conclusion: The effectiveness of malaria control in agricultural settings can be improved through free access to malaria testing and treatment as well as knowledge about anti-malaria treatment among the residents in agricultural areas.Contribution: The study revealed key determinants, including the promotion of free access to anti-malaria treatment, which should be considered for the effective management of malaria in agricultural areas.

Plasmodium vivax antigen candidate prediction improves with the addition of Plasmodium falciparum data

AbstractIntensive malaria control and elimination efforts have led to substantial reductions in malaria incidence over the past two decades. However, the reduction in Plasmodium falciparum malaria cases has led to a species shift in some geographic areas, with P. vivax predominating in many areas outside of Africa. Despite its wide geographic distribution, P. vivax vaccine development has lagged far behind that for P. falciparum, in part due to the inability to cultivate P. vivax in vitro, hindering traditional approaches for antigen identification. In a prior study, we have used a positive-unlabeled random forest (PURF) machine learning approach to identify P. falciparum antigens based on features of known antigens for consideration in vaccine development efforts. Here we integrate systems data from P. falciparum (the better-studied species) to improve PURF models to predict potential P. vivax vaccine antigen candidates. We further show that inclusion of known antigens from the other species is critical for model performance, but the inclusion of only the unlabeled proteins from the other species can result in misdirection of the model toward predictors of species classification, rather than antigen identification. Beyond malaria, incorporating antigens from a closely related species may aid in vaccine development for emerging pathogens having few or no known antigens.

Malaria Epidemiology in Rask City and Surrounding Areas (2020 - 2023), Southeast Iran

Background: Malaria, a disease caused by Plasmodium parasites and transmitted by Anopheles mosquitoes, remains a major global health challenge, causing widespread illness and mortality. Objectives: This study provides an in-depth analysis of malaria trends in Rask, Southeast Iran, from 2018 to 2023, assessing malaria prevalence, transmission factors, and impacts on the local population and healthcare system. Methods: Blood samples were collected from individuals suspected of having malaria at health centers in Rask. For each positive case, demographic information was recorded in a questionnaire. Data analysis was performed using SPSS 26, with t-tests applied to compare variables. Results: Findings indicate a peak in malaria cases in 2022, with an annual incidence rate of 2.49%. The most common species identified was Plasmodium vivax, affecting primarily males over the age of 12, with the highest number of cases reported in September. Conclusions: The results underscore the urgent need to enhance malaria prevention and control measures. The study emphasizes the value of targeted interventions, including improvements to prevention and treatment programs, reinforcement of healthcare systems, and advancement of health infrastructure. These strategies should consider climatic patterns and rainfall rates to effectively address malaria transmission dynamics.

Plasmodium cynomolgi Infections Not Found in Microscopy-Diagnosed Malaria Cases across Sabah, Malaysia

Zoonotic malaria presents a major public health challenge in Southeast Asia. Plasmodium cynomolgi coinfects the same macaque hosts and mosquito vectors as the most common cause of zoonotic malaria, Plasmodium knowlesi. Plasmodium cynomolgi appears morphologically similar to Plasmodium vivax on microscopy and can amplify P. vivax polymerase chain reaction (PCR) assays, confounding transmission estimates. We screened 2,103 samples for P. cynomolgi across all 26 districts in Sabah, Malaysia, from 2010 to 2021. Samples comprised 1,425 P. knowlesi, 256 P. vivax, 293 P. falciparum, and 31 Plasmodium malariae PCR-confirmed malaria cases and 100 malaria microscopy-positive and species-specific PCR-negative samples. A nested PCR assay targeting P. cynomolgi-specific 18S small subunit ribosomal ribonucleic acid with a detection limit of ∼2 parasites/µL was conducted on whole blood samples. No P. cynomolgi infections were detected. Symptomatic P. cynomolgi co-infections appear rare in Malaysia, although prevalence may be underestimated owing to the absence of routine molecular screening and the sensitivity of available assays.

A Severe Case of Plasmodium falciparum Malaria in a 44-Year-Old Caucasian Woman on Return to Western Romania from a Visit to Nigeria

Malaria is currently the most prevalent life-threatening infectious disease in the world. In this case report, we present a 44-year-old Caucasian woman with a low level of education and no significant past medical history who presented to the emergency room of the Emergency County Hospital of Arad, Romania, with a general affected state, a fever of 38.5 °C, chills, weakness, headache, muscle pain, nausea, icterus, and watery diarrheal stool. A viral infection was initially suspected, and the patient was transferred to the Infectious Diseases Department. The anamnesis revealed that the patient traveled to Nigeria (Ado Ekiti) and returned to Romania 14 days before presenting to the hospital without following antimalarial prophylaxis. A peripheral blood smear was conducted and revealed parasitemia with ring forms of Plasmodium falciparum (P. falciparum) of 10–15% within the red blood cells. Parasitemia increased within a day to 15–18%, and her health rapidly deteriorated. She was transferred to the Victor Babeș Infectious Disease Hospital in Bucharest for the urgent initiation of antimalarial treatment. The patient’s condition continued to worsen rapidly, and she succumbed to her illness due to multi-organ failure. This report details the first documented case of malaria imported from Nigeria to Romania. People traveling to malaria-endemic areas should be educated about preventing this parasitic infection, both by adopting measures to reduce the risk of mosquito bites and by using appropriate chemoprophylaxis. In the context of resuming travel after the COVID-19 pandemic, understanding and adhering to prophylactic measures is crucial to avoid tragic situations, as highlighted in this case report.

Characterization of T and B cell epitopes in PvCyRPA by studying the naturally acquired immune response in Brazilian Amazon communities

Plasmodium vivax, a challenging species to eliminate, causes millions of malaria cases globally annually. Developing an effective vaccine is crucial in the fight against vivax malaria, but considering the limited number of studies focusing on the identification and development of P. vivax-specific vaccine candidates, exploring new antigens is an urgent need. The merozoite protein CyRPA is essential for P. falciparum growth and erythrocyte invasion and corresponds to a promising candidate antigen. In P. vivax, a single study with multiple vaccine candidates indicates PvCyRPA with strong association with protection, outperforming classic malaria vaccine candidates. However, little is known about the specific naturally acquired response in the Americas, as well as the antigen epitope mapping. For this reason, we aimed to investigate the cellular and humoral immune response elicited against PvCyRPA in Brazilian endemic areas to identify the existence of immunodominant regions and the potential of this protein as a single or even a multi-stage specific malaria vaccine candidate for P. vivax. The results demonstrated that PvCyRPA is naturally immunogenic in Brazilian Amazon individuals previously exposed to malaria, which presented anti-PvCyRPA cytophilic antibodies. Moreover, our data show that the protein also possesses important immunogenic regions with an overlap of B and T cell epitopes. These data reinforce the possibility of including PvCyRPA in vaccine formulations for P. vivax.

Get inspired - A pilot qualitative study of global health volunteering with commonwealth partnerships for antimicrobial stewardship

Abstract Introduction The Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS), funded by the UK Department of Health and Social Care's Fleming Fund, managed by the Commonwealth Pharmacists Association and Tropical Health and Education Trust, aim to build antimicrobial stewardship (AMS) capacity in low/middle-income countries (LMICs) through health-partnerships with the UK.1 CwPAMS-Phase-2 (CwPAMS2) was launched in March 2023, and supports 24 UK-LMIC partnerships delivering AMS interventions in 73 health facilities across eight African countries: Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia. Since CwPAMS1 inception (2019), UK NHS volunteers have actively provided support for capacity building in LMIC-partner organisations.2,3 Aim To explore the impact of CwPAMS volunteering, in particular, to understand potential benefits and how it could be better integrated into NHS systems. Methods UK volunteers were identified through CwPAMS2 participation and leadership roles. Non-probabilistic, purposive sampling was used; a small number of volunteers were approached via email to pilot the qualitative, semi-structured interview. Data were collected between April/May-2024 with 5 UK volunteers, as well as their line managers; all agreed to scheduled, recorded discussions indicating consent. Interviews focused on the impact of volunteering experiences on UK NHS institutions, and how these could be more formally integrated into continuous professional development (CPD) pathways. Qualitative data was thematically analysed. No ethical approval was required for this study (programme evaluation). Results Volunteers had just begun their direct work in CwPAMS2, with >1000 combined days contributed, and <1000 more needed to reach anticipated outcomes. Interviewees reported benefits to the NHS through shifts in health workforce attitude, perspective and behaviours, consequently influencing wider teams (horizontally and vertically). Changes were regarded as extremely relevant and impactful to the NHS and staff CPD goals. A prominent theme from interviews was the significant impact of global health volunteering on recruitment and retention. Individuals spoke about an injection of motivation, passion and enthusiasm into work - a reminder of the importance of their roles and the reason for staying in their jobs longer: ‘it is a reason to come and join the team and a reason to stay’. A ‘can do’, problem-solving attitude also evolved, in stark contrast with non-volunteering staff e.g. volunteers identified/solved problems rather than reporting them to senior staff, as described by one manager. There was widespread appreciation for the NHS and the resources available in the UK, compared to LMICs. Shared examples of new systems, processes and clinical skills gained and transferred from LMICs into the NHS included: the ability to make alcohol hand gel in-house; dealing with malaria cases; improving stock management systems. Discussion/Conclusion Staff retention is a considerable challenge for the NHS. Volunteering is a great opportunity for personal/professional growth, fostering leadership and motivation, whilst simultaneously improving healthcare practices. Global health volunteering could be integrated into formal CPD pathways in the NHS to capitalise on the relatively small investment in staff time in return for knowledge and skills development. Full implementation of the questionnaire to assess the impact of CwPAMS volunteering on individuals and institutions is planned for delivery at the end of the programme.

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Republic of Korea

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Republic of Korea

Malaria treatment for prevention: a modelling study of the impact of routine case management on malaria prevalence and burden

BackgroundTesting and treating symptomatic malaria cases is crucial for case management, but it may also prevent future illness by reducing mean infection duration. Measuring the impact of effective treatment on burden and transmission via field studies or routine surveillance systems is difficult and potentially unethical. This project uses mathematical modeling to explore how increasing treatment of symptomatic cases impacts malaria prevalence and incidence.MethodsLeveraging the OpenMalaria stochastic agent-based transmission model, we first simulated an array of transmission intensities with baseline effective treatment coverages of 28%, 44%, and 54% incorporated to reflect the 2023 coverage distribution across Africa, as estimated by the Malaria Atlas Project. We assessed the impact of increasing coverage to as high as 60%, the highest 2023 estimate on the continent. Subsequently, we performed simulations resembling the specific subnational endemicities of Kenya, Mozambique, and Benin, using the Malaria Atlas Project estimates of intervention coverages to reproduce historical subnational prevalence. We estimated the impact of increasing effective treatment coverage in these example settings in terms of prevalence reduction and clinical cases averted in children under 5 years old and the total population.ResultsThe most significant prevalence reduction – up to 50% – was observed in young children from lower transmission settings (prevalence below 0.2), alongside a 35% reduction in incidence, when increasing effective treatment from 28% to 60%. A nonlinear relationship between baseline transmission intensity and the impact of treatment was observed. Increasing effective treatment coverage to 60% reduced the risk in high-risk areas (prevalence in children under 5 years old > 0.3), affecting 39% of young children in Benin and 20% in Mozambique previously living in those areas. In Kenya where most of the population lives in areas with prevalence below 0.15, and case management is fairly high (53.9%), 0.39% of children were estimated to transition to lower-risk areas.ConclusionsImproving case management directly reduces the burden of illness, but these results suggest it also reduces transmission, especially for young children. With vector control interventions, enhancing case management can be an important tool for reducing transmission intensity over time.

Assessing the impact of ecological, climatic, and socioeconomic factors on age-specific malaria incidence in India: a mixed-model approach using the Global Burden of Disease Study (2010–2019)

BackgroundMalaria continues to be a critical public health concern in India, predominantly driven by complex interplays of ecological, climatic, and socioeconomic factors.MethodsThis study aimed to assess the association between climatic variables (temperature and precipitation) and malaria incidence across India from 2010 to 2019, utilizing data from the Global Historical Weather and Climate Data for climate metrics and the Global Burden of Disease Study for malaria incidence rates. Generalized Linear Mixed Models (GLMMs) with a Poisson distribution were employed to analyze the data, adjusting for socio-economic status, as indexed by the Human Development Index (HDI).ResultsThe results indicated a declining trend in both the number of malaria cases and age-specific incidence rates (ASIR) over the study period. In 2010, India reported approximately 20.7 million cases with an ASIR of 1688.86 per 100,000 population, which significantly reduced to 9.8 million cases and an ASIR of 700.80 by 2019. High malaria incidence was consistently observed in the states of Jharkhand and Odisha, whereas Sikkim reported the lowest numbers. Statistical analysis identified significant associations between malaria incidence and both temperature deviations and precipitation levels, with variations also linked to HDI, suggesting better detection and reporting capabilities in more developed areas.ConclusionThe study underscores the critical interactions between climatic variables and socio-economic factors in shaping the trends of malaria incidence across India. These findings highlight the necessity for adaptive, localized public health strategies that integrate environmental monitoring with socio-economic data to efficiently predict and manage malaria outbreaks.

Impact of Climate Variability and Interventions on Malaria Incidence and Forecasting in Burkina Faso

Background: Malaria remains a climate-driven public health issue in Burkina Faso, yet the interactions between climatic factors and malaria interventions across different zones are not well understood. This study estimates time delays in the effects of climatic factors on malaria incidence, develops forecasting models, and assesses their short-term forecasting performance across three distinct climatic zones: the Sahelian zone (hot/arid), the Sudano-Sahelian zone (moderate temperatures/rainfall); and the Sudanian zone (cooler/wet). Methods: Monthly confirmed malaria cases of children under five during the period 2015–2021 were analyzed using Bayesian generalized autoregressive moving average negative binomial models. The predictors included land surface temperature (LST), rainfall, the coverage of insecticide-treated net (ITN) use, and the coverage of artemisinin-based combination therapies (ACTs). Bayesian variable selection was used to identify the time delays between climatic suitability and malaria incidence. Wavelet analysis was conducted to understand better how fluctuations in climatic factors across different time scales and climatic zones affect malaria transmission dynamics. Results: Malaria incidence averaged 9.92 cases per 1000 persons per month from 2015 to 2021, with peak incidences in July and October in the cooler/wet zone and October in the other zones. Periodicities at 6-month and 12-month intervals were identified in malaria incidence and LST and at 12 months for rainfall from 2015 to 2021 in all climatic zones. Varying lag times in the effects of climatic factors were identified across the zones. The highest predictive power was observed at lead times of 3 months in the cooler/wet zone, followed by 2 months in the hot/arid and moderate zones. Forecasting accuracy, measured by the mean absolute percentage error (MAPE), varied across the zones: 28% in the cooler/wet zone, 53% in the moderate zone, and 45% in the hot/arid zone. ITNs were not statistically important in the hot/arid zone, while ACTs were not in the cooler/wet and moderate zones. Conclusions: The interaction between climatic factors and interventions varied across zones, with the best forecasting performance in the cooler/wet zone. Zone-specific intervention planning and model development adjustments are essential for more efficient early-warning systems.

Assessing agricultural practices and insecticides resistance for effective malaria vector control in northwestern Iran

BackgroundAfter three years with no local transmission of malaria, an outbreak occurred in Iran in 2022. Key malaria control methods in Iran are including indoor residual spraying (IRS), long-lasting insecticide-treated nets (LLINs), and prompt diagnosis and treatment of malaria cases. Anopheles sacharovi is one of the main malaria vectors in Iran. This study aimed to determine the insecticides resistance status of An. sacharovi in northwestern Iran, to inform effective vector control programs in this region.MethodsLarval stages of An. sacharovi were collected from various larval habitats located in the villages along the Aras River. Adult susceptibility tests were performed on An. sacharovi using diagnostic doses of insecticides accordance to World Health Organization (WHO) guidelines. The study also evaluated agricultural insecticide and fertilizer usage alongside the presence of natural mosquito predators in breeding sites in the study area.ResultsAlongside various chemicals such as silica, humic acid, superphosphate, sulfur, urea, and solupotasse at different dose levels, organophosphorus and pyrethroid insecticides are commonly used in rice fields and orchards. Anopheles sacharovi displayed diverse reactions to insecticides, demonstrating resistance to DDT but sensitivity to malathion, and showing similar reactions to carbamate and pyrethroid insecticides.ConclusionsThese results provide significant insights into agricultural practices and the presence of mosquito larvae in the study area. The extensive use of a specific herbicide illustrates its popularity among farmers for weed control, while other agricultural products focus on enhancing soil fertility and productivity. The absence of mosquito larvae in habitats with predators indicates the usefulness of these predators in controlling the population of mosquitoes. The resistance of mosquitoes to certain insecticides highlights the need for careful selection and intermittent use of insecticides in vector control programs. These findings can inform the development of targeted strategies to reduce malaria transmission risks. Further research is essential for assessing the effectiveness of these interventions.

Perspectives of postpartum women on intermittent presumptive treatment in Uganda: implications for malaria prevention: a qualitative study

BackgroundMalaria during pregnancy leads to many deaths in Africa. COVID-19 contributed to more malaria cases due to interruptions in prevention efforts. Intermittent presumptive treatment (IPTP) is an effective malaria prevention strategy for pregnant women, but adoption barriers still exist. The study aim was to explore barriers to the adoption of IPTP at Kawempe National Referral Hospital (KNRH) Uganda.MethodsIn a qualitative study design, data was collected using focus group discussions. A total of 37 postpartum mothers were interviewed in six focus group discussions. The interviews were conducted using a structured guide to explore barriers to IPTP implementation at KNRH. The data was transcribed, coded, and analysed using NVivo 10.ResultsThe study found that mothers lacked adequate knowledge about IPTP, faced socioeconomic and cultural constraints, fear of side effects, a high pill burden, and experience of health system challenges as major themes of barriers to optimal IPTP use.Conclusions and recommendationsChallenges in the service delivery and inadequate information in regard to importance and expected side effects were identified by the users as the major barriers to IPTP delivery in public health care setting. Improving delivery of focused health education talks and health work attitude and delivery chain for IPTP in the health facilities are recommended to increase its uptake.

Importance of tailored non-clinical safety testing of novel antimalarial drugs: Industry best-practice

Malaria is an acute, debilitating parasitic illness. There were 249 million cases of malaria in 2022, resulting in 608,000 deaths globally, 76% of which were children ≤5 years. The unique nature of this disease (recurrences leading to re-treatments and numerous organ systems affected), specific clinical treatment regimens, poor compliance, and diversity of affected populations (predominantly pediatrics, women of childbearing potential, pregnant and lactating women), often makes standard testing approaches inadequate, and tailor-made safety assessments are more appropriate.We provide best practice recommendations based on company experience for the non-clinical safety assessment of antimalarial drugs, with a focus on small molecules since they represent the majority of drug candidates for this illness. We focus on specific testing considerations for repeat dose toxicity studies, including combination toxicity assessments, since new drug treatment regimens typically foresee short treatment durations to improve compliance (i.e., 1 day) with combinations of compounds to improve efficacy and limit potential resistance. Due to the target population, the timing of reproductive, developmental, and juvenile toxicity studies may be earlier than general testing roadmaps for other small molecule drugs.In conclusion, key recommendations presented should enable a more effective and efficient development path whilst protecting clinical trial participants and patients.

Drug Repurposing against Novel Therapeutic Targets in Plasmodium falciparum for Malaria: The Computational Perspective.

Malaria remains one of the most challenging tropical diseases. Since malaria cases are reportedly alarming in terms of infections and mortality, urgent attention is needed for addressing the issues of drug resistance in falciparum malaria. High throughput screening methods have paved way for rapid identification of anti-malarial. Furthermore, drug repurposing helps in shortening the time required for drug safety approvals. Hence, discovery of new antimalarials by drug repurposing is a promising approach for combating the disease. This article summarizes the recent computational approaches used for identifying novel antimalarials by using drug target interaction tools followed by pharmacokinetic studies.

High malaria parasitemia in an Italian man and severe delayed hemolytic anemia

Key Clinical MessageParenteral artesunate has become the choice treatment of cases of high parasitemia malaria. We report the case of an Italian man with a high malaria parasitemia who promptly improved with intravenous artenusate, but who developed a delayed severe hemolytic anemia associated with intravenous artesunate treatment, requiring blood trasfusions.

Analysis of External Environmental Design Factors on Mosquito Breeding in Sikka Regency, East Nusa Tenggara

Factors such as environmental temperature, rainfall, location of waste disposal sites, sunlight exposure, water flow, as well as chemical, biological, and socio-cultural conditions play a crucial role in the development of malaria cases. This study specifically aims to analyze the influence of environmental elements on the number of malaria and dengue fever (DF) cases in Sikka Regency, as well as to evaluate the physical design elements of the area that can reduce DF cases in the region. The research was conducted in several locations within Sikka Regency, taking into account the differences in location and the distance between buildings in relation to thermal characteristics. The results indicate that areas located more than 500 meters above sea level did not experience malaria or DF cases, which is also influenced by the outdoor environmental design, such as building density and vegetation size, affecting light intensity. Lower light intensity increases humidity, which accelerates mosquito breeding.

Estimated Plasmodium 18S ribosomal RNA prevalence in asymptomatic blood donors from three African countries.

The World Health Organization (WHO) African Region accounts for 94% of malaria cases globally, with variability recognized within endemic regions. To determine the detection rate of Plasmodium RNA in blood donors resident in malaria-endemic areas, samples from three African countries were tested using a Plasmodium nucleic acid test. Whole blood (WB) samples collected from routine donors in Cameroon, Madagascar and Mali were shipped frozen to the United States. Samples were tested individually from WB lysates with the Procleix Plasmodium assay (transcription-mediated amplification [TMA]). Reactive samples were considered either repeat reactive or initial reactive only, depending on TMA-retest results. When available, matching plasma samples were tested for Plasmodium antibodies by enzyme immunoassay (EIA). Plasmodium repeat reactivity ranged from 41% (91/223 tested) in Cameroon to 12% (26/216) in Mali and 1% (3/249) in Madagascar. Initially reactive samples, where reactivity did not repeat, were identified from Cameroon (5/223; 2%) and Mali (2/216; 1%). The matched-plasma subgroup had EIA reactivity ranging from 86% (113/131 tested) in Cameroon to 59% (10/17) in Mali and 27% (68/248) in Madagascar. Plasmodium ribosomal RNA (rRNA) detection and antibody rates varied greatly in the three countries studied. Detection of Plasmodium rRNA can provide an additional tool to address malaria risk in blood donors.

Effect of the second and third COVID-19 pandemic waves on routine outpatient malaria indicators and case management practices in Uganda: an interrupted time series analysis

BackgroundReports on the impact of COVID-19 pandemic on the quality of malaria care and burden in sub Saharan Africa have provided a mixed picture to date. The impact of the 2nd (Delta) and 3rd (Omicron) COVID-19 waves on outpatient malaria indicators and case management practices was assessed at three public health facilities with varying malaria transmission intensities in Uganda.MethodsIndividual level data from all patients presenting to the out-patient departments (OPD) of the three facilities (Kasambya, Walukuba and Lumino) between January 2019 and February 2022 were included in the analysis. Outcomes of interest included total number of outpatient (OPD) visits, proportion of patients suspected to have malaria, proportion of suspected malaria cases tested with a malaria diagnostic test, test positivity rates (TPR) and proportion of malaria cases prescribed artemether-lumefantrine (AL). Using the pre-COVID-19 trends between January 2019 and February 2020, interrupted time series analysis was used to predict the expected trends for these study outcomes during the 2nd wave (May 2021–August 2021) and 3rd wave (November 2021–February 2022). The observed trends of the study outcomes were compared with the expected trends.ResultsThere were no significant differences between the observed versus expected overall outpatient visits in the 2nd wave, however, a significant decline in OPD attendance was observed during the 3rd wave (15,101 vs 31,154; incidence rate ratio (IRR) = 0.48 [0.41–0.56]). No significant differences in the overall observed versus expected proportions of suspected malaria cases and test positivity rates in both COVID waves. However, a significant decrease in the overall proportion of suspected malaria cases tested with a malaria diagnostic test was observed during the 3rd wave (99.86% vs 99.99%; relative percent ratio [RPR] = 0.99 [0.99–0.99]). Finally, a significant decline in the overall proportion of malaria cases prescribed AL was observed during the 2nd wave (94.99% vs 99.85%; RPR = 0.95 [0.92–0.98]) but not the 3rd wave.ConclusionSignificant declines in OPD attendance and suspected malaria cases tested with malaria diagnostic test were observed during the 3rd COVID-19 wave, while AL prescription significantly reduced during the 2nd COVID-19 wave. These findings add to the body of knowledge highlighting the adverse impact of COVID-19 pandemic on the malaria which could explain the increase in the malaria burden observed during this period.