The impact of a humanitarian crisis on the magnitude of malaria in Tigray, Northern Ethiopia from 2014 to 2024

• Published in: Malaria Journal
• Main Authors: Gebregeworgs Gidey Hailemariam, Afewerki Tesfahunegn Nigusse, Mebrahtom Hafte Amaha
• Format: Article
• Language: English
• Published: BMC 2025-04-01
• Subjects: Malaria; Trend analysis; Incidence rate of malaria; Tigray war; Ethiopia
• Online Access: https://doi.org/10.1186/s12936-025-05366-x

Abstract Background Though Ethiopia has made a remarkable effort towards malaria prevention and control activities, malaria is occurring at epidemic levels in different regions. In Tigray, the health system including the surveillance system was damaged due to the war that erupted in November 2020, which requested to assess the burden of malaria in the region. A noticeable lack of malaria is due to the humanitarian crisis (war). Therefore, this study aimed to describe the malaria situation in the Tigray region of Ethiopia from 2014 to 2024. Methods A descriptive cross-sectional study design was conducted in January 2025 retrospectively data sourced from 2014 to 2024 in Tigray. Data was collected from the public health emergency management and health management information system database using a data abstraction tool. Data was cleaned and analysed through Microsoft Excel 2019 and ArcGIS 10.7. The analysed findings were presented using narratives, tables and graphs. Results Among 7,195,545 suspected cases, 2,185,318 (30.37%) were confirmed malaria cases, yielding an average incidence rate of 35.37 per 1,000 people (95% CI 24.80–45.94) and a case fatality rate of 27 per 100,000. Plasmodium falciparum (65.3%) was the predominant species, followed by Plasmodium vivax (34.7%). The highest transmission was recorded in 2024 (382,955 cases), while the lowest was in 2021 (19,110 cases). During the conflict, report completeness decreased by 83%. Malaria cases peaked in autumn, with an average incidence rate of males and females at 50.19 and 25.31 per 1000, population, respectively, and individuals over 15 years old were 43.16 per 1000. Incidence was highest in the western zone (85/1,000) and lowest in the Eastern and Mekelle zones (7/1,000). Conclusions The magnitude of malaria was low during the crisis due to a very low notification rate, but the disease flared up and still became a major public health problem during the post-war period due to improved data access. Therefore, scaling-up vector control measures during high malaria transmission periods and geographical priorities for controlling and eliminating malaria to achieve the country's elimination strategies.