INTRODUCTION
Globally, the World Health Organization (WHO) reported 263 million cases in 2023, an increase of 11 million when compared to cases in 2022. Additionally, the WHO estimated 597,000 malaria deaths in 2023, a decrease of 3,000 when compared to deaths in 2022 [1]. In 2023, 94% of global cases and 95% of global deaths were from the Sub-Saharan African region (SSA). Of those deaths, 76% were observed in children under five [2]. Malaria affects 13.3 million pregnant women in SSA annually and is responsible for 10,000 maternal deaths worldwide [3]. Rwanda is targeting the elimination of malaria by 2030, and is implementing community interventions, including distribution of long-lasting insecticide nets (LLINs), indoor residual spraying (IRS), and early diagnosis to control malaria [4,5]. The interventions decreased malaria cases from 345 per 1,000 in 2018 to 40 per 1,000 in 2023 [6]. Children under five years old and pregnant women are still the most vulnerable populations in Rwanda. The most affected area is the Eastern region, followed by the southern part of the country [7].
This surveillance report presents the patterns and trends of malaria cases among children under five years (2014-2024) and pregnant women from 2018 to 2023. This report provides insights to improve interventions to achieve the country's target of zero malaria cases by 2030.
METHODS
This was a retrospective analysis of malaria surveillance data from 2014 to 2024, focusing on children under five years and pregnant women in Rwanda. Data were sourced from the District Health Management Information System (DHMIS). Variables include demographic data, case numbers, deaths, and severity of malaria (characterized by organ failure and metabolic abnormalities). For consistency and completeness, data were cleaned before analysis. The population was calculated using 2022 census data. According to the 2022 census, 1,708,460 children are under five years old, and 3,445,665 women are of reproductive age [8]. Descriptive statistics using Excel were employed to calculate malaria prevalence and death rates by district, and year to identify trends over the decade.
Severe malaria: In this report, severe malaria refers to malaria cases in under-five children or pregnant women that progress to life-threatening conditions as defined by the World Health Organization (WHO). These include clinical or laboratory evidence of complications such as cerebral malaria, severe anemia (Hb <5 g/dL), respiratory distress, metabolic acidosis, hypoglycemia, shock, acute kidney injury, jaundice, or multi-organ failure.
Malaria-related death: A malaria-related death is defined as the death of a child under five or a pregnant woman with confirmed malaria (by rapid diagnostic test or microscopy) where malaria was the direct or underlying cause of death.
