Epidemiology and risk factors of malaria in Cabo Verde, 2015–2023, in the elimination era

Introduction: Cabo Verde was certified as malaria-free by the World Health Organization (WHO) in January 2024, becoming the fourth African nation to achieve this status. This study examines the epidemiological characteristics and associated factors of malaria cases in Cabo Verde from 2015 to 2023 to inform sustainable prevention strategies. Materials and methods: A retrospective, cross-sectional analysis was conducted using national surveillance data from 706 confirmed cases of malaria. Descriptive statistics and binary logistic regression were employed to identify factors associated with autochthonous versus imported cases. Statistical analyses were performed using SPSS v29.0.1.0. Results: Most cases (74.5%) occurred in males, with the highest incidence among individuals aged 20–54 years. The municipality of Praia accounted for 98.5% of autochthonous cases and 55% of imported cases. Fever (52.7%), headache (36.4%), and myalgia (20.4%) were the most common symptoms. Plasmodium falciparum caused all autochthonous infections, while imported cases included P. vivax, P. ovale, P. malariae, and mixed infections. Logistic regression identified fever (OR = 2.90; 95% CI: 1.24–6.78) and treatment with artemisinin-based combination therapy (ACT) plus primaquine (OR = 7.72; 95% CI: 1.12–53.29) as significant predictors of autochthonous cases. Chills were associated with imported cases (OR = 0.15; 95% CI: 0.07–0.29). Conclusions: Despite achieving malaria-free status, Cabo Verde remains vulnerable to imported cases due to its connectivity with endemic regions and receptivity level. Enhanced fever surveillance, targeted screening of travelers, and sustained vector control are critical to preventing reintroduction.