Resurgence of malaria in northern Ethiopia (Tigray), 2018–2024: evidence from routine surveillance data

Recent reports have documented a resurgence of malaria in several regions of Ethiopia; however, contemporary surveillance data from the Tigray region remain limited. This study analyzed malaria incidence trends in Tigray between 2018 and 2024 using routine surveillance data. Weekly malaria surveillance data were analyzed using descriptive and non-parametric statistical methods. Malaria incidence varied significantly across the study period. Compared with the 2018–2022 baseline period, median weekly incidence increased 2.5-fold in 2023. Elevated transmission persisted in 2024, with incidence remaining significantly higher than baseline levels through epidemiological week 27. The highest weekly incidence recorded in 2023 was approximately 4.8-fold greater than the baseline median. Spatial analyses revealed substantial heterogeneity, with a disproportionate burden concentrated in a limited number of woredas. Malaria incidence in Tigray increased significantly during 2023 and remained elevated in 2024. These findings address an important geographic gap in recent assessments of malaria epidemiology in Ethiopia and provide additional evidence that the malaria resurgence reported elsewhere in the country is also reflected in northern Ethiopia. Continued epidemiological and entomological surveillance, including monitoring for invasive vector species such as Anopheles stephensi , will be important for informing targeted malaria control efforts.