Evaluation of the malaria surveillance system and trends in Jimma town, Southwest Ethiopia, 2024: a mixed-method study.

Malaria remains a major public health concern in Ethiopia, including urban settings such as Jimma Town. Despite long-standing interventions, progress toward elimination targets has been inconsistent. Regular assessment of surveillance system performance is crucial for early detection, timely reporting, and effective response. To evaluate the performance of the malaria surveillance system and examine malaria trends in Jimma Town, Southwest Ethiopia, from 2012 to 2016 Ethiopian Fiscal Years (EFY), focusing on core system attributes and factors associated with recent increases in malaria cases. A facility-based cross-sectional study using a mixed-method design was conducted from October 14 to 31, 2024. Quantitative data were collected from malaria registers and the District Health Information System version 2 (DHIS2), while qualitative data were obtained through interviews with surveillance focal persons. A total of 10 health facilities (public and private) were assessed. Descriptive analysis summarized malaria trends, and thematic analysis examined system performance and challenges. Eight key informants participated, half with more than five years of experience. All public facilities adhered to national guidelines, whereas reporting consistency was lower among private clinics. The surveillance system was generally simple and flexible but limited by incomplete reporting, weak feedback mechanisms, and inadequate private-sector engagement. Malaria cases rose dramatically from 432 in 2012 to 11,824 in 2016 EFY, with Plasmodium falciparum accounting for 56.4% of infections. The largest increases occurred among school-aged children and adults, and the contribution of private facilities to case reporting grew from 47% to 66%. Although functional, the malaria surveillance system in Jimma Town is constrained by data incompleteness, limited feedback, and poor integration of private providers. Major limitations include reliance on routine data and a small qualitative sample size. Strengthening data quality assurance, enhancing routine analysis and feedback, and improving collaboration with private facilities are essential to advance Ethiopia's malaria elimination efforts.