Epidemiological trends of malaria in Sennar State, Sudan.

BACKGROUND: Malaria remains a major health issue worldwide, and has long been a challenging threat in Sudan. This study aims to provide analysis of malaria prevalence, incidence, and associated fever incidence and deaths, shedding light on the evolving burden of the disease in Sennar State, Sudan, to contribute valuable data to the global understanding of malaria epidemiology. METHODS: A descriptive cross-sectional study was conducted in Sennar State from 2018 to 2020. Data were collected through individual interviews using open-ended questionnaires to assess malaria-related fever and death and through parasitological confirmation of malaria infection using rapid diagnostic tests. Frequencies of fever incidence, malaria prevalence, and malaria-related death were calculated, alongside malaria fever incidence rates per 1000 population and annual percentage changes in malaria prevalence. RESULTS: A total of 2027 households were surveyed, with 503 in 2018, 516 in 2019, and 1008 in 2020, covering 8372 individuals. Fever prevalence was 41.0% in 2018, increased to 58.5% in 2019, then declined to 48.4% in 2020, with incidence rates varying across localities. Overall malaria prevalence rose from 2.8% in 2018 to 4.8% in 2019 before falling to 3.3% in 2020. According to localities, Abu Hujar consistently reported the highest malaria prevalence (13.6% in 2019; 9.5% in 2020), while Aldali reported none in 2018-2019. Malaria-related deaths totaled 12 in both 2018 and 2019, increasing to 22 in 2020, mainly in Sharg Sennar and Alsouki. The annual percentage changes in malaria prevalence showed a 71.4% increase in Sennar locality between 2018 and 2019 and a 31.2% state-level reduction between 2019 and 2020, underscoring locality-specific fluctuations in transmission. CONCLUSIONS: Malaria prevalence, incidence, fever incidence, and mortality fluctuated across Sennar state, with higher burden in rural areas. Findings highlight the need for sustained surveillance, diagnostics, and tailored, cost-effective interventions to inform policy and advance malaria control.