Evaluation of the Malaria Surveillance System and Trends in Jimma Town, Southwest Ethiopia, 2024: A Mixed-Method Study

Abstract Background : Malaria remains a major public health challenge in Ethiopia, with severe outbreaks occurring in Southwest Ethiopia. Over time, different interventions have been implemented to combat malaria. Despite these efforts, the country still faces challenges in achieving malaria elimination targets and ensuring the effective implementation of malaria surveillance systems. Objectives : The objective of this study was to evaluate malaria surveillance systems, trends, and key interventions in Jimma town, Southwest Ethiopia, 2024. Methods : A facility-based cross-sectional survey with a mixed-method approach was conducted from October 14 to 31, 2024, in Jimma town. Data were collected via a semi-structured questionnaire through document reviews and key informant interviews. Additionally, five years of Malaria case-based retrospective data were collected from records. An analysis of malaria cases by time, place, and demographic factors was performed. Results : The study involved eight key informants, half of whom had more than five years of experience in malaria surveillance. A review of malaria data revealed that 75% of the studies categorized data by age and sex, whereas no studies analyzed data by location and time or produced epidemic curves. All participants responded positively to the attributes of the malaria surveillance system (helpful, simple, adaptable, and representative). Furthermore, analysis of five years of malaria case data revealed a remarkable increase in cases of malaria, increasing from 432 to 11,824 cases annually. This increase in cases was sharp in children aged between 5 and 15 years (36 to 2,799). Adults over 15 years of age also face a high burden of cases, ranging from 173 to 7,442. Among the 19,124 cumulative cases, Plasmodium falciparum accounted for the majority (56.4%). Conclusions: The malaria surveillance system in Jimma town effectively met most core and support functions and was deemed simple, flexible, and representative. However, issues related to data quality, completeness, and timeliness, particularly in private health facilities, were identified. Moreover, over five years, malaria incidence increased twentyfold, with a sharp increase affecting all age groups. Addressing these gaps in the surveillance system is crucial for supporting efforts to achieve the national target of malaria elimination by 2030.