Contrasting Dynamics of Malaria: Comparative Analysis Between Peri-urban (Kati) and Hydro-agricultural (Markala) Environments in Mali 2018-2022

Malaria remains a major public health burden in Mali, requiring control strategies adapted to local epidemiological contexts. This study compared the evolution of malaria prevalence and determinants in the health districts of Kati (peri-urban/agricultural area) and Markala (agricultural/hydro-agricultural area). This was a cross-sectional, comparative study of malaria data from the districts of Kati and Markala from January 2018 to December 2022. The data were extracted from the District Health Information Software 2. The comparative statistical analysis used Chi-square tests and logistic regressions to identify the factors associated (age, sex, seasonality) with the observed variations. A total of 422,020 Cases of malaria were recorded in both districts. The Markala district had a higher average annual prevalence than Kati (6.038% vs 6.024%, p=0.001), although annual trends showed significant variability, notably a more pronounced increase in Kati in 2021. Seasonal analysis confirmed the epidemic peak during the high transmission period (July-October) in both districts, but the malaria burden in Markala appeared to be more chronic and less strictly seasonal, potentially linked to agricultural irrigation. This study revealed an epidemiological shift in Mali, with marked heterogeneity between peri-urban and hydro-agricultural areas. The increased prevalence in Kati in 2022 and the shift in disease burden towards those over 5 years of age, particularly women, necessitate adapting national strategies. Environmental management of rice cultivation, targeting of adults, and improved quality of routine data are crucial for precision vector control.