Epidemiological Trends of Malaria in Hirshabelle, Somalia (2022–2025)

Abstract

Background: Malaria is a major cause of illness and death in sub-Saharan Africa, and Somalia is one of the countries that is hit the hardest. The floodplains of the Shabelle River, together with irrigated farming and seasonal flooding in Hirshabelle State, make it easy for malaria to spread. Despite the use of insecticide-treated nets (ITNs), indoor residual spraying (IRS), and rapid diagnostic tests (RDTs), malaria is still a major public health problem in the area. Objective: The objective of this study was to analyse the epidemiological trends of malaria in Hirshabelle State, Somalia, from 2022 to 2025, focusing on annual incidence patterns by sex and age groups. Approaches: A retrospective analysis employed secondary data obtained from the Health Management Information System (HMIS) using the DHIS2 platform. The data consisted of confirmed malaria cases from healthcare facilities around Hirshabelle. A descriptive analysis was conducted in Stata 16.0 to examine the annual incidence, test positivity rate, and demographic distribution. Findings: From 2022 to 2025, there were 4,401 cases of malaria. The incidence rates fluctuated throughout time, recording the minimum rate in 2022 (0.38 per 1,000) and the maximum rate in 2023 (0.60 per 1,000). In 2024 (0.48 per 1,000) and 2025 (0.46 per 1,000), the rate experienced a slight decline. Females accounted for 67.4% of the cases, while children under five years accounted for 53.5% of the overall burden. The 5–14-year age cohort, albeit numerically inferior, exhibited the highest average annual incidence (2.17 per 1,000). Conclusion: Malaria in Hirshabelle continues to follow a cyclical pattern that is highly linked to how much rain occurs in a certain season. The continued high rates of illness among women and children, and other vulnerable groups, show that current treatments are not good enough. We need improved ways to stop the spread of malaria and aid in long-term control in Somalia. This includes better ways to prevent it, quicker access to diagnostic and treatment, and the use of climate-sensitive forecasting tools.