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Malaria epidemics and its drivers in Uganda in 2022
Maru W Aregawi1, Catherine Maiteki2, John C Rek2
1Global Malaria Programme, Universal Health Coverage/Communicable and Non-Communicable Diseases (UCN) Division, World Health Organization, Geneva, Switzerland. aregawim@who.int.
Malaria Journal
|July 17, 2025
Summary
Uganda experienced a significant malaria resurgence in 2022, with over 3.3 million excess cases and nearly 150,000 excess admissions. Programmatic gaps, not climate, likely drove this epidemic, necessitating improved surveillance and interventions.
Area of Science:
- Epidemiology
- Public Health
- Vector-borne Diseases
Background:
- Malaria poses a year-round threat in Uganda, with transmission varying regionally.
- An unprecedented malaria resurgence occurred in early 2022, impacting multiple districts.
- The National Malaria Control Division (NMCD) initiated a response to the 2022 epidemic.
Purpose of the Study:
- Assess the scale and causes of the 2022 malaria epidemics in Uganda.
- Quantify excess malaria cases and deaths attributed to the epidemic.
- Propose targeted prevention and response strategies for future outbreaks.
Main Methods:
- Analyzed District Health Information System (DHIS2) data from 2017-2022.
- Defined epidemics using a 75th percentile threshold (2017-2021) for comparison.
- Quantified excess malaria cases, admissions, and deaths using Area Under the Curve (AUC).
- Evaluated impact of Indoor Residual Spraying (IRS) and Integrated Community Case Management (iCCM) interventions.
- Assessed correlation between precipitation patterns and malaria epidemics.
Main Results:
- Malaria cases rose 31% in 2022 compared to the 2017-2021 3rd quartile.
- 64 out of 146 districts experienced malaria epidemics in 2022.
- The 2022 epidemic resulted in over 3.3 million excess outpatient cases and nearly 150,000 excess inpatient cases.
- Epidemics were paradoxically more frequent in IRS and iCCM intervention districts.
- Lagged rainfall (Lag 2) significantly increased malaria incidence (p<0.01).
Conclusions:
- The 2022 epidemic caused substantial excess malaria morbidity and mortality in Uganda.
- Gaps in intervention coverage (IRS, iCCM) and effectiveness were identified as key drivers.
- Minimal correlation with rainfall suggests climate was not the primary epidemic driver.
- Programmatic deficiencies, potential insecticide resistance, and vector changes likely contributed.
- Enhanced surveillance, sustainable funding, and tailored strategies are crucial for future malaria control.
