Abstract
Background: Malaria remains a major public health challenge globally, particularly in sub-Saharan Africa, where environmental, climatic, behavioural, and socioeconomic conditions continue to sustain transmission. In South Africa, malaria persists in endemic provinces such as Limpopo despite ongoing elimination efforts. This study assessed malaria test positivity, temporal trends, seasonal patterns, and factors associated with malaria positivity among adults in Maruleng Sub-District, Limpopo Province, South Africa.
Methods: A descriptive retrospective cross-sectional study was conducted using secondary surveillance data from the Maruleng Malaria Control Centre (MMCC) for the period 2018 to 2023. Records of adults aged 18 years and older tested for malaria at 11 clinics and one hospital were reviewed. Descriptive statistics were used to summarise demographic and clinical characteristics. Logistic regression analysis was performed to examine factors associated with malaria positivity. Monthly malaria case distributions were additionally analysed to assess seasonal variation in malaria occurrence.
Results: A total of 385 adult records were included, of which 366 were malaria-positive, yielding a test positivity rate of 95.1%. Most confirmed cases occurred among males (66.7%) and adults aged 18–35 years (47.5%). South African nationals comprised 87.4% of malaria-positive cases, while 79.0% reported no travel history outside South Africa. In univariate analysis, South African nationality was associated with higher odds of malaria positivity (OR 4.05; 95% CI 1.51–10.83; p = 0.005), whereas the composite socioeconomic risk factor variable was inversely associated with malaria positivity (OR 0.36; 95% CI 0.13–0.93; p = 0.037). These associations were not statistically significant in the multivariable model. Malaria case counts were highest in 2018 and 2019, declined markedly from 2020 to 2022, and increased again in 2023. Monthly analysis demonstrated significant seasonal variation in malaria occurrence (χ² = 166.36, df = 11, p < 0.001), with cases peaking during April and May.
Conclusions: Malaria remains an important public health concern in Maruleng Sub-District. Within this facility-based dataset, malaria positivity was high among tested adults, and confirmed cases were concentrated among young adults and males. Significant seasonal variation was observed, highlighting the importance of strengthening surveillance and implementing vector control interventions before peak transmission periods. Sustained surveillance, targeted vector control, and context-specific prevention strategies remain necessary to reduce malaria transmission in this setting.