Increasing incidence of malaria in pregnancy in Uganda, 2015–2023

Introduction: Malaria in pregnancy (MiP) is associated with increased maternal and fetal health risks. In Uganda, despite widespread implementation of preventive strategies, malaria upsurges, including the 2022 epidemic, have raised concerns about the impact on MiP cases, admissions, and deaths. We described the trends and distribution of MiP incidence, as well as related admissions and fatalities in Uganda from 2015 to 2023. Methods: We conducted a retrospective descriptive study using routinely reported MiP data in Uganda, from 2015 to 2023, obtained through the District Health Information System 2 (DHIS2). MiP incidence was defined as confirmed malaria cases per 1,000 pregnant women. Malaria test positivity rate, admissions, and deaths were also analyzed. Trends were assessed using the Mann–Kendall test and Sen’s slope, and stratified by age and region. Statistical analyses were conducted using Stata version 17, and the spatial distribution was mapped using Quantum Geographic Information System. Results: A total of 2,808,426 MiP cases were reported among 16,462,878 pregnant women with an average annual incidence of 170 cases per 1,000 pregnant women. There was an increase of approximately 7 cases per year (Sen’s slope: 6.7 cases per year, 95%CI=1.3–17), with the highest increase observed in 2022. Regionally, significant increases were observed in Busoga (27 cases per year, 95%CI: 18–43), Teso (15 per year, 95%CI: 4.7–34), Bunyoro (10 per year, 95%CI: 4–21), and West Nile (15 per year, 95%CI: 6.5–25). Age-stratified analyses showed MiP among adolescents (10–19 years) increased from 236 per 1,000 in 2020 to 351 per 1,000 in 2023 (p=0.013), compared to adults ≥20 years (121 per 1,000 to 187 per 1,000, p=0.017). No significant change in trends was observed in MiP admissions or mortality. Conclusion: There was an overall increase in MiP. MiP increased in both adolescent and older women, with a disproportionately higher burden among adolescents and in high-malaria-burden regions. Strengthening targeted strategies, including adolescent-focused interventions, enhanced regional surveillance, and improved access to preventive and curative services, is critical to reducing the burden of MiP in Uganda.