Abstract

Background: Malaria remains a significant public health challenge in sub-Saharan Africa and is endemic in certain areas of South Africa despite ongoing elimination efforts. This study assessed malaria positivity, temporal trends, seasonal patterns, and factors associated with malaria positivity among clinically suspected adult in Maruleng Sub-District, Limpopo Province. Methods: A retrospective cross-sectional study analysed routine malaria surveillance records from 2018 to 2023 among suspected adult cases (≥18 years) tested for malaria at 11 clinics and one hospital. Descriptive, regression, and seasonal trend analyses were performed. Results: Of 385 adult records analysed, 366 were malaria-positive (test positivity rate = 95.1%). Cases were mostly males (66.7%) and adults aged 18–35 years (47.5%). Malaria cases were highest in 2018 and 2019, declined between 2020 and 2022, and increased in 2023. Significant seasonal variation was observed, with the highest numbers of cases occurring in April and May (p < 0.001). Exploratory regression analyses did not identify any statistically significant independent predictors of malaria positivity after adjustment for potential confounders. Behavioural risk factors showed a non-significant trend towards increased odds of malaria positivity (aOR = 3.42; 95% CI: 0.78–14.98), although estimates should be interpreted cautiously because of the limited number of malaria-negative records. Conclusions: Malaria remains an important public health concern in Maruleng. The observed temporal and seasonal patterns highlight the importance of strengthening surveillance, seasonal preparedness, and targeted vector control interventions before peak transmission periods. Larger studies with greater outcome variability are needed to better characterise factors associated with malaria positivity.

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