Comparative Analysis of the Epidemiological Dynamics of Malaria in the Health Districts of Koulikoro and Timbuktu in Mali 2018-2022

In Mali, malaria remains a major public health challenge with heterogeneous transmission patterns. This study compared malaria morbidity in two distinct geographical contexts: Koulikoro (Sudanian zone) and Timbuktu (irrigated Sahelian zone). It was a descriptive, analytical study based on data from the DHIS2 (2018–2022). The variables analyzed included prevalence, seasonality, gender, age, and methods of biological confirmation (RDT, thick blood smear). Comparative statistical analysis used chi-square tests and logistic regressions to identify factors associated (age, sex, seasonality) with the observed variations. In 2021, Koulikoro recorded 58,999 confirmed cases of malaria. The region followed a strict rainfall pattern with a peak in the third quarter (T3). While Timbuktu experienced off-season peaks linked to irrigation (peaking in Q1 2021 with 13,883 cas-es), children under 5 were the most affected in Koulikoro (56.5% in 2022), whereas adults (≥ 5 years) bore 80% of the burden in Timbuktu. Thick-droplet irrigation use increased from 18.2% to 59.2% in Koulikoro, while Timbuktu remained 97% dependent on rapid diagnostic tests (RDTs), a statistically significant differ-ence (p<0.001). In Koulikoro, the prevalence of malaria increased significantly, rising from 4.99% in 2018 to a peak of 19.21% in 2021. In Timbuktu, the prevalence more than doubled between 2018 (8.04%) and 2020 (18.225%), before gradually declining to 14.87% in 2022. The study demonstrated the need to decentralize control strategies. Strengthening microscopy in the North and adjusting the schedule of the Integrated Malaria Control Program (IMCP) in irrigated areas are essential for sustainably reducing the burden of malaria in Mali.