Spatiotemporal, Demographic, and Climatic Drivers of Malaria Transmission in the Endemic Setting of Jazan, Saudi Arabia: A Retrospective Study.

Background objectives: Despite progress, malaria remains endemic in Jazan, Saudi Arabia necessitating updated epidemiological research to guide elimination strategies. This study analyzed recent surveillance data to elucidate drivers of sustained transmission. A retrospective, epidemiological study was conducted using malaria surveillance data from the Jazan region of Saudi Arabia over a 3-year period from January 2018 to December 2020.

Methods: Deidentified records of all confirmed malaria cases reported across Jazan during the study period were obtained from the Jazan Department of Health infectious disease surveillance system. Additional meteorological data was acquired to assess climatic correlates. The final analysis included 5255 confirmed cases meeting completeness criteria for key variables. Descriptive statistics characterized cases across demographic factors and spatial and temporal distributions. Correlations and linear regression modeling identified associations between monthly cases and weather parameters. Mapping visualized geographic patterns.

Results: Of 5255 confirmed cases, most were concentrated in Baish sector (50.8-72.0% annually), affected adult male foreigners (93.8-97.0%), peaked inconsistently across seasons, and were imported (85.4-94.9%). Non-Saudi nationality had 6-fold higher incidence versus Saudi citizens in 2020 (677.6 vs 23.1 per 100,000). Monthly cases associated negatively with temperature (p=0.015) and positively with windspeed (p=0.005).

Interpretation conclusion: Malaria persistence in Jazan involves geographic and demographic hotspots driven by imported infections and climate effects on vectors. Tailored programming aligned with evolving local dynamics will be essential to sustain elimination gains. Surveillance, optimized interventions, and flexible adaptation to high-risk locations/populations and meteorological influences are key priorities.