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The Amhara Region has recently experienced a significant resurgence, threatening to reverse previous progress. However, comprehensive analyses of this resurgence integrating long-term trends, parasite species dynamics, and spatiotemporal patterns are limited. Therefore, this study examines trends, spatial expansion, and control challenges associated with malaria resurgence in the Amhara Region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 11\u00a0years (January 2014\u2013December 2024) of weekly malaria surveillance data from 166 districts in the Amhara Region, Ethiopia. Joinpoint regression was employed to detect significant temporal trend changes. A resurgence threshold was defined a priori as a\u2009\u2265\u200920% increase in cases compared to the 3-year average baseline for the same period (Sep\u2013Dec 2021\u20132023), based on an expert consensus survey. Auto-regressive integrated moving average modelling was used to characterize and forecast the test positivity rate (TPR). The Getis-Ord Gi* statistic was used to identify spatial clustering and detect transmission hotspots.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During the study period, 7,710,733 malaria cases and 162 deaths were reported. Adults (\u2265\u200915\u00a0years) contributed 62% of cases. A single trend inflection point occurred in late 2018, marking a shift from a significant decline (Annual Percent Change [APC]: \u221213.2%) to a sharp resurgence (APC:\u2009+\u200912.6%, 2018\u20132024). The Annual Parasite Incidence (API) rose from 10.9 (95% CI 10.8\u201311.0) per 1000 in 2018 to 74.8 (95% CI 74.72\u201374.93) per 1000 in 2024.\n                      <jats:italic>Plasmodium vivax<\/jats:italic>\n                      became increasingly prominent, with its contribution to the total case burden rising from 25 to 43% (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u2009190,789.55, p\u2009&lt;\u20090.001). Its incidence surged 11-fold between 2018 and 2024 (from 2.7 to 32.4 per 1000). TPR increased from 10% (2018) to\u2009&gt;\u200950% during peak months by 2024. In 2024, a resurgence occurred in 83% of districts; hotspots expanded into urban centres and previously low-transmission highland areas.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The Amhara Region is experiencing a malaria resurgence characterized by intensified transmission, geographic expansion into urban and highland areas, and a significant shift toward\n                      <jats:italic>Plasmodium vivax<\/jats:italic>\n                      dominance. These findings exemplify an \"elimination-resurgence paradox,\" where prior success increases vulnerability to threats such as invasive vectors, conflict, and climate shifts.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-025-05668-0","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T02:16:17Z","timestamp":1764036977000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Resurgence of malaria in the Amhara Region, Ethiopia (2014\u20132024): trends, spatial expansion, and control challenges"],"prefix":"10.1186","volume":"24","author":[{"given":"Mastewal Worku","family":"Lake","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulusew Andualem","family":"Asemahagn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teshager Zerihun","family":"Nigussie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassahun Alemu","family":"Gelaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kindie Fentahun","family":"Muchie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailemariam Awoke","family":"Engedaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muluken Azage","family":"Yenesew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"5668_CR1","volume-title":"World malaria report 2024: addressing inequity in the global malaria response","author":"WHO","year":"2024","unstructured":"WHO. 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The study received ethical approval from the Bahir Dar University College of Medicine & Health Sciences (Ref\u202fBDU-CMHS- IRB 3053\/2024). As the study used anonymized, aggregate surveillance data with no individual identifiers, individual consent was waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"425"}}