Identifying and Defining Malaria Epidemics in Moderate to High Transmission settings in Sub-Saharan Africa: A Scoping Review Protocol.

Although significant gains in malaria control have been achieved, burden remains high in sub-Saharan Africa. Widespread scale-up of malaria control interventions has changed malaria epidemiology in some areas with transmission reductions impacting exposure, development of immunity, and populations at risk. These shifts may increase risk of epidemics even as malaria control is tightened. Disruptions in delivery of malaria control interventions can also result in resurgence of malaria or epidemics. Identifying true epidemics of malaria and differentiating them from other non-epidemic surges in burden in moderate to high transmission settings remains challenging due to lack of concise epidemic definitions and use of imprecise detection methods. This scoping review aims to: 1) describe historical definitions of malaria epidemics used in moderate to high transmission settings in sub-Saharan Africa; 2) compile and re-classify documented epidemic events in these settings using WHO criteria; 3) determine whether true malaria epidemics occur in these settings and distinguish them from non-epidemic surges in burden; 4) map and describe indicators and threshold methods used for epidemic detection in moderate to high malaria transmission settings; and 5) characterize the epidemiological features of true malaria epidemics in these contexts. The review will adopt the Joanna Briggs Institute’s (JBI) framework for scoping reviews. Published literature on Plasmodium falciparum-associated surges in malaria burden described as either ‘epidemics’, ‘resurgences’, ‘outbreaks’ or ‘upsurges’ from sub-Saharan Africa (SSA) published between 1950 and 2025 will be retrieved from PubMED, Scopus and Global Health databases. The key words ‘malaria epidemic’, ‘malaria resurgence’, ‘malaria outbreak’, ‘malaria upsurge’, ‘plasmodium falciparum’, ‘sub-Saharan Africa’, and individual country names combined using Boolean operators, and truncations, and in combination with relevant medical subject headings (MeSH terms) will be used. Duplicates will be removed, and retrieved articles screened by title, abstract, and full-text. Data will be extracted from relevant literature including epidemic descriptions, definitions, methods and thresholds for epidemic detection. Epidemics will be reclassified based on WHO definitions, and epidemiological characteristics retrieved for true epidemics. Evidence will then be selected, extracted, collated, analyzed and summarized into results in relation to the scoping review’s purpose. Findings will inform policy improvements and realignment of epidemic detection systems tailored to moderate to high malaria transmission settings, and foster appropriate resource allocation for true epidemics by national malaria control programs, aiming to reduce malaria morbidity and mortality related to epidemics.