Time series analysis of malaria in pregnancy, using wavelet and SARIMAX models.

Abstract

Malaria in pregnancy (MIP) remains a global health challenge, affecting approximately 40% of pregnant women. Despite malaria control efforts by the Nigerian Government and its partners, regional disparities in health outcomes and malaria incidence trends among pregnant women remain under-studied. This study objectives were to assess MIP variability compared to general malaria cases, and forecast short-term MIP incidence over two years. This was achieved by analyzing malaria in pregnancy (MIP) variability across Nigeria from January 2015 to January 2025, using wavelet coherence, patterns of transmission cycles and selecting best modelling approach by comparing ARIMA and SARIMAX models to assess temporal trends before the forecast of short-term MIP incidence. Findings showed significant regional variability, with Cross River peaking in 2017 and 2019, while Enugu recorded its lowest trough in 2017. Malaria peaks in southern states remained lower than troughs in northern regions. Strong cross-correlations between MIP and general malaria transmission cycles were observed in Kebbi, Niger, Yobe, and Ondo, indicating persistent trends, while South-South and South-East exhibited weaker correlations, likely due to intervention fluctuations. SARIMAX models captured MIP trends more effectively, except Kebbi, where ARIMA fit better, and Niger, where SARIMAX exaggerated forecasts due to sensitivity to exogenous variables. Thus, SARIMAX was adopted for Cross River, Enugu, Ondo, and Yobe; while ARIMA was used for Kebbi and Niger States. It was discovered that Cross River and Enugu exhibited intervention-driven malaria fluctuations, Ondo, Niger, and Yobe displayed unstable or cyclical trends, reinforcing the importance of climate-sensitive forecasting models and seasonal interventions for improving malaria prediction accuracy. South-South and South-East need improved healthcare access, North-Central and North-West require seasonality forecasting, while North-East demands urgent control measures. Targeted malaria interventions are crucial to support achievement of the Nigeria's National Malaria Elimination Programme (NMEP) goals.