Malaria is an infectious parasitic disease; in Brazil, its main etiologic agents are Plasmodium vivax and Plasmodium falciparum. The disease is concentrated mainly in the Brazilian Amazon region and remains relevant globally. In 2015, Brazil launched the National Program for Malaria Prevention, Control and Elimination (PNCEM), aiming to eliminate malaria by 2035. This study aimed to assess the reduction in malaria incidence in Maranhão and compare it with the national epidemiological pattern.

Descriptive, ecological, retrospective study with a quantitative approach using secondary data from the SIVEP-Malaria information system (2003–2024). Data were analyzed by percentage change and compared with Brazil using Google Sheets.

From 2003 to 2024, Maranhão recorded 84,786 malaria cases, 66.57% autochthonous (56,443), with predominance of P. vivax (79.04%; 67,015). The highest number of cases occurred in 2004 (14,505 positives), and the lowest in 2024 (506 cases). Between 2003 and 2024, Maranhão showed a 95.47% reduction, whereas Brazil showed a 65.53% reduction over the same period. Between 2015 and 2024 (start of the national elimination plan), the reduction was 8.15% in Maranhão and 0.25% nationally. In Brazil, malaria showed a stable pattern from 2020–2024, averaging 139,495.4 cases/year. In Maranhão, the average was 838.6 cases/year, with a marked reduction between 2023 and 2024 (50.68%). Maranhão’s share of Brazil’s malaria cases fell from 2.73% in 2003 to 0.36% in 2024. Malaria is endemic and concentrated in the Amazon region, including nine states (Acre, Amazonas, Amapá, Maranhão, Mato Grosso, Pará, Rondônia, Roraima, and Tocantins). In 2003, Brazil launched the National Malaria Control Plan, later replaced in 2015 by the PNCEM.

Maranhão showed a substantial reduction in malaria cases, especially compared with national trends; however, levels remain high, and greater effectiveness of public policy programs is needed to achieve elimination.