Introduction: Malaria remains a public health concern and one of the top three causes of morbidities at outpatient department in Liberia. To implement preventive, diagnostic, and malaria treatment measures, the annual malaria episodes is required for planning of interventions and procurement. We determined the median annual malaria episodes and factors associated with more than one episode.

Methods: A retrospective cross-sectional study; January 2015 to December 2016-confirmed malaria in 15 randomly selected health facilities was conducted. Facilities stratified into three groups based on cases reported per annum; those with > 1,500 malaria cases per annum as high burden facility, 1,000 – 1,500 cases as moderate, and < 1,000 cases as low. One health facility per strata randomly selected from each of the five health divisions. Data extracted from health records were patient’s ID(identifier), age, sex, address, visit date and diagnosis. Frequency, proportion, mean, median and interquartile range of episodes’ data calculated.

Results: Of the 35,249 malaria cases reported, 82% (29,236) met the study criteria. Children age ≤ 5 had the highest individual annual episodes. The overall annual median (Interquartile range, IQR) malaria episodes was 1 (IQR, 12). Trends of confirmed malaria increased from 454 cases in January 2015 to 909 in December 2016. Attendance in North Central region, and age less than 5 were significant factors associated with more than one episode of malaria.

Conclusion: Children under five reported high annual individual episodes of malaria. The overall annual median episode is one. No difference between the WHO estimated annual episode used for malaria programmatic planning.