<p>Severe malaria cases as a proportion of all malaria cases decreased from 7.0% in 2017 to 5.0% in 2021 (p&lt;0.001). The proportion reduced among children 5 years (4.4% to 3.5%, p=0.001), females (6.1% to 4.6%; p=0.001), and males (7.2% to 6.0%; p&lt;0.001). Among the 15 regions, only Bukedi (OR=1.04; p&lt;0.001) and Northern Central regions (OR=1.02; p&lt;0.001) had increases. Cases increased at regional referral hospitals (OR=1.15; p&lt;0.001) but all other health facility levels had significant reductions. Both private (OR=1.13; p&lt;0.001) and public (OR=1.09; p&lt;0.001) health facilities had increases.</p>