Background:The occurrence of malaria in Ethiopia has been documented since 1958.Since then epidemics with different magnitude have occurred that caused significantmorbidity, mortality and considerable socio economic burden. The country has witnessedrecurrent epidemics of the disease, resulting in grave consequences including in areasdesignated as highland fringe. Scrutinized analysis of trends of malaria over longerperiod of time gives valuable information to tackle subsequent epidemics and helps forevaluation of interventions and sound planning in a resource limited country likeEthiopia.rnObjective:assess trend of epidemic malaria and its determinants in Tigray regionbetween 2001 and 2008.rnMethods:A Retrospective 8 years data werecollected from health facilities in Tigrayregion between 2001 and 2008.Data werecollected on structured and pretested tools bytrained data collectors. Data were cleaned and entered in to SPSS, version15, andanalyzed for results.rnResults: Overall in the study area malaria accounted for 28% of all outpatientconsultations made,32.6% of all admissions and 22.6% of all deaths that had occurred inhealth facilities in the entire studied periods, between 2001 &2008. There were decreasedadmissions and deaths after late 2006. The cessations of treatment of febrile individualsby community health workers( CHW) at their vicinity since the late 2006, has increasedthe flow of outpatient consultations to health facilities ,inflating malaria specificconsultations in all facilities and malaria specific admissions in health centers in the late2006 and 2007. Prior to 2006 indoor residual insecticidal spray was mainstay of vectorcontrol in the region but later in 2006 long lasting insecticide treated nets( ITN)distribution became the mainstay and at the same time Arthemesinin based CombinationTherapy( ACT) was deployed in most weredas under study.rnConclusions:The deployment of Arthemesin Combination Therapy (ACT) and scale upof distribution of long lasting insecticide treated nets (ITN) in 2006 was followed by thedecreased trend of malaria outpatient consultations, admissions and death in the region in2007. The preventive intervention being employed should be sustainable and ongoingsurveillance is needed to monitor their effectiveness. Further studies are needed toevaluate other factors that affect the dynamic of malariatransmission.