Loreto, a region located in the Amazon basin, has reported more than 80% of malaria cases in Peru. Application of diagnostic methods in remote areas is challenging
hence, the identification of factors associated with Plasmodium infection is necessary to improve malaria control. A cross-sectional study was conducted in health facilities in Loreto from 2012 to 2023. Data and blood samples for malaria diagnosis were collected. We performed an analysis to identify associated factors to malaria positivity. Among 2989 participants with malaria symptoms, the prevalence was 87.6% and Plasmodium vivax was the most prevalent species (74.0%). We identified several factors associated with malaria positivity such as age, occupation, sleeping with open windows, previous malaria episodes, number of malaria episodes in the last 12 months, and others. The high prevalence of malaria and the predominance of P. vivax highlight the relevance of P. vivax-targeted control programs to reach elimination in low-endemic areas.