Background: The United Nations Inter-Agency and Expert Group on Millennium Development Goals (MDGs), established incidence rate as one of the indicators for monitoring progress on Malaria control. Data on malaria incidence rates in Edo State, Nigeria, 2006-2013 were published in 2015. The current study focused on incidence rates, 2014-2018. In addition, trends in malaria diagnoses were also investigated. Methods: Records of numbers of patients from the 18 Local Government Areas (LGAs) complaining of malaria, at LGA Health Centres, State Hospitals, etc. were obtained from the Department of Disease Control, State Ministry of Health, Benin City. Patients were placed in 3 categories: Fever, without malaria confirmation, confirmed uncomplicated, confirmed severe. Human population records over the 5-year period were obtained from the Nigeria Population Commission, Benin City. Incidence rates were calculated and relative proportions of patients in the 3 categories determined. Results: The numbers of fever cases, without malaria confirmation, varied across LGAs and constituted 58.00-68.00% of all fever cases annually. In confirmed cases of malaria, most were uncomplicated. The highest numbers of confirmed cases were in Egor and Oredo LGAs. The pattern was similar in uncomplicated and severe cases. The ratios of uncomplicated and severe cases of malaria varied significantly (p<0.05) annually. Malaria incidence rates varied among LGAs in each of the years: 2014 (0.75-5.48%), in 2015 (0.24-2.55%), in 2016 (1.44-5.21%), in 2017 (1.17-9.69%), in 2018 (0.63-4.03%). However, these differences were not significant (p>0.05). In the period 2014-2018, malaria incidence rates of 5.00% and above were recorded only 5times across LGAs: Egor, 2014 (5.48%); Esan Central, 2016 (5.14%; Ovia southwest, 2016 (5.21%), 2017 (9.69%); Uhunmwnde, 2017 (5.05%). Conclusion: The decline in malaria incidence rates, 2014-2018, over the 2006-2013 data indicates progress. However, there are still daunting challenges which have been detailed in the text. These results also highlight the need for malaria test confirmation rather than utilizing fever as the exclusive symptom for malaria. All stakeholders must intensify efforts to ensure that this downward trend in malaria incidence rates is sustained.