Africa remains at the epicenter of the malaria epidemic

Published: 30 November 2023 (Dar Es Salaam, Tanzania)

Climate change adds new layer of complexity to fight against disease

The World Malaria Report released Thursday by WHO shows that Africa continues to bear the heaviest burden of malaria. Globally in 2022, the continent accounted for 94% of all malaria cases (233 million cases) and 95% of all malaria deaths (580 000 deaths). The most heavily impacted by the disease remain children with about 78% of all malaria deaths in the region being among children under the age of five.

State of malaria in Africa

According to the report, since 2000, malaria case incidence and mortality rates in Africa have declined. However, since 2015, the rate of progress in reducing both cases and deaths has stalled in several countries. Africa is off track for both the malaria morbidity and mortality Global Technical Strategy for Malaria (2016-2030) 2025 milestones by 52% and 50%, respectively.

However, the overall regional trend masks progress in individual countries. Between 2019 and 2022, Rwanda saw a steep decline in malaria cases (3.8 million). In 2022, Ethiopia, South Africa, and Zimbabwe achieved a reduction in the mortality rate of 55% or more. And, although 27 countries are off track to meet the 2025 mortality milestone, they achieved mortality rate reductions of less than 55%.

In 2022, Comoros and Sao Tome and Principe reported zero malaria deaths for the first time. And that same year, Botswana, Eritrea and Eswatini all reported fewer than 10 malaria deaths. Cabo Verde has reported zero malaria deaths since 2018 and has requested an official certification of malaria elimination from WHO.

Use of insecticide-treated nets (ITNs) has remained largely unchanged since 2015 among pregnant women and young children, with 56% among young children and pregnant women sleeping under a net in 2022. There is greater access to preventive therapies for pregnant women and children with 42% coverage of intermittent preventive treatment of malaria in pregnancy and 49 million children receiving Seasonal Malaria Chemoprevention in 17 African countries in 2022. Globally, 3.9 billion Rapid Diagnostic Tests for malaria and 4 billion treatment courses of Artemisinin-based combination therapies (ACTs) were delivered between 2010 and 2022.

Climate change, a new frontier in the battle against malaria

The report highlights the impact of climate change on malaria and the broader health and development agenda. Climate change is a major threat to global health, impacting livelihoods, nutrition, security, and access to health services. Vulnerable communities are disproportionately affected. For malaria climate conditions directly influence mosquito breeding and malaria transmission, while indirect effects include disruptions to essential health services and supply chains, population displacement, and increased poverty and malnutrition. Between 2019 and 2022, 41 malaria-endemic countries suffered humanitarian and health emergencies, not including the COVID-19 pandemic. Many saw significant increases in malaria.

Stepping up efforts to win the battle

Stepping up malaria financing and political commitment- is critical. The current funding is substantially below the target, with a widening gap. Strengthening surveillance, harnessing innovation and the strategic use of data, addressing biological threats such as drug and insecticide resistance, and addressing the impact of climate change and socioeconomic constraints are vital for achieving global targets.

Investments that will bring new vector control approaches, vaccines, diagnostics, and antimalarial medicines will be needed to speed the pace of progress and attain global targets. Urgent action is needed to mitigate climate change impacts, including reducing the health sector’s carbon footprint, and building resilient health systems, primary health care, and universal health coverage. The centrality of increased domestic financing for malaria such as the establishment of End Malaria Councils and Funds across Africa, and ensuring a data-driven, multisectoral response to weather events and malaria transmission with malaria as a pathfinder to pandemic preparedness and response remain key.