The African continent continues to shoulder the world’s heaviest malaria burden, despite notable successes in reducing cases and achieving malaria elimination in some countries, according to a recent update presented by Dr. Felicia Owusu-Antwi of the World Health Organization (WHO) Ghana.
Speaking at a conference to mark World Malaria Day, Dr. Owusu-Antwi highlighted that in 2023, the WHO African Region accounted for an overwhelming 94% of global malaria cases, reinforcing the continent’s central role in the global fight against the disease. Globally, an estimated 263 million malaria cases were recorded in 2023, reflecting an increase of 11 million from 2022, with a case incidence rate of 60.4 per 1,000 populations at risk.
Countries with the Highest Burden
The malaria burden in Africa remains concentrated in a handful of countries. Nigeria led with 26% of global cases, followed by the Democratic Republic of the Congo (13%), Uganda (5%), Ethiopia (4%), and Mozambique (4%).
Africa also experiences the highest malaria mortality, accounting for an estimated 95% of malaria deaths worldwide. The countries bearing the highest death tolls include Nigeria, DRC, Mozambique, Angola, Uganda, and Burkina Faso. Although global malaria deaths fell slightly from 622,000 in 2020 to 597,000 in 2023, Africa continues to suffer the vast majority of fatalities, with a mortality rate of 13.7 per 100,000 populations.
Progress Amidst Challenges
Despite the persistent burden, the continent has made substantial progress. Between 2000 and 2023, approximately 1.7 billion malaria cases were prevented in the African region alone. Globally, 12 million malaria deaths were averted in the same period, with the African region contributing nearly the entire total. In 2023 alone, over 1 million deaths were prevented globally.
However, progress towards the Global Technical Strategy for Malaria (GTS) 2016–2030 has been slower than anticipated. By 2023, only 26% of the 93 malaria-endemic countries met the GTS morbidity milestone. While 34% showed progress, they still fell short. In terms of mortality, 38% met the GTS target, and 40% recorded partial reductions.
Key Barriers to Progress Several complex factors continue to impede malaria control efforts across Africa:
Epidemics and crises, such as COVID-19, armed conflicts, famine, and flooding. Weak health systems, including fragile supply chains, limited health infrastructure, staffing shortages, and data gaps. Chronic underfunding, with malaria funding reaching only US$ 4.3 billion in 2023—far below the required US$ 8.3 billion. Inadequate coverage and quality of core malaria interventions. Biological challenges, such as insecticide and drug resistance, decreased diagnostic test sensitivity, and the spread of invasive mosquito species like Anopheles stephensi. Programmatic weaknesses, including issues with prioritization, management, procurement, and human resources.
Success Stories ; Malaria Elimination Is Possible
Despite these hurdles, some African nations have made significant strides. Algeria (2019), Cabo Verde (2024), and Egypt (2024) have all achieved malaria-free certification by WHO.
Cabo Verde’s success was attributed to strong political commitment, domestic financing, multi-sectoral coordination, and integration of malaria efforts into primary healthcare, alongside the use of technologies like GIS mapping.
Egypt’s achievement is particularly remarkable, following nearly a century-long effort. From early vector control programs in the 1920s to joining WHO’s Global Malaria Eradication Programme and implementing modern surveillance and rapid-response systems, Egypt’s sustained commitment paid off. Public awareness campaigns, trained health workers, and decisive action during outbreaks—such as in Aswan in 2014—played key roles in the country’s success.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus praised Egypt’s achievement, calling it “a testament to the commitment of the people and government… an inspiration to other countries in the region, and a demonstration of what’s possible with the right resources and the right tools.”
The Way Forward The contrasting picture of burden and success highlights a critical message: malaria can be eliminated, but only with strong political will, robust health systems, adequate financing, cross-border cooperation, and the strategic use of technology.
For much of Africa, however, the path forward remains fraught with operational and financial obstacles. As the continent carries the brunt of the global malaria burden, scaling up proven tools, improving health system resilience, and closing the funding gap remain urgent priorities in the fight against this preventable and treatable disease.
Story by: Emmanuel Gameli Dovia
