Malaria cases are increasing significantly in five high-burden African countries despite decades of global control efforts, according to a new analysis of World Health Organization data spanning 2015-2024. The study, published in PLOS Global Public Health, reveals concerning trends that threaten progress toward WHO elimination targets.
Nigeria and DRC Lead Concerning Trend
Nigeria shows the most significant increase in malaria cases with Mann-Kendall statistics of 3.94, followed by the Democratic Republic of the Congo at 3.76, according to researchers Dr. Loick Pradel Kojom Foko and Dr. Amit Sharma. Both countries demonstrated statistically significant upward trends with p-values of 0.002.
Three additional countries—Cameroon (3.40, p=0.005), Uganda (2.86, p=0.02), and Mali (2.50, p=0.04)—also showed sustained increases in malaria burden. These five nations are part of the WHO’s High Burden to High Impact initiative, which targets the world’s highest malaria-endemic countries.
Biological Threats Undermining Control Strategies
The analysis identifies four critical biological threats compromising malaria control efforts across these regions. Antimalarial drug resistance and insecticide resistance are emerging alongside pfhrp2 gene deletions, which affect rapid diagnostic test accuracy, researchers report in the study.
Perhaps most concerning is the invasion of Anopheles stephensi mosquitoes, an urban malaria vector not traditionally found in Africa. These biological challenges intersect with climate change, armed conflict, and population displacement to create what the authors describe as “silent challenges” complicating control efforts.
The WHO Global Malaria Programme has documented similar resistance patterns across sub-Saharan Africa, though the concentration in High Burden to High Impact countries presents particular concerns for global elimination strategies.
Mixed Progress Toward 2030 Elimination Goals
While mortality trends remain “heterogeneous and mostly non-significant” across the studied countries, the sustained case increases threaten WHO’s Global Technical Strategy target of a 90% reduction in malaria burden by 2030. However, Cabo Verde’s recent malaria-free certification demonstrates that elimination remains achievable, the researchers note.
The study recommends strengthening integrated, real-time malaria surveillance and response systems as a priority intervention. Additionally, researchers emphasize evaluating the impact of emerging challenges like climate change on transmission patterns across affected regions.
Achieving the WHO Global Technical Strategy target of ≥90% reduction in malaria burden by 2030 in HBHI countries is ambitious but feasible if locally driven, multisectoral solutions are implemented with urgency and sustained commitment.
— Dr. Loick Pradel Kojom Foko and Dr. Amit Sharma, PLOS Global Public Health (2024)
Key takeaways
- Five African countries show statistically significant increases in malaria cases from 2015-2024
- Four biological threats including drug resistance and new mosquito vectors are undermining control efforts
- Real-time surveillance systems and climate impact assessments are urgently needed
Frequently asked questions
Which countries show the highest increases in malaria cases?
Nigeria leads with Mann-Kendall statistics of 3.94, followed by the Democratic Republic of the Congo at 3.76. Both showed statistically significant increases with p-values of 0.002.
What biological threats are undermining malaria control?
Four main threats include antimalarial drug resistance, insecticide resistance, pfhrp2 gene deletions affecting diagnostic accuracy, and invasion of Anopheles stephensi mosquitoes into African urban areas.
Can the WHO 2030 elimination targets still be achieved?
Researchers describe the 90% reduction target as “ambitious but feasible” if locally driven, multisectoral solutions are implemented urgently. Cabo Verde’s recent malaria-free certification demonstrates elimination remains possible.
The research underscores that while malaria control faces unprecedented challenges from biological resistance and environmental factors, targeted interventions combining surveillance strengthening with locally adapted strategies offer pathways toward the 2030 elimination goals. Success will require sustained commitment from both national governments and international partners to address the complex intersection of biological, environmental, and social factors driving transmission patterns across high-burden regions.
Source: Turning the tide against malaria in high-burden African countries: Trends, threats, and solutions
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