Malaria

Unique identifier / Notation

BI0219

Synonyms

Ague miasm paludism jungle fever

Malaria is a life-threatening disease caused by parasites that are transmitted to people mostly through the bites of infected female Anopheles mosquitoes. In 2023, there were an estimated 263 million cases of malaria worldwide and the estimated number of malaria deaths stood at 597,000 in 83 countries (adapted from WHO, 2024a).

Primary reference(s)

WHO, 2024a. Malaria. World Health Organization (WHO). Accessed 26 May 2025.

Annotations

Additional scientific description

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called 'malaria vectors'. There are 5 Plasmodium parasite species that cause malaria in humans and 2 of these species - P. falciparum and P. vivax - pose the greatest threat. P. falciparum is the deadliest malaria parasite and the most prevalent on the African continent. P. vivax is the dominant malaria parasite in most countries outside of sub-Saharan Africa. The other malaria species which can infect humans are P. malariae, P. ovale and P. knowlesi (WHO, 2024a).

The WHO African Region continues to carry the heaviest burden of the disease, accounting for an estimated 94% of malaria cases worldwide in 2023. The WHO Eastern Mediterranean Region has experienced a 57% increase in incidence since 2021, rising to 17.9 cases per 1,000 population at risk in 2023. The top five countries carrying the heaviest estimated burden of malaria cases in 2023 were Nigeria (26%), the Democratic Republic of the Congo (13%), Uganda (5%), Ethiopia (4%) and Mozambique (4%). Children under 5 accounted for about 76% of all malaria deaths in the Region. In 2023, humanitarian emergencies due to conflict, violence and natural disasters disproportionately affected populations in malaria-endemic countries. Conflict and violence affected 43 endemic countries, with a total of 51.3 million internally displaced persons (IDPs) in these countries. Additionally, 22.7 million of the 37.3 million registered refugees globally originated from malaria-endemic countries (WHO, 2024a; 2024b).

Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10 to 15 days after the infective mosquito bite. The first symptoms - fever, headache, and chills - may be mild and difficult to recognise as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death. Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ failure is also frequent. In malaria-endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur (WHO, 2024).

Progress in global malaria control is threatened by emerging resistance to insecticides among Anopheles mosquitoes. However, new-generation nets, which provide better protection against malaria than pyrethroid-only nets, are becoming more widely available and represent an important tool in global efforts to combat malaria. Anopheles stephensi presents an added challenge for malaria control in Africa. Originally native to parts of South Asia and the Arabian Peninsula, the invasive mosquito species has been expanding its range over the last decade, with detections reported to date in eight African countries. An. stephensi thrives in urban settings, endures high temperatures and is resistant to many of the insecticides used in public health (WHO, 2024a; 2024b).

The WHO recommends malaria diagnosis be made using parasite-based diagnostic testing, either by microscopy (allowing visualisation of the parasite) or by malaria rapid diagnostic tests (RDT) that are genus- or species-specific. RDT has been restricted to remote areas with limited access to good-quality microscopy services. Diagnosis of all suspected cases should be confirmed by either of these two methods before treatment, as a measure to avoid antimalarial drug resistance (WHO, 2024a).

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Countries that have achieved at least 3 consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. Since 2015, 15 countries have been certified by the WHO Director-General as malaria-free, including Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Argentina (2019), Algeria (2019), China (2021), El Salvador (2021), Azerbaijan (2023), Tajikistan (2023), Belize (2023), Cabo Verde (2024) , Egypt (2024) and Georgia (2025) (WHO, 2024a; WHO, 2025).

The World Malaria Report 2023 provides a comprehensive update on global and regional malaria data and trends. The report tracks investments in malaria programmes and research as well as progress across all intervention areas: prevention, diagnosis, treatment, elimination and surveillance. It also includes dedicated chapters on the consequences of malaria on maternal, infant and child health, the 'High burden to high impact' approach as well as biological threats to the fight against malaria. The report is based on information received from more than 80 countries and areas with ongoing malaria transmission. This is supplemented by data from national household surveys and databases held by other organizations (WHO, 2024b).

WHO has published consolidated WHO Guidelines for malaria, incorporating all of the current WHO recommendations for malaria. These are the product of careful evaluation following standardized methods as part of the WHO process for developing guidelines (WHO, 2024c).

Metrics and numeric limits

Globally, in 2023, the number of malaria cases was estimated at 263 million, with an incidence of 60.4 cases per 1,000 population at risk (WHO, 2024). This is an increase of 11 million cases from the previous year and a rise in incidence from 58.6 cases per 1,000 population at risk in 2022. Globally, in 2023, the number of deaths was estimated at 597,000, with a mortality rate of 13.7 per 100,000. The number of malaria deaths and the mortality rate steadily decreased from 622,000 and 14.9 deaths per 100,000, respectively, in 2020 (WHO, 2024a).

For WHO's World Malaria Day in 2024, it was reported that 94% of all malaria cases are in the WHO African Region, 249 million, new cases of malaria in 2022 and 608 000 malaria deaths in 2022 (WHO, 2024d).

Malaria remains a significant public health challenge globally. In 2023, there were an estimated 263 million new malaria cases in 83 countries, up from 252 million in 2022 and 226 million in 2015. However, malaria control efforts have paid off. Since 2000, they have helped prevent an estimated 2.2 billion cases and 12.7 million deaths globally. In 2023 alone, more than 177 million cases and 1 million deaths were averted, the vast majority of them - 80% of cases and 94% of deaths - in Africa. The malaria burden in the WHO Eastern Mediterranean Region has surged in recent years, with an estimated 10.2 million cases reported in 2023, a 137% increase as compared to 2015. (United Nations, 2025).

Key relevant UN convention / multilateral treaty

International Health Regulations (2005), 3rd ed. (WHO, 2016).

Drivers

Malaria mostly spreads to people through the bites of some infected female Anopheles mosquitoes. Blood transfusion and contaminated needles may also transmit malaria. The first symptoms may be mild, similar to many febrile illnesses, and are difficult to recognize as malaria. Left untreated, P. falciparum malaria can progress to severe illness and death within 24 hours.

Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances (WHO, 2024a).

Impacts

Globally, in 2023, the number of malaria cases was estimated at 263 million, with an incidence of 60.4 cases per 1,000 population at risk. This is an increase of 11 million cases from the previous year and a rise in incidence from 58.6 cases per 1,000 population at risk in 2022. Globally, in 2023, the number of deaths was estimated at 597,000, with a mortality rate of 13.7 per 100,000. The number of malaria deaths and the mortality rate steadily decreased from 622,000 and 14.9 deaths per 100,000, respectively, in 2020. The WHO African Region continues to carry the heaviest burden of mortality, with 95% of estimated malaria deaths worldwide (WHO, 2024).

Multi-hazard context

Not only does malaria continue to directly endanger health and cost lives, but it also perpetuates a vicious cycle of inequity. People living in the most vulnerable situations including pregnant women, infants, children under 5 years of age, refugees, migrants, internally displaced people, and Indigenous Peoples continue to be disproportionately impacted (WHO, 2024d).

Displacement due to conflict, violence and disaster affects populations in situations of vulnerability, particularly in malaria-endemic regions. IDPs and refugees often face barriers to accessing health care. Women, girls and young children are among the most affected during crises, being at higher risk of malnutrition and violence, which increase their vulnerability to diseases like malaria. Natural hazards, such as floods, hurricanes and droughts, drive displacement and can disrupt malaria control efforts by damaging infrastructure and limiting access to health services (Acosta-España et al., 2024).

The malaria burden in the WHO Eastern Mediterranean Region has surged in recent years, with an estimated 10.2 million cases reported in 2023, a 137% increase as compared to 2015. WHO’s Eastern Mediterranean Region comprises 21 Member States along the shore of the Mediterranean Sea, North Africa, the Horn of Africa, and parts of West and Central Asia, with a population of nearly 679 million people. African countries in this region include Djibouti, Egypt, Libya, Morocco, Somalia, Sudan and Tunisia. The alarming rise in cases has been driven by catastrophic floods in Pakistan, which led to 3.7 million additional cases between 2021 and 2023, while ongoing conflict and instability in countries such as Sudan and Yemen continue to disrupt malaria control efforts. Sudan has the highest malaria incidence rates in the Region. In 2023, more than 3.4 million cases were estimated, together with 7,900 deaths, though the figures could be higher due to underreporting as a result of the ongoing conflict and communication breakdown in Sudan (United Nations, 2025).

Faced with growing challenges, including emerging resistance to antimalarial drugs and insecticides and the impact of climate change on mosquito habitats and transmission patterns, innovative strategies are urgently needed to ensure progress towards malaria elimination (United Nations, 2025).

Risk Management

Malaria can be prevented by avoiding mosquito bites and with medicines. Treatments can stop mild cases from getting worse (WHO, 2024 a).

Vector control is a vital component of malaria control and elimination strategies as it is highly effective in preventing infection and reducing disease transmission. The 2 core interventions are insecticide-treated nets (ITNs) and indoor residual spraying (IRS). Progress in global malaria control is threatened by emerging resistance to insecticides among Anopheles mosquitoes. However, new-generation nets, which provide better protection against malaria than pyrethroid-only nets, are becoming more widely available and represent an important tool in global efforts to combat malaria (WHO, 2024a).

Travellers to malaria-endemic areas should consult their doctor several weeks before departure. The medical professional will determine which chemoprophylaxis drugs are appropriate for the country of destination. Preventive chemotherapy is the use of medicines, either alone or in combination, to prevent malaria infections and their consequences. It requires giving a full treatment course of an antimalarial medicine to vulnerable populations at designated time points during the period of greatest malarial risk, regardless of whether the recipients are infected with malaria (WHO, 2024a).

WHO recommends malaria vaccines for the prevention of P. falciparum malaria in children living in areas where malaria is endemic, prioritizing areas of moderate and high transmission. Since October 2021, WHO has recommended broad use of the RTS,S/AS01 malaria vaccine among children living in regions with moderate to high P. falciparum malaria transmission. The vaccine has been shown to significantly reduce malaria, and deadly severe malaria, among young children. In October 2023, WHO recommended a second safe and effective malaria vaccine, R21/Matrix-M. Vaccines are now being rolled out in routine childhood immunisation programmes across Africa.  Malaria vaccines in Africa are expected to save tens of thousands of young lives every year. The highest impact will be achieved, however, when the vaccines are introduced alongside a mix of other WHO-recommended malaria interventions such as bed nets and chemoprophylaxis (WHO, 2024a; 2024b).

Early diagnosis and treatment of malaria reduces disease, prevents deaths and contributes to reducing transmission. WHO recommends that all suspected cases of malaria be confirmed using parasite-based diagnostic testing (through either microscopy or a rapid diagnostic test) (WHO, 2024a).

Subsequent to the emergence of partial artemisinin resistance in the Greater Mekong subregion, WHO is very concerned about confirmed partial artemisinin resistance in Eritrea, Rwanda, Uganda and the United Republic of Tanzania. Based on available evidence, such resistance is also suspected in Ethiopia, Namibia, Sudan and Zambia. In 2022, WHO developed a strategy to curb antimalarial drug resistance in Africa. Regular monitoring of antimalarial drug efficacy is needed to inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance (WHO, 2024a).

The Global technical strategy for malaria 2016–2030 was adopted by the World Health Assembly in May 2015. It provides a comprehensive framework to guide countries in their efforts to accelerate progress towards malaria elimination. The strategy sets the target of reducing global malaria incidence and mortality rates by at least 90% by 2030. This updated version, endorsed by the World Health Assembly in May 2021 through resolution WHA74.9, reflects lessons learned in the global malaria response over the last 5 years. While the milestones and targets remain the same, the approaches to tackling the disease, in some areas, have evolved to keep pace with the changing malaria landscape.

Monitoring

WHO supports countries to conduct all-hazards strategic risk assessment in the contexts of health emergencies and disasters, which results in the development of a country risk profile. Empowered with the country risk profile, inclusive of a seasonal risk calendar, countries can anticipate potential emergencies before they occur to trigger early alerts and inform early actions (WHO, 2021b).

Malaria surveillance is the continuous and systematic collection, analysis and interpretation of malaria-related data, and the use of that data in the planning, implementation and evaluation of public health practice. Improved surveillance of malaria cases and deaths helps ministries of health determine which areas or population groups are most affected and enables countries to monitor changing disease patterns. Strong malaria surveillance systems also help countries design effective health interventions and evaluate the impact of their malaria control programmes (WHO, 2024a).

WHO's Early Warning, Alert and Response System (EWARS) has been designed to improve disease outbreak detection in emergency settings, such as in countries in conflict or following a disaster from natural hazards. It is a simple and cost-effective way to rapidly set up a disease surveillance system. EWARS is deployed during an emergency as an adjunct to the national disease surveillance system. WHO works with Ministries of Health and health sector partners to train local health workers to use the system. After the emergency, EWARS should re-integrate back into the national system (WHO, 2023).