MALARIA

Key facts
 Globally in 2023, there were an estimated 263
million malaria cases and 597 000 malaria
deaths in 83 countries.
 The WHO African Region carries a
disproportionately high share of the global
malaria burden.
 In 2023, the WHO African Region was home to
94% of malaria cases (246 million) and 95%
(569 000) of malaria deaths.
 Children under 5 accounted for about 76% of
all malaria deaths in the Region.

Overview
Malaria is a life-threatening disease spread to
humans by some types of mosquitoes. It is
mostly found in tropical countries. It is
preventable and curable.
The infection is caused by a parasite and does
not spread from person to person.
Symptoms can be mild or life-threatening.
Mild symptoms are fever, chills and headache.
Severe symptoms include fatigue, confusion,
seizures, and difficulty breathing.
Infants, children under 5 years, pregnant
women and girls, travellers and people with
HIV or AIDS are at higher risk of severe
infection.
Malaria can be prevented by avoiding
mosquito bites and with medicines.
Treatments can stop mild cases from getting
worse.
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 difficulty to recognize as malaria. Left
untreated, P. falciparum malaria can progress
to severe illness and death within 24 hours.
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.

Symptoms
The most common early symptoms of malaria
are fever, headache and chills.
Symptoms usually start within 10–15 days of
getting bitten by an infected mosquito.
Symptoms may be mild for some people,
especially for those who have had a malaria
infection before. Because some malaria
symptoms are not specific, getting tested
early is important.
Some types of malaria can cause severe
illness and death. Infants, children under 5
years, pregnant women, travellers and people
with HIV or AIDS are at higher risk. Severe
symptoms include:
 extreme tiredness and fatigue
 impaired consciousness
 multiple convulsions
 difficulty breathing
  dark or bloody urine
 jaundice (yellowing of the eyes and skin)
 abnormal bleeding.
People with severe symptoms should get
emergency care right away. Getting
treatment early for mild malaria can stop the
infection from becoming severe.
Malaria infection during pregnancy can also
cause premature delivery or delivery of a
baby with low birth weight.

Disease burden
According to the latest World malaria
report, there were 263 million cases of
malaria in 2023 compared to 252 million
cases in 2022. The estimated number of
malaria deaths stood at 597 000 in 2023
compared to 600 000 in 2022.
The WHO African Region continues to carry a
disproportionately high share of the global
malaria burden. In 2023 the Region was home
to about 94% of all malaria cases and 95% of
deaths. Children under 5 years of age
accounted for about 76% of all malaria deaths
in the Region.
Over half of these deaths occurred in four
countries: Nigeria (30.9%), the Democratic
Republic of the Congo (11.3%), Niger (5.9%)
and United Republic of Tanzania (4.3%).

Prevention
Malaria can be prevented by avoiding
mosquito bites and by taking medicines. Talk
to a doctor about taking medicines such as
chemoprophylaxis before travelling to areas
where malaria is common.
Lower the risk of getting malaria by avoiding
mosquito bites:
 Use mosquito nets when sleeping in
places where malaria is present.
 Use mosquito repellents (containing DEET,
IR3535 or Icaridin) after dusk.
 Use coils and vaporizers.
 Wear protective clothing.
 Use window screens.
Vector control

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.
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.
Chemoprophylaxis

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. In
some cases, chemoprophylaxis drugs must be
started 2–3 weeks before departure. All
prophylactic drugs should be taken on
schedule for the duration of the stay in the
malaria risk area and should be continued for
4 weeks after the last possible exposure to
infection since parasites may still emerge
from the liver during this period.

Preventive chemotherapies

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.
Preventive chemotherapy includes perennial
malaria chemoprevention (PMC), seasonal
malaria chemoprevention (SMC), intermittent
preventive treatment of malaria in pregnancy
(IPTp) and school-aged children (IPTsc), post-
discharge malaria chemoprevention (PDMC)
and mass drug administration (MDA). These
safe and cost-effective strategies are
intended to complement ongoing malaria
control activities, including vector control
measures, prompt diagnosis of suspected
malaria, and treatment of confirmed cases
with antimalarial medicines.
Vaccine

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 immunization
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.

Treatment
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).
Malaria is a serious infection and always
requires treatment with medicine.
Multiple medicines are used to prevent and
treat malaria. Doctors will choose one or more
based on:
 the type of malaria
 whether a malaria parasite is resistant to
a medicine
 the weight or age of the person infected
with malaria
 whether the person is pregnant.
These are the most common medicines for
malaria:
 Artemisinin-based combination therapy
medicines are the most effective
treatment for P. falciparum malaria.
 Chloroquine is recommended for
treatment of infection with the P.
vivax parasite only in places where it is
still sensitive to this medicine.
 Primaquine should be added to the main
treatment to prevent relapses of infection
with the P. vivax and P. ovale parasites.
Most medicines used are in pill form. Some
people may need to go to a health centre or
hospital for injectable medicines.
Antimalarial drug resistance

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.
For more on WHO’s work on antimalarial drug
resistance in the Greater Mekong subregion,
visit the Mekong Malaria Elimination
Programme webpage.

Genetic mutations
Most rapid diagnostic tests (RDTs) for malaria
target one or two specific proteins produced
by the P. falciparum malaria parasite: HRP2
and HRP3. However, parasites with genetic
mutations, that prevent the expression of
these proteins, are not detected by these
tests. This means that malaria patients may
not be diagnosed, allowing these mutated
parasites to spread. In 2023, these mutated
parasites were reported in 41 malaria
endemic countries, including in Burkina Faso,
Chad, Togo, and Indonesia for the first time.
Although their prevalence is still low in most
countries, it exceeds 15% in Brazil, Djibouti,
Eritrea, Nicaragua and Peru.

Elimination
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. Continued measures to prevent re-
establishment of transmission are required.
In 2023, 35 countries reported fewer than
1000 indigenous cases of the disease, up
from just 13 countries in 2000. 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, 14 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) and Egypt
(2024).
Surveillance
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 response
The WHO Global technical strategy for malaria
2016–2030, updated in 2021, provides a
technical framework for all malaria-endemic
countries. It is intended to guide and support
regional and country programmes as they
work towards malaria control and elimination.
The strategy sets ambitious but achievable
global targets, including:
  reducing malaria case incidence by at
least 90% by 2030
 reducing malaria mortality rates by at
least 90% by 2030
 eliminating malaria in at least 35 countries
by 2030
 preventing a resurgence of malaria in all
countries that are malaria-free.
Guided by this strategy, the Global Malaria
Programme coordinates the WHO’s global
efforts to control and eliminate malaria by:
 playing a leadership role in malaria,
effectively supporting member states and
rallying partners to reach universal health
coverage and achieve goals and targets of
the Global Technical Strategy for Malaria;
 shaping the research agenda and
promoting the generation of evidence to
support global guidance for new tools and
strategies to achieve impact;
 developing ethical and evidence based
global guidance on malaria with effective
dissemination to support adoption and
implementation by national malaria
programmes and other relevant
stakeholders; and
 monitoring and responding to global
malaria trends and threats.