In the quiet shadows of Ethiopian cities, an invader lurks—one that follows in the footsteps of humanity, multiplying rapidly in the smallest pools of water. This intruder is Anopheles stephensi, a species of mosquito that has emerged as a formidable vector of malaria, a disease often dubbed “the disease of poverty.” Unlike its predecessors, this mosquito is adapting to environments once deemed inhospitable—breeding in the scorching heat of places like Semera and Logiya in the Afar region, where temperatures can soar to 43 degrees Celsius.
Anopheles stephensi is now a significant urban malaria vector, transmitting both Plasmodium falciparum and Plasmodium vivax—the parasites responsible for the majority of malaria cases here, according to reports.
Chalachew Sisay (PhD), an expert from the Malaria Consortium, a leading non-profit in the fight against communicable diseases, warns that this mosquito has found its way into some of Ethiopia’s hottest regions. “The new species of mosquito is encroaching upon regions previously too hot for its survival. It has spread from Adama to Metehara, even reaching as far south as Hawassa, the capital of Sidama.”
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The rapid expansion of Anopheles stephensi, coupled with climate change, ongoing conflicts, and limited resources, has fueled a significant rise in malaria cases. “We’ve seen malaria cases jump from 1.2 million in 2016/17 to 4.2 million in 2023,” Chalachew notes. As Technical Officer for the Senay Project—a joint anti-malaria initiative by the Health Development and Anti-Malaria Association (HDMA) and the Malaria Consortium in five districts of the Amhara region—he has witnessed the relentless advance of the disease.
The resurgence is alarming. After a decade of progress in malaria control, with cases reduced from over four million in 2010 to just 962,000 in 2018, the numbers have climbed once again.
By 2021, cases reached 2.3 million, then 3.3 million in 2022, and now well over 4.2 million in 2023. Some reports even suggest the figure has hit five million. Chalachew cautions that the true scale of the crisis may be underreported due to incomplete data collection.
“Timeliness and completeness of reporting have fallen below standard, often under 50 percent,” he said. This means the actual number of cases could be significantly higher.
Regionally, the burden of malaria is heaviest in Oromia, Amhara, and South West Ethiopia Peoples’ regions, which together account for nearly 70 percent of all cases. Southern Ethiopia contributed 288,124 cases, while Tigray reported 155,905, and Benishangul-Gumuz recorded 137,052. Even regions like Addis Ababa, typically considered less vulnerable, reported 8,712 cases, underscoring the widespread nature of the threat.
Ethiopia was once lauded for its malaria control efforts. Back in 2008, as the country garnered international recognition for its community health initiatives, Leslie Reed, then the USAID Mission Director for Ethiopia, issued a prescient warning that while substantial progress in scaling up malaria control interventions continues, “nearly 70 percent of Ethiopians are at risk of contracting the disease. We cannot lose momentum against the ancient killer. Diverting our focus will result in a resurgence of malaria illness and death, risking the extraordinary progress achieved to date.”
A Crisis Reignited
For nearly a decade, Ethiopia appeared on the brink of a major public health victory: a country almost free of malaria. But that progress, built through years of integrated intervention, began to unravel around 2016. “Even before COVID-19, we saw signs of a relapse, but the pandemic’s arrival was the major disruption,” Chalachew said. “The conditions simply didn’t allow for the community-based surveillance and interventions necessary to keep this ‘disease of poverty’ in check.”
Chalachew underscores the fragility of Ethiopia’s malaria gains. “When it comes to malaria, a lapse of even a year or two in interventions can lead to disastrous consequences.” He has been closely monitoring the situation in five districts of the Amhara Region as part of the Senay Project.
The numbers are stark: between weeks 1 and 27 of 2024, a total of 44,449 cases were reported across Ayehu Guagusa, Baso Liben, Debre Elias, Gozamen, and Jabi Tenan districts. Jabi Tenan alone accounted for over 60 percent of these cases, with close to 27,000 reported, and Ayehu Guagusa accounts for over 25 percent of the cases, with over 11,000 reported.
The resurgence is particularly severe in areas along riverbanks, such as the Abbay (Nile) River basin, where water schemes have become malaria hotbeds. “Malaria risks should have been factored into the design of these projects, including the Grand Ethiopian Renaissance Dam,” Chalachew notes, highlighting a critical oversight.
A recent overview by the Malaria Consortium reveals the alarming scope of the crisis in the Amhara region: 23 million patients were seen at health facilities in the first half of 2024, with 6.3 percent diagnosed with malaria. The total number of cases reached 1.5 million, with Plasmodium falciparum responsible for 53 percent of them. The number of cases rose by 29 percent from the previous year, reflecting a troubling trend, particularly among children under five, who represented 11.7 percent of the total cases.
The surge in cases can be attributed to several factors. “Climate anomalies, conflict, and humanitarian crises have created ideal conditions for the disease to thrive,” Chalachew explains. Adding to the challenge is the emergence of Anopheles stephensi, a fast-breeding mosquito species that has proven resistant to existing drugs. Security issues in parts of Oromia and Amhara regions have further hampered essential surveillance and intervention efforts, allowing malaria to spread unchecked.
Climate change, with its erratic rainfall patterns, has also played a significant role in the resurgence. “These conditions are perfect for both the mosquito vector and the ‘Plasmodium’ parasite,” he says, pointing to the unpredictable weather that now characterizes much of Ethiopia.
The World Health Organization (WHO) warns that the first symptoms of malaria—fever, headache, and chills—can be mild and easily overlooked.
Without prompt treatment, particularly for Plasmodium falciparum, malaria can lead to severe illness or death, with complications such as multi-organ failure in adults and severe anemia or cerebral malaria in children. Accurate data on malaria-related deaths in Ethiopia remains elusive, but Chalachew points out that the number of fatalities has decreased compared to previous decades, thanks to improved access to healthcare and increased public awareness. However, malaria still ranks among the top ten causes of death in the country.
While the decline in malaria-related deaths is a positive sign, the disease’s economic impact remains devastating. “A farmer struck by malaria can’t tend to his crops for days, leading to lost productivity and income,” Chalachew explains. The ripple effects extend to employee absenteeism, increased healthcare costs, and educational setbacks for students.
This economic toll is why malaria is often called the “disease of poverty.” As WHO notes, the threat is particularly severe in sub-Saharan Africa, where countries like Nigeria and the Democratic Republic of the Congo account for nearly half of all malaria deaths worldwide.
Malaria patients, left feverish and weak, struggle with poor appetite and are vulnerable to other illnesses. As Ethiopia confronts this resurgent crisis, the need for sustained and targeted intervention has never been more urgent. The fight against malaria is far from over, and without renewed focus, the progress of the past decade risks being undone.
Meanwhile, in connection with World Malaria Day, August 20, WHO Director General Tedros Gebreyesus said on X (formerly twitter), “I started my career as a malaria researcher, and I longed for the day that we would have an effective vaccine against this ancient and terrible disease.”
“Now WHO recommends the use of two vaccines, RTS,S and R21, for children living in malaria endemic areas,” he wrote. “Every 2 minutes a child dies from malaria. Vaccines are among the key tools to save more children from deadly mosquito bites.”
