Malaria remains one of the most persistent public health challenges in Africa, with millions of lives at risk due to increasing drug resistance, climate change, humanitarian crises, and funding gaps. These factors, combined with the spread of invasive mosquito species, are making malaria transmission more difficult to control, particularly in urban areas.
Historically, malaria has been a predominantly rural disease, but rapid urbanization and environmental changes are shifting the burden to cities. The African Leaders Malaria Alliance (ALMA) has warned that as urbanization accelerates, malaria is becoming an urgent urban health crisis. Poor infrastructure, inadequate drainage, and overcrowded settlements provide breeding grounds for mosquitoes, increasing the risk of transmission.
One of the biggest threats to malaria control is the growing resistance of both malaria parasites and mosquito vectors. Drug resistance is making common antimalarial treatments less effective, complicating efforts to cure infections. Meanwhile, mosquitoes are becoming resistant to insecticides, reducing the efficacy of crucial prevention tools like insecticide-treated nets and indoor residual spraying. This dual resistance poses a severe challenge to malaria control, particularly in densely populated urban environments where transmission rates can be high.
Climate change is exacerbating malaria transmission by altering weather patterns and creating favorable conditions for mosquito breeding. Rising temperatures, increased rainfall, and humidity accelerate the life cycle of mosquitoes, allowing them to spread into previously malaria-free urban areas. Additionally, warmer climates speed up the development of malaria parasites inside mosquitoes, leading to faster and more widespread transmission.
ALMA has cautioned that malaria is creeping into regions where it has not traditionally been a problem. Without swift intervention, the hard-won gains made in malaria control over the past two decades could be reversed.
In many African cities, rapid population growth has outpaced infrastructure development, leading to poor sanitation and stagnant water sources that become mosquito breeding grounds. This problem is further worsened by conflict and displacement, as people forced to flee their homes often end up in overcrowded, unsanitary conditions with limited access to healthcare. These factors make refugees and internally displaced persons particularly vulnerable to malaria.
Another alarming development is the spread of Anopheles stephensi, an invasive mosquito species that thrives in polluted water and man-made containers commonly found in urban areas. Unlike traditional malaria vectors that breed in rural settings, Anopheles stephensi has adapted to city environments, making malaria control efforts even more challenging. The mosquito has already been detected in at least 10 African countries, including Kenya, and its presence could lead to increased malaria outbreaks in cities that were once considered low risk.
Despite the growing threat of malaria, financial constraints remain a significant barrier to progress. According to the World Malaria Report 2022, only about 50% of the estimated $7.3 billion required globally for malaria elimination has been mobilized. This funding shortfall threatens the sustainability of critical malaria interventions such as vector control, treatment, and surveillance.
ALMA warns that without urgent financial support, Africa risks a resurgence in malaria cases and deaths, particularly among vulnerable populations like children and pregnant women. The 2023 Africa Malaria Progress Report highlights a budget gap of at least $1.5 billion just to maintain basic malaria services. If this gap is not addressed, malaria incidence and mortality could rise significantly by 2030, undoing decades of progress.
To address the growing threat of malaria in urban settings, a multi-pronged approach is essential:
Strengthening Surveillance and Early Detection – Improved data collection and monitoring systems can help detect resistance patterns and identify malaria outbreaks before they escalate.
Innovative Vector Control Strategies – Research into new insecticides, biological mosquito control methods, and genetic modification technologies could help combat insecticide resistance.
Urban Infrastructure Improvements – Better drainage systems, waste management, and water sanitation can reduce mosquito breeding grounds in cities.
Expanding Access to Malaria Prevention and Treatment – Ensuring that vulnerable populations, particularly in informal settlements, have access to effective malaria treatment and preventive measures is critical.
Climate Adaptation Strategies – Environmental management, early warning systems, and sustainable urban planning can mitigate malaria risks associated with climate change.
The fight against malaria is at a critical juncture. While Africa has made significant progress in reducing malaria cases and deaths over the past two decades, emerging threats such as climate change, drug resistance, and invasive mosquito species are putting these gains at risk. Without increased financial investment and a renewed commitment to malaria control efforts, the disease could make a deadly resurgence, particularly in urban areas.
Closing the funding gap, investing in innovative solutions, and strengthening public health infrastructure will be crucial in ensuring that malaria elimination efforts stay on track. The time to act is now before malaria once again becomes a major public health crisis across the continent.
