Ethiopia recorded more than 7.3 million confirmed malaria cases and 1,157 deaths in 2024, the highest annual incidence in seven years, according to a national landscape analysis published in March 2026 in the open-access Malaria Journal. The study, led by Sileshi Demelash Sasie and colleagues and drawing on peer-reviewed work plus consultations with malaria programme professionals, places that surge inside longer-running gaps in nets, spraying, diagnostics and surveillance rather than treating it as a one-year spike with a single cause. About 75 percent of Ethiopia’s land area is malaria-endemic, and more than 50 million people remain at risk, the authors wrote, even after earlier decades of progress that cut malaria deaths sharply between 2000 and 2016.
Most of the 2024 cases were laboratory-confirmed, with Plasmodium falciparum accounting for more than two-thirds of infections, the landscape analysis said. Roughly 69 percent of the population still lives in malaria-endemic areas, and periodic outbreaks continue to drive under-five deaths in several regions. The sharp rise in 2023 and 2024 has worried national health authorities and global partners because it arrives alongside climate variability, population movement and strain on health facilities, the authors noted, while stressing that no single factor explains the rebound on its own.
Household surveys reviewed in the paper put national ownership of insecticide-treated nets at about 64 percent on average, with much lower coverage and use in some high-burden and urban-adjacent settings, especially in parts of Oromia and densely populated areas. Indoor residual spraying, which means coating interior walls with insecticide so mosquitoes that rest indoors are less likely to transmit malaria, reached only about half of the high-risk zones that programmes had targeted, and logistical delays plus pyrethroid resistance reduced how well those campaigns worked. Digital malaria surveillance platforms were running in about 80 percent of health facilities, yet studies still found delayed reporting, incomplete data and weak feedback, especially in remote districts.
Diagnostics have also become less reliable in places where they are needed most. The landscape analysis reported intermittent stock-outs, expired rapid diagnostic tests, and widespread deletions of the pfhrp2 and pfhrp3 genes in Plasmodium falciparum parasites. Those gene deletions can make common HRP2-based rapid tests miss infections, so a patient can be sick with malaria and still receive a false-negative strip result. After outbreaks, only about half of health facilities reported timely replenishment of essential malaria commodities within three months, and there was little evidence of routine after-action reviews that would turn each surge into a written lesson for the next season.
Cross-cutting constraints listed by the authors include delayed financing, fragmented digital systems, limited routine mosquito surveillance and thin community engagement in prevention. Insecticide resistance is now widespread among malaria mosquitoes in Ethiopia, with reduced susceptibility to pyrethroids and emerging concerns about other chemical classes in some settings. The invasive urban-adapted mosquito Anopheles stephensi has also established itself in cities and peri-urban areas that were once treated as lower risk, changing where transmission can flare. Outdoor and early-evening biting patterns documented in entomological studies further weaken strategies that assume most infectious bites happen indoors at night under a net or beside a sprayed wall.
A second Malaria Journal meeting report, published in July 2026, zooms in on Plasmodium vivax, the malaria parasite that can hide in the liver and cause relapses weeks or months after the first illness. Ethiopia has seen vivax’s share of cases rise in several regions, reaching more than 40 percent in Amhara, more than 30 percent in Tigray, and between 10 and 25 percent in Somali and Dire Dawa, according to regional health bureau representatives quoted in that report. National case totals climbed from about 900,000 recorded cases in 2019 to between 7.3 and 12 million in 2024 in the figures the meeting report cites, and the World Health Organization’s broader malaria accounting for 2024 put Ethiopia among the countries that drove a large share of the global increase that year.
Ethiopia’s current radical-cure practice for vivax uses a low total dose of primaquine, 3.5 milligrams per kilogram over 14 days, without routine testing for G6PD enzyme deficiency, the meeting report said. Radical cure means treating both the blood-stage infection and the liver stages that can restart the disease later. Newer evidence supports a higher total primaquine dose of 7 milligrams per kilogram over seven or 14 days, and a single 300-milligram dose of tafenoquine, both of which need careful G6PD testing because people with low enzyme activity can suffer dangerous red-blood-cell breakdown from those medicines. The EFFORT trial and related analyses discussed at the Addis Ababa meeting in November 2025 found stronger protection against recurrence with high-dose primaquine or single-dose tafenoquine than with the low-dose course Ethiopia still uses as standard practice.
Thirty-eight representatives from the National Malaria Control Programme, research institutes, regional health bureaus and partners met in Addis Ababa on November 28 and 29, 2025, to review that evidence against funding cuts, climate pressure and operational disruptions. Stakeholders said those systemic pressures, including population displacement and weakened routine services, have limited how far the programme can sustain older interventions, let alone roll out G6PD-guided radical cure at health-post level where national policy expects most malaria patients to be treated. Cost uncertainty around drug prices and testing, plus incomplete knowledge of how much of the vivax burden comes from true relapses rather than new mosquito bites, still hold back a clear policy shift, the meeting report said.
Health access in conflict-affected areas sits beside those national figures without turning the malaria story into a war dispatch. The landscape analysis and meeting report both flag population displacement and disrupted services as pressures on surveillance, commodity supply and community prevention, and Amhara and Tigray appear in the vivax share figures as regions where the parasite mix is already shifting. Exact district-level malaria tolls tied to specific 2026 battles had not been independently verified in the two Malaria Journal papers, which stay focused on programme systems, parasite biology and treatment policy rather than front-line casualty counts.
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