Malaria is on the rise in southern Africa, with several countries – including Botswana, eSwatini, Namibia and Zimbabwe – reporting new outbreaks, underscoring the ongoing challenges in eradicating the disease in Africa.
Data from the Surveillance and Disease Intelligence Division of the Africa Centres for Disease Control and Prevention (Africa CDC) reveals a dramatic spike in Zimbabwe, where suspected cases have increased in 2025. As of epidemiological week 23, of 2025, Zimbabwe has reported 111,998 cases and 310 deaths (case fatality rate [CFR]: 0.27%) as compared to 29,031 cases with 49 deaths (CFR: 0.17%) in the same period in 2024.
“This surge is no coincidence,” says Dr Memory Mapfumo, an epidemiologist at the Africa CDC. “Prolonged rains have fuelled mosquito breeding, while activities like gold panning, fishing and artisanal mining are exposing more individuals to risk, especially during peak mosquito activity hours.” A contributing factor is the interconnectedness of the countries, which drives transmission.
Across Zimbabwe, 115 out of 1,705 health facilities have been affected, highlighting the widespread impact of the disease on healthcare infrastructure. Since the start of 2025, Mashonaland Central Province has accounted for 32% of all malaria cases, while Manicaland reported 25% of the malaria-related deaths.
The situation is worsened by the low use of insecticide-treated bed nets (ITNs), leaving communities exposed and placing further strain on already stretched health systems. This reflects a broader challenge across southern Africa, where shifting climate patterns and expanding high-risk livelihoods are driving a growing malaria threat, necessitating quicker, more targeted and sustained responses.
However, malaria is endemic across sub-Saharan Africa, particularly in regions with high temperatures and rainfall, which create ideal breeding grounds for Anopheles mosquitoes, the vector that transmits the malaria parasite. The central part of the continent – both north and south of the equator – experiences the highest malaria incidence. Other factors include the tropical climate, as well as displacement and limited access to preventive measures.
Southern Africa, although comparatively less affected, remains vulnerable to the disease due to climatic conditions that favour mosquito breeding, cross-border population movements and localised outbreaks in high-risk areas. The region’s malaria burden fluctuates with rainfall patterns, human activities such as mining and agriculture, and gaps in healthcare access, making sustained intervention crucial for reducing transmission.
“As climate change accelerates, we are witnessing shifts in temperature and rainfall that are expanding the range of malaria-carrying mosquitoes, introducing vectors into previously unaffected regions,” said Dr Merawi Aragaw, head of Africa CDC’s Surveillance and Disease Intelligence.
He emphasised that this is not only a regional issue but a global challenge that calls for coordinated international efforts. “Sustained vector control measures – including environmental management, strengthening surveillance, drug and diagnostic resistance monitoring, and fostering cross-border collaboration – will be critical in mitigating the growing threat of vector-borne diseases, especially malaria,” said Dr Merawi.
The regional surge underscores a broader global trend, with malaria cases worldwide climbing to 263 million in 2023, up from 252 million the previous year, and Africa accounting for 95% of all malaria-related deaths. Despite these alarming figures, there have been significant successes: Cabo Verde was certified malaria-free in 2023, and Egypt is poised to achieve the same in 2024.
Yet for many countries in southern Africa, the road to elimination remains steep, with outbreaks threatening to reverse years of progress.
Take Botswana, which since epidemiological weeks 1–23 of 2025 has recorded 2,223 cases and 11 deaths, compared to 218 cases and no deaths in the same period in 2024. Okavango has been hit hardest, accounting for 69% of the cases. Since the outbreak began in November 2024, a total of 2,344 cases have been reported, with sporadic outbreaks appearing in non-endemic districts.
Flooding caused by heavy rains has contributed significantly to the outbreak by creating favourable conditions for mosquito breeding. Furthermore, many local residents remain unaware of the risks, contributing to delayed responses when symptoms first appear. To counter this, Botswana’s Ministry of Health has intensified case management and surveillance, launched community engagement campaigns, and distributed ITNs. However, efforts have been hindered by inadequate funding and community resistance to the interventions.
Although the Kingdom of eSwatini is in the malaria elimination phase, eSwatini, too, is grappling with an upsurge in malaria cases. The Ministry of Health recently issued a press notice to draw attention to the issue. From July 2024 to March 2025, the kingdom has recorded 187 malaria cases. Children under 15 years account for 15% of the reported cases, which has led to increased school absenteeism.
Twenty per cent of cases have been among farmers, especially those involved in illegal farming activities in the mountains. These farmers often work at night, guarding their crops without any protective measures, leaving them exposed to mosquito bites. The majority of cases are concentrated in the Hhohho and Lubombo regions, prompting the Ministry of Health to increase its response efforts, including indoor residual spraying (IRS) and the distribution of ITNs.
Despite these interventions, eSwatini’s malaria elimination programme faces significant hurdles. There are challenges in achieving complete coverage of IRS and ITN distribution, and many individuals still fail to adopt protective behaviours. Nonetheless, the government remains committed to eliminating malaria and addressing the underlying causes, such as illegal farming and inadequate community awareness.
Namibia is another country witnessing a significant rise in malaria cases, with over 89,959 cases and 146 deaths reported since November 2024 from 37 of 121 districts. Of these cases, 18% (15,954 cases) are imported from neighbouring countries experiencing malaria outbreaks, and 82% are local.
The hardest-hit districts in Namibia include Katima Mulilo, Nkurenkuru, Andara, Outapi and Rundu. Malaria continues to have a severe impact on children above five years and pregnant women, who represent 11% and 3% of the reported cases, respectively. Most cases reported were among males (58%).
Of major significance is the interconnectedness of southern Africa, which complicates malaria control efforts, especially in border regions.
In Botswana, districts bordering Namibia and Zimbabwe are particularly vulnerable to cross-border transmission, with malaria spreading easily between neighbouring countries with ongoing outbreaks. This highlights the importance of regional cooperation and cross-border surveillance in combating the disease. Efforts to enhance case management, improve surveillance and increase the use of ITNs are critical in curbing transmission in these high-risk areas.
According to Africa CDC, the increase in malaria cases in the region highlights the pressing need for continued vigilance and investment in malaria control. Governments need to enhance their efforts to improve the use of ITNs, strengthen community engagement, and address the environmental and social factors driving the outbreaks, such as illegal farming and exposure to mosquito breeding grounds.
Equally important is the need for a concerted effort to address delays in reporting, ensuring the timely and accurate collection of data to inform public health interventions. Yet, while the fight against malaria remains an uphill battle, the successes in Cabo Verde and Egypt offer hope that with the right strategies, the elimination of malaria in southern Africa is possible.
