Rethinking malaria elimination: a perspective on challenges and solutions in Angola

(2025) 24:214 Domingos Malaria Journal https://doi.org/10.1186/s12936-025-05398-3 Malaria Journal Open Access PERSPECTIVE Rethinking malaria elimination: a perspective on challenges and solutions in Angola Edmilson Serra Domingos1* Abstract Background Multiple challenges hinder malaria control in Angola, including climatic variability, ineffective vector control, population displacement, socioeconomic inequalities, and increasing resistance to anti-malarial drugs and insecticides. These barriers have been further exacerbated by the COVID-19 pandemic, disrupting healthcare services and reversing prior gains. Despite a 36% reduction in malaria mortality since 2000, Angola remains off track to meet the Global Technical Strategy (GTS) targets for 2025, with no significant progress recorded in reducing malaria mortality between 2015 and 2023. Perspectives This paper analyses Angola’s malaria landscape, emphasizing that persistent healthcare system weaknesses such as financial instability, workforce shortages, poor disease surveillance, and regional disparities in intervention coverage, necessitate urgent, tailored responses. Drawing from lessons learned in successful malaria elimination programmes in Cabo Verde, Algeria, China, and the recent WHO recommendations, the study recommends the implementation of three integrated strategies: (i) mass drug administration, to rapidly reduce transmission and help consolidate malaria control; (ii) intermittent preventive treatment for school-age children, to protect a high-risk yet often overlooked population; and (iii) post-hospitalization malaria prevention to decrease readmissions and mortality linked to severe malaria episodes. Conclusion Achieving malaria elimination or a substantial reduction in Angola’s disease burden demands increased political commitment, sustainable financing, professional capacity building, and rigorous monitoring. A coordinated, evidence-based approach, aligned with WHO recommendations and tailored to Angola’s epidemiological context, is essential to overcoming barriers and accelerating progress toward the 2030 malaria elimination goal. Keywords Malaria elimination, Public health, Vector control, Child mortality, Preventive treatment, Healthcare system challenges, Angola, Antimalarial resistance Background Malaria remains the leading cause of mortality in Angola, representing one of the country’s most pressing public health challenges, particularly affecting children under five and pregnant women [1]. Plasmodium falciparum, *Correspondence: Edmilson Serra Domingos 1 Sagrada Esperança Clinic, Av. Murtala Mohammed, 298 Luanda, Angola the most lethal malaria-causing protozoan, predominates and sustains high transmission rates across the country. Between 2010 and 2021, Angola reported approximately 127,507 malaria-related deaths [2, 3], and in 2023, the country ranked second in the Central African region, accounting for 13% of malaria-related mortality and 14% of new cases [4]. Although significant progress has been made, including a 36% reduction in malaria mortality since 2000 and a decrease in morbidity from 26.6 to 15% between 2000 © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Domingos Malaria Journal (2025) 24:214 and 2018 [3, 5], several challenges persist. The COVID19 pandemic severely disrupted malaria services, and Angola was among the five countries with the highest increase in malaria cases between 2019 and 2021, registering an additional 1.4 million cases [2]. Interestingly, regions with higher malaria prevalence reported lower COVID-19 incidence, suggesting a potential protective effect, although this association remains speculative [6]. Multiple challenges hinder malaria control in Angola, including climatic variability, seasonal transmission shifts, ineffective vector control, internal population displacement, growing resistance to anti-malarial drugs and insecticides, and persistent socioeconomic inequalities [2, 5]. These challenges are especially pronounced in rural areas, where access to healthcare and preventive measures remains limited. Angola, alongside other member states of the Southern African Development Community (SADC)—including Botswana, Eswatini, Mozambique, Namibia, South Africa, Zambia, and Zimbabwe—is implementing coordinated malaria control strategies with the goal of achieving elimination by 2030. Despite coordinated efforts under regional initiatives such as the Elimination 8 (E8) and Angola’s ambition to transition toward pre-elimination [1, 7], the country remains off track to meet the Global Technical Strategy (GTS) for Malaria targets, which call for a 75% reduction in incidence and mortality by 2025. Given this scenario, this paper analyses the persistent challenges hampering malaria elimination in Angola, critically evaluate existing interventions, and propose targeted strategies to accelerate progress. By aligning national actions with Sustainable Development Goal (SDG) 3—Good Health and Well-being, particularly target 3.3 to end malaria epidemics by 2030, this perspective highlights the urgent need for innovative, coordinated, and sustainable interventions adapted to Angola’s specific epidemiological context. Key challenges in an endemic context Malaria transmission in Angola is heavily influenced by climatic factors, being unviable at temperatures below 16 °C or above 40 °C. The country’s equatorial, tropical, and subtropical zones create highly favourable conditions for year-round transmission [8]. However, disease burden varies across regions, with higher intensity observed in areas with elevated humidity and precipitation [9, 10]. Beyond environmental conditions, multiple socioeconomic and healthcare system weaknesses exacerbate the malaria crisis. Malaria remains a major contributor to child mortality, particularly in impoverished communities where limited education, poor sanitation, lack of access to clean water and electricity, and improper use of Page 2 of 7 mosquito nets sustain high transmission rates. Pregnant women, especially in rural areas, are particularly vulnerable, often resulting in low birth weight and elevated infant mor (...truncated)