Malaria is actively transmitted in 83 countries worldwide, concentrated heavily in sub-Saharan Africa but also present across parts of South and Southeast Asia, Central and South America, the Middle East, and Oceania. In 2023, these countries recorded an estimated 263 million new cases, with the African continent alone accounting for 94% of them.
Sub-Saharan Africa Carries the Heaviest Burden
The vast majority of the world’s malaria cases and deaths occur in sub-Saharan Africa. The region accounts for roughly 94% of global cases and 95% of malaria-related deaths. Countries with the highest transmission include Nigeria, the Democratic Republic of the Congo, Uganda, Mozambique, and Niger, which together make up a large share of all cases worldwide. The dominant parasite species across Africa is the most dangerous one, responsible for severe illness and the vast majority of malaria deaths globally. In 2022, sub-Saharan Africa recorded an estimated 234.8 million clinical cases of this species alone.
Within African countries, risk varies significantly by location. Rural areas carry the greatest burden, as mosquitoes breed in standing water near agricultural land, forests, and wetlands. Cities generally have lower transmission because urban development destroys mosquito breeding habitats and residents have better access to healthcare. However, rapidly growing cities with poor infrastructure and unplanned settlements can still have significant malaria pockets, particularly among the urban poor who lack screened housing and nearby clinics.
South and Southeast Asia
India is by far the largest contributor to malaria in Asia, though it has made dramatic progress. Between 2017 and 2023, India cut its annual cases from 6.4 million to 2 million, a 69% reduction. Other countries in the region with ongoing transmission include Indonesia, Myanmar, Pakistan, and Papua New Guinea. A major outbreak occurred in Pakistan in 2022 after severe flooding created vast new mosquito breeding grounds.
Southeast Asian nations like Cambodia, Laos, Vietnam, and Thailand still report malaria, though case counts are relatively low compared to Africa. Much of the transmission in this region is concentrated along forested borders where migrant workers and rural communities live. Several countries in the region are actively pursuing elimination within the next decade.
Central and South America
Malaria transmission persists in parts of Central and South America, though at much lower intensity than in Africa or Asia. Countries with ongoing cases include Brazil, Venezuela, Colombia, Peru, and several others in the Amazon basin region. Venezuela has seen a resurgence in recent years tied to political and economic instability that disrupted public health programs. In contrast, several countries in the Americas have recently eliminated the disease entirely. El Salvador was certified malaria-free in 2021, Belize in 2023, and Suriname in 2025.
The Middle East and Eastern Mediterranean
A handful of countries in the Eastern Mediterranean and Middle East still have malaria transmission, including Yemen, Sudan, Somalia, and Djibouti. Sudan in particular carries a substantial burden. Egypt, which had lingering low-level transmission, achieved WHO malaria-free certification in October 2024. Other countries in the broader region, such as Saudi Arabia and Iran, have very limited or no remaining transmission.
Countries That Recently Eliminated Malaria
The WHO certifies a country as malaria-free after it demonstrates at least three consecutive years of zero locally acquired cases. Since 2020, ten countries have earned this certification:
- El Salvador (2021)
- China (2021)
- Azerbaijan (2023)
- Tajikistan (2023)
- Belize (2023)
- Cabo Verde (2024)
- Egypt (2024)
- Georgia (2025)
- Suriname (2025)
- Timor-Leste (2025)
China’s elimination is particularly notable. It reported 30 million cases annually in the 1940s and still had hundreds of thousands of cases in the early 2000s before driving the number to zero through aggressive surveillance and mosquito control.
Altitude and Geography Affect Risk Within Countries
Being in an endemic country does not mean every part of that country carries malaria risk. Altitude is one of the biggest factors. In Ethiopia, for example, areas above roughly 1,750 meters (about 5,740 feet) were traditionally considered too cold for the mosquitoes that spread malaria. Capital cities like Nairobi (Kenya) and Addis Ababa (Ethiopia) sit at high elevations where transmission is minimal or absent, even though lower-lying parts of the same countries have intense year-round malaria. However, rising temperatures are pushing malaria into highland areas that were previously safe, making this threshold less reliable than it once was.
Desert and arid regions within endemic countries also tend to have very low risk, since mosquitoes need standing water to breed. Coastal cities, river valleys, and areas with seasonal flooding carry higher risk.
Can You Get Malaria in the U.S. or Europe?
The United States and Western Europe are not endemic for malaria, but locally acquired cases occasionally occur. In 2023, the U.S. saw its first local transmission in 20 years: seven cases in Florida, one in Texas, and one in Maryland. These cases were spread by local mosquitoes that bit someone carrying the parasite from overseas, then transmitted it to others nearby. Outbreaks like this remain rare and are quickly contained. The roughly 2,000 malaria cases diagnosed in the U.S. each year are almost entirely in travelers returning from endemic countries.
Southern Europe faces a similar situation. Countries like Greece and Italy have had isolated local cases in recent years, but sustained transmission has not returned. The combination of strong healthcare infrastructure, window screens, air conditioning, and mosquito control keeps these events from becoming outbreaks.
What Travelers Should Know About Risk
If you’re traveling to an endemic country, your actual risk depends on the specific region you’re visiting, the time of year, and how much time you spend outdoors between dusk and dawn, when malaria-carrying mosquitoes are most active. A business trip to a high-altitude African capital carries very different risk than a rural visit to a lowland area during the rainy season. The global malaria incidence rate is about 60 cases per 1,000 people at risk, but that average obscures enormous variation. Some communities in West Africa face infection rates many times higher, while urban areas in Southeast Asia may see very few cases.
Preventive medication is available and highly effective for travelers heading to high-risk areas. Your destination, itinerary, and length of stay all factor into which prevention strategy makes the most sense. Bed nets treated with insecticide and insect repellent containing DEET provide additional protection, especially in rural settings.