Challenges to Malaria Elimination in Ethiopia by 2030: A Review

Malaria disease is a major health issue in Ethiopia, affecting three-fourths of the country's land area and more than two-thirds of the population living below 2000 m altitude. Over 42 Anopheles species have been identified in the country, but Anopheles arabiensis was the only major malaria vector, accounting for the majority of illness and mortality. However, there is a new invasive malaria vector, Anopheles stephensi, which is strikingly similar to the primary vector. This species transmits both Plasmodium falciparum and Plasmodium vivax and has gained resistance to all four types of insecticides, such as A. arabiensis. Plasmodium falciparum and Plasmodium vivax accounted for the majority of malaria cases in the country. However, these species have evolved resistance to several antimalarial medications throughout the country, adding to the burden. Furthermore, the country has just had a long civil war, which has resulted in an alarming spike in malaria cases throughout the country. Even in a few regions, such as Amhara and Oromo, the disease is spreading rapidly and beyond the control of regional health bureaus. All of these issues constitute major impediments to the country's malaria elimination aim. This article provides a comprehensive summary of the status of new and invading species, the status of insecticide-resistant malaria vectors, the ranges of drug-resistant Plasmodium species, the impacts of neglected Plasmodium vivax, and the impacts of civil war on Ethiopia's malaria elimination aim.