Background
The entire population of Mozambique (approximately 32.4 million in 2023) is at risk of malaria, with 77% of the population living in districts with 2023 incidence above 100 cases per 1,000 population. Despite significant investment and progress in malaria control over years, the disease remains a major public health burden in Mozambique. In 2016, the Malaria Strategic Plan (MSP) baseline year, there were just over 8.5 million new cases of malaria reported, with 10% of those cases diagnosed at the community level by the community Health Workers (APEs). Malaria cases increased annually between 2016 and 2020, with nearly 10 million total malaria cases reported in 2017, 10.3 million in 2018, 10.9 million in 2019, 11.3 million in 2020, 10.1 million in 2021, 12.4 million in 2022, and 13.2 million in 2023. The number of reported cases decreased for the first time in 2021 to 10.1 million. Crude incidence decreased by 12.5% from 2020 to 2021, from 375 cases per 1,000 in 2020 to 328 cases per 1,000 in 2021, 392 cases per 1,000 in 2022, and 408 cases per 1,000 in 2023. Between 2017 and 2023, APEs on average identified 12% of cases.
Parasitological confirmation of malaria has remained significantly high over the past five years, with annual blood examination rate (ABER) as high as 67% in 2019, with slight decreases at 65% in 2020 and 63% in 2021, and then 73% in 2022 and 77% in 2023. Meanwhile, the test positivity rate (TPR) has remained stable during that time (57% in 2017, 55% in 2018 and 2019, 58% in 2020, 52% in 2021, 53% in 2022, and 53 % in 2023). The drop in incidence in 2021 coincides with a drop in TPR. This would suggest that the drop in incidence is not caused by a decrease in testing or care-seeking.
Although the number of malaria deaths reported has been decreasing in the past years, malaria remains an important cause of child mortality in Mozambique. In 2017, 1,114 inpatient malaria deaths were reported, 970 in 2018, 734 in 2019, 563 in 2020, 406 in 2021, 423 in 2022, and 356 in 2023. It should be noted that there is evidence of underreporting of malaria deaths.