ArticleMalaria journal2026
Malaria time series analysis, forecasting, and development of curated intervention strategies for the elimination of malaria from Afghanistan.
Article in Malaria journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAccording to the World Health Organization (WHO), Afghanistan has the world's seventh-highest reported malaria burden, outside Africa. The objectives of this study were to determine the historical trend of malaria in Afghanistan over the past three decades, conduct a forecast analysis using best-fitted predictive models based on historical data, and conduct district-level stratification of malaria-endemicity to inform customised control and elimination intervention strategies for ending malaria in Afghanistan.
methodsDistrict-level monthly malaria incidence data from 2018 to 2023 were obtained from the Afghanistan Ministry of Public Health. The annual malaria cases from 1990 to 2023 were obtained from the WHO.
resultsFrom 2018 to 2023, the test positivity rate (TPR) was 15.2%, with 96.5% of cases being Plasmodium vivax, 3.2% being P. falciparum, and 0.3% having mixed infections of P. vivax and P. falciparum. The mean annual malaria cases from 2018 to 2023 were 153,295 per year. Nearly one-fourth of total malaria cases occurred in districts along the Pakistan border, which also comprised most of the country's highly endemic areas. In contrast, districts bordering Iran, Turkmenistan, Uzbekistan, Tajikistan, and China together contributed less than 1% of cases. The annual trends of the time series data on malaria cases in Afghanistan from 1990 to 2023 exhibited a non-linear cyclic trend, with the highest cases reported in 2002. The number of cases then steadily declined until 2013, after which they further increased in the following 4 years, 2014-2017. Forecasting analysis suggests that the country is unlikely to achieve malaria elimination by 2035 under the current intervention policy.
conclusionsAbout 43% of the districts with zero or low malaria endemicity are ready for sub-national malaria elimination. There is a need for context-specific strategies of vector control and case management to eliminate malaria in moderate- and high-endemic districts. The districts along the Afghan-Pakistan border are hosting the majority of infections and require effective cross-border collaboration between the two countries to meet their malaria elimination goals.
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