Incidence

In 2010, an estimated 0.26 billion (95% UI: 0.22 to 0.31 billion) incident cases of malaria were recorded globally. This number decreased to 0.24 billion (95% UI: 0.19 to 0.30 billion) by 2019; however, it rose again to 0.25 billion (95% UI: 0.20 to 0.32 billion) in 2021. The ASR of malaria incidence declined from 3,789.28 (95% UI: 3242.61 to 4534.81) per 100,000 populations in 2010 to 3332.96 (95%UI 2666.75 to 4225.54) per 100,000 populations in 2019, with an EAPC of −1.44% (95% CI −2.09 to −0.79%). Nevertheless, the ASR of malaria incidence was 3485.27 (95% UI 2804.46 to 4435.69) per 100,000 populations in 2021, with an EAPC of 2.26% (95% CI 1.84–2.68%) from 2019 to 2021, suggesting a shift from a downward trend to an upward trend relative to the period 2010 to 2019 (Table 1; Fig. 1A). As shown in (Fig. 1A), the trends for both genders decreased gradually from 2010 to 2019, and maintained stable for several years thereafter. After that, another sharp rise was seen again after 2019. The overall ASR of malaria incidence was slightly higher among females than males across the study period, and the highest incidence of malaria was observed among children under 5 years of age, followed by at ages of 5 to 14 years. Increasing incidence was noticed after 2019 among children under 5 years (Fig. 1B). ASR of malaria incidence was highest in low SDI regions, while the fastest increase rate was seen in middle SDI regions (Fig. 1C). The top 10 countries with incidence of over 20% (over 20,000 per 100,000 populations) included Liberia, Benin, Burkina Faso, Solomon Islands, Sierra Leone, Guinea, Central African Republic, Mozambique, Nigeria and Democratic Republic of the Congo in 2021 (Table 2), where the increasing rate remained stable after the COVID-19 pandemic. Notably, Nicaragua is the country with the highest rate of change in malaria incidence: increased incidence from 27.86 per 100,000 populations in 2010 to 459.40 per 100,000 populations in 2019, followed by a sharp increase to 2340.84 per 100,000 populations in 2021, with an annual increasing rate of over 125% after the COVID-19 pandemic (Supplementary Table 1).

The ASR of malaria from 2010 to 2021. (A) Incidence grouped by gender; (B) Incidence grouped by age groups; (C) Incidence grouped by SDI regions; (D) Deaths grouped by gender; (E) Deaths grouped by age groups; (F) Deaths grouped by SDI regions; (G) DALYs lost due to malaria grouped by gender; (H) DALYs lost due to malaria grouped by age groups; (I) DALYs lost due to malaria grouped by SDI regions. ASR Age-standardized rate, DALYs disability-adjusted life years, SDI socio-demographic index.

Death

In 2010, 866,834 deaths occurred due to malaria, which decreased to 667,861 in 2019; however, the deaths rebounded to 748,131 in 2021. The overall ASR of malaria mortality was 13.00 (95% UI 7.05 to 21.16) per 100,000 populations in 2010, decreased to 9.30 (95% UI 3.73 to18.07) per 100,000 populations in 2019, and rose to 10.51 (95% UI 3.81 to 21.45) per 100,000 populations in 2021 (Table 1). There was no significant difference in malaria mortality across genders (Fig. 1D). Deaths due to malaria were extremely high among younger populations and were lowest at ages of 15 to 59 years (Table 1; Fig. 1E). The ASR of malaria mortality was negatively associated with SDI levels, showing that low SDI regions had the highest ASR (Fig. 1F). Countries with a malaria mortality rate of more than 1% (> 100 per 100,000 populations) included Burkina Faso, Sierra Leone, Niger, Liberia, Benin, Cote d’Ivoire, Cameroon, Mozambique, and Nigeria in 2021 (Table 2). Notably, Uganda experienced a 50% decline in the malaria mortality from 2010 to 2019 (from 89.91 to 45.00 per 100,000 populations), but it returned to previous levels after the COVID-19 pandemic (93.01 per 100,000 populations).

DALYs

The numbers of DALYs lost due to malaria have showed a downward trend before the COVID-19 pandemic and an upward trend after the COVID-19 pandemic, with 66.43 million in 2010, 49.72 million in 2019, and 55.17 million in 2021. DALYs lost due to malaria had experienced a significant decline from 2010 to 2019, followed by a sharp increase after the COVID-19 pandemic (Fig. 1G). Most DALYs lost due to malaria was found among populations under 5 years of age (Fig. 1H) and those from low SDI countries (Table 1; Fig. 1I). The top ten countries with the heaviest burden of DALYs lost due to malaria included Sierra Leone, Burkina Faso, Niger, Benin, Liberia, Cote d’Ivoire, Nigeria, Uganda, Burundi, and Cameroon. Among these countries, Uganda experienced a doubled DALYs lost due to malaria in 2021 [6008.63 per 100,000 populations, 95% UI (2044.84 to 11,064.79) per 100,000 populations] comparing to 2996.12 (95% UI 1102 to 5597.64) per 100,000 populations in 2019 (Table 2).

Projection of malaria burden in 2030

To illustrate the impact of the COVID-19 pandemic on the malaria burden in the coming decade, we initially utilized data from 1990 to 2019 to forecast future trends in malaria incidence. The malaria burden was projected to continue its decline after 2019, with an estimated incidence rate of 2806.07 cases per 100,000 populations by 2030 (Fig. 2A and Supplementary Table 2). We then extended our analysis to include data from the pandemic era (1990–2021) to reassess the disease burden up to 2030. The findings indicated an additional 472.59 cases per 100,000 populations, resulting in a total of 3278.65 cases per 100,000 populations in 2030 (Fig. 2A). A similar increase in deaths and DALYs lost due to malaria was noted, suggesting that the projected malaria burden in 2030 surpassed the estimates made in 2019 (Fig. 2B, C).

The ASR of malaria and its prediction to 2030. (A) The prediction of incidence; (B) The prediction of deaths; (C) The prediction of DALYs lost due to malaria. The green line represents predictions based on data up to 2019, while the red line represents predictions based on data up to 2021. ASR age-standardized rate, EAPC estimated annual percentage change.