A Review of Malaria Control Efforts in Eritrea
Published 08/20/2025 in Scholar Travel Stipend
Written
by Hannah Menghis |
08/20/2025
When I first proposed studying malaria in Eritrea, my goal was to better understand how a country at the northernmost limit of malaria transmission in East Africa could sustain and build upon its progress toward elimination.
Malaria remains one of the most pressing public health challenges on the African continent, accounting for over 90% of global cases, according to the WHO (WHO, 2024). In Eritrea, the disease is endemic year-round, with peak transmission during the rainy season from July through September. For a country that reduced malaria incidence by 89% and mortality by 96% between 1998 and 2012, the recent resurgence, rising from 44,063 reported cases in 2021 to more than 175,000 in 2024, is a sobering reminder that progress can be fragile. My project sought to examine the effectiveness of Eritrea’s malaria control strategies, and to explore how local knowledge and resources influence malaria transmission and prevention.
Conducting regular reviews of countries’ infectious disease control efforts are critical in order to identify weaknesses early, optimize resources, and promote accountability, transparency, and effectiveness. Several studies have similarly demonstrated that “adequate knowledge of communities on malaria prevention is a key element in designing, executing and meeting the desired outcomes of malaria prevention intervention” (Andegiorgish et al., 2023). These studies are particularly useful in low-resource settings where efficient use of minimal resources can make a considerable difference in preventing future outbreaks. By conducting this review, I wanted to gain insight into the allocation of resources for malaria control in Eritrea, which disparities in resources require attention, and more broadly understand how underdeveloped nations respond to (often neglected) infectious diseases. Without this understanding, interventions can be ineffective and even counterproductive.
Methodology and Fieldwork
The first two weeks in Asmara allowed me to gain baseline national-level data. The Manager of the National Malaria Control Program (under the Ministry of Health) granted me access to records on current and past malaria incidence trends, along with details on their epidemiologic surveillance. The third week took me to a small city south of Asmara in the Debub zone called Mendefera. Here, I worked closely with the Malaria Entomology Laboratory, a critical center for malaria prevention. The center not only studies mosquito entomology, but also distributes free insecticide-treated bed nets, sprays insecticides in people’s homes, and clear puddles of stagnant water. The work was deeply rooted in local knowledge and community trust, with small, coordinated efforts making the difference between containment and resurgence. Perhaps the most empowering prevention method I saw employed was education campaigns, whether by teaching local residents how they can take part in mitigating transmission or by broadcasting informational interviews on the local TV channel.
Three major themes emerged from my fieldwork:
- Environmental management is the most effective and valued control measure. Across all regions, communities that consistently removed stagnant water and maintained vector control efforts reported fewer cases during peak season. However, lapses in this practice, often due to a relaxed mindset that malaria is no longer a top priority, were directly linked to local spikes in malaria cases.
- Gaps in community awareness and sustained engagement remain. While most residents understood malaria’s symptoms and dangers, misconceptions persisted. Some associated the disease solely with the rainy season, neglecting year-round prevention. Others doubted the need for continued bed net use or even repurposed bed nets (e.g., using the bed net as a curtain) after years without major outbreaks.
- Resource limitations and emerging biological threats are major obstacles. Public health workers repeatedly emphasized the strain of financial and human resource shortages. Due to political factors, nonprofit organizations are scarce and most of the working-age population is occupied with participating in “public defense”. Additionally, the emergence of Anopheles stephensi, with its adaptability and resistance traits was widely viewed as a game-changing challenge, potentially undoing decades of vector control gains.
Analysis
Eritrea’s malaria control program has demonstrated the effectiveness of targeted interventions when resources and community engagement align. The not-so-old adage referring to the severity of malaria, “If you go to Barentu [a town in Eritrea], take your coffin with you” has slowly been forgotten as the steep declines in incidence and mortality throughout the late 90s to mid 2000s proved that well-coordinated campaigns like bed net distribution, vector control, and health education can yield dramatic results. However, the resurgence since 2021 underscores the fragility of these gains when vigilance wanes.
Furthermore, the rise of Anopheles stephensi, alongside continued resource strains, presents a more complex challenge. Its broad habitat tolerance, resistance to control measures, and ability to transmit multiple malaria parasites mean Eritrea must adapt both vector control strategies and surveillance methods. Current interventions, largely designed for Anopheles gambiae, will need reengineering to remain effective.
While it is difficult to confidently assert that Eritrea is on-track to reach its malaria elimination goal by 2030, the country will need to continue reinvigorating community engagement through year-round education campaigns that address both knowledge1 and motivation. There will also need to be an expanded capacity for rapid local response to surveillance data, ensuring that outbreak signals lead to swift interventions.
However, it is easy to make recommendations from afar about how to help move towards elimination but without sufficient financial and human resources on the ground, even the most carefully designed interventions cannot be implemented at the necessary scale or sustained over time. Clinics cannot respond rapidly to outbreaks without trained staff, vector control programs cannot adapt to new species without specialized expertise, and education campaigns cannot reach remote communities without the funds to travel and translate materials. This is where the fight against malaria intersects directly with health equity. A country’s ability to eliminate a disease should not be dictated by the size of its budget or the number of trained personnel it can afford to employ. Global health equity demands that countries like Eritrea, who are committed to elimination but constrained by resources, receive consistent, predictable support from international and regional partners. Ensuring that often neglected communities have access to the appropriate resources and are receiving the targeted support they need is crucial for global health security. Only by bridging these inequities can the 2030 target become more than an aspirational date on paper.
Acknowledgements
This project would not have been possible without the support and encouragement of the staff at the Eritrean Ministry of Health including Selam Mihreteab and Dr Araya Berhane. Thank you also to the Mendefera Zonal Medical Director, Dr Amanuel Mihreteab, and to the scientists at the Malaria Entomology Laboratory in Mendefera for welcoming me and teaching me about all things malaria: Mikiael Habtemariam, Asmerom Zerisenay Gebregziabher, Zemikiael Ogbagiorgis (special shout out to him for his continued dedication to his work and community--still going strong at 90 years old!), Ghirmai Werede, Yohannes Shumondi, and Samrawit Zeweldi. Lastly, I would be remiss to not give my sincerest thanks to Tsighereda Menghisteab, Freweini Menghisteab, and Menghis Samuel for helping me arrange and successfully complete this project.
References
- “Fact Sheet about Malaria.” World Health Organization, World Health Organization, 4 Dec. 2023,
www.who.int/news-room/fact-sheets/detail/malaria#:~:text=The%20estimated%20numbe r%20of%20malaria,cases%20and%2095%25%20of%20deaths.
- Andegiorgish AK, Goitom S, Mesfun K, Hagos M, Tesfaldet M, Habte E, Azeria E, Zeng
L. Community knowledge and practice of malaria prevention in Ghindae, Eritrea, a Cross-sectional study. Afr Health Sci. 2023 Mar;23(1):241-254. doi: 10.4314/ahs.v23i1.26. PMID: 37545951; PMCID: PMC10398460.
- Mihreteab S, Lubinda J, Zhao B, Rodriguez-Morales AJ, Karamehic-Muratovic A, Goitom A, Shad MY, Haque U. Retrospective data analyses of social and environmental determinants of malaria control for elimination prospects in Eritrea. Parasit Vectors. 2020 Mar 12;13(1):126. doi: 10.1186/s13071-020-3974-x. PMID: 32164770; PMCID: PMC7068948.
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