Malaria is one of the major infectious tropical diseases with substantial socio-economic repercussions in the sub-Saharan African region. Despite intensive efforts and remarkable progress that over several decades successfully cut by half the world’s malaria burden, in recent years' progress has hindered and appears to be overturning due to different reasons in different countries of the world. Estimates for 2021 were 247 million infections and 619,000 deaths, confirming malaria’s ongoing threat to public health and productivity [1]. Of greatest concern are infections with Plasmodium falciparum, which comprise 90% of cases and may be lethal, though geographically widespread Plasmodium vivax also causes significant morbidity [1].

Malaria is an important public health concern in Ethiopia, particularly in Tigray. More than 40 million people in Ethiopia living between altitudes of 1500 m and 2500 m are at risk of getting malaria [2-4]. They are exposed to low or unstable malaria transmission, resulting in a low level of immunity. Hence, people of all ages are vulnerable to all severe forms of the disease. Transmission in these areas is seasonal and largely depends on rainfall and altitude, with peaks from the months of September to December after the high rain season and from March to May during and after the low rains [5]. In Africa, the highlands are defined as having an altitude higher than 1500 m above sea level or with daily mean temperatures below 20°C. Ethiopia, Kenya, Tanzania, Rwanda, Burundi, Uganda, and Madagascar constitute about 82.4% of all African highlands. Ethiopian highlands make up 60% of all highlands in East Africa [6].

Estimates from the World Health Organization (WHO) in 2003 showed that malaria epidemics kill 110,000 people each year, and 110 million people were considered at risk in the highlands [6]. A complex set of environmental, biological, and socioeconomic factors, including climate change [8-10], land use changes [6,9], drug resistance [7], cessation of malaria control activities [6], and demographic changes [7], were hypothesized to influence malaria in the highlands.

According to a WHO report in 2022, following the genocidal war in Tigray since 2021, malaria cases increased by 80% [11], due to which health services were stopped, damaged, and looted. Thus, malaria outbreaks are emerging in highland areas of Tigray due to the cessation of malaria prevention and control in the region, such as prophylactic drugs. Hence, this urge to write this short manuscript is to draw attention from the scientific community of the world, experts, donor’s organizations, and other concerned bodies to consider and give priority to the region that needs urgent action.

Data sharing statement

All datasets synthesized are summarized in the manuscript.

Ethics approval and consent to participate

Not applicable

Author contributions

Brhane Berhe Aregawi: Conceptualization, investigation, writing-original draft preparation; Hadush Negash Meles: Conceptualization, writing-reviewing and editing, supervision. All authors made substantial contributions to read and approve the final draft of the manuscript for submission, gave final approval of the manuscript version to be published, and agreed to be accountable for every step of the work.

Funding

The authors declared they have not received specific funding resources.

Disclosure

The authors declared they have no competing interests.

Abbreviations

WHO: World Health Organization

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