Malaria is actively transmitted in 80 countries, concentrated heavily in sub-Saharan Africa, South and Southeast Asia, and parts of Central and South America. The WHO African Region carries the greatest burden by far, with just 11 countries accounting for roughly two-thirds of all global cases and deaths. But the disease’s reach extends well beyond Africa, and where you are within a country matters as much as which country you’re in.
Sub-Saharan Africa: The Epicenter
Sub-Saharan Africa is home to the vast majority of malaria cases worldwide. The parasite species responsible for most severe illness and death, Plasmodium falciparum, dominates across the continent. This species thrives in the region’s tropical climate and is spread by mosquito species that are particularly efficient at transmitting the parasite to humans.
Countries with the highest burden include Nigeria, the Democratic Republic of the Congo, Uganda, Mozambique, and Niger. These nations, along with a handful of others, make up the core of the global malaria crisis. Transmission occurs year-round in many equatorial zones, though it peaks during and just after rainy seasons when mosquito breeding sites expand. In West Africa, for example, the heaviest transmission typically follows rainy seasons running from May through July and again from September onward, with a lag of several weeks between peak rainfall and peak malaria cases.
Pregnancy makes the disease especially dangerous in this region. In 2023, roughly 12.4 million out of 36 million pregnancies in moderate- and high-transmission African countries involved a malaria infection. Young children are the other high-risk group, as they haven’t yet built partial immunity through repeated exposure.
South and Southeast Asia
Outside Africa, South and Southeast Asia represent the next major zone of malaria transmission. The picture here looks different from Africa in one important way: a second parasite species, Plasmodium vivax, is the dominant form. P. vivax was long considered less dangerous than P. falciparum, but it causes serious and sometimes fatal illness, particularly in impoverished communities with limited healthcare access. Both species put roughly 2.5 billion people at risk of infection globally.
Countries like India, Bangladesh, Myanmar, Cambodia, and parts of Indonesia all have areas of active transmission. Risk is not uniform across these countries. In India, for instance, malaria is concentrated in forested and tribal regions rather than major cities. Cambodia’s border regions with neighboring countries have historically been hotspots. The CDC publishes sub-national maps for countries like these, showing that malaria risk can vary dramatically between provinces or even districts within the same country.
Central and South America
Malaria persists in parts of Central and South America, though the overall burden is far lower than in Africa or Asia. The Amazon basin, spanning Brazil, Peru, Colombia, and Venezuela, is the primary transmission zone. Bolivia and parts of Central America also carry risk in lowland and forested areas. Both P. falciparum and P. vivax circulate in the Americas, with P. vivax being more common in many areas.
Several countries in the region have recently eliminated malaria entirely. Belize was certified malaria-free in 2023, El Salvador in 2021, and Suriname in 2025. These successes show that elimination is achievable even in tropical climates when sustained investment is maintained.
Where Malaria Has Been Eliminated
The list of countries certified malaria-free by the WHO has grown steadily. Recent additions include Cabo Verde and Egypt (both in 2024), China (2021), Azerbaijan (2023), Georgia (2025), and Timor-Leste in Southeast Asia (2025). Europe, North America, Australia, and most of East Asia are malaria-free, though imported cases occur when travelers return from endemic areas.
Certification requires a country to prove that local mosquito-borne transmission has been interrupted for at least three consecutive years. It doesn’t mean the mosquitoes capable of carrying malaria are gone. It means the chain of transmission from person to mosquito to person has been broken through a combination of treatment, mosquito control, and surveillance.
Climate and Altitude Shape the Map
Malaria’s geographic boundaries are set largely by temperature, rainfall, and humidity. The parasite cannot develop inside a mosquito when temperatures drop below about 16°C (61°F), and temperatures above 40°C (104°F) kill mosquitoes faster than they can reproduce. Humidity below 60% also makes it difficult for mosquitoes to survive long enough to transmit the parasite.
This is why altitude matters. Highland areas in countries like Kenya, Ethiopia, and Tanzania that sit above roughly 1,500 to 2,000 meters are often too cool for consistent transmission, even though the surrounding lowlands are heavily affected. It also explains why desert regions, despite being warm, are generally malaria-free: too little rainfall means too few mosquito breeding sites.
Rainfall has a sweet spot. Too little and mosquitoes can’t breed. Too much and floodwaters destroy the shallow, stagnant pools where larvae develop. In the Sahel, Guinea savannah, and East Africa, monthly rainfall above about 400 mm can actually flush out breeding sites and temporarily reduce transmission. In west Central Africa, that threshold is closer to 600 mm.
Urban vs. Rural Risk
Within endemic countries, malaria risk is generally much higher in rural areas than in cities. Across dozens of African cities, researchers found a clear gradient: rural residents experienced an average of about 126 infective mosquito bites per year, compared to 64 in periurban (city-edge) areas and 19 in urban centers. In Ouagadougou, Burkina Faso, the infection rate was nearly three times higher in rural surroundings (69%) than in the city center (24%).
Cities tend to have fewer mosquito breeding sites, more access to healthcare, and better housing that keeps mosquitoes out. But this pattern has notable exceptions. In Libreville, Gabon, slum conditions in the urban center created more transmission than the wealthier periurban suburbs surrounding it, with the city center seeing nearly seven times more infective bites per person per year. In Maputo, Mozambique, people who worked in urban farming areas had higher infection rates regardless of where they lived, because agricultural plots create standing water where mosquitoes breed.
The takeaway: being in a major city within an endemic country lowers your risk, but doesn’t eliminate it, especially in neighborhoods with poor drainage or informal settlements.
What This Means for Travelers
If you’re traveling to an endemic country, the CDC maintains detailed, country-specific maps showing which regions carry malaria risk and which don’t. These maps matter because many popular tourist destinations within endemic countries are in low-risk or malaria-free zones. A beach resort in southern Thailand, for instance, carries very different risk than a rural village near the Myanmar border.
Your risk also depends on timing. Traveling during the dry season generally means fewer mosquitoes and lower transmission. Elevation matters too: highland destinations in East Africa or Southeast Asia may fall outside the transmission zone entirely. Preventive medication is recommended for most travelers to high-risk areas, and the specific medication depends on which part of the world you’re visiting, since drug-resistant parasites are more common in Southeast Asia than in Africa or the Americas.