Climate change is poised to expose more people to malaria in cooler parts of Africa by the end of the century, with cases potentially rising as much as 20% in coastal southern Africa, according to a new study published in Nature.

By 2050, rising temperatures are projected to expand the range of malaria-carrying mosquitoes into cooler parts of southern and eastern Africa, increasing cases by about 5% in the East African highlands — including parts of Kenya and Ethiopia — as well as in Angola, Zambia and eastern South Africa, the study found.

The reverse is expected in some of Africa’s hottest regions, where transmission is projected to fall by about 5% in countries including Nigeria, Burkina Faso and Mali. In parts of the Sahel, conditions may become too hot for mosquitoes to survive, potentially eliminating the disease altogether.

In South Africa, far more children are at risk of contracting the disease, with three northeastern provinces most vulnerable, said Christopher Trisos, director of the Climate Risk Lab at the University of Cape Town and a co-author of the study.

“South Africa and its global health partners need to prepare local malaria control and health systems now for this growing risk,” Trisos said.

Malaria killed an estimated 579 000 people in Africa in 2024, about three-quarters of them children under five, according to the World Health Organization.

“Our study shows that climate change’s influence on childhood malaria risk is not uniform across Africa, underscoring the difficulty and complexity of adaptation and health planning across the continent,” said Romaric Odoulami, co-author and researcher at the African Climate and Development Initiative.

Still, the researchers said the projected increase is not inevitable.

Limiting global warming to 2 degrees Celsius would prevent about five additional malaria cases per 1 000 children in southern Africa, with even greater benefits in the East African highlands, according to the study.

Efforts to cut emissions must be matched by stronger malaria surveillance and control, particularly in southern and eastern Africa where there is less experience at tackling it, the study found.