Situational analysis of malaria in Cabo Verde: From endemic control to elimination, history, cases data and challenges ahead.

On 12 January 2024, Cabo Verde was officially certified by the WHO as a malaria-free country after six consecutive years without local transmission. This study analysed the malaria history of Cabo Verde from 1953 to certification in 2024, highlighted the valuable lessons learned, and discussed challenges for prevention reintroduction. Malaria data from the last 35 years (1988-2022) were analysed using descriptive analyses, and cases were mapped using the USGS National Map Viewer. From 1988 to 2022, 3,089 malaria cases were reported, 2.381 (77.1%) locally and 708 (22.9%) imported. Imported cases were reported nationwide except on Brava Island. Six municipalities did not report any cases, while local cases were restricted to Santiago and Boavista, with 2.360 and 21 cases, respectively. Malaria history in the country revealed six remarkable steps and three periods of interruption in the transmission of local malaria cases. The last local cases were reported in Boavista in 2015 and Santiago in 2017. Since 2018, introduced cases have been recorded from time to time. Disease lethality was low, with ten malaria deaths from 2010 to 2023, and the highest value of 8.3% (3/36) recorded in 2011. With this certification, Cabo Verde became a reference in Africa for its health sector organisation, multisectoral, and partnership in malaria control. However, maintaining the certification presents several sustainability challenges for the country. Additionally, robust epidemiological and entomological surveillance, continued investigations, and ongoing research are crucial.