Geospatial mapping of malaria risk in flood-prone zones of Sub-Saharan Africa.

The World Health Organisation (WHO) aims to eliminate malaria by 2030; yet, the disease remains endemic in Sub-Saharan Africa. Stagnant floodwaters provide ideal breeding grounds for mosquitoes. Previous estimates of potential malaria risk in flood zones have been limited due to insufficient large-scale geospatial data. Here, we integrate high-resolution flood maps (2000-2018) from the Global Flood Database, malaria incidence data from the Malaria Atlas Project, and geospatial population data across 492 flood-prone zones in 38 countries. We used a geospatial statistical models to assess malaria relative risk and drivers. We found that in East and West Africa, malaria relative risk is elevated in flood-prone regions compared to national baselines. We estimate that ∼12 million individuals diagnosed with Plasmodium falciparum (Pf )were exposed to flooding events, representing one-third of the population affected by floods. Our analyses find that flood exposure is one of the main drivers of the malaria burden in flood zones. These findings identify critical malaria hotspots and key drivers in flood-prone zones, and can help inform WHO's malaria eradication strategies by guiding policymakers on the geographic distribution of vulnerable areas.