By Amindeh Blaise Atabong, Robbie Corey-Boulet and Jennifer Rigby
BOGO, Cameroon (Reuters) -Nine-month-old baby Mohamat burned with fever for three days before his family took him to the closest health centre in northern Cameroon, but it was too late. He died of malaria that day.
Mohamat's death was part of a spike this year in malaria fatalities that local health officials attribute to foreign aid cuts by the United States.
Before the cuts, Mohamat might have been diagnosed earlier by one of more than 2,000 U.S.-funded community health workers who would travel over rough dirt roads to reach the region's remotest villages.
And at the health centre, he might have been treated with injectable artesunate, a life-saving drug for severe malaria paid for by U.S. funds that is now in short supply. But the centre had none to give out.
Reuters travelled to northern Cameroon - where the U.S. had played a leading role in the malaria response for nearly a decade - to document how the sudden cuts are contributing to delayed malaria diagnoses, inadequate treatment and a growing number of deaths. This story is based on interviews with more than 20 doctors, nurses, community health workers, residents and former U.S. officials involved in malaria programming.
Mohamat's father, sorghum and banana farmer Alhadji Madou Goni, is mourning a son he had hoped would one day escape poverty.
"I feel so sad about my loss. I hope no one suffers from this (malaria) again," Goni, 30, told Reuters as he sat outside his home, his wife next to him holding prayer beads.
"Since there is hardship here, and people don't have the means, we hope aid comes."
U.S. MALARIA PROGRAMME DISRUPTED BY CUTS, END OF USAID
Upon taking office in January, U.S. President Donald Trump paused all foreign aid, including the President's Malaria Initiative (PMI), launched in 2005 by George W. Bush. The PMI is credited with helping to save 11.7 million lives and prevent 2.1 billion malaria cases.
A limited waiver issued in February allowed life-saving work on malaria to continue, but PMI's 30 partner countries - most of them in Africa - have reported major disruptions linked to the dissolution of the U.S. Agency for International Development, the main implementer of PMI-funded programmes.
In Cameroon's Far North region, where Goni lives, the cuts stripped support for PMI-funded community health workers who distributed prevention tools like bed nets and identified serious cases.
PMI funded half - 1,492 out of 2,824 - of all community health workers in the region, said Dr Jean-Pierre Kidwang, coordinator of the regional technical group for malaria control.
The support included a monthly stipend of 15,000 CFA francs ($26), a transport allowance, bicycles and clothing.
Nearly all of the U.S.-funded community health workers are now out of service. Prosper Laurent Messe Fouda, head of planning, monitoring and evaluation at the National Malaria Control Programme, confirmed that 2,105 out of the 2,354 U.S.-funded workers in Cameroon's Far North and North regions were no longer working.
AFTER FALLING FOR YEARS, MALARIA DEATHS NOW RISING
PMI made Cameroon a focus country in 2017, and recorded malaria deaths in Far North dropped from 1,519 in 2020 to 653 in 2024 - but now appear to be rising, Kidwang said.
"With PMI funding, we moved from a mortality rate of 17% to bring the situation down to 8%," Kidwang said.
"Now, with the September–October peak underway, available trends indicate that fatalities are rising sharply, even though official data has yet to be released," he said, citing a figure of 15% for the first half of 2025.
"We may get to a point where all the gains against malaria are reversed."
The Trump administration says it is reforming foreign aid that did not align with its "America First" agenda and Secretary of State Marco Rubio has said repeatedly that no-one has died as a result of the cuts.
Trump has said the U.S. pays disproportionately for foreign aid and wants others to pay more. Between 2010 and 2023, the U.S. contributed an average of 37% of funding for malaria programmes, the World Health Organization says.
This year, the U.S. has cancelled more than 80% of aid contracts, but said life-saving work, including for malaria, would continue. Yet organizations on the ground and the WHO in April said "critical gaps" remained in the malaria response after the cancellations.
Going forward, Trump's initial budget request for fiscal year 2026 included a 47% cut to PMI's budget from the just below $800 million it had hit in recent years, though Congress will have the final say later this year.
The "America First Global Health Strategy" Rubio announced in September stated some commitments to reducing malaria mortality and incidence, but made no mention of PMI or budgets. A State Department spokesperson confirmed to Reuters that the programme would continue.
Anne Linn, former senior community health advisor for PMI, told Reuters that before the January cuts the programme supported 115,000 community health workers across 30 countries. That all disappeared, she said, although it is unclear how much funding has since resumed and where governments and non-profits have stepped in to fill urgent gaps.
The State Department spokesperson said in the future it would provide support to fight malaria through bilateral agreements with partner countries, and committed to maintaining 100% of current U.S. funding for commodities such as nets and drugs and frontline health workers in fiscal year 2026, before asking governments to co-invest. They gave no details of their current annual budget.
CUTS BEING FELT IN SEVERAL AFRICAN COUNTRIES
The effects of the cuts have been felt in a number of African countries, including Liberia, where some community health workers are volunteering without pay.
In Cameroon's Far North, a region prone to droughts and flooding as well as violence linked to the Islamist Boko Haram insurgency in neighbouring Nigeria, the cuts came as officials were training community health workers to deploy during the rainy season, which runs from May to October, Kidwang said.
Oumarou Gassi, one of the health workers, said he was devastated to lose the job.
"I am struggling to survive. The little I used to get from the PMI project was helpful in supporting my family," he said.
With health workers no longer in the field, more malaria cases are becoming severe, and the U.S. cuts have also hit the supply of injectable artesunate, Kidwang said.
Far North was out of stock for much of this year, he said.
Some 200,000 vials arrived in Maroua, the regional capital, on September 2, but that is not enough to meet the region's needs for even three months, he said.
Authorities are trying to fill the gap but face resource constraints, said Olivia Ngou, executive director of Impact Sante Afrique, a nonprofit.
PICTURE UNCLEAR AS U.S. CUTS ALSO AFFECT DATA COLLECTION
Just how bad the situation gets may be difficult to gauge given that PMI also played a major role in data collection.
That data is no longer online. PMI's website says it is "currently undergoing maintenance as we expeditiously and thoroughly review all of the content" to comply with Trump's executive orders.
As a result, "we won't know the extent to which this bounce back is going to occur," said Louisa Messenger, a public health expert at the University of Nevada-Las Vegas who has worked with PMI and other malaria programmes in Africa.
The big-picture data matters little to Djidja and Daouda Amadou, who lost their five-month-old girl to malaria in July.
Like Goni, they waited in hopes the child's fever would subside before taking her to a health clinic, where staffers referred them to Maroua.
By the time they arrived, it was too late, and now their baby is buried under a mound of earth in their yard.
"I am devastated," Amadou said quietly. "The child's memory keeps coming back to me."
(Reporting by Amindeh Blaise Atabong in Bogo, Robbie Corey-Boulet in Dakar and Jennifer Rigby in London; Writing by Robbie Corey-Boulet; Editing by Estelle Shirbon, Alexandra Hudson)
