Although Ghana had appeared in three consecutive World Cups, the Black Stars failed in their bid to qualify for the 2018 FIFA World Cup. Afful appeared six times in qualifying, including four matches in the third round as Ghana placed third in their group and missed out on the World Cup for the first time since 2002. In the fall of 2018, he returned to the Ghana team for the first time since the qualifying failure and made two appearances in 2019 Africa Cup of Nations qualifying as the Black Stars finalized a spot at the final tournament. Afful was not named to Ghana's roster for the tournament as he was dealing with an injury suffered at the club level.