By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
In December 2024, WHO published updated versions of the “Master Protocol for Surveillance of pfhrp2/3 Deletions and Biobanking to Support Future Research” and the “Response Plan to pfhrp2 gene deletions”. These topics are highly relevant to the sensitivity of most rapid diagnostic tests for malaria used in the field. See also the paper by Ngalame AL & al. below on this topic.
On 11 March, UNICEF announced the shipment of malaria vaccines to Mali; then on 17 March, GAVI, the Vaccine Alliance, announced that “Burundi joins the list of 17 other countries on the African continent to have introduced malaria vaccine into routine immunization with Gavi support.” The vaccine used in both countries is the RTS,S preparation, developed by GSK. More recently, the US Government’s support of GAVI has come under serious doubt. It is unclear how the withdrawal of US support, which has been significant at $300 million per year, would affect malaria vaccination programs.
The Economist included an article in the 31 March issue on the consequences of diminished funding available from rich countries for international health assistance, focusing especially on how this may affect the deployment of the two recently WHO-approved malaria vaccines.
On the same date, WHO issued an advisory about Rapid Diagnostic Tests (RDTs), which may show faint positive test lines. “The faint test lines were predominantly observed for patients with low parasitemia (200 parasites/µl). However, some patients with higher parasitemia also generated faint test lines.” WHO counsels that faint test lines be also regarded as positive RDTs
On 3 April, Malaria World Journal published a review of a book titled Practical Control of Malaria Vectors, a collection, edited by Charlwood, D, of contributions by multiple authors. The review, by Bart GJ Knolls, is complimentary.
The end of April brings us WHO-declared special days of relevance to the fight against malaria: 24 to 30 April 2025 is World Immunization Week and 25 April 2025 is World Malaria Day. These days are all the more meaningful in view of the recent decimation of financial and hands-on support for the fight.
PEER REVIEWED ARTICLES (see notes after citations from non-peer-reviewed publications)
Daily JP & Parikh S, Malaria, New Eng J Med, 2025 Apr 3, 392:1320, https://doi.org/10.1056/ NEJMra2405313, is an excellent summary of the current knowledge of the disease, its treatment, and prevention aimed at physicians in resource-rich societies.
Prevention
Vaccines
Nigeria first started using the R212/Matrix M vaccine in November 2024. Alagbe OO & al. published an article on its acceptability, Awareness, Perceptions and Willingness to Accept Malaria Vaccine for Children Under Age 5 Among Mothers in Northcentral Nigeria: A Cross-Sectional Study, BMJ Open. 2025 Mar 25; 15(3):e091739, https://doi.org/10.1136/bmjopen-2024-091739, based on interview and questionnaire data from 376 women approximately a year earlier. While aty the time fewer than a quarter of the women had been aware of the existence of anti-malaria vaccines, once they were made aware, over 90% expressed interest in having it administered to their children under age five, including willingness to pay for it. “[Younger] age, marital status, educational level and income were significantly associated with willingness to vaccinate…” {It will be interesting to see whether these data hold up six months after the introduction of the vaccine in the country.}
Human monoclonal antibodies have been used in vaccine development. Patel PN & al., A Strain-Transcending Anti-AMA1 Human Monoclonal Antibody Neutralizes Malaria Parasites Independent of Direct RON2L Receptor Blockade, Cell Rep Med. 2025 Mar 18; 6(3):101985, https://doi.org/10.1016/j.xcrm.2025.101985 explores some of the molecular an analyses that in their opinion will favor this approach to immunization against malaria.
Another paper with a similar approach to anti-malaria vaccine development is by Parveen S & al. They describe the development of two substances developed in the laboratory from human cloned cells that have significant anti-Pf sporozoite activity in Novel, Fully Human, Anti-PfCSP Antibodies with Potent Antimalarial Activity Using a Phage Display Based Strategy, Vaccine. 2025 Mar 17; 54:126993, https://doi.org/10.1016/j.vaccine.2025.126993.
Sallam M & al., Current Developments in Malaria Vaccination: A Concise Review on Implementation, Challenges, and Future Directions, Clin Pharmacol. 2025 Apr 1; 17:29-47, https://doi.org/10.2147/cpaa.s513282 is presented as a review of the literature between 2015 and 2024 relevant to the development of the two vaccines already in use and some in development. Based on review of the abstract, the article contains no new information on the subject.
Vectors
Epstein A & al., Evaluating the Impact of Two Next-Generation Long-Lasting Insecticidal Nets on Malaria Incidence in Uganda: An Interrupted Time-Series Analysis Using Routine Health Facility Data, BMJ Glob Health. 2025 Mar 11; 10(3):e017106, https://doi.org/10.1136/bmjgh-2024-017106 is an article from the same group that produced Gonahasa S & al., LLIN Evaluation in Uganda Project (LLINEUP2) – Effect of Long-Lasting Insecticidal Nets (LLINs) Treated with Pyrethroid Plus Pyriproxyfen vs LLINs Treated with Pyrethroid Plus Piperonyl Butoxide in Uganda: A Cluster-Randomised Trial, PLOS Glob Public Health. 2025 Feb 26; 5(2):e0003558, https://doi.org/10.1371/journal.pgph.0003558 last month, reporting on a different aspect of the same study. The authors state that while there was a significant (23%) drop in malaria incidence within the 12 months of net distribution in the population studied, the drop was not sustained during the second year. In their conclusion, the authors themselves call attention to the fact that the so-called “long lasting” nets lose their effectiveness after only a year under current circumstances.
Sih C & al. studied the ownership and distribution of insecticide treated nets (ITNs) in an area of Côte d’Ivoire of high endemicity of malaria. As explained in Evaluation of Household Coverage with Long-Lasting Insecticidal Nets in Central Côte d’Ivoire, Malaria J, 2025 Mar 29, 24:104, https://doi.org/10.1186/s12936-025-05335-4, the authors considered adequate coverage if the household had one ITN per every 2 persons and at least on in every “sleeping unit.” Among 10,630 households in 43 villages, the authors found that while 63.8% of households possessed ITNs, only 37.6% of them possessed at least one ITN per two persons and only 37.1% had at least one per sleeping unit two years after the last mass distribution campaign.
Most researchers have found that that the use of ITNs, even when they are available, is much less than desirable. Vey T & al., Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama “Secure Voucher” Study Cluster Randomized Controlled Trial, J Med Internet Res. 2025 Mar 19; 27:e51524, https://doi.org/10.2196/51524 describes the result of a study aimed at assessing “the efficacy of mobile messaging in increasing the redemption of e-vouchers for [ITNs] for pregnant women and adolescents in Tanzania… The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm … There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers.”
Also from Tanzania comes Sichalwe MM & al.’s report, Predictors of Insecticide-Treated Net Utilization Among Caregivers of Under-Five Children in Butiama District, Tanzania J Vector Borne Dis. 2025 Apr 5, https://doi.org/10.4103/jvbd.jvbd_213_24. Based on questionnaires completed by 384 women with small children in their household, ITN ownership was 82.3%, but only “50.8% used [the ITN] the night before the study. Key predictors of ITN use included being female, having primary education, and being aware of the correct timing for use.
On the same subject., Kombate G & al., Dynamics in Ownership, Access and Use of Long-Lasting Insecticidal Nets in Togo: Evidence from Three Population-Based Surveys, PLOS Glob Public Health. 2025 Apr 2; 5(4):e0004393, https://doi.org/10.1371/journal.pgph.0004393 reveals that although ITN use in families increased between 2010 and 2017, it remained well below the WHO standard of 80% proper use. There are no more recent data reported.
A very important point made by Somda Z & al. in High Pyrethroid Resistance Is Associated with High Frequencies of 1014F and 1014S kdr Mutations in Anopheles arabiensis (Diptera: Culicidae) from Ouagadougou, Burkina Faso, J Med Entomol. 2025 Mar 17; 62(2):381-388, https://doi.org/10.1093/jme/tjae135 is that in laboratory assays, locally collected vector mosquitoes were highly resistant to pyrethroid insecticides, while mostly susceptible to organophosphates. The paper concerns itself with the genetic mechanism of the eresistance.
Mulebeke R & al. aim “to review the available evidence on the strategies and deployment of current tools targeting vectors and parasites in resource-limited settings, focusing on sub-Saharan Africa” in Enhancing Malaria Elimination in High-Transmission Settings: The Synergy of Concurrent Vector Control and Chemotherapy, Malaria J, 2025 Apr 1, 24:105, https://doi.org/10.1186/s12936-025-05339-0. They state that “[c]ombining malaria interventions can create a synergistic effect, where the combined impact is greater than the sum of individual interventions. For example, simulations show benefits from combining MDA [mass drug administration] and IRS, vaccines and bed nets, or the RTS,S vaccine with perennial malaria chemotherapy… [as well as] combining IRS and MDA, or SMC [seasonal malaria chemoprophylaxis] with seasonal malaria vaccination, has demonstrated increased protective effects.” Conversely, some combinations, like ITNs and IRS, “may not provide additional benefit.”
“Vector control remains the principal method to prevent malaria transmission and has led to significant reductions in malaria incidence across endemic regions…. An Entomological Surveillance Planning Tool (ESPT) was designed to translate normative guidance into an operational tool that supports cost effective, locally tailored, and evidence-based vector control. To facilitate ESPT implementation, an interactive digital toolkit (eSPT) was created to support question-based surveillance planning.” Hemingway C & al., Evaluation of a Digital Entomological Surveillance Planning Tool for Malaria Vector Control: Three Country Mixed Methods Pilot Study, PLoS One. 2025 Mar 10; 20(3):e0303915, https://doi.org/10.1371/journal.pone.0303915 is a report on how 49 users in three Sub-Saharan countries reacted to the toolkit. “Quantitative measures showed that the facilitated eSPT workshop increased participants’ knowledge and self-efficacy in question-based entomological surveillance planning. Target users responded positively to the eSPT, reporting high usability scores and satisfaction with the interface. Respondents from academic institutes, central government and international NGOs reported the eSPT to be a useful training tool and believed it could provide substantial efficiencies in the planning process.”
“One approach to interrupting the transmission of insect-borne diseases that is successfully used in veterinary medicine is exploiting the ability of antiparasitic drugs to make vertebrate blood toxic for blood-feeding insects. Recent studies have identified … an enzyme of the tyrosine detoxification pathway, as essential for hematophagous arthropods to digest their blood meals… A US Food and Drug Administration-approved HPPD enzyme inhibitor called nitisinone is a drug used to treat rare human-inherited disorders” such as alkaptonuria. Haines LR & al., Anopheles Mosquito Survival and Pharmacokinetic Modeling Show the Mosquitocidal Activity of Nitisinone, Sci Transl Med. 2025 Mar 26; 17(791):eadr4827, https://doi.org/10.1126/scitranslmed.adr4827 reports that “feeding human blood containing nitisinone to insectary-reared female Anopheles gambiae mosquitoes was mosquitocidal to both young and old mosquitoes as well as insecticide-resistant Anopheles strains.” The authors also state that blood from alkaptonuric patients treated with nitisinone killed mosquitoes as well and compare the action of nitisinone to that of invermectin.
“There is an immediate necessity to explore innovative biological strategies to combat mosquito-borne illnesses. One promising avenue in current research is the development of bioinsecticides utilizing advanced nanotechnology.” Kalaivani S & al., Biosynthesis of Silver Nanoparticles Using Soil Actinobacterium Streptomyces anthocyanicus and Investigation of their Larvicidal Potentials Against Culex quinquefasciatus, Aedes aegypti, and Anopheles stephensi, J Invertebr Pathol. 2025 Mar 20: 108316, https://doi.org/10.1016/j.jip.2025.108316 “aimed to synthesize silver nanoparticles [AgNP] from … Streptomyces anthocyanicus.” In the laboratory, AgNP had strong larvicidal effects against all three species of mosquito vectors. “The research suggests that AgNPs synthesized by [Streptomyces anthocyanicus] could be an environmentally friendly option for biological mosquito control.”
“Microsporidia MB is a naturally occurring symbiont in Anopheles arabiensis mosquitoes that inhibits the development of Plasmodium. It is transmitted both vertically and horizontally, enabling its spread within mosquito populations. Currently, mating is the only known mechanism for horizontal transmission.” Maina T & al. studied transmission of Microsporidia MB under laboratory condition and report that the “age of mosquitoes does not affect the transmission of Microsporidia MB from males to females …. However, transmission of the Microsporidia MB from female mosquitoes to males was not observed in the 3–4 days old age group. Although heterogeneous, there is higher overall transmission from male to female (41.5%) compared to female to male (22.4%).” The authors conclude that “Microsporidia MB infected males can potentially disseminate Microsporidia MB in the natural mosquito populations, thus, contributing to malaria control. However, semi-field studies are required to validate these results in a natural environment.” The article is Maximizing Horizontal Transmission Through Mating: Increased Mating Frequency and Mating Competitiveness Associated with Microsporidia MB-Infected Anopheles arabiensis Males, Malaria J, 2025 Apr 9, 24:114, https://doi.org/10.1186/s12936-025-05354-1
Woyessa D & Yewhalaw D, Anopheles Mosquito Fauna, Blood Meal Sources and Transmission Intensity from High and Moderate Malaria Endemic Areas of Ethiopia, Sci Rep. 2025 Mar 27; 15:10636, https://doi.org/10.1038/s41598-025-94739-y is a description of the various species of Anopheles and their biting behaviors in the regions of Ethiopia studied.
An editorial characterized as “hardtalk,” Knols, Bart GJ, Tackling the Unfolding Anopheles stephensi Crisis in Africa: Minimise Research and Maximise Action, Malaria World J, 2025 Mar 19, 16:6, https://doi.org/10.5281/zenodo.15052092, urges shifting attention from writing papers about the mosquito invading Africa to devoting attention and resources to fighting its spread.
Chemoprophylaxis
“Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SP + AQ) involves the monthly administration of therapeutic doses to children under five years of age during periods of high risk of malaria in regions where malaria transmission is highly seasonal. Current SMC guidelines recommend administering the same treatment to both non-infected and asymptomatic Plasmodium falciparum-infected children.” Sanogo D & al., High Incidence of Clinical Malaria Among Asymptomatic Plasmodium falciparum Infected Children Receiving SMC with Sulfadoxine-Pyrimethamine and Amodiaquine (SP + AQ) in Koulikoro, Mali, Malaria J, 27 Mar 2025, 24:102, https://doi.org/10. 1186/s12936-025-05283-z calls into question this practice at least in Mali, because the authors found that “[a]symptomatic infected children had a significantly higher risk of clinical malaria during the transmission season” and conclude that their ”findings demonstrate an elevated risk of clinical malaria in asymptomatic infected children during SMC implementation. Screening and treating P. falciparum infections prior to SMC administration could substantially enhance the effectiveness of this strategy in reducing malaria morbidity in endemic areas.”
SMC “is an effective malaria preventive intervention in sub-Saharan Africa. As with other drug-based interventions, large-scale deployment increases drug pressure, which may result in drug-resistant parasite strains thereby jeopardising the impact of the intervention. Mutations in Pfdhps and Pfdhfr genes are known to be associated with resistance to sulfadoxine and pyrimethamine, respectively, making the surveillance of molecular markers crucial in settings where SMC is widely applied.” Millogo KS & al. assessed “the distribution of Pfdhfr and Pfdhps alleles before and after the 2021 annual campaign of SMC in the health district of Nanoro in Burkina Faso and report in Seasonal Malaria Chemoprevention and Mutations in Pfdhfr and Pfdhps Genes in Children in the Health District of Nanoro, Burkina Faso, Malaria World J, 2025 Mar 17, 16:5, https://doi.org/10.5281/zenodo.15039792 that although the frequency of mutations was high, there was no significant change in the frequency after SMC as compared to before. However, the article does not comment on the efficacy of SMC under these circumstances.
What happens to children once they “age out” of being targets of SMC? Manga IA & al. address this question in their article, Asymptomatic Carriage of Plasmodium falciparum in Children no Longer Targeted for Seasonal Malaria Chemoprevention and with a History of Exposure to this Strategy: A Cross-Sectional Study in Southern Senegal, PLoS One. 2025 Mar 25; 20(3):e0318037, https://doi.org/10.1371/journal.pone.0318037, albeit with data that are up to eight years old. They report the rate of carrying Plasmodium while asymptomatic to be19.47% (called “malaria prevalence” in the abstract but clarified to be asymptomatic in the article itself), comparable to rates of asymptomatic carriers in the region, reported elsewhere. Thus, it appears that the benefit of SMC does not carry over to later ages. Girls had higher rates of positivity than boys.
“In 2022, the World Health Organization extended their guidelines for perennial malaria chemoprevention (PMC) from infants to children up to 24 months old,” which extends the previous recommendation of up to 15 months. Sen S & al., Public Health Impact of Current and Proposed Age-Expanded Perennial Malaria Chemoprevention: A Modelling Study, Sci Rep. 2025 Mar 26; 15:10488, https://doi.org/10.1038/s41598-025-93623-z contains modeling data that supports the recommendation. “PMC’s total impact outweighed the risk of delayed malaria in children up to age five and remained cost-effective across currently recommended transmission intensities (over 10% prevalence) when delivered through the existing Expanded Program on Immunization channels.”
Other
Cissoko M & al. evaluated “the impact of control interventions at the health district level on malaria incidence in the general population” of Mali. While they noted significant increases in the deployment of ITNs and of SMC between 2017 and 2022, the reductions in incidence of malaria attributable to the two measures were disappointing at 0.22% and 0.19% respectively. The article is Impact of Control Interventions on Malaria Incidence in the General Population of Mali, J Epidemiol Glob Health. 2025 Mar 12; 15:40, https://doi.org/10.1007/s44197-025-00381-2. This article could also be cited under Epidemiology
Diagnosis
General diagnostics
Given the known limitations of malaria diagnostic tests, even including microscopy, Jang WS & al. address the fact that the most reliable test, quantitative polymerase chain reaction (qPCR) is either not available or not affordable in many malaria endemic settings. In Development of a Rapid Malaria LAMP-MS Assay for Diagnosis of Malaria Infections, Sci Rep. 2025 Mar 12; 15:8547, https://doi.org/10.1038/s41598-025-92935-4 they describe a “malaria diagnostic platform by combining the Chelex-100/boiling DNA extraction method with a Loop-mediated Isothermal Amplification-MicroScanner (LAMP-MS) assay.” They claim very high sensitivity for both P. falciparum and P. vivax assays and 100% specificity and conclude that “LAMP-MS is a rapid and reliable alternative to PCR-based methods, especially in resource-limited environments.”
Microscopic diagnosis of malaria, which used to be regarded as the gold standard is also under scrutiny, given the evidence of “submicroscopic” disease, both symptomatic and asymptomatic uncovered by PCR testing. Dahiya A & al. reviewed the literature on the development of artificial intelligence (AI) based software to diagnose malaria from blood smears. Their paper, Deep Learning Method for Malaria Parasite Evaluation from Microscopic Blood Smear, Artif Intell Med. 2025 Mar 15; 163:103114, https://doi.org/10.1016/j.artmed.2025.103114 concludes that “[a]utomated methods for malaria diagnostics show considerable promise in improving diagnostic accuracy and reducing human error. While deep learning models have demonstrated high performance, challenges remain in data standardization and real-world application.”
Thomson RM & al., WHO Malaria Nucleic Acid Amplification Test External Quality Assessment Scheme: Results of Eleven Distributions Over 6 Years, Malaria J, 2025 Mar 23, 24:94, https://doi.org/10.1186/s12936-025-05282-0 is a report on external quality control [QC] of several laboratories performing nuclear acid amplification test for P. falciparum. The authors conclude that external quality control results improved over time, justifying the role of QC.
Field diagnostics
Ngalame AL & al. tested a particular brand of rapid diagnostic test (RDT) against microscopy. As reported in Assessment of the Diagnostic Performance of the SD Bioline Malaria Antigen Test for the Diagnosis of Malaria in the Tombel Health District, Southwest Region of Cameroon, PLoS One. 2025 Mar 13; 20(3):e0298992, https://doi.org/10.1371/journal.pone.0298992, while the test was 100% specific (all microscopy negative samples were also negative on RDT), it was only 45% sensitive, missing 73 of 133 microscopy-positive specimens (of 250 people tested). The authors raise doubts about the value of using RDT as a screening test because of the low sensitivity.
In Tanzania, Seth MD & al. found that up to 29.4% of blood spots collected from individuals who were negative on routine clinical tests for malaria in low transmission settings were positive for P. falciparum on qPCR testing. They conclude that there is a “substantial reservoir that is likely to perpetuate transmission but can be missed by routine malaria case management strategies. Thus, control and elimination programmes may benefit from adoption of more sensitive detection methods to ensure that a higher proportion of subpatent infections are detected.” The paper is Prevalence of Subpatent Plasmodium falciparum Infections in Regions with Varying Transmission Intensities and Implications for Malaria Elimination in Mainland Tanzania, Malaria J, 2025 Mar 26, 24:101, https://doi.org/10.1186/s12936-025-05341-6. This article could also be classified under Epidemiology
The title of DeVita TN & al., False Alarm on a Malaria “Outbreak” Linked to Inconsistencies in Malaria Diagnostic Supply: A Call to Strengthen Supply Chain Management: Sierra Leone, May–July 2023, Malaria J, 2025 Mar 26, 24:100, https://doi.org/10.1186/s12936-025-05312-x may be open to misunderstanding. Based on the abstract the thrust of the paper seems to be that fluctuations in the supply of rapid diagnostic test (RDT) kits result in wide swings in the reported frequency of malaria. The “false alarm” may refer to the perceived sudden increase of malaria when RDT kit stocks are high, but if in fact the higher statistics are the correct ones, that should raise concern as well.
Budodo R & al.’s article, Performance of Rapid Diagnostic Tests, Microscopy, and qPCR for Detection of Plasmodium Parasites Among Community Members with or Without Symptoms of Malaria in Villages Located in North-Western Tanzania, Malaria J, 2025 Apr 9, 24:115, https://doi.org/10.1186/s12936-025-05361-2 is a study comparing the three diagnostic methods in communities where several species of Plasmodium may infect the inhabitants. In this study, RDTs outperformed microscopy although both of these methods had low sensitivity in situations of low parasite burden.
New diagnostic methods
None this month
Treatment
Treatment results
After an investigation of treatment results for 224 of 234 patients with confirmed malaria out of a sample of 460 symptomatic individuals, Demass TB & al., Treatment Outcomes of Patients with Uncomplicated Malaria and Associated Factors in Northwest Ethiopia: A Prospective Follow-Up Study, 2024, BMC Infect Dis. 2025 Mar 19; 25:387, https://doi.org/10.1186/s12879-025-10791-z reports that in 42 (18.8%) of patients the treatment was unsuccessful (defined as development of severe malaria on days 1-3 or presence of parasitemia any time between 3 and 28 days after initiation of treatment). Among the factors associated with unsuccessful treatment was P. vivax infection or treatment with artemether-lumefantrime (coartem) twice a day for three days and 14 days of primaquine (as opposed to those receiving only one day of primaquine). The authors speculate that these failures may have been caused by the lack of chloroquine, which would have been the preferred regimen for P. vivax.
Side effects and complications
None this month
Guidelines
None this month
Drug resistance
Pernaute-Lau L & al. “retrospectively analyzed data from a randomized clinical trial, where patients received either DHA-PPQ [dihydroartemisinin-piperaquine] or artesunate-amodiaquine for recurrent malaria episodes over two years. [They] observed an increase in the relative risk of re-infection among patients receiving DHA-PPQ compared to artesunate-amodiaquine after the first malaria season. This was driven by shorter average times to reinfection and coincided with an increased frequency of infections comprising pfpm3 multi-copy parasites.” The paper is Decreased Dihydroartemisinin-Piperaquine Protection Against Recurrent Malaria Associated with Plasmodium falciparum Plasmepsin 3 Copy Number Variation in Africa, Nat Commun. 2025 Mar 18; 16:2680, https://doi.org/10.1038/s41467-025-57726-5
“Artemisinin partial resistance, mediated by mutations in the Plasmodium falciparum kelch13 gene (k13), rapidly spread in southeast Asia, undermining the antimalarial effectiveness of artemisinin-based combination therapies. k13 mutations have also arisen in Africa, but their rates of increase are not well characterised. [Meier-Scherling CPG & al.] aimed to quantify the selection of k13 mutations in Africa …” They conclude in Selection of Plasmodium falciparum kelch13 Mutations in Uganda in Comparison with Southeast Asia: A Modelling Study, Lancet Microbe. 2025 Mar 17: 101027, https://doi.org/10.1016/j.lanmic.2024.101027 that the “k13 mutation selection in Uganda was similar to that observed in southeast Asia, suggesting that frequencies of k13 mutations will continue to increase quickly in Uganda. These commensurate levels of selection indicate a high potential for rapid transmission across other parts of Africa.”
Patrick OJ & al. investigated a genetic property of the parasite that predisposes it to resistance to multiple antiplasmodials in use today and report in, Prevalence and Distribution of Plasmodium falciparum Multidrug Resistant 1 D1246Y Allele Among Children in Ibadan Southwest, Nigeria, Sci Rep. 2025 Mar 21; 15:9715, https://doi.org/10.1038/s41598-025-94668-w that among 97 samples taken from children with proven plasmodial infection, almost half (47) carried the parasite with the mutant allele. The authors discuss the implication of the finding.
Igwe MC & al. discuss the development of antimalarial drug resistance in terms of the principles of the development of evolution in Evolutionary Biology of Antimalarial Drug Resistance: Understanding of the Evolutionary Dynamics, Medicine (Baltimore). 2025 Mar 14; 104(11):e41878, https://tinyurl.com/mr4xuhuh. They extend the discussion to include potential microbiological and public health approaches on overcoming the threat that resistance poses to the fight against the disease.
New drug research
Okwu DG & al. gathered data “from the medicines for malaria venture (MMV) portfolio and clinical trial databases between 2020 and 2024.” They reviewed 16 clinical trials “involving healthy volunteers, experimentally infected volunteers, asymptomatic P. falciparum carriers, and malaria patients.” The drugs included ganaplacide, cabamiquine, ferroquine, pyronaridine, usually in combination with each other or with lumefantrine as well as other drugs still under coded designations. As the authors conclude in The Non-Artemisinin Antimalarial Drugs Under Development: A Review, Clin Microbiol Infect. 2025 Mar 20: S1198-743X(25)00127-2, https://doi.org/10.1016/j.cmi.2025.03.009, “several promising candidate drugs with novel modes of action are advancing through clinical development. Many are expected to become available for treating uncomplicated and severe malaria within the next decade.”
Acridones are a class of organic chemical compounds being investigated for anti-cancer action. Dodean RA & al., Development of Next-Generation Antimalarial Acridones with Radical Cure Potential, J Med Chem. 2025 Apr 3, https://doi.org/10.1021/acs.jmedchem.5c00419 is a report of laboratory testing some of these compounds against both blood stage and liver stage Plasmodium parasites. According to the authors the results are encouraging and justify further research into these potential anti-malarials.
Plant extracts and traditional treatments
None this month
Campaigns and Policies
“In Mali, access to health care facilities (HCFs) is limited due to distance and transportation costs, and this limitation may have led to an under detection of COVID-19 cases.” Breton G & al., Successful Integration of Community-Based Rapid Antigen Testing for COVID-19 and Malaria in Mali, Am J Trop Med Hyg. 2025 Mar 5: tpmd230855, https://doi.org/10.4269/ajtmh.23-0855 a prospective randomized study compared a community-based, integrated COVID-19 and malaria testing strategy (intervention arm) to the national standard-of-care strategy (SOC arm). Baased on the results, the authors conclude that “[i]ntegration of community-based testing for COVID-19 and malaria Ag-RDTs was found to be feasible. However, limited access to HCFs in rural areas highlights the need for treatment services to be available at the community level.”
Adokiya MN studied the system of referral of pregnant patients with malaria to the nearest treatment facility. Perspectives of Health Workers on Malaria Case Referral Among Pregnant Women Attending Antenatal Care in Savelugu Municipality, Ghana: A Qualitative Descriptive Study, PLoS One. 2025 Mar 18; 20(3):e0319567, https://doi.org/10.1371/journal.pone.0319567 concludes that whereas participants described the referral system “(patient awareness and consent, documentation, referral coordination, and post-referral feedback) and a referral mechanism (ambulance/nurse accompaniment” for the very sick) as robust, but reported “transport challenges as the main obstacle to its operation. The study also revealed that health workers do not accompany all referral cases,” resulting in some patients not showing up for the referral.
Epidemiology
Climate change, biodiversity and environment
“Cyclone Idai was one of the most destructive cyclones in the Southern Hemisphere. Malaria prevention is not part of cyclone response, but housing damage has been shown to increase malaria risk. [Searle KM & al. assessed] the extent to which housing damage led to insecticide treated net (ITN) damage, thus compounding malaria risk” and report in Household Storm Damage Limits Use of and Access to Insecticide Treated Bednets in Mozambique, Ann Hum Biol. 2025 Mar 9; 52:2461145, https://doi.org/10.1080/03014460.2025.2461145 that We “even minor household damage was associated with 70% decreased odds of ITN use.” As severe storms become more frequent due to climate change, the authors recommend “further research to assist malaria control programs in their success.”
Okafor UA & al. “investigated the future (2021-2050) impact of Climate Change on Malaria Prevalence in the Upper River Region of The Gambia under two representative concentration pathways …, comparing it with the observed evaluation period of 2011-2022. They report in Projection of Future Malaria Prevalence in the Upper River Region of The Gambia, Malaria J. 2025 Apr 3; 24:108, https://doi.org/10.1186/s12936-025-05348-z that an increase in malaria incidence is expected under both “climatic scenarios for both age categories with a clear indication in the population above five years… thus, a strategic and robust intervention scheme is highly solicited.”
Climate change may affect the risk of mosquito-borne diseases. Gizaw AK & al. “investigated how temperature affects the population dynamics of all stages of Anopheles arabiensis mosquitoes, including eggs, larvae, pupae, and adults. [They] developed and analyzed a mathematical model that incorporates logistic growth and temperature.” Their paper, Modeling the Variability of Temperature on the Population Dynamics of Anopheles arabiensis, BMC Res Notes. 2025 Mar 29; 18:132, https://doi.org/10.1186/s13104-025-07153-y describes the m,odel and how it was developed, but does not actually apply it.
Risk factors
It has been known for some time that individuals with sickle cell trait (i.e. heterozygous for Hemoglobin S) are relatively resistant to malaria. That is apparently not the only genetic condition that affects how a person’s body handles infection by the Plasmodium parasite. Bamikole OJ & al.’s article, Association of Toll Like Receptors Polymorphism (TLR1-rs4833095, TLR1-rs5743611, TLR6-rs5743810, TLR6-rs5743809, TLR4-rs4986790, TLR4-rs4986791, TLR9 rs187084) with Clinical Outcome of Malaria Among Children in Ibadan, Southwest Nigeria, Pathog Glob Health. 2025 Mar 21:1-12, https://doi.org/10.1080/20477724.2025.2478362 reveals on the basis of genetic and epidemiological studies that some individuals with one or another gene in the complex described in the title of the paper may be uniquely susceptible to severe malaria.
Using national databases as the source for their paper, Nadakou NT & al. noted a 23.5% positive RDT rate. They then describe in Risk Factors Associated with Malaria Infection in Children Aged From 6 to 59 Months in Niger: A Cross-Sectional Study, BMC Public Health. 2025 Mar 14; 25:1001, https://doi.org/10.1186/s12889-025-22211-7 the data underpinning their conclusions that [c]hildren from low-income households and those from middle-income households are respectively 50% and 63.7% more likely to have malaria compared to those from high-income households. Children whose mothers have no level of education and those whose mothers have a primary level of education have a risk respectively 2.5 times and 2.3 times greater of having malaria than those whose mothers have the highest level. Children in urban areas are 69.1% less likely to suffer from malaria infection than those in rural areas.”
According to Asifat OA & al., “[w]hile housing structure and sanitation are recognized as risk factors in other African countries, their relationship with malaria infection among under-five children in Nigeria remains underexplored.” The authors used data from a nationwide survey to report in Relationship Between Unimproved Household Sanitation Facilities and Malaria Infection Among Under-Five Children in Nigeria: Insights from Malaria Indicator Survey 2021, Malaria J, 2025 Mar 27, 24:103, https://doi.org/10.1186/s12936-025-05340-7 that “[m]alaria risk among under-five children in Nigeria is strongly associated with socioeconomic factors, rural residence, and maternal education, but not unimproved sanitation alone.”
Asosega KA & al. analyzed data from over 3000 mother/under 5 child pairs from the national survey and report in Malaria Prevalence Dynamics and Risk Covariates Among Children Under 5 in Ghana: Insights from a Bayesian Multilevel Approach, BMJ Open. 2025 Mar 27; 15(3):e088910, https://doi.org/10.1136/bmjopen-2024-088910 a “malaria prevalence of 29.7% … among children under 5, and … 8.9% of the risk of malaria infection significantly varied by community differences. Also, “the average annual rainfall significantly increased the risk of malaria infection among children under 5 years …. Children from rich households …, who sleep under insecticide-treated nets (ITNs) … and are not anaemic have significantly reduced the risk of malaria infection than those from poor households, children with severe anaemia and those who do not sleep under ITNs at night.”
Based on six-year-old national survey data, Takramah WK & al. report in Bayesian Spatiotemporal Modelling and Mapping of Malaria Risk Among Children Under Five Years of Age in Ghana, BMC Infect Dis. 2025 Mar 28; 25:430, https://doi.org/10.1186/s12879-025-10787-9 that “[s]ocio-economic and climatic factors such as household size …, rural area …, rainfall …, and maximum temperature … were all shown as statistically significant predictors of malaria risk in children aged 6-59 months. Hot spot DHS clusters (enumeration areas) with a significantly high relative risk of malaria among children aged 6-59 months were repeatedly detected in the Ashanti region…”
General epidemiology
Bayode T & al. studied “the complex interplay between urban structure and health in rapidly urbanizing cities in Nigeria. The study broadly used very high-resolution satellite imagery and gathered primary data. With the aid of the very high-resolution imagery and identified neighborhoods, two neighborhoods each were sampled…” Their paper, City Classification and Health Burden: Evidence from U5 Malaria in the Rapidly Growing City of Akure, Nigeria, IJID Reg. 2024 Dec 12; 14:100515, https://doi.org/10.1016/j.ijregi.2024.100515 reports that “under 5 malaria varies significantly among the settlement classes with highest … difference between peri-urban settlement and medium-density settlement … The study shows higher malaria burden in the informal and peri-urban settlement compared with the lower prevalence in formal settlements.”
When newborns are diagnosed with malaria, it follows that their mothers transmitted the disease, even if they themselves had no symptoms. Omidiji MO & al. studied the incidence of congenital malaria in an era of IPTp-SP chemoprevention for expectant mothers. They report in Prevalence of Congenital Malaria in an Urban and a Semirural Area in Lagos: A Two-Centre Cross-Sectional Study, Sci Rep. 2025 Mar 28; 15:10709, https://doi.org/10.1038/s41598-025-94800-w that among 291 mother-baby pairs studied, there were no cases of congenital malaria, though evidence of placental malaria was present in 18.9%, predominantly among younger, less educated, and more semirural women.
Cao Y & al., Time Trends in Malaria Incidence from 1992 to 2021 in High-Risk Regions: An Age-Period-Cohort Analysis Based on the Global Burden of Disease Study 2021, Int J Infect Dis. 2025 Apr; 153:107770, https://doi.org/10.1016/j.ijid.2024.107770 confirms what has been published elsewhere about the decline of malaria during the time period under review, but calls agttention to the facts that “Sub-Saharan Africa has the highest age-standardized rate at 20,225.9 per 100,000 …, accounting for 92% of all new cases globally. From 1992 to 2021, age-standardized malaria incidence rates generally declined across highest-risk regions, although Sub-Saharan Africa saw the smallest decline, with a net drift of -0.74% …. The 0-4 age group faces the highest risk, which decreases with age.”
Please see Cissoko M & al., Impact of Control Interventions on Malaria Incidence in the General Population of Mali, J Epidemiol Glob Health. 2025 Mar 12; 15:40, https://doi.org/10.1007/s44197-025-00381-2 above, under Prevention/Other
Please see Seth MD & al. Prevalence of Subpatent Plasmodium falciparum Infections in Regions with Varying Transmission Intensities and Implications for Malaria Elimination in Mainland Tanzania, Malaria J, 2025 Mar 26, 24:101, https://doi.org/10.1186/s12936-025-05341-6 above, under Diagnosis/Field diagnostics.
Spatiotemporal studies
Mwesigwa A & al., Genetic Diversity and Population Structure of Plasmodium falciparum Across Areas of Varied Malaria Transmission Intensities in Uganda, Malaria J, 2025 Mar 24, 24:97, https://doi.org/10.1186/s12936-025-05325-6