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By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
News
On 12 March, WHO published the 102-page 2nd edition of its Malaria Survey Assessment Toolkit, which is available from the compiler of these reports or at https://iris.who.int/server/api/core/bitstreams/c4cb6cbf-e70c-49dd-9511-cc688a5b654e/content.
A report from Nature Africa (https://www.nature.com/articles/d44148-026-00065-4) on 25 March:
“When floods swept through southern Mozambique at the start of 2026, they did more than submerge homes and roads. Clinics were damaged, supply chains cut and hundreds of thousands of people displaced. The crisis is a stark illustration of the climate–health nexus: extreme weather that destroys the infrastructure needed to respond to the very diseases it helps spread.
Mozambique’s Ministry of Health (MISAU) reports that 229 health facilities were damaged or flooded during the crisis. …
More than 720,000 people have been affected by the floods, with Gaza province accounting for roughly three-quarters of those displaced. As services faltered, infectious diseases began to surge. In Gaza province, malaria cases rose from 2,541 during the same period in 2025 to more than 12,400 in 2026, according to health authorities.”
On 1 April, Malaria Journal published a 12-page “Meeting Report” from a workshop held in December 2024, synthesizing “testimonies from six African countries (Chad, Côte d’Ivoire, Democratic Republic of the Congo (DRC), Madagascar, Rwanda, and Senegal) highlighting how climate variability has recently influenced malaria epidemiology and how national malaria control programmes (NMCPs) are adapting.” The report is available at https://doi.org/10.1186/s12936-026-05885-1.
Also on 1 April, The Guardian published a report citing an article from the journal Insects that concluded that when larvae of An. arabiensis are exposed to the sublethal doses of the common mosquito control substance pyripoxifen, the resultant adults are less fertile up to three gebnerations. https://www.ippmedia.com/the-guardian/news/local-news/read/researchers-identify-safe-chemical-for-disabling-malaria-carrying-mosquitoes-2026-04-01-145255
On 8 April, WHO published an article titled “Mapping malaria risk to guide global action,” https://www.who.int/news-room/feature-stories/detail/mapping-malaria-risk-to-guide-global-action ,calling attention to the Malaria Atlas Project and organizations that collla borate on the project.
According to an Editorial, Vaccines Mean Malaria Deaths Should Be Falling — Not Rising, in Nature on 21 April, 652:835 (https://www.nature.com/articles/d41586-026-01253-w) “there will be little to celebrate on World Malaria Day on 25 April. Global malaria cases, which stood at 238 million in 2018, had climbed to 282 million by 2024, the latest year for which figures are available. Deaths from the disease rose from 575,000 to 610,000 over the same period. Malaria remains endemic in 80 countries. Ending malaria epidemics by 2030 is a target of the United Nations Sustainable Development Goals, but progress has clearly stalled.” After decrying the funding problems that have only grown since 2024, the editorial concludes thus: “Some diseases are genuinely difficult, if not impossible, to eliminate. Malaria is not one of them. Egypt and Cabo Verde are among the countries that have wiped out the disease. They succeeded by treating malaria as a national priority, and supporting elimination efforts with robust data systems and surveillance, as well as extensive community engagement.”
“Ahead of World Malaria Day on 25 April, the World Health Organization (WHO) has announced a significant step forward in the fight against malaria with the prequalification of the first treatment developed specifically for newborns and young infants weighing between two and five kilograms. The prequalification designation indicates that the medicine meets international standards of quality, safety and efficacy, and will help to expand access to quality-assured treatment for one of the most underserved patient groups.
The newly prequalified treatment, artemether-lumefantrine, is the first antimalarial formulation designed specifically for the youngest malaria patients. Until now, infants with malaria have been treated with formulations intended for older children, which increase the risk of dosing errors, side effects and toxicity. WHO prequalification will enable public sector procurement, contributing to closing a long-standing treatment gap for some 30 million babies born each year in malaria-endemic areas of Africa.” https://www.who.int/news/item/24-04-2026-who-prequalifies-first-ever-malaria-treatment-for-newborns-and-infants-adds-new-diagnostic-tests
Peer Reviewed Articles
Prevention
Vaccines
Wassercamp N & al., The Malaria Vaccine Programme Evaluation in Kenya: Results of a Baseline Household Survey Prior to the Introduction of the RTS,S/AS01 Vaccine, Malaria J, 2026 Apr 21, https://doi.org/10.1186/s12936-026-05911-2 describes the pre-vaccine status of malaria and attitudes regarding the vaccine, before the vaccine campaign. “High malaria burden, strong coverage of core interventions, and strong caregiver support provided a favorable context for RTS,S introduction. However, gaps in second-year-of-life services and suboptimal vaccination records retention may challenge delivery and monitoring of the 4th RTS,S dose. These findings establish a benchmark for evaluating RTS,S rollout and integration into routine child health services.”
Ashie A & al. state that during the three-country pilot program for the RTS,S/AS01 vaccine, “establishing a robust pharmacovigilance (PV) system to monitor rare but potentially serious adverse events following immunization (AEFIs) was a critical component of the program’s design.” As reported in Safety Monitoring of the RTS,S/AS01E Malaria Vaccine: Experiences and Lessons from Routine Pharmacovigilance in Ghana, Kenya, and Malawi, Malaria J, 2026 Apr 4, https://doi.org/10.1186/s12936-026-05889-x, “Causality assessment of serious AEFIs by national expert advisory committees did not reveal any new safety concerns associated with the RTS,S/AS01E vaccine or confirm the safety signals observed in the Phase 3 clinical trials. The PV efforts successfully supported the safe rollout of the vaccine, contributing to substantial public health benefits in these endemic regions. Challenges encountered included underreporting of AEFIs, delays in data submission and in investigating serious AEFIs, and poor report quality despite targeted investments to strengthen the systems.”
Phiri AE reports on the cost-effectiveness of both malaria vaccine currently endorsed by WHO, in a variety of settings in Zambia. While his modeling demonstrates significant reductions in both malaria incidence and mortality for both vaccines, he concludes in Provincial Stratification and Equity-Weighted Cost-Effectiveness of Malaria Vaccines in Zambia Under Climate Variability, BMJ Public Health. 2026 Mar 5; 4(1):e004172, https://tinyurl.com/yt3dvpxu that “RTS,S is borderline cost-effective at current prices, while R21 is highly cost-effective and potentially dominant.” Further, he draws attention to the fact that the benefits of vaccination are not uniform across provinces.
Similar to Zambia, Ochanda PN & al. reveal that the cost of introducing the RTS,S vaccine places a large burden on the national malaria control budget in Uganda. They advocate in The Cost and Budget Impact of Malaria Vaccine Introduction in Uganda, Value Health Reg Issues. 2026 Mar 15:101608, https://doi.org/10.1016/j.vhri.2026.101608 that “the government should prioritize funding and adopt cost-effective strategies, such as targeting high-transmission areas and expanding prevention efforts, to maintain affordability and achieve long-term success.”
Pilot studies with the RTS,S/AS01 vaccine demonstrated significant reduction in malaria incidence among vaccinated children. Gbaguidi GJ & al., Assessing the Potential Impact of the RTS,S/ASO1 Vaccine on Malaria Burden in Benin: A Mathematical Modelling Approach, Malaria J, 2026 Mar 21, https://doi.org/10.1186/s12936-026-05881-5 appears to be a study of the potential benefit to the entire population of any age in a defined geographic are of Benin. Although the reduction in cases in the entire population is much smaller than that confined to children alone, it is nonetheless statistically significant. The modeling also concludes that optimal reduction of malaria prevalence occurs when all children receive the entire series, including two boosters.
“Using a stochastic, individual-based Plasmodium falciparum malaria transmission model,” McCain K & al. estimated “the impact of (1) one-off catch-up campaigns with R21/Matrix-M to previously unvaccinated age groups between age 6 months and 14 years, and/or (2) extra boosters at 2, 5, and/or 10 years after the primary series in low, moderate, and high transmission settings.” They conclude in Public Health Impact of Catch-Up Vaccination or Additional Booster Doses with Pre-Erythrocytic Malaria Vaccine R21/Matrix-M: A Modelling Study, BMC Med. 2026 Mar 25, https://doi.org/10.1186/s12916-026-04822-y that “catch-up campaigns or extra booster doses of R21/Matrix-M can provide benefits beyond routine administration, with the per-additional-dose value approaching that of routine vaccination, but this varies by transmission and seasonality setting. Further empirical studies, particularly on vaccine efficacy in older children, are warranted to inform policy guidance for malaria vaccination implementation.”
According to Josue Kedakse TSN & al., “Cameroon is the first country to introduce malaria vaccine (MV) into routine immunisation, following the pilot programme. The vaccine was introduced in 42 health districts across all 10 regions, with plans to scale up in additional districts in future. A mini-postintroduction evaluation (mini-PIE) was conducted to rapidly review the MV programme, make improvements and inform future strategies.” Even though their article, Evaluation of the First Malaria Vaccine Introduction: Ongoing Learning Opportunities During the Introduction into Routine Immunisation in Cameroon, BMJ Glob Health. 2026 Mar 26; 11(3):e017315, https://doi.org/10.1136/bmjgh-2024-017315 acknowledges that vaccination rates were low (56% for first dose, diminishing after that), the authors regard the introduction “largely successful, despite vaccine misinformation, demonstrating the importance of community dialogue and engagement in successful vaccine introduction.”
The abstract of Chuang YM & al., A Multivalent Peptide Vaccine Against Malaria, Targeting Plasmodium Circumsporozoite Protein and Mosquito AgTRIO, J Infect Dis. 2026 Feb 18; 233(2):e496-e500, https://doi.org/10.1093/infdis/jiaf432 is quoted in its entirety: “Malaria begins when an infected mosquito injects saliva containing Plasmodium sporozoites into the host skin. The immune response against a mosquito saliva protein, AgTRIO, reduces Plasmodium infection and can work in combination with antibody against the Plasmodium circumsporozoite protein (CSP). We have now developed a chimeric peptide, PfAg, containing regions from Plasmodium falciparum CSP (PfCSP) and AgTRIO. Mice administered PfAg generated robust humoral responses against both PfCSP and AgTRIO. After exposure to PfCSP-expressing Plasmodium berghei-infected mosquitoes, PfAg-immunized inbred C57BL/6 and outbred CD-1 mice had significantly improved survival compared with control animals. These data will aid in the development of a new malaria vaccine.”
D'Alessio F & al. report on the deliberations on preventing malaria in pregnancy in Immunization Strategies to Prevent Malaria in Pregnancy - a Multistakeholder Workshop, Vaccine. 2026 Mar 25; 79:128505, https://doi.org/10.1016/j.vaccine.2026.128505. Apparently, the “risk is greatest in primigravidae and secundigravidae, as immunity develops over successive pregnancies. As existing malaria control strategies remain insufficient, (malaria in pregnancy) vaccines have the potential to complement them by eliciting immunity comparable to that seen in multigravidae. To be effective, such a vaccine should provide long-lasting immunity and target adolescent girls and women before their first pregnancy.” The authors also state that vaccine candidates are in currently under development.
Vectors
Danga SPY & al., Awareness, Attitudes, and Control Measures Regarding Malaria and Mosquitoes in the North Region of Cameroon, J Med Entomol. 2026 Mar 9; 63(2):tjag017, https://doi.org/10.1093/jme/tjag017 reveals two major barriers to malaria control in the geographic area the authors studied. First, even though over 96% of households studied asserted that they owned and properly used insecticide treated nets (ITNs), they also acknowledged in large numbers that they misused the nets in their efforts in animal husbandry and fishing. Likewise, most subjects interviewed did not seek treatment within 24 hours of the onset of illness, citing costs and perceived health care staff inadequacies as reasons for avoiding recommended care. “The findings reveal a stark divergence between high net ownership and widespread misuse, coupled with suboptimal treatment-seeking behavior. This underscores the urgent need for targeted health education to correct misconceptions, promote proper net use, and encourage timely treatment to enhance malaria control efficacy in the region.”
Based on data from the 2022-23 national health survey, Mooney HA & al. claim in Risk Factors for Malaria Among Children Under Five Living in Net-Owning Households in Mozambique from the 2022-3 Demographic and Health Survey, Trans R Soc Trop Med Hyg. 2026 Mar 31: trag028, https://doi.org/10.1093/trstmh/trag028 that “household net use showed no significant association with CU5 malaria after controlling for wealth index.” However, children of the least wealthy responders had the highest burden of malaria, followed by the middle-income group. It is unclear from the abstract whether the malaria burden refers to incidence or prevalence
Baravuga ME & al. report on “entomological and anthropological surveillance of interacting mosquito and human” behaviors in their article, Nationally Representative Programmatic Surveillance of Mosquito and Human Behaviours that Influence Human Exposure to Malaria Transmission and the Impact of Vector Control Across Tanzania, Malaria J. 2026 Mar 28, https://doi.org/10.1186/s12936-026-05893-1. “An. funestus s.s. and An. gambiae s.s. were predominantly human-fed, …. Higher proportions of host-seeking An. arabiensis were caught outdoors (64.9%) than An. gambiae s.s. (58.4%) or An. funestus s.s. (42.4%). Across all age groups, people were more likely to be outdoors during the early evening hours (18:00 to 21:00), with the highest proportions observed among adolescents (13-17 years) and adults (≥ 18 years) …. Adolescent males were less likely to use bednet relative to other demographic groups. Higher temperatures were associated with reduced reported bednet use during the dry season but not during the wet season.”
Ismail HM & al. argue in their article, Multimodal Platform for ITN Efficacy: Surface Chemistry, Bioavailability, and Mosquito Behavior, Sci Adv, 2026 Apr 10; 12(15):eaeb2023, https://doi.org/10.1126/sciadv.aeb2023, that coating by per- and polyfluoroalkyl substances (PFAS) is essential for maximal efficiency of pyrethroid-impregnated ITNs. They state that “behavioral assays suggest that PFAS-free formulations reduce mosquito contact time and insecticide uptake, with resistant strains showing decreased irritancy and knockdown.”
Githu V & al. investigated the various methods by which vector control interventions such as ITNs, indoor residual spraying (IRS), and larval source management (LSM) are evaluated. Their source of information was 149 published articles on the subject and the focus of the paper, A Systematic Review of Entomological Outcomes and Sampling Approaches Used in the Evaluation of Cluster Randomised Controlled Trials for Malaria Vector Control Products, Malaria J, 2026 Mar 22, https://doi.org/10.1186/s12936-026-05866-4 was the effects on the target mosquitoes. The authors conclude that no standard method of evaluating entomological outcomes exists and recommend that such a standard be established.
Kudom AA & al. studied disposal and reuse of ITNs and conclude in Disposal Practices of Long-Lasting Insecticidal Nets, Toxicity of the Discarded Nets and Its Potential Implication on the Development of Pyrethroid Resistance in Anopheles gambiae in Southern Ghana, Malaria J, 2026 Mar 26, https://doi.org/10.1186/s12936-026-05875-3 that repurposed ITNs “retain biologically active insecticide residues capable of exerting strong sublethal effects on malaria vector larvae. Although this does not constitute direct evidence of resistance evolution, such exposure may contribute to selection pressures that maintain or amplify existing insecticide resistance.”
Olapeju B & al. assert in Couple Concordance Related to ITN Use in Malawi, Malaria J, 2026 Mar 23, https://doi.org/10.1186/s12936-026-05877-1 that “couples are likely either to jointly use or not use ITNs consistently.” This conclusion is based on an extensive questionnaire of 3,862 households in which “54% of couples reported consistent ITN use among both men and women. In 39% of couples, both men and women did not use ITNs consistently. In just 3% of couples, only the men reported consistent net use and in 6% only the women reported consistent net use.” The authors stratify their results according to geography and educational background.
“Insecticide-treated net (ITN) usage is a well-established and effective intervention, often outperforming other measures such as indoor residual spraying (IRS). However, multiple survey studies have reported improper use of ITNs across various … countries. This misuse likely poses an important barrier to the intervention’s success…” Laxmi & al. address this issue in Insecticide-Treated Net Use and Elimination of Malaria in Sub-Saharan African Countries: Assessing the Global Technical Strategy Using an Evolutionary Game Approach, BMC Infect Dis, 2025, 25:1707, https://doi.org/10.1186/s12879-025-12066-z by stating that “countries can be classified into different categories based on the transmission rates, mosquito prevalence, and socio-economic conditions. The authors demonstrate that while some countries can meet the GTS 2025 and 2030 targets through their ongoing efforts in ITN usage to control malaria, others require enhanced social awareness campaigns, economic assistance, and improvements in ITN efficacy to achieve success. The analysis emphasizes that country-specific behavioural interventions are essential for accelerating malaria elimination.”
Although the focus of Barrow A & al., Integrated Housing Quality and Insecticide-Treated Net Use: Propensity Score Methods for Childhood Anemia Prevention in The Gambia, Malaria J, 2026 Apr 13, https://doi.org/10.1186/s12936-026-05909-w is childhood anemia the authors strongly relate the effects to malaria, particularly because is high malaria transmission rural areas, use of improved housing and ITNs was not associated with lower rates of anemia, whereas in low transmission areas and urban settings, it was.
Hougbe SZ & al. report in Entomological Surveillance of Malaria Vector: Species, Behaviors, and Insecticide Resistance in Southern and Central Benin, BMC Infect Dis. 2026 Mar 3, https://doi.org/10.1186/s12879-026-12989-1 that among Anopheles collected in various sites in Benin, “pyrethroid resistance was widespread, with kdr allele frequencies exceeding 65% in all sites; susceptibility to pirimiphos-methyl was generally higher but reduced mortality was observed in some districts.” The predominant species collected was An. gambiae sensu lato.
Dennehy J & al. describe the aim and process of an upcoming trial of a Spatial Emanator in Evaluation of the Protective Efficacy of a Transfluthrin-Based Spatial Repellent Product to Reduce Malaria Prevalence in Uganda: Study Protocol for a Cluster-Randomised Double-Blinded Control Trial, the Mossie-GO Trial, Trials. 2026 Feb 3, https://doi.org/10.1186/s13063-025-09365-w. “The study’s primary objective is to demonstrate and quantify the protective efficacy of Mossie-GO™, a transfluthrin-based active spatial repellent device, in reducing prevalence of malaria infection in children ≤ 5 years of age, as determined by rapid diagnostic test (RDT) and microscopy.”
According to Adeogun AO & al., “chromosomal inversions are key drivers of local adaptation and ecological diversification in Anopheles gambiae, the principal malaria vector in sub-Saharan Africa. Among these, the 2La inversion is associated with tolerance to aridity, behavioural variation, and insecticide resistance.” Two articles by these authors deal with this genetic change. In Spatial Distribution of the 2La Chromosomal Inversion in Anopheles gambiae Populations Across Nigeria: Ecological Associations and Implications for Malaria Control, Trop Med Health. 2026 Mar 31, https://doi.org/10.1186/s41182-026-00941-7 the authors report that the genetic change occurs primarily in the arid north of the country, with gradual change to the original genotype in the humid fertile south of the country. In Spatial Eco-Climatic Gradients Drive Adaptive 2La Chromosomal Inversion Polymorphism in Anopheles coluzzii, a Major Malaria Vector in Nigeria, Int J Health Geogr. 2026 Apr 6, https://doi.org/10.1186/s12942-026-00465-7, they assert that similar findings have been noted with this different Anopheles species in Nigeria.
Tchouakui M & al. focus on the genetics of insecticide resistance in Metabolic Insecticide Resistance DNA Markers in Malaria Vectors, Trends Parasitol. 2026 Apr 10: S1471-4922(26)00077-2, https://doi.org/10.1016/j.pt.2026.03.013. The authors “highlight available DNA-based diagnostic methods for operational genomic surveillance (of An. gambiae and An. funestus), and outline priorities for extending this framework to new insecticides and other vector species.”“Larval source management (LSM) can be highly effective for controlling malaria vectors such as Anopheles funestus s.s., which typically exploit large and permanent aquatic habitats. While these habitats can persist year-round in endemic regions of Africa, their availability and use shift between wet and dry seasons.” Kahamba NF & al. report in Seasonal Variation in Aquatic Habitat Availability and Use by the Malaria Vector, Anopheles funestus, Malaria J, 2026 Apr 11, https://doi.org/10.1186/s12936-026-05898-w that “An. funestus was commonly found in river streams, ground pools, and ditches across both seasons. During the wet season, however, it also occupied spring-fed wells, rice fields, and dug pits, indicating broader habitat use.” These findings lead the authors to note that “expanded use of diverse sites in the wet season has important implications for LSM. Targeting persistent habitats during the dry season may offer a more efficient and feasible window for implementing this intervention.”
Please see Shaba-santu A & al., Prevalence and Factors Associated with Malaria Amongst Under-Five Children in Senga Hill District, Northern Province, Zambia, A Community-Based Cross-Sectional Study, Malaria J, 2026 Mar 31, https://doi.org/10.1186/s12936-026-05853-9 and Yitageasu G & Demoze L, Spatial Epidemiology of Malaria by Bed Net Utilization in 19 Sub-Saharan African Countries: A DHS-Based Study (2013–2023), Malaria J, 2026 Apr 1, https://doi.org/10.1186/s12936-026-05904-1 in Epidemiology/Risk factors.
Chemoprophylaxis
“Sulfadoxine-pyrimethamine (SP) is the only WHO-recommended option for the intermittent preventive treatment of malaria in pregnancy (IPTp). However, coverage is suboptimal, efficacy is limited in areas of high resistance and SP is contraindicated in the first trimester and women living with HIV receiving cotrimoxazole.” Audibert C & al., Improving Malaria Chemoprevention Coverage in Pregnancy: Surveying Stakeholder Preferences for New Product Profiles and Community-Delivery Approaches Across Five African Countries, PLOS Glob Public Health. 2026 Mar 13; 6(3):e0005607, https://doi.org/10.1371/journal.pgph.0005607 is a report on information gathered on desired features of better IPTp from a diverse group of patients, doctors, nurses, and others in five African countries. “Across stakeholders the most important attribute was safety in all trimesters, followed by short duration of therapy, few tablets per day…. All stakeholder groups indicated that a long-acting injectable with at least three months' coverage would enhance adherence. For oral medication, pregnant women believed being able to take food with treatment was the most important attribute to enhance adherence, while a four-tablet daily dosing would decrease adherence…”
Access to antenatal care is a major determinant of the adequate application of IPTp. Matanda DJ & al., Extreme Weather Events and Malaria Prevention in Pregnancy: A Mediation Analysis of Antenatal Care and Sulfadoxine-Pyrimethamine Use in Two Malaria-Endemic Counties of Kenya, Malaria J. 2026 Mar 13, https://doi.org/10.1186/s12936-026-05859-3 reports that extreme weather events, such as floods, storms or even droughts are reported by the population as inhibiting their accessing antenatal care. The authors calculated an average loss of 23% of antenatal visits, which translates to a 45% disruption of three applications of IPTp.
In their study of pregnant women in Nigeria Inyangudo GN & al. report poor utilization of ITNs, barely 50% exposure to a single administration of IPTp and 7% completion of three administrations. The authors recommend the “integration of unconventional healthcare providers such as faith-based and traditional birth attendants into malaria in pregnancy preventive initiatives.” The paper is Factors Influencing the Utilisation of Malaria Preventive Services During Pregnancy in Ile Ife, Nigeria: A Mixed Method Approach, Malaria J. 2026 Mar 11, https://doi.org/10.1186/s12936-026-05844-w
Still in Nigeria, but using data from 2018, Ladan SM & al., Prevalence and Inequalities of Missed Opportunities for Intermittent Preventive Therapy (IPTp) of Malaria Among Pregnant Women: An Analysis of 2018 Nigeria DHS, Malaria J, 2026 Mar 31, https://doi.org/10.1186/s12936-026-05840-0 “revealed a high prevalence (75%) and a pro-rich/pro-educated inequality of missed opportunities for IPTp-SP among pregnant women in Nigeria. Among women who attended four or more ANC visits, 75% received fewer than three IPTp-SP doses; this represents 42.5% of the total sample analyzed in this study. It showed an inverse relationship with prevalence increasing as education and wealth decrease.”
Using data from 2021concerning 1262 pregnant women attending antenatal clinics (ANCs), Zafindraibe NJ & al. report in Prevalence of Malaria During Pregnancy and Coverage of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Urban Amboasary-Sud, Southern Madagascar, Malaria J, 2026 April 11, https://doi.org/10.1186/s12936-026-05901-4 that among “ANC attendees, 64.9% (819/1262) received at least one dose of IPTp-SP, but only 49.9% (409/819) completed the recommended three or more doses. Malaria RDTs were performed among symptomatic women (n = 289), with a positivity rate of 21.1%... In multivariable analysis, living within 5 km of a health facility … and attending four or more ANC visits … were independently associated with adequate IPTp-SP coverage.”
Akilimali A & al., Time to Act; Let Us Unite to Eliminate Malaria Among Pregnant Women in War Zone from Eastern Democratic Republic of the Congo: A Review, Health Sci Rep. 2026 Apr 5; 9(4):e72262, https://doi.org/10.1002/hsr2.72262 is a call to action to prevent malaria in pregnancy. Based on a review of the literature, “malaria in pregnancy (MiP) prevalence rates between 17% and 40%, with a significant 26% asymptomatic pooled estimate creating silent transmission reservoirs. Research shows early-stage parasitemia is linked to reduced umbilical artery resistance and fetal growth restriction. Armed conflict has decimated infrastructure, leading to critical shortages of insecticide-treated nets and intermittent preventive treatment. … Eliminating MiP in conflict zones requires a concerted effort to strengthen the six pillars of the health system: service delivery, workforce, information, medical products, financing, and governance. Immediate action is required to address stockouts, improve healthcare worker training, and ensure clear, context-specific policies.”
The evolution of P. falciparum to resistance against drugs of treatment also extends to drugs of prevention. Diallo MA & al., Emergence of Plasmodium falciparum pfdhps A581G Mutation in Southern Senegal Under Seasonal Malaria Chemoprevention Pressure, 2020-2023, Commun Med (Lond). 2026 Mar 27, https://doi.org/10.1038/s43856-026-01553-2 describes the findings of genetic markers associated with resistance to sulfadoxine-pyrimethamine in two districts in southern Senegal over a four-year period. This mutation is present as yet in only about 10% of specimens studied, but the frequency is increasing over time.
Other
“Evidence of natural infection with Wolbachia and its negative correlation with Plasmodium falciparum among wild malaria vectors has opened new avenues for utilization of Wolbachia in malaria vector control.” Mmweteni RE & al. explore the relationship in Detection of Supergroup B Wolbachia Strains and Their Co-Infection with Plasmodium falciparum in Wild Anopheles funestus in Southeastern Tanzania: Implications for Malaria Control, Parasit Vectors. 2026 Mar 17, https://doi.org/10.1186/s13071-026-07330-3. They state that since the species of Anopheles prevalent in Tanzania is different from that in which the negative correlation was originally described, exploration of this subject is critical in determining whether Wolbachia may somehow be utilized in the fight against malaria. The paper reports that a very large proportion of the Anopheles funestus species collected harbored Wolbachia and only one of the 400 mosquitoes tested had both Wolbachia and P. falciparum. Given the relatively modest size of this sample, the authors counsel further exploration of this symbiosis.
“…biological control, which involves the use of natural organisms and biological agents to target mosquito vectors, is increasingly accepted as a viable solution” in the fight against malaria. Kumari S & al., Exploring the Scope and Status of Biological Interventions in Malaria Control, Am J Trop Med Hyg. 2026 Apr 7: tpmd250084, https://doi.org/10.4269/ajtmh.25-0084 lists the following methods: “viruses, fungi, microbial pathogens, natural predators, alkaloids, essential oils, and plants with larvicidal properties. In addition, genetic techniques such as the sterile insect technique and genetically modified mosquitoes offer new approaches to managing mosquito populations. Additionally, entomopathogenic fungi are of particular interest because they can infect and kill mosquito vectors.”
“PDBC-Bb5a is a strain of the entomopathogenic fungus Beauveria bassiana (Balsamo) Vuillemin,” known to be lethal to An, stephensi. Siddaramegowda R & al. tested which starch is the best medium for propagating it. They state in Effect of Solid Substrates on the Production and Germination of Beauveria bassiana (Balsamo) Vuillemin, and Their Infectivity Against the Malaria Vector, Anopheles stephensi (Diptera: Culicidae), Malaria J. 2026 Apr 11, https://doi.org/10.1186/s12936-026-05863-7 that the fungus grown on white rice was more efficacious in killing An. stephensi that the strains grown on other starches such as barley.
Bradley J & al., Concerns Regarding Study of Spatial Emanators for Malaria Control, Lancet Infect Dis, 2026 Apr 2, https://doi.org/10.1016/S1473-3099(26)00174-X calls into question the conclusions of Allan RJ, & al. in The Effectiveness of Long-Lasting Spatial Repellent Emanators Against Malaria in Humanitarian Crisis Settings in Northern Nigeria: A Two-Arm Pragmatic, Open-Label, Controlled Trial, Lancet Infect Dis. 2026 Jan 8: S1473-3099(25)00684-X https://doi.org/10.1016/s1473-3099(25)00684-x, because of the statistical analysis, to which the original authors reply, highlighting continuing disagreement.
Ivermectin is reputed to be a transmission blocking agent, preventing malaria parasites to travel from infected person to a biting mosquito. Ramadan S & al. set out to “evaluate the effectiveness of ivermectin in reducing malaria transmission outcomes in adult populations, including malaria incidence, prevalence, mosquito mortality, and safety outcomes.” They reviewed ten relevant articles covering over 63,000 particiants and report in Efficacy of Ivermectin for Malaria Vector Control: A Systematic Review and Meta-Analysis of Randomized Clinical Trials, Malaria J, 2026 Mar 31, https://doi.org/.1186/s12936-026-05895-z that while “entomological trials demonstrated increased mosquito mortality following ivermectin exposure, … (the published) evidence does not demonstrate consistent reductions in malaria incidence or prevalence with ivermectin administration.”
Liang C & al. conducted a questionnaire-based inquiry of preventive practices among 606 miners, of whom 485 returned interpretable documents. They report in Knowledge, Attitudes and Practices of Malaria Control and Prevention in a High-Exposure Occupational Group: A Cross-Sectional Survey of Mining Workers in Haut-Katanga Province in the Democratic Republic of Congo, Travel Med Infect Dis. 2026 Mar 31: 102976, https://doi.org/10.1016/j.tmaid.2026.102976 that whereas over 90% or responders claimed to have used ITNs and 99+% wore long-sleeved clothing, only 75% were judged to have full understanding of malaria preventive practices.
In a study similar to the above, but using healthcare workers as sources of information, Diallo EM & al., Healthcare Providers' Knowledge, Perceptions and Practices of Malaria Control Strategies in the Republic of Guinea: Insights from a Qualitative Study, BMJ Glob Health. 2026 Mar 31; 11(3):e020033, https://doi.org/10.1136/bmjgh-2025-020033 “highlighted gaps in integrated vector control related to insecticide-treated net (ITN) distribution, use and larval destruction … (and that SMC) started with delays in covered districts…” Some healthcare providers “often viewed malaria patients as poor, neglectful or unwilling to follow medical advice. It was noted that many only sought appropriate care after failing to self-medicate or developing complications.” At the same time, there were comments regarding non-compliant practices with national case management guidelines. “These mainly related to overcharging for services linked to malaria, provider complacency, poor reception of patients and over-reliance on clinical experience for diagnosis.”
One of the aims of gene drive approach to malaria control is to diminish the number of female offspring of mosquitoes. Grilli S & al.’ paper, Sex Distorter Male Drive for Resistance-Resilient Population Control of the Human Malaria Vector Anopheles gambiae, Nat Commun. 2026 Apr 11, https://doi.org/10.1038/s41467-026-71627-1 describes “two germline-specific promoters, spo11 and vasa1, in the malaria vector Anopheles gambiae. These promoters display distinct temporal and spatial expression patterns, making them well-suited for potential applications in CRISPR-based gene drives and sex ratio distortion systems. Leveraging these unique promoter features, (the authors) developed a Sex Distorter Male Drive (SDMD) technology that generates a highly male-biased progeny while spreading through super-Mendelian inheritance.” The authors “present SDMD as a promising and potentially resistance-resilient tool for the population suppression of Anopheles mosquitoes in malaria-endemic regions.”
The benefits of safe house construction have generally been published from West Africa. Mshamu S & al., A Sustainable House Design to Improve Child Health in Rural Africa: A Cluster-Randomized Controlled Trial, Nature Med, 2026 Apr 21, https://www.nature.com/articles/s41591-026-04367-w addresses the issue from Tanzania, where children growing up in so-called Star Homes, designed to “provide an insect-proof, cleaner, cooler and smoke-free environment, with a reliable supply of water and sanitation” were compared over three years to similar age children growing up in traditional rural homes. “… after 3 years, children living in Star Homes had 44% less malaria … compared to children living in traditional homes. Children in Star Homes had 30% less diarrhea … and 18% less (acute respiratory infections) than children living in traditional homes. Children under 5 years of age living in Star Homes were also taller for their age than those living in traditional homes.”
Diagnosis
General diagnostics
Two articles address problems of accuracy of diagnosis in Ethiopia. Bogate A & al., Uncovering Silent Malaria Reservoirs in Southern Ethiopia: Community-Based Molecular Detection of Asymptomatic and Sub-Microscopic Infections and Their Implications for Diagnosis and Control, Malaria J, 2026 Mar 26, https://doi.org/10.1186/s12936-026-05878-0 demonstrates that quantitative polymerase chain reaction (qPCR) detects many more asymptomatic infections by the Plasmodium parasite than either rapid diagnostic testing (RDT) or microscopy. In the authors’ study of 525 participants, 164 (31.2%) of them harbored either P. falciparum or P. vivax or both. Likewise, Jima B & al., Microscopy Underestimates Submicroscopic Malaria Infections in Ethiopia’s Southern Rift Valley: A Community-Based Cross-Sectional Study, Malaria J, 2026 Mar 28, https://doi.org/10.1186/s12936-026-05890-4 reports discrepancies between microscopy and nested PCR results, including misidentification of species on microscopy, with potential failures of therapy as a result.
Field diagnostics
The “spread of Plasmodium falciparum parasites with pfhrp2 and pfhrp3 gene deletions challenges their effectiveness, raising concerns in affected areas.” Mazigo E & al., Diagnostic Challenges of Histidine-Rich Protein 2-Based Rapid Diagnostic Tests Due to pfhrp2 and pfhrp3 Gene Deletions in Asymptomatic Malaria in Tanzania, Infect Dis Poverty. 2026 Mar 9;15(1):31, https://doi.org/10.1186/s40249-025-01397-3 “aimed to assess the prevalence of pfhrp2 and pfhrp3 gene deletions and evaluate the diagnostic performance of HRP2-based RDTs in detecting asymptomatic malaria infections in Tanzania.” Among 3489 asymptomatic participants from both high and low endemicity villages, RDT detected 710 (77.6%) of 915 qPCR-positive cases compared to 492 (53.8%) by (light microscopy (LM)). Compared with qPCR, RDT produced 143 (5.6%) false positives and 205 (22.4%) false negatives, whereas LM had 60 (2.3%) false positives and 423 (46.2%) false negatives. Overall accuracy was similar for RDT (90.0%) and LM (86.2%), with higher sensitivity for RDT.” The authors conclude that for now, the use of HRP2-based RDTs is justified in Tanzania but further surveillance is warranted.
Proper treatment of malaria depends on accurate diagnosis. Fenomanana J & al., Field and Laboratory Evaluation of Abbott-Bioline™ Malaria Ag Pf/Pv RDT Performance in a High-Transmission Setting: Contrasting Results with a Low-Endemic Area, Malaria J, 2026 Mar 18, https://doi.org/10.1186/s12936-026-05869-1 reports tests done in Madagascar with a particular kit that had demonstrated very inaccurate results in Southeast Asia. In the authors’ study, “malaria prevalence was 70.2% by PCR and 48.6% by microscopy. Against microscopy, Abbott-Bioline™ Malaria Ag Pf/Pv achieved sensitivity of 99.1% (95% CI 94.9–100) and specificity of 93.7% (95% CI 87.4–97.4). Parascreen® Malaria Ag Pf/Pan showed sensitivity of 100% (95% CI 96.6–100) and specificity of 92.8% (95% CI 86.3–96.8). Against PCR, sensitivity decreased to 73.2% for Abbott-Bioline™ Malaria Ag Pf/Pv and 74.5% for Parascreen® Malaria Ag Pf/Pan, while specificity remained 98.5% for both tests.” The authors point out that even in this setting, both RDTs “missed approximately 25% of PCR-positive infections.”
The reliability of RDT-based testing has been called into question. Ahogni I & al. investigated one aspect of diagnostic reliability, namely the interpretation of the test in the field. As a result of a six-month study including over 35,000 RDT interpretations by community healthcare workers (CHWs) and overseen by expert interpreters, the authors report in The Accuracy of Recording Malaria Rapid Diagnostic Test (RDT) Results in Public Health Facilities in Benin; Results from the MaCRA Project, Malaria J, 2026 Mar 28, https://doi.org/10.1186/s12936-026-05871-7 that “overall agreement between (CHW) and reference panel interpretations was 94.3%,” leading to the conclusion that CHWs in Benin “showed high accuracy in interpreting and reporting malaria RDT results…However, negative results misrecorded as positive, especially in adult patients, remains a concern.”
Boadu S & al. also address the reliability of RDT kits in Evaluation of Malaria Rapid Diagnostic Test Kit Performance in a High-Transmission Setting: A Facility-Based Cross-Sectional Study in Rural Ghana, Malaria J, 2026 Mar 19, https://doi.org/10.1186/s12936-026-05876-2. They conclude on the basis of tests of 404 children that the “overall accuracy of the (specific kit in use in six rural facilities) was 94.8%.” (These results have to be interpreted with caution: the control was microscopy, not qPCR tests. See the articles by Bogate and Jima above.)
As international aid for health prevention is drying up, many countries have difficulty accessing uo to date supplies. In this environment, Ndizeye R & al., Test Performance of Expired Malaria Rapid Diagnostic Tests: A Pilot Diagnostic Accuracy Study Conducted in Western Uganda, J Infect Dis. 2026 Feb 19 :jiag105, https://doi.org/10.1093/infdis/jiag105 is a report on the performance of two brands of RDT kits that had expired, comparing their results to unexpired RDT kits used to test the same person. While the article itself is not available for review, the abstract states that every kit that expired less than 9 months before the test date gave accurate results, whereas kits 10 months or more their expiration date gave invalid results. (It is unknown how other manufacturers’ expired kits may have performed.)
Getachew H & al. call attention to the low but significant prevalence of P. malariae and P. ovale infections in Ethiopia, misdiagnosed in the sample they investigated as I infections. Their artricle, The Hidden Malaria: Misidentification of Plasmodium malariae and Plasmodium ovale in Low-Transmission Setting Targeted for Elimination in Ethiopia, Res Sq Preprint. 2026 Apr 9:rs.3.rs-9131091, https://doi.org/10.21203/rs.3.rs-9131091/v1, has not been peer reviewed, but is cited here to call attention to these “minor” malaria pathogens that infect people in Africa.
Schultz JC & al. “assessed the quality of malaria microscopy in 29 HFs (health facilities) in Siaya County, western Kenya, from January–July 2024 by evaluating the concordance of routine HF BS (blood smear) results with expert microscopy. … (Of) 1,494 blood smears examined, 501 (34%) were positive. Concordance between routine microscopy and expert re-reading was 91% (1,289/1,414), ranging from 55% (6/11) to 100% (60/60) across health facilities. Percent agreement between HF slide 1 and slide 2 was 86% (1,276/1,485), with a range from 55% (6/11) to 98% (39/40) by HF.” The authors conclude in Malaria Microscopy Evaluation and Quality Assurance in Rural Clinics of Rarieda and Alego Usonga Sub-Counties of Siaya County, Western Kenya, Malaria J, 2026 Apr 9, https://doi.org/10.1186/s12936-026-05886-0 that while “overall concordance was high, the variability in results by HF, limited accuracy at low parasite densities, and challenges with required infrastructure highlight the need for ongoing malaria microscopy quality assurance to ensure proper case management.”
New diagnostic methods
None this month
Treatment
Treatment results
A study encompassing 12 articles over 24 years and covering over 9 million patients, Okek EJ & al., Progression from Uncomplicated to Severe Malaria Among Children in Settings Receiving Different Combinations of Malaria Control Interventions in Sub-Saharan Africa: A Systematic Review and Meta-Analysis, Trop Med Health. 2026 Mar 20; 54:54, https://doi.org/10.1186/s41182-026-00938-2 concludes that “in comparison to single or no intervention, combination of multiple malaria control interventions significantly protects against severe malaria, parasitaemia, gametocytes and uncomplicated malaria. In comparison to single or no interventions, deployment of multiple combinations of control interventions did not offer additional protection against progression from uncomplicated to severe malaria.”
WHO “recommends malaria-endemic countries regularly (ideally biennially) assess the efficacy of commonly used antimalarials.” An evaluation by Cavros I & al., “of Sierra Leone’s first and second-line antimalarials assessed artemether-lumefantrine (AL) in three sentinel sites … and artesunate-amodiaquine (ASAQ) in two sites,” Efficacy and Safety of Artemether-Lumefantrine (AL) and Artesunate-Amodiaquine (ASAQ) for the Treatment of Uncomplicated Plasmodium falciparum Malaria Among Children 6–59 Months in Three Sentinel Sites of Sierra Leone, 2021–2022, Malaria J, 2026 Apr 9, https://doi.org/10.1186/s12936-026-05850-y, concludes on the basis of a study of 496 children that “AL and ASAQ remain efficacious for treatment of P. falciparum infection in Sierra Leone.”
Side effects and complications
None this month.
Guidelines
Dieci M & al. reviewed the care received by 239 febrile children whose caregivers consulted one of 39 different pharmacies, but no doctors or nurses. They report in Guideline-Concordant Care and Outcomes for Pediatric Malaria Cases: Descriptive Evidence from Pharmacy-Based Fever Management in Kenya, Malaria J, 2026 Apr 7, https://doi.org/10.1186/s12936-026-05864-6 that 69% of the children “received a malaria diagnostic test. Of those tested, 59% were malaria-positive, and 78% of these received appropriate antimalarial treatment. Only 3% of malaria-negative children received antimalarials. Among malaria-positive children treated with antimalarials, 88% had fully recovered at follow-up” as determined by querying the caregivers. “These findings underscore the importance of pharmacies in malaria case management and highlight the need for further research and policy attention to this critical access point in the healthcare system.”
Drug resistance
João MF & al. state that efficacy of artemether-lumefantrine in the treatment of P. falciparum “has been reported below 90% in two provinces, underscoring the need for routine resistance surveillance.” Their paper, Geographical Heterogeneity in Antimalarial Resistance Markers by Genomic Surveillance in Angola, 2023, Am J Trop Med Hyg. 2026 Mar 17: tpmd250226, https://doi.org/10.4269/ajtmh.25-0226 reports that in a study of 820 specimens obtained from a variety of sites, different genetic markers of resistance to one or more antimalarials was found in various provinces. Interestingly, the marker for artemisinin partial resistance was very rfare in this sample. “These findings highlight the need for continued monitoring to safeguard treatment efficacy, reinforcing the importance of molecular surveillance in malaria control strategies.”
Moriarty LF & al. state that traditional therapeutic efficacy studies are too slow and inefficient to stay ahead of the development of artemisinin resistance in Antimalarial Efficacy Monitoring After Nearly 20 Years of Artemisinin-Based Combination Therapy in Africa: Recalibrating Guidance, Trends Parasitol. 2026 Apr 2: S1471-4922(26)00048-6, https://doi.org/10.1016/j.pt.2026.02.012. Considering advances in molecular surveillance {presumably including genetic as well}, they recommend coupling therapeutic efficacy studies with molecular surveillance in order to “provide timely and actionable data for malaria-endemic countries as they manage treatment policies in the context of drug resistance in Africa.”
New drug research
Handford MJ & al. report on the study of 25 new analogs of the quinoline group of drugs in their vpaper, Designing Novel Bisquinoline Antimalarials from Historical 4-Aminoquinolines to Combat Drug-Resistant Malaria, Antimicrob Agents Chemother. 2026 Mar 2: e0130025, https://doi.org/10.1128/aac.01300-25. These “analogs exhibited potent in vitro activity … against both drug-sensitive and multidrug-resistant P. falciparum strains, while maintaining favorable cytotoxicity profiles.”
Sarma K & al., Advancing Global Malaria Control: Therapeutic Strategies, Drug Discovery, and Formulation Innovations, Infection. 2026 Mar 19, https://doi.org/10.1007/s15010-026-02770-6 appears to focus on the need for new drugs or combinations for malaria, with particular attention to the research that is supported by Medicines for Malaria Venture, a non-profit foundation in Switzerland.
Rathi M & al. report on the finding of two antimalarial metal compounds in Bioactive Transition Metal(II) Hydrazone Complexes: Spectral Elucidation, Antimalarial, Antioxidant, and Antimicrobial Activities Correlated with Molecular Docking and Absorption, Distribution, Metabolism, Excretion, and Toxicity, ChemMedChem. 2026 Mar 27;21(6): e202501071, https://doi.org/10.1002/cmdc.202501071. These findings are very preliminary in terms of active drug development.
Fabbri C & al. also investigated metallic complexes with drugs. They report in Ruthenium Complexes of Atovaquone Acting on Multiple Stages of the Plasmodium Life Cycle, J Med Chem. 2026 Apr 11, https://doi.org/10.1021/acs.jmedchem.5c02978 that complexes ruthenium with the “broad-spectrum drug Atovaquone (ATV) … revealed key determinants for antiplasmodial activity, such as the importance of the oxidation state [Ru(III) versus Ru(II)] and of hydrophilic or lipophilic coligands. These complexes demonstrated broader activity against both asexual and sexual parasite stages than ATV. Due to this broader effect, complexes exhibited faster action in antiplasmodial activity than ATV. {Ruthenium is an extremely rare and very scattered element of the platinum class. Practical use of this metal on the scale antimalarials are needed is doubtful.}
Plant extracts and traditional treatments
Based on a search of literature, Nurhidayanti DR & al. state that they have identified 88 natural substances with anti-malarial properties in Post-Artemisinin Anti-Malarial Discovery from Nature: Unaltered Natural Products, Lead Optimisation, and Advanced Techniques in the Discovery, Nat Prod Res. 2026 Mar 22:1-16, https://doi.org/10.1080/14786419.2026.2643914. {This reviewer is not familiar with this publication, which claims on its website that it subjects articles to peer review. However, the very poor English of the abstract and the lack of recognition of the publication by PubMed may lead one to be cautious interpreting this abstract.}
Other
Based on a review of 92 articles on the subject, Amoadu M & al. report in Delay in Malaria Care-Seeking for Children Under Five in Africa: A Systematic Review, Malaria J, 2026 Mar 17, https://doi.org/10.1186/s12936-026-05868-2 that the “prevalence of delayed malaria care-seeking among children under five ranges from 2% to 95.8%. Factors associated with these delays include financial constraints, long travel distances, reliance on traditional treatments, and the perception of malaria as a mild illness. Additionally, health workers’ attitudes and shortages of essential health facility logistics further hinder timely care-seeking by caregivers. These delays are associated with increased mortality, progression to severe malaria, and serious neurological and haematological complications.”
In an extensive review of the history of antimalarial pharmacology, Milić M & al. advocate searching for compounds that may attack the malaria parasite by multiple mechanisms. The paper is Polypharmacology in Malaria Treatment: Single Drugs, Multiple Mechanisms, Greater Impact, Trends Parasitol. 2026 Mar 16:S1471-4922(26)00040-1, https://doi.org/10.1016/j.pt.2026.02.004.
Please see Danga SPY & al., Awareness, Attitudes, and Control Measures Regarding Malaria and Mosquitoes in the North Region of Cameroon, J Med Entomol. 2026 Mar 9; 63(2):tjag017, https://doi.org/10.1093/jme/tjag017 above, under Prevention/Vectors
Campaigns and Policies
Campaigns and Policies
Elendu C investigated the cost-effectiveness of Nigeria’s national investments in malaria control over a quarter century, keyed to Presidential terms. His data indicate that not only did larger investments yield benefits in terms of reduced disease incidence and in mortality, but also that with larger investments, the cost per quality of life improvement moves in a favorable direction. The article is Economic Evaluation of Anti-Malarial Drug Policies Across Presidential Regimes in Nigeria: A Comparative Analysis from 1999 to Present, PLoS One. 2026 Mar 11; 21(3):e0344909. https://doi.org/10.1371/journal.pone.0344909.
Community health volunteers (CHVs), as presented in Odongo W & al., Community Health Volunteers Improve Access to Malaria Case Management in Siaya County, Kenya, Malaria J, 2026 Mar 31, https://doi.org/10.1186/s12936-026-05883-3 seem to be indistinguishable from Community Health Workers (CHWs) in other articles. The authors conclude that “CHVs extend access to malaria diagnosis and treatment, particularly in areas with limited (health facility) coverage. Their practices align with national guidelines, and program expansion with adequate support could enhance malaria control in resource-limited settings.”
Diallo EM & al. developed a complicated model to predict the benefits of free diagnosis and care of malaria. They conclude in Model-Based Assessment of the Effects of Selective Free Healthcare and Differentiated Diagnosis on Malaria Burden in the Republic of Guinea, Trop Med Int Health. 2026 Apr 17, https://doi.org/10.1111/tmi.70144 that “(r)educing financial and geographical barriers improves access to malaria treatment, although disparities remain … Given limited resources, it is crucial to focus investments on effective interventions. This study shows that targeted selective free healthcare and differentiated screening improve access to ACTs, reduces malaria incidence and prevents severe cases, especially in children under five of age.”
Epidemiology
Climate change, biodiversity and environment
“Climate change is recognized as a critical determinant of malaria transmission in the coming decades.” Yahouedo AG & al. synthesize “testimonies from six African countries … highlighting how climate variability has recently influenced malaria epidemiology and how national malaria control programmes (NMCPs) are adapting” in their article Climate Change and Malaria Control in Africa: Country Experiences and Strategic Responses, Malaria J. 2026 Apr 1; 25:148, https://doi.org/10.1186/s12936-026-05885-1. “The correlation between changing patterns of rainfalls, floodings, and how they affect the expansion of mosquito vector habitats with malaria transmission has been reported. Adaptive strategies adopted by the NMCPs include integrating climate and health data, strengthening surveillance and establishing early warning systems, engaging and educating communities, promoting multisectoral collaboration, and leveraging technology and innovation. However, systemic barriers, such as limited data integration capacity, infrastructural deficits, behavioural factors, and financial constraints, continue to impede effective implementation of adaptive strategies.”
Bouopda-Tuedom AG, & al. studied “the entomological profile of malaria in two ecologically distinct settings in Cameroon, Mfou, a forest region, and Tibati, a savannah region.” Based on a “total of 3,651 Anopheles mosquitoes … collected,” half in each region, they report in Mosquito Vector Composition and Biting Behavior of Malaria Vectors in Forest Versus Humid Savanna Eco-Epidemiological Settings of Cameroon, Malaria J. 2026 Apr 2, https://doi.org/10.1186/s12936-026-05861-9, that while the dominant species of Anopheles were different in the two regions., their biting behavior was similar. “Notably, [the authors] recorded substantial outdoor and early morning biting activity by Anopheles mosquitoes in the two surveyed localities. These findings underscore the limitations of bed nets as a standalone intervention and emphasize the need for complementary control strategies targeting both indoor and outdoor mosquito populations.”
Traoré N & al. “investigated the seasonal patterns of malaria mortality among children under five years of age and their association with climatic factors, such as rainfall and land surface temperature (LST), using wavelet analysis on mortality data from the Nouna Health Demographic Surveillance System spanning 2002-2021.” They also report on the “effects of interventions, including coverage of insecticide-treated nets (ITNs) and artemisinin-based combination therapies (ACTs), on malaria mortality alongside climate effects” in Assessing the Role of Interventions and Climate on Malaria Mortality Among Children Under Five Years of Age: Insights from Two Decades of Data from the Health Demographic Surveillance System of Nouna, Burkina Faso, J Glob Health. 2026 Apr 3; 16:04080, https://doi.org/10.7189/jogh.16.04080. They conclude that that ITNs were “more effective in reducing malaria mortality than temperature, but rainfall had a greater opposing impact on increasing malaria mortality. The seasonal mortality pattern was more influenced by rainfall than by temperature.”
“…existing approaches to analyzing climate-malaria relationships, often rely on seasonal averages, ignoring the potential influence of rare climatic extremes and migration flows.” Matamanda SH & al., Malaria at the Margins: Climatic Extremes, Migration, and Urban Informal Settlement Risk in South Africa, Malaria J, 2026 Apr 8, https://doi.org/10.1186/s12936-026-05907-y “investigates how climatic extremes, climatic variability, and migration flows interact to shape malaria risk and inform adaptive surveillance and control strategies.” Based on extensive analysis, the authors conclude that “[c]limatic extremes and post‑shock mobility reorganise malaria risk in South Africa. Tail‑aware, lag‑sensitive and mobility‑integrated surveillance is essential for adaptive elimination planning.”
Please see Matanda DJ & al., Extreme Weather Events and Malaria Prevention in Pregnancy: A Mediation Analysis of Antenatal Care and Sulfadoxine-Pyrimethamine Use in Two Malaria-Endemic Counties of Kenya, Malaria J. 2026 Mar 13, https://doi.org/10.1186/s12936-026-05859-3 under Prevention/Chemoprophylaxis
Please see Kahamba NF & al. Seasonal Variation in Aquatic Habitat Availability and Use by the Malaria Vector, Anopheles funestus, Malaria J, 2026 Apr 11, https://doi.org/10.1186/s12936-026-05898-w under Prevention/Other
Risk factors
War has been known for centuries to be a risk factor for a variety of diseases. Lake MW & al., Understanding Malaria Resurgence in the Amhara Region, Northwestern Ethiopia: A Qualitative Study of Perceived Drivers from Stakeholder and Community Perspectives, BMC Infect Dis. 2026 Feb 19; 26:531, https://doi.org/10.1186/s12879-026-12929-z reports findings consistent with this historical truth, based on interviews with stakeholders in a civil war-torn region where malaria resurgence has been noted. Other causes noted in the paper include “irregular rainfall, land use change, irrigation schemes, and construction-related water storage [as well as] recurrent stockouts of antimalarials and diagnostics, delayed or incomplete vector control, and reliance on passive surveillance. Behavioral factors such as low perceived susceptibility and severity, reliance on traditional and religious healers, misuse of insecticide-treated nets, and weak regulation of private providers were seen to delay care-seeking and undermine prevention, particularly in conflict-affected and remote areas.”
Thalassemia, a hereditary blood disorder characterized by abnormal hemoglobin production … is believed to confer protection against malaria, reducing the severity of the disease and its associated complications.” Donkor AB & al. investigated the evidence for this interaction by reviewing 15 studies, of which eight had sufficient data to undergo meta-analysis. The conclusion of their article, Exploring the Protective Effects of Thalassemia Against Malaria in Africa: A Systematic Review, Syst Rev. 2026 Mar 19, https://doi.org/10.1186/s13643-026-03149-2 is that while “the pooled estimate suggested a protective trend, the association was not statistically significant and was characterized by substantial heterogeneity across studies.” The authors also comment on the fact that considering also sickle cell anemia, there seems to be some as yet unexplored link between hemoglobinopathies and malaria.
“Placental malaria remains a significant contributor to adverse maternal and neonatal outcomes in malaria endemic settings globally. [Atukunda AR & al.] investigated the prevalence of placental malaria and associated factors among pregnant women delivering in Health facilities in Mayuge district, eastern Uganda.” They report in Prevalence of Placental Plasmodium falciparum Malaria and Associated Factors Among Pregnant Women in Health Facilities in Eastern Uganda, Malaria J, 2026 Mar 21, https://doi.org/10.1186/s12936-025-05495-3 that among 180 participants in the study, the prevalence by microscopy was 11.67%, whereas by qPCR, it was 23.89%. “Being between 15-to-19 years of age and those who did not attend any antenatal care during pregnancy were significantly associated with an increased odds of having placental malaria … respectively. {Note that the discrepancy between diagnostic methods is similar to that reported in the two papers from Ethiopia above, in Diagnosis/General diagnostics.}
“Using data from the 2021 Global Burden of Disease (GBD) study, [Deng JJ & al.] conducted a systematic analysis of the global, regional, and national malaria burden attributable to [child growth failure] from 1990 to 2021. As reported in The Unequal Malaria Burden Attributable to Child Growth Failure: A Global Analysis Among Children Under Five from 1990 to 2021, Travel Med Infect Dis. 2026 Mar 25:102974, https://doi.org/10.1016/j.tmaid.2026.102974, “[g]lobally, the malaria burden attributable to CGF significantly declined since 1990 …, but showed an upward trend after 2019 … Substantial variations across sex, age, regions, and countries were observed. Specifically, higher burdens were observed in males … [and] children aged 6-11 months. … Western Sub-Saharan Africa and Nigeria, [continue] to bear a disproportionately high burden.”
Plasmodium vivax infections are frequent in Ethiopia. “The red blood cell had sufficient data reticulocyte stage is the primary target, and entry is facilitated primarily by the interaction between the Duffy-binding protein (PvDBP) and the Duffy Antigen Receptor for Chemokines (DARC).” Because of this, it has been held that individuals negative for the Duffy blood group would be resistant to P. vivax infections. Tsigie M & al., Genetic Variation in the Duffy Blood Group Among Vivax Malaria Patients and Its Impact on Disease Susceptibility, Malaria J, 2026 Apr 3, https://doi.org/10.1186/s12936-026-05897-x explored the relationship between P. vivax and Duffy antigen in 485 infections of which all but 30 were P. vivax alone, the rest in combination with P. falciparum. Only two of the patients were negative for Duffy; both had mixed infections. The authors conclude that “Duffy negativity is not an absolute barrier to P. vivax infection, suggesting the existence of a possible alternative invasion pathway.”
In a study of 216 children in a single District over ten months by Shaba-santu A & al., “the overall malaria prevalence was 31% … data analysis revealed that correct hanging of an ITN reduced the odds of being positive for malaria by 88% …. Having two insecticide treated nests (ITNs) and indoor residual spraying (IRS) done in the last spraying season reduced odds of being malaria positive by 86% … and 58% …, respectively. Further, being a male child had increased odds of being positive by 204%.” The paper is Prevalence and Factors Associated with Malaria Amongst Under-Five Children in Senga Hill District, Northern Province, Zambia, A Community-Based Cross-Sectional Study, Malaria J, 2026 Mar 31, https://doi.org/10.1186/s12936-026-05853-9.
Using a sample of 89 blood specimens collected for another purpose, Jaramillo-Underwood A & al. describe the use of serologic analysis to detect immunologic evidence of recent infections, When they describe this approach in Risk Factors and Geospatial Associations with Plasmodium falciparum Malaria Infection and IgG Seroprevalence: Nigeria, 2018, J Infect Dis. 2026 Apr 8: jiag098, https://doi.org/10.1093/infdis/jiag098, they report that “participants age 5-14 years had the highest odds of active infection versus children <5 years. Compared to the lowest wealth category, the wealthiest category showed a 5-fold reduction in odds of active infection, and urban living was associated with a 30% reduction.”
Yitageasu G & Demoze L, Spatial Epidemiology of Malaria by Bed Net Utilization in 19 Sub-Saharan African Countries: A DHS-Based Study (2013–2023), Malaria J, 2026 Apr 1, https://doi.org/10.1186/s12936-026-05904-1 correlates the incidence of malaria with bed net usage, using data from governmental programs in the countries studied. “Regarding bed net usage, 49.17% … reported no bed net, 48.06% … used insecticide-treated nets (ITNs), and 2.77% … used untreated bed nets. Malaria prevalence was highest among no bed net users with 32.75%, followed by 28.91% among untreated bed net users and 13.23% among ITN users.”
General epidemiology
“Uganda has a high, spatially heterogeneous burden of sickle cell disease (SCD) with national screening indicating sickle cell trait at 13.1 percent and disease at 0.7 percent, concentrated in the northern and eastern regions where Plasmodium falciparum transmission remains intense.” Paasi G & al. advocate “expansion of newborn sickle cell screening and (alignment of) new hubs with malaria control activities in the highest-burden districts” in A Maximal-Coverage Approach to Prioritizing Newborn Sickle Cell Screening Sites in Uganda Using a Sickle Cell-Malaria Co-Risk Surface, Malaria J. 2026 Mar 3, https://doi.org/10.1186/s12936-026-05846-8.
While malaria caused by P. ovale is considered less serious than that caused by P. falciparum, P. ovale has a hypnozoite form that can survive in the liver and cause recurrences, like P. vivax. In fact, Carey-Ewend K & al. state that P. ovale is the most common malaria parasite found throughout sub-Saharan Africa capable of causing relapse. Their paper, Frequent Plasmodium ovale Recurrence in Coastal Tanzania, Clin Infect Dis. 2026 Mar 21: ciag199, https://doi.org/10.1093/cid/ciag199 reports that despite apparent cure of the P. ovale infection, about half the patients studied presented with a median of ten weeks after the initial infection. Genotyping seemed to indicate reinfection rather than recurrence. The significance of these findings is unclear.
Adegoke TM & al. reviewed 102 papers dealing with the epidemiology of malaria in sub-Saharan Africa. They report in A Systematic Review of Epidemiological Models for Malaria Transmission in Sub-Saharan Africa, Malaria J, 2026 Mar 24, https://doi.org/10.1186/s12936-026-05870-8 that “the most prevalent models were transmission-focused models (52.9%, 54 articles), which involved disease dynamics. Intervention models contributed 21.6% (22 articles), optimal control models 9.8% (10 articles) and combined optimal control-cost-effectiveness models 15.7% (16 articles). Key gaps include limited incorporation of drug and insecticide resistance, migration dynamics, and climate variability.”
Tarama CW & al. conducted a survey among 1127 asymptomatic children in three Districts to determine their potential as reservoirs of malaria. They report in School-Aged Children as a Silent Reservoir of Plasmodium falciparum: Findings from a Cross-Sectional Survey Conducted in Burkina Faso in 2022, Malaria J, 2026 Mar 30, https://doi.org/10.1186/s12936-026-05867-3 that “among school-aged children (5–10 years), 66.5% tested positive by microscopy versus 21.6% in children under five. Gametocyte carriage reached 3.9% overall and was twice as high in school-aged children (67 vs. 32 gametocytes/μL).” Thus they conclude that “school-aged children are a major reservoir for asymptomatic and potentially infectious malaria. Their inclusion in surveillance and control strategies is critical.”
“Identifying the spatial heterogeneity in malaria transmission is crucial for designing geographically targeted control interventions, especially in high-burden communities where hotspot identification and delineation can facilitate the decision-making process toward resource allocation to specific areas where they are most needed.” Monteiro GM & al., Identification of Malaria Hotspots in Southwestern Benin Through Spatial Joint Modelling of Malaria Incidence and Vector Abundance, Malaria J, 2026 Apr 4, https://doi.org/10.1186/s12936-026-05891-3 relied on modeling to identify four ecological factors that “emerged as consistent and key drivers for all three processes: wind speed, mid-infrared reflectance, leaf area index and land surface temperature. Contrary to common assumptions, An. funestus showed stronger spatial correlation with malaria incidence … compared … An. gambiae s.l.(indicating) high heterogeneity in the spatial association between malaria and its primary vector species, with An. funestus playing a potential prominent role than previously recognized.” The authors assert that their “framework offers a useful insight of the distinct ecological preferences of each malaria vector species…”
Jorgenson B & al. attempted to link malaria infection rates to when heads of households are active in their work, especially at sunrise and sunset. Even though The Effect of Head of Household Occupation and Activity at Sunrise and Sunset on Malaria Prevalence in Sussundenga, Mozambique, Am J Trop Med Hyg. 2026 Mar 26: tpmd250655, https://doi.org/10.4269/ajtmh.25-0655 does not report statistically different infections rates in those active at those times as compared to those who are not, the authors claim to discern a trend in favor of increased rates that they deem worthy of further investigation.
According to Bakare EA & al., “understanding malaria seasonal patterns and synchrony between cases in different transmission settings in Nigeria, and forecasting future outbreaks is … critical for guiding public health policies.” In Exploring the Past and Forecasting the Future of Malaria in Selected Nigerian States: A Time Series Modelling Approach Using Wavelet and SARIMA, PLoS One. 2026 Apr 2; 21(4):e0337791, https://doi.org/10.1371/journal.pone.0337791, the authors how they used a mathematical model to analyze data from ten years to discern seasonal variations in four different states. “These findings emphasize the need for state-specific malaria interventions to capture the variability observed in (one province), and regionally coordinated control measures for (two others) where very strong synchrony exists. They also provide useful guide for policymakers on optimally timing interventions in line with observed seasonal patterns.”
Notwithstanding the title of Rios-Teran CA & al.’s article, The Dynamics of Asymptomatic Plasmodium spp. Infections Following 10 Years of Malaria Control Interventions in Northern Sahelian Ghana, PLoS Negl Trop Dis. 2026 Apr 13; 20(4):e0014174, https://doi.org/10.1371/journal.pntd.0014174, it is a spatiotemporal study of infections by P. malariae and P. ovale species among the population of the region studied. When IRS was discontinued, these infections rose despite seasonal malarial chemotherapy.
Spatiotemporal studies
Mohamed-Djawad MH & al., Spatio-Temporal Heterogeneity of Urban Malaria in Libreville, Gabon (2012–2023): Neighborhood-Level Hotspot Analysis for Micro-Stratified Control, Malaria J, 2026 Mar 19, https://doi.org/10.1186/s12936-026-05865-5
Teshome Z & al., A Six Years Trend Analysis of Malaria Prevalence in Central Ethiopia Region, Malaria J, 2026 Mar 23, https://doi.org/10.1186/s12936-026-05873-5
Tadesse S & al., Fatal and Non-Fatal Health Outcomes of Malaria Among Reproductive Age Women in Eastern Sub-Saharan Africa, from 1990 to 2023, Malaria J, 2026 Apr 3, https://doi.org/10.1186/s12936-026-05903-2
Addis GT & al., Referral Patterns and Associated Factors Among Adult Patients Admitted with Severe Malaria at Shedeho Meket Primary Hospital, Northeast Ethiopia, BMC Infect Dis. 2026 Apr 11, https://doi.org/10.1186/s12879-026-13261-2
Leake Y & al., Congenital and Neonatal Malaria in Ethiopia: A Narrative Review, J Parasitol Res. 2026 Apr 15; 2026:6152607, https://doi.org/10.1155/japr/6152607
Sanoussi MK & al., Prevalence and Spatial Distribution of Malaria-Causing Plasmodium Infections in the Niger Republic, Malaria J, 2026 Apr 18, https://doi.org/10.1186/s12936-026-05910-3