By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
Leader
WHO published a “Global Guidance” with the title of Prevention of Re-Establishment of Malaria Transmission on 11 July 2025. It is available from the complier of these reports or at https://www.who.int/publications/i/item/9789240112087 See further for other WHO publications
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On 23 July, Africa CDC announced that “[m]alaria is on the rise in southern Africa, with several countries – including Botswana, eSwatini, Namibia and Zimbabwe – reporting new outbreaks, underscoring the ongoing challenges in eradicating the disease in Africa.
Data from the Surveillance and Disease Intelligence Division of the Africa Centres for Disease Control and Prevention (Africa CDC) reveals a dramatic spike in Zimbabwe, where suspected cases have increased in 2025. As of epidemiological week 23, of 2025, Zimbabwe has reported 111,998 cases and 310 deaths (case fatality rate [CFR]: 0.27%) as compared to 29,031 cases with 49 deaths (CFR: 0.17%) in the same period in 2024…
‘As climate change accelerates, we are witnessing shifts in temperature and rainfall that are expanding the range of malaria-carrying mosquitoes, introducing vectors into previously unaffected regions,’ said Dr Merawi Aragaw, head of Africa CDC’s Surveillance and Disease Intelligence.” (https://africacdc.org/news-item/malaria-surge-in-southern-africa/)
Articles commenting on this rise have also appeared in The New York Times and The Economist.
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On 24 July, WHO certified Timor-Leste as malaria free. “Since gaining independence in 2002, Timor-Leste has made remarkable strides in the fight against malaria – reducing cases from a peak of more than 223 000 clinically diagnosed cases in 2006 to zero indigenous cases from 2021 onwards.” https://www.who.int/news/item/24-07-2025-timor-leste-certified-malaria-free-by-who
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On 4 August, Agropasteur.com, an apparently francophone Africa-focused agricultural website published a lengthy article against the implementation of a gene-drive study in Burkina Faso. It made several references to problems with the study as well as to other opinions against gene drive but contained no searchable references to published scientific papers. The article may be accessed at https://agropasteur.com/releasing-genetically-modified-mosquitoes-in-burkina-faso-is-dangerous/
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An interesting commentary appeared on 6 August on the “Simply Science” electronic column published weekly by The Economist. Its introduction reads “There is an arms race under way in science publishing. On one side are paper mills, shadowy companies which produce and sell fake papers in bulk. On the other are scientific journals, which try to keep the fraud out and the genuine stuff in. … the gatekeepers appear to be losing. One new estimate suggests that while the number of scientific articles doubles every 15 years or so, the number produced by paper mills doubles every 1.5 years. With AI tools capable of generating plausible nonsense getting ever easier and cheaper to use, that gulf may increase further.” The article then goes on to say how many peer reviewed publications are fighting against this phenomenon.
The website retractionwatch.com cites over 500 papers (most of them on COVID) that have been retracted over the past several years, some because of plagiarism, some that had fraudulent peer review, and for other causes. Respected scientific publishing houses of Elsevier (publisher of The Lancet), Springer (publisher of Nature), and Biomed Central (part of Springer and publisher of Malaria Journal) were among those of papers eventually retracted.
While the generator of these monthly reports cannot assure the reader that every article cited is scientifically valid, he assures the readers that he reads all abstracts and many articles with an eye to detect signs of duplication or other signs of lack of original work. Several articles are excluded from these reports every month as a result. The website www.scopus.com, which lists reliable journals around the world does not include bioRxiv, which has been cited in past reports, but will not be cited from now on.
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On 13 August, the World Health Organization (WHO) issued a new recommendation “supporting the use of spatial emanators, introducing a new class of intervention for malaria vector control.
Spatial emanators – also known as spatial repellents – emit active ingredients into the air to kill mosquitoes, deter them from entering treated spaces, and prevent them from locating and biting human hosts. They offer a promising complement to existing prevention measures such as insecticide-treated nets (ITNs) and indoor residual spraying. Unlike ITNs, spatial emanators may provide an added layer of protection against day-time mosquito biting, when residents of a household are active within the home and not sleeping under a net.” https://www.who.int/news/item/13-08-2025-who-recommends-spatial-emanators-for-malaria-vector-control-and-prequalifies-first-two-products
On the same day, the 478-page document, WHO Guidelines for Malaria was published. https://iris.who.int/bitstream/handle/10665/382254/B09514-eng.pdf?sequence=1
PEER REVIEWED ARTICLES (see notes after citations from non-peer-reviewed publications)
Prevention
Vaccines
During the pilot phase of introduction of the RTS,S/AS01E (RTS,S) malaria vaccine for the prevention of Plasmodium falciparum malaria in children, only certain communities were chosen for vaccinating children while other areas served as controls. Hence the use of the term “subnational” in the title of Jalang’o R & al.’s paper, Subnational Introduction of the RTS,S/AS01E Malaria Vaccine into Routine Immunization: Experience and Lessons from the Three Pilot Countries, Malaria J, 2025 Jul 28, 24:244, https://doi.org/10.1186/s12936-025-05484-6. “Vaccination coverage improved over time, reaching about 80% for the first dose and around 75% for the third dose by 2023 in the initial pilot areas. Implementation challenges included an inadequate understanding of age eligibility among healthcare workers during the early phase of introduction, low fourth dose coverage (with a median coverage of 46% in 2023 across the three countries), and disruptions to service delivery caused by disease outbreaks and other natural disasters. Health stakeholders and caregivers attested to the positive impact of introducing the malaria vaccine, including a reduction in malaria hospitalizations and the strengthening of the National Immunization Programme (NIP) through routine immunization refresher training and supportive supervision.”
Adoma PO & al., Community Engagement in Promoting Malaria Vaccine Uptake for Children Under-Five, Sci Rep. 2025 Jul 23; 15(1):26711, https://doi.org/10.1038/s41598-025-01616-9“explores the factors that influence community engagement as a plausible strategy in promoting the uptake of the malaria vaccine among children under five. A descriptive and analytical cross-sectional study design was employed using structured questionnaires.” The authors conclude that “individuals with high educational attainment tend to prioritize vaccine effectiveness and safety, while those with lower educational attainment prioritize factors such as vaccine cost and cultural considerations [over] effectiveness.”
Kigongo E & al., Community Readiness and Acceptance for the Implementation of the Malaria Vaccine Among Caretakers of At-Risk Children in Sub-Saharan Africa: A Systematic Review and Meta-Analysis, Malaria J, 2025 Aug 12, 24:259, https://doi.org/10.1186/s12936-025-05384-9 is a meta-analysis of 34 papers on the subject. While the average willingness to have a child vaccinated was 80% across the studies, one study reported rates as low as 53% from the DRC.
Rice BL & al. considered “disruptions to malaria control measures when evaluating intervention recommendations in high malaria burden, climate vulnerable geographies. [The authors] quantified the effects of a range of available interventions for malaria and identified newly available malaria vaccines as having considerable potential in mitigating these risks.” They focused on resurgence after severe weather events, such as cyclones. Their paper, Vaccination to Mitigate Climate-Driven Disruptions to Malaria Control in Madagascar, Science. 2025 Jul 17; 389(6757):eadp5365, https://doi.org/10.1126/science.adp5365, alludes to models of rebound in infection rates after chemoprophylaxis and asserts that the 70% effectiveness rate of the R21 vaccine is superior over the long term over intermittent chemoprophylaxis.
Vectors
Usage of ITNs remains a problem that needs addressing throughout sub-Saharan Africa. From Taremwa K & al., Barriers to Effective Usage of Insecticide-Treated Mosquito Nets (ITNs) Among Women of Reproductive Age in Tanzania: A National Cross-Sectional Survey, Malaria J, 2025 Jul 17, 24:234, https://doi.org/10.1186/s12936-025-05417-3 is a report on this subject. Using data one over 15,000 childbearing age women obtained from the 2022 Tanzania Demographic and Health Survey, the authors conclude that “ITN usage among women of reproductive age in Tanzania is influenced by education level, geographic location, marital status {specifically monogamous versus polygamous households}, and perceived ITN effectiveness. These findings highlight the need for targeted interventions, such as educational campaigns, equitable ITN distribution, and context-appropriate malaria prevention strategies, to improve ITN coverage and reduce the malaria burden.”
War presents multiple challenges to prevention and treatment of disease. Gebrekidan GB & al., The Status of Ownership and Utilization of Long-Lasting Insecticidal Treated Nets in War-Torn Tigray, Ethiopia, Sci Rep. 2025 Jul 30; 15:27847, https://doi.org/10.1038/s41598-025-03180-8 focuses on the effects of the recent conflict in Ethiopia, which may well have long lasting effects. However, when it comes to ownership and use of ITNs, the survey the authors conducted among 2338 households, the results are comparable to those in the rest of the country (58.1% ownership and 61.6% of those owning claiming to have used it).
Okova D & al. conclude in Between-and Within-Socioeconomic Groups Temporal Inequality in the Uptake of Malaria Prevention Strategies Among Pregnant Women and Under-Five Children in Ghana (2003–2022), Malaria J, 2025 Aug 22, 24:173, https://doi.org/10.1186/s12936-025-05512-5 that “[d]espite overall improvements in malaria prevention uptake, substantial socioeconomic inequalities persist especially within social and geographic subgroups. Equity-focused strategies must complement national-level efforts by addressing barriers specific to underserved populations, including informal urban settlements and remote rural communities.”
Ndalama F & al. examined the management of [community health workers (CHWs)] recruited to support a phase III trial of Attractive Targeted Sugar Baits (ATSBs) in Western Zambia… A literature review, review of Zambia Ministry of Health Guidelines, and review of WHO guidelines was conducted to identify best practices and common challenges for CHWs contributing to the delivery of malaria interventions.” , As the authors report in Comparative Analysis of the Use of Community Health Workers While Deploying the Attractive Targeted Sugar Bait (ATSB) for Malaria Control in Western Province, Zambia, Malaria J, 2025 Aug 14, 24:260, https://doi.org/10.1186/s12936-025-05503-6, the “analysis found that ATSB trial practices largely aligned with literature best practices and established guidelines, particularly in training and incentive structures. However, challenges were identified in achieving gender balance (32% female CHWs in year 2), community involvement in CHW selection, and coordination between CHWs and research team members.”
Chaccour C & al. studied whether mass administration of ivermectin once a month for three months during the rainy season may reduce the incidence of malaria by killing the mosquitoes that feed on children who received the drug. In a massive study of over 20,000 individuals, they conclude in Ivermectin to Control Malaria – A Cluster Randomized Trial, New Eng J Med, 2025 Jul 23, 393:362-75, https://doi.org/10.1056/NEJMoa2411262 that incidence of malaria during the subsequent six months was reduced by 26% in the treated versus the control group. The authors also state that there were no safety issues encountered as a result of treatment.
In an apparently novel application of gene drive, Li Z & al. describe a mutation in the genome of An. stephensi that renders the mosquito gut resistant to infection by Plasmodium parasites, while apparently having no significant effect on the survival of the insects. Their paper, Driving a Protective Allele of the Mosquito FREP1 Gene to Combat Malaria, Nature, 2025 Jul 23, https://doi.org/10.1038/s41586-025-09283-6 focuses mostly on the genetic aspects of generating colonies of mutated mosquitoes.
Another paper about gene drive, Gendron WAC & al., Evaluating the Cost of Malaria Elimination by Anopheles gambiae Precision Guided SIT in the Upper River Region, The Gambia, PLOS Glob Public Health. 2025 Jul 18; 5(7):e0004903, https://doi.org/10.1371/journal.pgph.0004903 is discussed below, under Campaigns and Policies.
Ebuako AA & al. collected mosquitoes in a poorly served isolated community in Ghana. They report that only about 13% of specimens collected were Anopheles species and very few of the latter resistant to insecticides. The findings in Malaria Vector Diversity, Transmission and Insecticide Resistance in Island Communities Along the Volta Lake in Southern Ghana, BMC Infect Dis. 2025 Jul 9; 25:904, https://doi.org/10.1186/s12879-025-11283-w also “indicate high indoor biting and resting densities of Anopheles mosquitoes.”
Bacterial larvicides have repeatedly been reported to be useful in anti-malarial campaigns. Mataba GR, Systematic Literature Review of Bacterial Larvicides Bacillus thuringiensis var israelensis and Bacillus (Lysinibacillus) sphaericus for Malaria Control in Africa, Int J Environ Health Res. 2025 Jul 15: 1-28, https://doi.org/10.1080/09603123.2025.2533346 argues that the literature is missing convincing evidence that large-scale application of these organisms has caused society-wide benefits, despite the confirmation of effective killing of mosquito larvae.
Two papers deal with the larvicidal properties of plant extracts. As the second of these states: “Insecticides are … chemical toxins [that] pose significant risks to human and animal health due to their direct effects and their impact as environmental pollutants. To mitigate these chemical hazards, the use of phytocompounds with superior larvicidal or mosquitocidal effects, low toxicity levels in mammals, and short-term environmental persistence may be a preferable alternative.” Tadesse S & al. tested extracts of four different plants native to Ethiopia for activity against the main malaria vector in the country. As they describe in Larvicidal and Adulticidal Effects of Ethiopian Medicinal Plants Against Anopheles gambiae (Diptera: Culicidae), Malaria J, 2025 Jul 30, 24:246, https://doi.org/10.1186/s12936-025-05443-1, two of the extracts tested demonstrated significant larval mortality under laboratory conditions. The authors recommend further testing of these two extracts with view toward including them in future larvicidal campaigns. Nwonuma CO & al., Larvicidal and Adulticidal Effects of Combined Hydroethanolic Extracts of Clove Flower Buds and Garlic Bulbs on Anopheles gambiae, Malaria J, 2025 Aug 1, 24:249, https://doi.org/10.1186/s12936-025-05440-4 report that the combination of the two extracts of common dietary plants, but not each of them separately, produce larvicidal effects.
Once hailed as the key to eradication of mosquito borne diseases world-wide, DDT has been revealed as the destroyer of much of our wildlife. That resulted in its being included in the Stockholm Convention on Persistent Organic Pollutants of 2001, which envisioned its use being discontinued over eight years of the effectiveness of the agreement (2004). van den Berg H & al., DDT: Last Mile in the Global Phase-Out of Its Use for Disease Vector Control? Lancet Planet Health, 2025 Jul 16, https://doi.org/10.1016/j.lanplh.2025.06.007 recounts the current status of the insecticide, which was still in use in India, South Africa, and Zimbabwe in 2023 and held in reserve for emergency response in several other countries. The article contains “recommendations to attain a global phase-out of DDT and to address the problem of disposal of obsolete stocks.”
Chemoprophylaxis
“Despite the progress made in the coverage of Intermittent Preventive Treatment of malaria during pregnancy using sulfadoxine-pyrimethamine (IPTp-SP), notable gaps persist in understanding the individual and community-level factors that correlate with optimal dosing adherence.” Once again, the failure of “uptake” of a proven preventive regimen is documented by Stephano EE & al. in their article, Individual and Community-Level Correlates of Optimal Doses of Sulfadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria During Pregnancy in Tanzania: A Multilevel Analysis of the 2022 National Survey, Malaria J, 2025 Jul 23, 24:240. https://doi.org/10.1186/s12936-025-05482-8. In an analysis of data about 4497 pregnant women, the authors report full compliance with the recommended three or more doses of IPTp-SD to be 31.2%. Correlations with optimal compliance included multigravida women as opposed to those in their first pregnancies; those who made three or more prenatal visits, and geographic factors. “These results emphasize the need for targeted interventions addressing individual and community-level barriers to IPTp-SP uptake.”
Okot F & al., “We witnessed medicines help our children, then we became proud”: Experiences and Acceptability of Seasonal Malaria Chemoprevention in Aweil, South Sudan, Malaria J, 2025 Aug 14, 24:262, https://doi.org/10.1186/s12936-025-05501-8 reports high acceptability of seasonal malaria chemoprevention among children, even though it required multiple administrations of the medications. However, the article relies mostly on quotes from interviews and is short on data.
Malnutrition of children often accompanies the history of malaria. Hhera JJ & al. set out to study the impact of malaria chemoprophylaxis administered every four months to school-age children. While the study confirmed the association of malaria and malnutrition, neither of the two preventive regimens affected the degree of malnutrition among the treated, as compared to control groups. The paper is Malaria-Malnutrition Interaction: Prevalence, Risk Factors, and the Impact of Intermittent Preventive Therapy for Malaria on Nutritional Status of School-Age Children in Muheza, Tanga, Tanzania — A Cross-Sectional Survey and a Randomized Controlled Open-Label Trial, BMC Public Health. 2025 Aug 13 25:2754 https://doi.org/10.1186/s12889-025-23315-w
Other
With reference to transmission blocking agents, see and Ye T & al., Single Low-Dose Primaquine for Malaria Control in Africa: A Systematic Review of Safety, Efficacy and Implementation Barriers, BMJ Glob Health. 2025 Aug 14; 10(8):e020264, https://doi.org/10.1136/bmjgh-2025-020264 as well as Kumsa T & al., Efficacy and Gametocyte Carriage in Plasmodium falciparum Cases Treated with Artemether-Lumefantrine Alone Versus with Single-Dose Primaquine in Ethiopia: A Randomized Controlled Study, Acta Trop, 2025 Aug 21: 10780, https://doi.org/10.1016/j.actatropica.2025.107800 below, under Treatment/Other
Diagnosis
General diagnostics
Microscopy remains a “gold standard” of malaria diagnosis according to many authors. What they don’t usually mention is that there are two ways of diagnosing malaria under the microscope: (1) “Thin smears,” which require a search for parasites inside of red blood cells seen on routine hematologic smears of the various blood cells, and (2) “thick smears,” which are special preparations that break up the cells and concentrate the residual material in which the parasite cells are somehow preserved and observable. While the latter requires special skills to prepare the interpret the slides, traditional teaching holds it more sensitive in being able to find the parasite. Anderson N expounds the contrary view in Perfect vs Practical: Utilizing Hematology Thin Smears for the Diagnosis of Plasmodium and Babesia, J Clin Microbiol. 2025 Jul 11:e0064425, https://doi.org/10.1128/jcm.00644-25, namely that thin smears are very sensitive, making thick smears and the attendant complexities not necessary in laboratories of limited resources.
Lim MS & al., Rapid and Multiplex Diagnosis of Malaria Using Chelex-100 Extraction and LAMP-MS Assay, Bio Protoc. 2025 Jul 5; 15(13):e5375, https://doi.org/10.21769/bioprotoc.5375 is a description (complete with illustrations in the article) of a diagnostic method that the authors claim to be inexpensive and reliable for several species of Plasmodium infection. According to the authors, it demonstrates “sensitivity and specificity comparable to traditional PCR-based diagnostics, making it a practical and scalable solution for use in resource-constrained environments.”
Accurate diagnosis of malaria begins with the decision to test those suspected of harboring the parasite. Burger G & al., The Malaria Care Cascade and Factors Associated with Receiving a Malaria Test in Children Under 5 Years of Age and Pregnant Women with Fever: A Cross-Sectional Household Survey from Three Regions in Guinea and Three Districts in Sierra Leone in 2022, BMJ Glob Health. 2025 Jul 17; 10(7):e018368, https://doi.org/10.1136/bmjgh-2024-018368 is a report from two countries, in each of which a variable number of children and pregnant women with fever are tested at all (from 42 to 96% and 62 to 91%, respectively, depending on location). “Between 54% and 81% of children and 24% to 69% of pregnant women with malaria received treatment within 2 days of fever-onset by region/district, while delays were reported at all steps of the care cascade.” The authors do not report on efforts to remedy the situation.
Genetically caused false negative RDTs have been the subject of many papers. Some DY & al. state that another issue may be the persistence of histidine-rich protein 2 (HRP2) in people who have recovered from malaria and are presenting with a febrile illness. Their paper, Refining Malaria Diagnosis in High-Transmission Areas: A Dual-Approach with Rapid Diagnostic Tests (RDTs) and dbPCR-NALFIA, Malaria J, 2025 Aug 7, 24:252, https://doi.org/10.1186/s12936-025-05500-9, addresses this eventuality by recommending the use of both HRP2-based and lactic dehydrogenase (LDH) based RDTs for diagnosing malaria. If the LDH based test is positive, or if both tests are negative, the presence or absence of malaria is determined. However, in case of positive HRP2 and negative LDH, a special polymerase chain reaction (PCR) test is used to resolve the diagnostic dilemma. In their hands, this course of action yields the most reliable result, as verified by microscopy.
Field diagnostics
In view of the concerns about gene deletions making HRP2-based RDTs less useful than before, Sambe BS & al. tested some RDT products that incorporated both HRP2 and LDH detection. It is unclear why they did the testing in communities where the gene deletion was known to be rare, but the short conclusion was that in this setting LDH detection did not add much to the accuracy of diagnosis, which was ultimately established by PCR testing. The paper is Performance and Usability Evaluation of Three LDH-Based Malaria Rapid Diagnostic Tests in Kedougou, Senegal, Parasit Vectors. 2025 Jul 12; 18(1):280, https://doi.org/10.1186/s13071-025-06914-9. {Two additional items of concern about this paper: (1) The sensitivity of microscopy was only 53% possibly reflecting inadequate training of staff, and (2) The authors considered the HRP2 test sensitivity of 78% to be acceptable.}
Two examples of papers that duplicate work published in the past, including the conclusion that the genome associated with false negative RDTs based on HRP2 is present to a significant extent in samples collected in the geographic areas studied are Tufa TB & al., Plasmodium falciparum Kelch13 Variants and Histidine-Rich Protein 2/3 Deletions in Central Ethiopia, 2023, Am J Trop Med Hyg. 2025 Jul 15: tpmd250114, https://doi.org/10.4269/ajtmh.25-0114 and Adamu A & al., Deletion of Target Gene (Histidine-Rich Protein 2/3) for Plasmodium falciparum Rapid Diagnostic Tests in Amhara Region, Ethiopia: A Cross-Sectional Study, Malaria J, 2025 Aug 2, 24:250, https://doi.org/10.1186/s12936-025-05485-5. Still, in the context of the campaign against malaria, continual surveillance and publication of the results in the peer reviewed literature is important. Adamu & al. recommend the use of RDTs based on LDH.
New diagnostic methods
“Although malaria microscopy is currently the gold standard, it is laborious, requires extensive training, and relies heavily on the proficiency of microscopists. Though malaria rapid tests are widely used, they show poor sensitivity at low parasitemia levels, are affected by gene deletions, and offer only qualitative results… The Sysmex XN-31 (Sysmex, Kobe, Japan) is an automated hematology analyzer that can detect and quantify malaria parasites.” Onsongo S & al. “evaluated the diagnostic performance of the Sysmex XN-31 automated analyzer for detecting malaria parasites compared to expert microscopy” and report in The Diagnostic Performance of a Sysmex XN-31 Automated Malaria Analyzer vs. Expert Microscopy, Int J Lab Hematol. 2025 Aug; 47(4):613-621, https://doi.org/10.1111/ijlh.14456 that it performed comparably to expert microscopy with slightly diminished specificity when it came to identify the specific Plasmodium species causing the infection.
Treatment
Treatment results
Please see Kumsa T & al.’s article, Efficacy and Gametocyte Carriage in Plasmodium falciparum Cases Treated with Artemether-Lumefantrine Alone Versus with Single-Dose Primaquine in Ethiopia: A Randomized Controlled Study, Acta Trop, 2025 Aug 21: 10780, https://doi.org/10.1016/j.actatropica.2025.107800, below.
Side effects and complications
“In August 2022, an epidemiologic investigation into an outbreak of cases of black water fever, a severe and fatal complication of malaria, was conducted in Kakumiro District, Central Uganda. Findings revealed an association between self-medication and the development of severe malaria complications.” A year later, Zalwango MG & al. conducted a survey of 592 households in the same area, in search of factors that influence self-medication. As they describe in Self-Medication for Malaria and Associated Factors in Kakumiro District, Uganda, August 2023: Implications for Malaria Management and Mortality Prevention, Malaria J, 2025 Jul 23, 24:241, https://doi.org/10.1186/s12936-025-05488-2, of the participants interviewed, 368 “had self-medicated for malaria. Self-medication was significantly associated with household heads aged ≥ 35 years …., distances ≥ 5 km to the health facility …, and storage of antimalarial drugs at home …. The major reason for self-medication was antimalarial stockouts at health facilities. Drugs used for self-medication were commonly known to 65% of the respondents and were bought from drug shops…”
Guidelines
Gebremichael MA & al. “aimed to determine the level of adherence to malaria diagnosis and treatment guidelines among healthcare providers working in the public health facilities” in SW Ethiopia. Using medical records review, focus groups, and In-depth Interviews, they evaluated the “adherence of healthcare providers … according to recommendations of the current malaria diagnosis and treatment guidelines.” Reviewing 1684 patient records, they found the “overall adherence of healthcare providers to the updated malaria treatment standards [to be] 36.99%.” During the interviews, the practitioners cited “[s]hortage of anti-malarial drugs … as the foremost barrier followed by lack of training on the updated malaria case management guideline, shortage of health professionals, and lack of laboratory materials.” The paper is Evaluation of Anti-Malarial Treatment for Elimination of Malaria in South West Ethiopia: A Concurrent Triangulation Design for Prompt Decision, Malaria J, 18 Jul 2025, 24:237, https://doi.org/10.1186/s12936-025-05396-5.
Drug resistance
Brhane BG & al. “analyzed 1199 clinical Plasmodium falciparum infections from 12 sentinel sites across five regions in Ethiopia, collected between 2019 and 2023. … [and] assessed the prevalence of resistance-associated mutations, complexity of infection (COI), and parasite relatedness…” As they report in Rising Prevalence of Plasmodium falciparum Artemisinin Partial Resistance Mutations in Ethiopia, Commun Med (Lond). 2025 Jul 18; 5:297, https://doi.org/10.1038/s43856-025-01008-0, the most prevalent mutation associated with artemisinin partial resistance was present in 15.7% of samples. Another such mutation was found exclusively in a facility serving refugees from Sudan and South Sudan.
Aranda-Díaz A & al. collected “dried blood spots and epidemiological data … from confirmed Plasmodium falciparum cases at 61 health facilities across all 10 Zambian provinces from March to July 2023. A total of 2,486 samples were genotyped…” The authors report in Plasmodium falciparum Genomic Surveillance Reveals a Diversity of kelch 13 Mutations in Zambia, Am J Trop Med Hyg. 2025 Jul 31: tpmd250110, https://doi.org/10.4269/ajtmh.25-0110 not only a diversity of mutations partially resistant to artemisinins, but also some resistance to lumefantrine and the IPTp regimen of sulfadoxine-pytimethamine.
Like Adamu & al. above, Onchieku NM & al., Prevalence of Plasmodium falciparum Parasites Harbouring Chloroquine-Resistant but Not Artemisinin-Resistant Alleles in Busia County, Western Kenya, Malaria J, 2025 Jul 30, 24:247, https://doi.org/10.1186/s12936-025-05486-4 is an example of a paper that duplicates work published in the past, in this case the conclusion that the genome associated with artemisinin resistance is not present in samples collected in the geographic area studied. Still, in the context of the campaign against malaria, continual surveillance and publication of the results in the peer reviewed literature is important.
A somewhat similar study, Boene S & al., Antimalarial Drug Resistance and Population Structure of Plasmodium falciparum in Mozambique Using Genomic Surveillance at Health Facilities in 2021 and 2022, Sci Rep. 2025 Aug 11; 15:29335, https://doi.org/10.1038/s41598-025-02166-w reports the finding of resistance to piperaquine (an ingredient in IPTp for pregnant women) but not to artemisinins.
One section of Williamson T & al., A Timeline of Reckoning: Tracking the Historical Rise of Antimicrobial Resistance Across HIV, TB, and Malaria, J Glob Antimicrob Resist. 2025 Jul 22: S2213-7165(25)00171-7, https://doi.org/10.1016/j.jgar.2025.07.014 is devoted to the description of the rise of parasite resistance to antimalarials. Of interest is that tThe average time frame of resistance arising is slower for antimalarials than for anti-HIV and anti TB regimens. The article also states that no resistance has developed to lumefantrine, even though the drug has been in use for almost 50 years. {The latter conclusion is disputed by two articles cited this month, Brhane & al. and Aranda-Díaz & al.}
Guissou RM & al. extrapolated the cost of various strategies to mitigate the spreading of artemisinin resistance from a pilot study in one health district to the entire country of Burkina Faso. They conclude in Multiple First-Line Therapeutic Strategies to Mitigate Artemisinin Resistance: Cost Analysis of a Pilot Study from a Health System Perspective in Kaya Health District, Burkina Faso, Malaria J, 2025 Aug 7, 24:254, https://doi.org/10.1186/s12936-025-05493-5 that of “the six activities involved in routine malaria care delivery, four incur additional costs when the [multiple first line tyherapies] strategy is implemented: support material production, health worker training and supervision, and the chosen artemisinin-based combination therapy (ACT) costs, if different from the standard cost.” Most of the costs are generated by the doubling of the cost of acquiring, storing and administering the alternative drug regimens.
Okitwi M & al. tested “susceptibilities to nine drugs of isolates collected from individuals presenting with uncomplicated falciparum malaria … Uganda and performed deep sequencing, with analysis of 80 Plasmodium falciparum genes, to evaluate associations between susceptibilities and potential resistance markers for samples studied since 2016” and report in Changes in Susceptibility of Plasmodium falciparum to Antimalarial Drugs in Uganda Over Time: 2019-2024, Nat Commun. 2025 Aug 9; 16:7353, https://doi.org/10.1038/s41467-025-62810-x that over time “susceptibilities improved for chloroquine, decreased for lumefantrine, mefloquine, and [dihydroartemisinin], and were unchanged for other drugs [tested].”
New drug research
Zinc pyrithione (ZPT) is an FDA-approved dermatologic preparation with antimicrobial properties. Rajendran V & Sivaraja YR tested its effects on P. falciparum under laboratory conditions and report in Zinc Pyrithione Inhibits Blood-Stage Parasites of Plasmodium falciparum and Its Combinatorial Effect with Dihydro-Artemisinin and Chloroquine in Culture, Parasitol Int. 2025 Aug; 107:103041, https://doi.org/10.1016/j.parint.2025.103041 that “parasite viability was significantly inhibited by ZPT treatment for 96 h … and moderate inhibitory effects for 12 and 24 h” in both chloroquine sensitive and resistant P. falciparum in culture. Furthermore, ZPT in combination with dihydro-artemisinin and chloroquine demonstrated additive interactions in both [sensitive and resistant] parasites. At therapeutic dosages, ZPT failed to cause hemolysis in human erythrocytes.”
“… artemisinin partial resistance (ART-R) is now prevalent in Southeast Asia and has emerged in eastern Africa, threatening ACT efficacy. Artefenomel, a synthetic 1,2,4-trioxolane, exhibits an extended pharmacokinetic exposure profile that predicts for efficacy against ART-R parasites. Unfortunately, the development of artefenomel was halted recently after almost a decade in the clinic. [Klope MT & al.] describe studies of an artefenomel-adjacent chemotype that combines potent in vitro activity against clinical ART-R parasites, an extended pharmacokinetic profile with single-exposure efficacy in a murine malaria model, and enhanced stability in human microsomes and hepatocytes” in their article, Identifying a Next-Generation Antimalarial Trioxolane in a Landscape of Artemisinin Partial Resistance, Sci Adv. 2025 Aug 8; 11(32):eads9168, https://doi.org/10.1126/sciadv.ads9168
Wagner A & al. describe a new class of chemical that is active against P. falciparum in the laboratory in their article, Discovery and Optimization of a Novel Carboxamide Scaffold with Selective Antimalarial Activity, Eur J Med Chem. 2025 Jul 5; 291:117572, https://doi.org/10.1016/j.ejmech.2025.117572
Plant extracts and traditional treatments
Idi Issa Abdoulahi M & al., Bio-Guided Investigation of Nine [of] Niger’s Ethnomedicinal Plants Reveals Nature-Derived Antimalarial Chemical Pharmacophores for Drug Discovery, Chem Biodivers. 2025 Jul 18: e00879, https://doi.org/10.1002/cbdv.202500879 reports on investigation of several plants used in folk medicine in Niger, of which the methanolic extract of one, Phyllanthus pentandrus, (an herb found in sub-Saharan Africa) displayed the most promising activity against P. falciparum in the laboratory. Four others were also cited as having some effect as well. The authors consider these results as validating the use of these plants.
Two African herbs, Tephrosia villosa, and Gnidia Stenophylla have been used for generations against malaria in folk medicine. Their activity against Plasmodium falciparum and the mouse model of malaria have been repeatedly confirmed, recently in Alemu MA & al., Antimalarial Activity of Root Extract of Tephrosia villosa L. Pers. (Fabaceae) on Plasmodium berghei-Infected Mice, Sci Rep. 2025 Jul 25; 15:27162, https://doi.org/10.1038/s41598-025-11137-0 and Salile SS & al., Antimalarial Activity of Hydroalcoholic Extract and Fractions from Gnidia stenophylla Roots: In-Vitro Effects on P. falciparum and In-Vivo Suppression in P. berghei-Infected Mice, J Ethnopharmacol. 2025 Jul 29:120341, https://doi.org/10.1016/j.jep.2025.120341.
Other
“Since 2012, the WHO has recommended a single low dose of primaquine (SLDPQ, 0.25 mg/kg) alongside artemisinin-based combination therapies (ACTs) to block Plasmodium falciparum transmission and combat artemisinin resistance. Despite its proven benefits, SLDPQ adoption in African malaria policies remains limited.” Ye T & al., Single Low-Dose Primaquine for Malaria Control in Africa: A Systematic Review of Safety, Efficacy and Implementation Barriers, BMJ Glob Health. 2025 Aug 14; 10(8):e020264, https://doi.org/10.1136/bmjgh-2025-020264 is a “review of studies published between 2012 and 2023 on the safety, efficacy and implementation of SLDPQ in Africa … Data were extracted and analysed from 41 studies, including 15 randomised controlled trials (RCTs) and 26 non-trial studies. SLDPQ was found to be safe and well-tolerated, including in glucose-6-phosphate dehydrogenase deficiency individuals and children under 5. Eight RCTs confirmed significant reductions in gametocyte carriage, validating SLDPQ’s individual-level efficacy. However, evidence on community-level impact remains limited.”
Somewhat similarly to the above, Kumsa T & al., Efficacy and Gametocyte Carriage in Plasmodium falciparum Cases Treated with Artemether-Lumefantrine Alone Versus with Single-Dose Primaquine in Ethiopia: A Randomized Controlled Study, Acta Trop, 2025 Aug 21: 10780, https://doi.org/10.1016/j.actatropica.2025.107800 reports that gametocytes (the form of the parasite that is transmissible to the mosquito) were lower in patients who received primaquine as well as ACT. However, the authors note that gametocytes were present in low numbers in all patients, calling into question the statistical validity of the finding..
Campaigns and Policies
Using modeling, Gendron WAC & al. conducted a pre-implementation study of the cost and benefit of a gene drive project that they call precision guided sterile insect technique (pgSIT), They conclude in Evaluating the Cost of Malaria Elimination by Anopheles gambiae Precision Guided SIT in the Upper River Region, The Gambia, PLOS Glob Public Health. 2025 Jul 18; 5(7):e0004903, https://doi.org/10.1371/journal.pgph.0004903 that implementation will save several lives and significantly reduce the burden of illness at an acceptable economic cost. This paper could also be cited under Prevention/Vectors.
According to Obeagu EI & al., “[c]ommunity education initiatives have demonstrated significant success in enhancing awareness and promoting preventive measures such as the use of insecticide-treated nets and early treatment-seeking behavior. Behavioral change communication strategies leverage mass media, interpersonal communication, and social mobilization to foster positive health behaviors and mitigate harmful practices. Community-based interventions, involving local populations in planning and execution, have proven effective in fostering ownership and sustainability, leading to notable reductions in malaria prevalence.” The authors state in Behavioral Health Interventions in Malaria Control: Efficacy and Implementation, Medicine (Baltimore). 2025 Aug 1; 104(31):e43762, https://doi.org/10.1097/md.0000000000043762 that “fostering community involvement, multi-sectoral collaboration, and leveraging innovative communication technologies can enhance the effectiveness and reach of these interventions. By integrating behavioral health strategies with existing medical and technological measures, malaria control programs can achieve more significant and sustainable impacts.”
“Community health workers (CHWs) in … Madagascar provide malaria case management services to children younger than 5 years old, although they typically do not treat older children and adults, leaving a gap for those living far from health facilities. To determine the efficacy of expanding malaria community case management (mCCM) to community members of all ages, [Rabesandratra HF & al. conducted] a cluster randomized trial … in one district of Madagascar from November 2020 to December 2021.” As described in An Anthropological Analysis of Acceptability and Feasibility of Expanding Community-Based Malaria Management to All Ages in Madagascar: Levels and Challenges for National Scale-Up, Am J Trop Med Hyg. 2025 Aug 12: tpmd240678, https://doi.org/10.4269/ajtmh.24-0678, “[t]wo major findings emerged. First, stakeholders found age-expanded mCCM to be consistent with existing CHW roles and practices. Age-expanded mCCM induced a recognition of adults’ susceptibility to malaria and led to a more accurate understanding of malaria. Second, structural and community-based challenges were not fully resolved by age-expanded mCCM, and some, such as the question of the cost of care, emerged after its implementation.”
Epidemiology
Climate change, biodiversity and environment
Pabon-Rodriguez FM & Ayodo G state that “[d]espite well-documented relationships between climate and malaria transmission, there is a lack of information on how precipitation and temperature as climatic factors specifically impact malaria burden among different age groups in high-transmission areas…”, In their paper, The Influence of Climatic Factors on Age-Group-Specific Malaria Burden in Western Kenya, Public Health Challenges, 2025 Jun, 4:2, e70052, https://doi.org/10.1002/puh2.70052, they report that that “2-month lagged precipitation and temperature were significant predictors of malaria positivity, with older age groups showing higher susceptibility. Site-to-site and year-to-year variations were also identified as important sources of variation to be considered.”
Even in a small country like Togo, malaria epidemics may occur at different times of the year, dependent on weather patterns. This is demonstrated in Thomas A & al., Identifying Malaria Epidemic Periods in Togo by Health District and Target Group: A Generalised Additive Model Approach, BMC Infect Dis. 2025 Aug 13; 25:1013, https://doi.org/10.1186/s12879-025-10956-w, albeit the data cited are from 2013 to 2017.
Talbot B & al. set out to determine the effect of ITN use on mosquito densities and frequency of Plasmodium-infected vectors but report in Ecological Drivers of Malaria Vector Habitat and Transmission Over 1 Year of Long-Lasting Insecticidal Net Intervention in Cote d’Ivoire, Parasit Vectors. 2025 Aug 12; 18:343, https://doi.org/10.1186/s13071-025-06984-9 that they “did not detect an effect of intervention arm on the probability of occurrence of any vector species, while [the authors] found strong significant effects of a combination of land cover, climate, topography and/or population density variables on each of the three mosquito vector species and malaria-infected vectors. [These] results suggest environmental factors may have facilitated or restricted changes in the probability of occurrence of vector species and infected vectors in the context of vector control interventions.”
Risk factors
Fambirai T & al. conducted a case control study of risk factors in a community that they regard as having good preventive services programs (primarily indoor residual spraying). They report the following factors as being of significance: “engaging in night outdoor social and religious activities … and having a garden …. Wearing full body clothing at night … and sleeping in a sprayed room were protective for contracting malaria. The majority of cases (96.74%) and controls (92.22%) had good knowledge of malaria transmission and preventative measures. The paper is Risk Factors for Contracting Malaria in Six Wards of Mudzi District, Zimbabwe: A Case Control-Study, PLoS One. 2025 Aug 7; 20(8):e0329093, https://doi.org/10.1371/journal.pone.0329093
People living on the island of Zanzibar have relatively low risk of being infected by the malaria parasite. Makenga G & al., Occupations at High Risk for Malaria in Zanzibar: A Case–Control Study, May–August 2023, Malaria J, 2025 Aug 20, 24:268, https://doi.org/10.1186/s12936-025-05517-0 report on occupational risk factors on the island, as follows: “In urban districts, night watchmen/police …, construction workers …, and farmers … were found to have higher odds of malaria infection compared to those not working in those professions. Other high-risk behaviours in urban districts included night-time activities …, meals taken outside …, and recent travel within Zanzibar …. In rural districts, outdoor night-time activities … and taking meals outside … were risk factors for malaria; however, no higher risk occupational groups were identified.”
General epidemiology
Ntuomi F & al., Malaria Resurgence in Africa: Confronting the Challenges, Lancet Infect Dis, 2025 Aug 14, https://doi.org/10.1016/S1473-3099(25)00499-2 reiterates facts to which this report already alludes in its Leader (items from WHO and CDC Africa). However, the causes of the resurgence are not known yet.
Mawuli MA & al. tested 98 asymptomatic children for Plasmodium parasite presence by a variety of diagnostic tests and found 70% to harbor parasites. Among those, 33% were found by PCR to have gametocytes, which are transmissible to mosquitoes. Despite this potential, only 4 of the 19 gametocyte-positive blood samples caused transmission to Anopheles gambiae mosquitoes under laboratory conditions. The implications of these findings, reported in Assessment of the Infectivity of Malaria Parasites From Asymptomatic School Children to Anopheles gambiae Mosquitoes in a High Transmission Area in Ghana, Sci Rep. 2025 Jul 2; 15(1):22561, https://doi.org/10.1038/s41598-025-06844-7, are unclear.
“In Uganda, malaria is a year-round health threat, with transmission intensity varying across regions. Despite ongoing intensified interventions, an unprecedented malaria resurgence in early 2022 affected several districts…” Aregawi MW & al., Malaria Epidemics and Its Drivers in Uganda in 2022, Malaria J, 2025 Jul 17, 24:235, https://doi.org/10.1186/s12936-025-05351-4 assesses “the scale and underlying causes of the epidemics, quantify the excess cases and deaths, and propose targeted prevention and response strategies… The 2022 malaria epidemic affected 64 districts, with over 3.3 million excess cases and nearly 150,000 excess admissions. Gaps in IRS, iCCM, and intervention coverage, along with minimal rainfall correlation and high vulnerability in bimodal regions, highlight the need for better surveillance, sustainable funding, and tailored responses.”
Nuwasiima S & al. conducted tests of the reliability of a new method of gathering clinical and public health data as they relate to malaria in Uganda. They report in Concordance of Data on Key Malaria Indicators Between DHIS2 and Source Do.cuments, and Influencing Factors at Public Primary Health Facilities in Eastern Uganda: A Mixed Methods Study, Malaria J, 2025 Aug 20, 24:270, https://doi.org/10.1186/s12936-025-05519-y that the concordance was unacceptably low (36.7%) and recommend further training of data gatherers, as well as moving toward automatic data capture from local health records to the extent possible.
Bashir SG & al. analyzed the peer reviewed literature and WHO reports pertaining to malaria incidence and anti-malarial campaigns in 12 East African countries from 2015 to 2024. The results, as reported in The Burden of Malaria in East Africa: Prevalence, Risk Factors, and Control Strategies, Malaria J, 2025 Aug 8, 24:255, https://doi.org/10.1186/s12936-025-05492-6 are as follows: “Uganda, South Sudan, and Burundi report the highest malaria incidence (250 + per 1000), while Eritrea and Comoros maintain the lowest. Artemisinin partial resistance has reached > 20% in multiple areas, and pyrethroid resistance in Anopheles vectors is undermining control efforts. Climate change is expanding malaria transmission into highland zones. Funding gaps persist, with only 48% of required resources secured. Nonetheless, integrated strategies involving [ITNs], indoor residual spraying, vaccination, and community engagement reduce severe malaria by up to 47%.”
“Malaria control in African cities faces challenges mainly due to rapid and unplanned urbanization and the spread of the new urban malaria vector, Anopheles stephensi. By 2050, nearly 70% of the world`s population will live in urban areas, a significant increase from the current rate.” Merga H & al., Urban Malaria and Population Mobility in Sub-Saharan Africa: Systematic Review and Meta-Analysis, Malaria J, 2025 Aug 18, 24:264, https://doi.org/10.1186/s12936-025-05508-1 is a systematic review and meta-analysis that maps “the epidemiology of urban malaria in sub-Saharan Africa (SSA) [that] showed a high prevalence of urban malaria infection in SSA with high country-wise heterogeneity. … having a travel history and owning livestock in the house were identified as factors associated with urban malaria infection.”
Spatiotemporal studies
Setegn A & al., Prevalence and Associated Factors of Malaria Among Febrile Patients at Two Sites with Different Transmission Intensities, Northwest Ethiopia, Parasite Epidemiol Control. 2025 Jun 16; 30:e00441, https://doi.org/10.1016/j.parepi.2025.e00441
Chol CJ & al., Trend of Malaria Parasites Infection in Ethiopia Along an International Border: A Bayesian Spatio-Temporal Study, Infect Dis Poverty. 2025 Jul 11; 14(1):66, https://doi.org/10.1186/s40249-025-01320-w
Avenié TJD & al., Epidemiological Profile and Risk Factors for Malaria in Rural Communities Before the Operationalization of the Singrobo-Ahouaty Dam, Southern Cote d’Ivoire, Trop Med Infect Dis. 2025 Jul 15; 10(7):197, https://doi.org/10.3390/tropicalmed10070197
Gena A & al., Prevalence of Malaria, Anemia and Associated Factors Among School Children in Hawassa City, Sidama, Ethiopia, PLoS One. 2025 Jul 17; 20(7):e0327378, https://doi.org/10.1371/journal.pone.0327378
Mharakurwa S & al., Emergence of Urban Malaria and the Associated Risk Factors: A Case–Control Study in Mutare City, Zimbabwe, Malaria J, 2025 Jul 28, 24:245, https://doi.org/10.1186/s12936-025-05494-4
Akoma ON & al., A Cross-Sectional Survey of Malaria in Asymptomatic and Symptomatic Individuals in an Endemic Area of Northcentral Nigeria, J Vector Borne Dis. 2025 Jul 30, https://doi.org/10.4103/jvbd.jvbd_16_25
Adam J & al., Prevalence and Determinants of Malaria Among Children Aged 6–59 Months in Tanzania: A Nationwide Cross-Sectional Study, Malaria J, 2025 Aug 1, 24:247, https://doi.org/10.1186/s12936-025-05409-3#Sec2
Oniyelu DO & al., Time Series Analysis of Malaria in Pregnancy, Using Wavelet and SARIMAX Models, PLoS One. 2025 Aug 6; 20(8):e0328888, https://doi.org/10.1371/journal.pone.0328888