By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
“Following a nearly century-long effort, [The Republic of] Georgia has been certified malaria-free by the World Health Organization (WHO). With today’s announcement, Georgia joins the ranks of 45 countries and 1 territory that have achieved this milestone.” https://www.who.int/news/item/23-01-2025-georgia-certified-malaria-free-by-who
Gavi, the Vaccine Alliance, announced on 22 January that 9.8 million doses of malaria vaccines were administered in 15 African countries in 2024. Given that both WHO-approved vaccine series requires three shots followed by a booster a year later, that means that somewhat more than 3 million children received one or the other vaccine. That is of course but a small proportion of all African children who need protection from malaria.
On the same day WHO stated that “[o]ver 18 million doses of malaria vaccine were administered in the [African] Region in 2024.” It is unclear how that figure relates to the one cited from Gavi above.
Bloomberg reported on 27 January that during the recent rainy season malaria infections in Namibia spiked even higher than the previous year, which had seen an increase of 20% from the prior year.
On 28 January, Duke Global Health Institute published a news release claiming that its staff instituted Seasonal Malara Chemoprevention in Northwest Kenya with support from Catholic Relief Services and the Turkana County government in 2024 and preliminary results in January 2025 indicated a reduction of “cases of seasonal malaria by 70 percent among children.”
Readers of this report are probably already familiar with Stephanie Nolen’s article in the New York Times on 1 February. If not, its title is “Health Programs Shutter Around the World After Trump Pauses Foreign Aid.”
With a title of When words fail, the MalariaWorld website published an editorial which stated in part: “The U.S. withdrawal from the World Health Organization, the freeze of health and foreign aid, and the ruthless causing of uncertainty and heartless dismissing of people, also in our field of work.”
On 12 February, News-Medical.net reported on a news release by Sanaria Inc., which extolled the possibility of a single-shot vaccine against falciparum malaria. The news release has a very optimistic headline; it refers to the Roozen & al. article on which we reported last month. There is also commentary on the same subject by Goswami and Kappe (see below).
PEER REVIEWED ARTICLES (see notes after citations from non-peer-reviewed publications)
Prevention
Vaccines
Seidlein LV, Roll out and Prospects of the Malaria Vaccine R21/Matrix-M, PLoS Med. 2025 Jan 17; 22(1):e1004515, https://doi.org/10.1371/journal.pmed.1004515 is a complex article that includes not only the topic identified in the title, but a brief background of the RTS,S/A01 vaccine as well as an analysis of the ongoing and current need for vaccines.
Diawara H & al. report in Acceptability of the R21/Matrix-M Malaria Vaccine Alongside Existing Malaria Interventions in the Trial Context, BMJ Glob Health. 2025 Feb 3; 10(2):e015524, https://doi.org/10.1136/bmjgh-2024-015524 that in Mali, “[a]cceptability of the R21/Matrix-M vaccine was driven mainly by the high burden of malaria in the highly seasonal study area and consequent demand for a malaria vaccine, a perceived high efficacy of the R21/Matrix-M vaccine, and a high level of trust and confidence in the trial and trial team. These perceptions of the acceptability of the R21/Matrix-M vaccine led to a reduced perceived importance of seasonal malaria chemoprevention (SMC) among some caregivers, while others viewed R21/Matrix-M, SMC and insecticide-treated nets as complementary.”
In one of the many follow ups after the introduction of the RTS,S/AS01E vaccine, Ali MS & al. noted the fact that immune responses after vaccinating children are short lived. This includes the response after the booster dose given after one year. In The Anti-Circumsporozoite Antibody Response to Repeated, Seasonal Booster Doses of the Malaria Vaccine RTS,S/AS01E, NPJ Vaccines. 2025 Feb 6; 10(1):26, https://doi.org/10.1038/s41541-025-01078-0, the authors describe what happens when boosters are repeated every year up to age five just before the high transmission season in two Sahel countries. They noted that “a high, although declining, level of efficacy was sustained” in the 150 children studied. Children with the highest levels of response had better protection against malaria than those with lower response.
Su XZ & al. note that the currently available malaria vaccines have limited efficacy and induce limited durability of immunity. In Malaria: Factors Affecting Disease Severity, Immune Evasion Mechanisms, and Reversal of Immune Inhibition to Enhance Vaccine Efficacy, PLoS Pathogens, 2025 Jan 23, https://doi.org/10.1371/journal.ppat.1012853, the authors state that “overcoming the systematic immune inhibition and immune cell dysfunction/exhaustion may be required before high titers of protective antibodies can be achieved” and review “the factors affecting the disease severity, the genetics of host–parasite interaction, immune evasion mechanisms, and approaches potentially to improve host immune response for vaccine development.”
Kisambale AJ & al., Genetic Diversity of Plasmodium falciparum Reticulocyte Binding Protein Homologue-5, Which Is a Potential Malaria Vaccine Candidate: Baseline Data from Areas of Varying Malaria Endemicity in Mainland Tanzania, Malaria J, 2025 Jan 27, 24:29, https://doi.org/10.1186/s12936-025-05269-x basically confirms what has already been reported elsewhere, namely that the P. falciparum protein that is a potential target of new vaccines demonstrates low level of genetic diversity, enhancing the likelihood that a vaccine against it may be more broadly effective than the two vaccines currently employed in Africa.
DNA vaccines work on the same principle as mRNA vaccines (induce the vaccinee’s cells to manufacture a protein, which then provokes an immune response) but are stable at room temperature. Cao Y & al., Distinct Immunogenicity Outcomes of DNA Vaccines Encoding Malaria Transmission-Blocking Vaccine Target Antigens Pfs230D1M and Pvs230D1, Vaccine. 2025 Jan 8; 47:126696, https://doi.org/10.1016/j.vaccine.2024.126696 studied the DNA vaccine approach for transmission blocking vaccines against both P. falciparum and P. vivax. The authors conclude that their results demonstrate the potential of their approach in eventually synthesizing potent transmission blocking vaccines against each of the two species.
After a review of 28 publications related to malaria vaccine clinical trials in Africa (and 22 related to TB vaccine trials), Hamisi MA & al., A Systematic Review on Malaria and Tuberculosis (TB) Vaccine Challenges in Sub-Saharan African Clinical Trials, PLoS One. 2025 Jan 24; 20(1):e0317233, https://doi.org/10.1371/journal.pone.0317233 concludes that “[f]actors such as population characteristics, pathogen genetic diversity, vaccine nature, strategy, and formulation were associated with slow progress of the malaria and TB vaccine candidates in sub-Saharan African clinical trials.” The conclusion is somewhat surprising, given that in the Results section the authors state the following: “the major challenges in sub-Saharan African clinical trials were immunogenicity and efficacy, rather than safety.”
The Lancet recently published three letters relating to Datoo MS & al.’s article, Safety and Efficacy of Malaria Vaccine Candidate R21/Matrix-M in African Children: A Multicentre, Double-Blind, Randomised, Phase 3 Trial, Lancet. 2024 Feb 1: S0140-6736(23)02511-4, https://doi.org/10.1016/s0140-6736(23)02511-4, in which the correspondents raise concerns about the durability of immunity, access to the vaccine, relationship to other vaccination schedules, and possible excess female mortality relating to the vaccines. The three letters are all published under the same heading, The R21/Matrix-M Malaria Vaccine: Questions Remain, Lancet. 2025 Jan 25; 405(10475):298-99, and can be accessed at https://doi.org/10.1016/s0140-6736(24)02777-6 and https://doi.org/10.1016/s0140-6736(24)02778-8
Dar es Salaam remains the effective capital of Tanzania, while the newly designated capital in Dodoma is being developed. Mwingira F & al.’s paper, Knowledge and Willingness Towards Malaria Vaccines Among Caregivers in Dar es Salaam, Tanzania, Malaria J, 2025 Feb 6, 24:35, https://doi.org/10.1186/s12936-024-05183-8 explores the attitudes toward malaria vaccination in this relatively sophisticated population. Respondents to their survey “were predominantly women (97.3%) aged 18 to 52 years. Overall, 87.4% had knowledge of malaria disease, …. Most respondents (86.3%) knew about malaria prevention/control methods. However, only 14.7% of the recruited caregivers were aware of the malaria vaccine. Of those exposed to vaccine messages, 67.4% were aware that the vaccine was for children under 5 years of age, while 53.5% knew that the vaccine was for pregnant women. Despite their low exposure, most respondents (92.8%) were willing to receive the malaria vaccine for their children under five years.” The authors advocate more effective community education.
By contrast, Adigwe OP & Onaybayba G found the following in 1413 responses to questionnaires sent during a national survey in Nigeria: “More than two-thirds (69.6%) of the participants indicated that they were worried about side effects that may be associated with the malaria vaccine. A strong majority (90%) of the participants indicated that the vaccine should be administered at no cost to citizens, while 46.7% of the respondents were willing to pay for the malaria vaccination. Levels of education attained by the respondents influenced their willingness to pay for malaria vaccination. This variable also underpinned participants’ reasons for non-acceptance of the vaccine. Those who attained only primary and secondary levels of education were significantly more likely to reject the malaria vaccine because they were against vaccines in general…” The paper is Acceptance and Affordability of Malaria Vaccines: Issues Relating to Hesitancy and Willingness to Pay Amongst Nigerian Parents of Under-Five Children, Malaria J, 2025 Feb 7, 24:36, https://doi.org/10.1186/s12936-025-05268-y
In a study of access by 4662 households to insecticide treated bed nets and vaccines, Ko YK & al. report in Where is the Hard-To-Reach Population? Spatial Analysis from a Cross-Sectional Study on the Access to Bed Net and Malaria Vaccine in the Lake Victoria Region, Kenya, Malaria J, 2025 Feb 12, 24:42, https://doi.org/10.1186/s12936-025-05280-2 that the “overall uptake proportions were 89.9% for net distribution, 84.4% for net usage, 88.2% for vaccine uptake, and 53.7% for vaccine completion. All four outcomes showed [statistically significant] geographical heterogeneity … Distance to the nearest health centre was negatively associated with all outcomes. Household wealth was positively associated with all outcomes.”
Goswami D & Kappe SHI, Setting Sights on a Single-Shot Malaria Vaccine, Nature Med, 2025 Jan 3, 31:33-34, https://doi.org/10.1038/s41591-024-03427-3 is a commentary on Roozen GVT, van Schuijlenburg R, Franke-Fayard BMD & al., Single Immunization with Genetically Attenuated PfΔmei2 (GA2) Parasites by Mosquito Bite in Controlled Human Malaria Infection: A Placebo-Controlled Randomized Trial, Nature Med. 2025 Jan 3, https://doi.org/10.1038/s41591-024-03347-2 (reported last month). This commentary emphasizes the possibility that the GA2 vaccine may be effective after a single injection. However, the commentary itself is behind a paywall, so it could not be reviewed in detail.
Chick JA & al. used artificial intelligence to design a vaccine candidate that contained components from both pre-erythrocytic and blood-stage parasites. They report that in experiments on mice, the substance triggered a strong immune response and the mice sowed no evident “adverse reactions.” The article is Computational Design, Expression, and Characterization of a Plasmodium falciparum Multi-Epitope, Multi-Stage Vaccine Candidate (PfCTMAG), Heliyon. 2025 Jan 18; 11(2):e42014, https://doi.org/10.1016/j.heliyon.2025.e42014.
Dacon C & al., Protective Antibodies Target Cryptic Epitope Unmasked by Cleavage of Malaria Sporozoite Protein, Science, 2025 Jan 3, 387:6729, https://doi.org/10.1126/science.adr0510 is a basic science immunology article identifying a location on the circumsporozoite protein of P. falciparum other than that targeted by the current vaccines, which, in the view of the authors may be a more useful target of vaccines or monoclonal antibodies in the future.
The somewhat cryptic abstract of Nema S & al.’ s article, Unlocking the Potential of Blood-Stage Vaccines for Malaria Elimination, Trans R Soc Trop Med Hyg. 2025 Feb 8: traf013, https://doi.org/10.1093/trstmh/traf013 states: “… Currently, pre-erythrocytic vaccines like RTS, S/AS01 and R21/Matrix-M are in use, but their effectiveness is limited. Ongoing research on blood-stage vaccine candidates such as RH5, MSP1 and MSP3 has shown promising results. Incorporating a blood-stage vaccine could greatly enhance malaria control by targeting the symptomatic phase of the infection, providing additional protection alongside pre-erythrocytic vaccines and other control methods. …. Combining pre-erythrocytic and erythrocytic-stage vaccines could lead to better protection, improved public health outcomes and significant progress toward malaria elimination.” The article itself is behind a paywall.
Mulamba C & al., Plasmodium falciparum Gametocyte Burden in a Tanzanian Heterogeneous Transmission Setting, Malaria J, 2025 Feb 21, 24:54, https://doi.org/10.1186/s12936-025-05270-4 relates to the development of transmission blocking vaccines and is described below, under Epidemiology.
Vectors
The indoor residual spraying (IRS) agent “VECTRON™ T500, with broflanilide as its active ingredient, is a recently developed candidate insecticide formulation which has shown promising results in certain phase II experimental hut trials. Simma EA & al. “evaluated the efficacy of VECTRON™ T500 on various wall surfaces (mud, dung, paint, and cement) and assessed its decay rates over time in Ethiopia.” Their article, Determination of the Residual Efficacy of Broflanilide (VECTRON™ T500) Insecticide for Indoor Residual Spraying in a Semi-Field Setting in Ethiopia, Malaria J, 2025 Feb 13, 24:44, https://doi.org/10.1186/s12936-024-05239-9 reports on comparing this compound with the use of Actellic 300CS or spraying with water only in huts with various wall compositions. The results of actual killing rates of Anopheles mosquitoes showed that “VECTRON™ T500 induced over 80% mortality across all wall surface types throughout the entire nine-month study period. In contrast, Actellic® 300CS achieved over 80% mortality for six months, except on dung wall surfaces, after which its efficacy declined sharply below 80%.”
Ngongang-Yipmo ES & al. “assessed the efficacy of the dual active ingredients net Royal Guard against pyrethroids-resistant malaria vectors in Cameroon, establishing its long-term impact on mosquitoes’ life traits after exposure.” They observed that despite the inadequate killing of resistant mosquitoes by these nets, the exposed An. funestus population was observed to have lower fecundity and lower blood feeding ability. The paper is Long-Term Impact of Exposure to Royal Guard, a Pyriproxyfen-Based Bed Net, on Pyrethroid-Resistant Malaria Vectors from Cameroon Using DNA-Based Metabolic Resistance Markers, Pest Manag Sci. 2025 Jan 23, https://doi.org/10.1002/ps.8615.
Commenting on the variable longevity of insecticide treated nets (ITNs) after mass distributions, Gunderson AK & al. addressed the ITN “coverage gap that emerges in the period after mass distribution campaigns through the implementation of a novel [ITN] distribution strategy utilizing the existing community healthcare worker (CHW) infrastructure.” They report in Targeted Distribution of Long-Lasting Insecticidal Nets by Community Health Workers to Sustain Household Coverage: A Pilot Feasibility Study in Western Uganda, PLOS Glob Public Health. 2025 Jan 24; 5(1):e0003660, https://doi.org/10.1371/journal.pgph.0003660 that in a pilot study during which CHW’s identified the need for additional ITNs in two villages, but distributed nets only in one of them, they found that appropriate utilization of nets increased in the village in which nets were distributed, but declined in the control village.
Davis KM, & al., An Observational Study Evaluating the Epidemiological and Entomological Impacts of Piperonyl Butoxide Insecticide-Treated Nets (ITNs) Compared to a Combination of Indoor Residual Spraying (IRS) Plus Standard Pyrethroid-Only ITNs in Amhara Region, Ethiopia, BMJ Glob Health. 2025 Jan 29; 10(1):e016617, https://doi.org/10.1136/bmjgh-2024-016617 reports that there was “a positive impact of non-pyrethroid IRS deployed annually alongside standard pyrethroid ITNs in a setting of confirmed pyrethroid resistance. While an overall positive impact of PBO ITNs was detected, a waning impact of the nets 2 years post distribution was observed.”
Lissenden N & al. compared “the efficacy of three different partially treated net[s] relative to fully treated nets; roof-only treated nets, side-only treated nets, and nets with treated roof and pyrethroid-only side panels.” These trials, reported in Meta-Analysis on the Entomological Effects of Differentially Treated ITNs in a Multi-Site Experimental Hut Study in Sub-Saharan Africa, Malaria J, 2025 Feb 4, 24:34, https://doi.org/10.1186/s12936-025-05264-2 “were conducted on a range of net products with different [active ingredients], across a range of geographies in Africa (East and West), vector species (Anopheles gambiae, Anopheles coluzzii, Anopheles arabiensis, and Anopheles funestus), hut designs (East and West African style) and hosts (cows and humans).” The unsurprising results “showed that partially-treated net that restrict the insecticide treatment to specific panels of an ITN do not give equivalency or superiority in either mortality or blood-feeding inhibition to fully treated nets.”
“The insecticidal effectiveness of ITNs” at various time intervals after distribution was assessed with the World Health Organization (WHO) cone test using a laboratory-reared, susceptible colony of Anopheles coluzzii by Cisse MBM & al., who report in Use of a Portable Field-Adapted Liquid Chromatographic System (C-Vue Machine) to Estimate the Quantity of Deltamethrin on Insecticide-Treated Nets Paired with WHO Cone Bioassays to Determine ITN Bioefficacy as Part of Three-Year Durability Monitoring in Mali, Malaria J, 2025 Feb 20, 24:53, https://doi.org/10.1186/s12936-025-05261-5 that “net type effectiveness and insecticide content were consistently lower than expected at 3 years, and users washed nets with local soaps containing sodium hydroxide, detergent or bleach.”
“Although insecticide-treated nets (ITNs) are essential interventions for preventing malaria, their use in Nigeria is still sub-optimal.” Barrow A & al. investigated “the prevalence of and factors associated with ITN use among women of reproductive age in Nigeria” They report in Coverage and Contextual Factors Associated with Insecticide-Treated Net Use Among Women of Reproductive Age in Nigeria: Evidence from the 2021 Malaria Indicator Survey Data, PLOS Glob Public Health. 2025 Feb 18; 5(2):e0004207, https://doi.org/10.1371/journal.pgph.0004207 that the ”weighted prevalence of ITN use was 41.5% … The results showed Muslim women had 21% … lower odds of ITN use, when compared with the Christian women. Those who had living children were more likely to report ITN use, when compared with women with no child. The non-poor women had higher odds of ITN use, when compared with the poor women … ,women from multi-ethnic [communities] had 26% lower odds of ITN use, when compared with those from mono-ethnic community.”
Williams SMT & al. studied ITN use in two communities in Sierra Leone that house universities. As reported in Assessing Insecticide Treated Nets Awareness at Njala University: Case Study of Njala and Towama Campuses, Sierra Leone, BMC Public Health. 2025 Feb 10; 25(1):532, https://doi.org/10.1186/s12889-024-21007-5, they found high awareness of the recommendation to use the nets. “… factors like age, sex, education, marital status, and sources of information were significantly associated with ITN knowledge and utilization. Moreover, health workers’ campaigns and interpersonal networks (community leaders, plus family and friends) play crucial roles in promoting ITN utilization, while mass media campaigns alone may not suffice.” However, almost half of the participants found “current ITN campaign strategies” ineffective.
Abu Bonsra E & al., Insecticide-Treated Bed Nets (ITN) Ownership and Utilization Patterns Among Caregivers with Children Under Five Years: A Community-Based Cross-Sectional Study in Battor, North Tongu District, Ghana, PLOS Glob Public Health. 2025 Feb 6; 5(2):e0004228, https://doi.org/10.1371/journal.pgph.0004228 is yet another article reporting underutilization of ITNs. In the community they studied, net ownership was as low as 77 out of 211 households surveyed. As usual, the factors involved included “sex …, educational level …, marital status …, religion …, challenges faced in using ITNs …, affordability …, and cultural beliefs…” The authors’ recommendations are also similar to that of others: “To enhance ITN utilization, the Ghana Health Service should tailor interventions to address practical barriers and improve educational outreach, bridging the gap between knowledge and usage.”
The extension of the habitat of Anopheles stephensi to Africa has created new problems in larval management, since this mosquito tends to lay its eggs in urban water collections. Further, according to Yared S & al., Anopheles stephensi Larval Habitat Super Productivity and Its Relevance for Larval Source Management in Africa, bioRxiv [Preprint]. 2025 Jan 24: 2025.01.23.633752, https://doi.org/10.1101/2025.01.23.633752, as “the dry season progressed, An. stephensi productivity significantly concentrated in large water reservoirs (for drinking and construction) to a point in which up to 77% of all larvae originated from 23% of the sites. Such superproductive sites were primarily water cisterns used for residential or construction purposes.” The authors comment on the implications of this finding on larval control management. {bioRxiv is a website that publishes submitted papers without formal peer review.}
Okumu F & al. express concern in Elevating Larval Source Management as a Key Strategy for Controlling Malaria and Other Vector-Borne Diseases in Africa, Parasit Vectors. 2025 Feb 7; 18(1):45, https://doi.org/10.1186/s13071-024-06621-x that larval source management (LSM) is not being supported adequately. They attribute this situation the fact that in WHO’s guidelines “recommend the use of LSM as a supplementary intervention to the core vector control methods (insecticide-treated nets and indoor residual spraying), arguing that its feasibility in many settings can be limited by larval habitats being numerous, transient, and difficult to find or treat.” In contrast, real life experiences have led the authors to conclude that the modality may have more merit. However, research into it is not very heavily funded. The authors suggest that “having WHO guidelines that recognize LSM as a key intervention to be delivered in multiple contextualized forms would open the door to increased flexibility for funding and aid…”
In order to better understand the optimal application of larviciding, Marubini E & al. studied the water characteristics where mosquito larvae hatched and the water composition in those bodies of water. Anopheles arabiensis Larval Habitats Characterization and Anopheles Species Diversity in Water Bodies from Jozini, KwaZulu-Natal Province, Malaria J, 2025 Feb 20, 24:52, https://doi.org/10.1186/s12936-025-05287-9, is their article, which reports that the predominant species in these bodies was An. arabiensis. The paper also enumerates the chemical characteristics of waters that host these larvae.
Heavy metals are known to be larvicidal for mosquitoes. Koto Yérima Gounou Boukari M & al., Exposure to Copper Metal Enhances the Tolerance of An. gambiae s.s. over Multiple Generations While Reducing Both Fertility and Fecundity in this Primary Malaria Vector, Wellcome Open Res. 2025 Feb 5; 9:623, https://doi.org/10.12688/wellcomeopenres.23229.2 reports laboratory testing of copper exposure to An. gambiae larvae. The higher the concentration the copper was, the more effective the larvicidal effect. In subsequent generations, adult mosquitoes that emerged from surviving larvae demonstrated lower rates of egg production (fecundity) and lower hatching rate of the eggs laid (fertility). This works against the previously noted effect of larval tolerance of heavy metals in subsequent generations.
“Entomopathogenic fungi engineered to express insect-specific neurotoxins have demonstrated potential as microbial control agents against malaria mosquitoes. Currently, the primary application method is via direct contact of spores with indoor resting mosquitoes. However, many malaria-transmitting mosquitoes feed and rest outdoors. To target these, [Bilgo E & al.] developed an alternative application method that exploits the lethality of transgenic fungi as a sexually transmitted mosquito disease.” In Transmission of Transgenic Mosquito-Killing Fungi During Copulation, Sci Rep, 2025 Jan 6, 5:2181, https://doi.org/10.1038/s41598-024-83242-5, the authors describe the experiments that resulted in close to 100% lethality in female Anopheles after mating with infected males. However, this degree of lethality was restricted to the first 24 hours of experimentally infecting the males.
Much has been written about the possible application of gene drive to eliminate insect vectors of certain diseases. Larrosa-Godall M & al., Challenges in Developing a Split Drive Targeting dsx for the Genetic Control of the Invasive Malaria Vector Anopheles stephensi, Parasit Vectors. 2025 Feb 7; 18(1):46, https://doi.org/10.1186/s13071-025-06688-0 relates the experience the authors had in inserting a gene in male and female Anopheles mosquitoes to reduce the female population. The outcome of repeated crossings was that “dominant effects on male and female fertility were observed, which would be sufficient to hinder spread of such a drive.” The paper highlights the difficulties in employing the technique.
Xu X & al., Gene Drive-Based Population Suppression in the Malaria Vector Anopheles stephensi, Nat Commun. 2025 Jan 24; 16(1):1007, https://doi.org/10.1038/s41467-025-56290-2 claims success in creating the same mutation that did not materially affect outcomes in the paper above. Even though this article was published earlier than the above one, the likelihood is that the investigations of the two groups took place at the same time.
Chemoprophylaxis,
The results of using seasonal malaria chemoprevention (SMC) for children under age 10 over one season in accordance with WHO recommendation are described by Kazanga B & al. in Impact of Seasonal Malaria Chemoprevention Timing on Clinical Malaria Incidence Dynamics in the Kedougou Region, Senegal, PLOS Glob Public Health. 2025 Jan 15; 5(1):e0003197, https://doi.org/10.1371/journal.pgph.0003197. “Children under SMC presented an overall lower incidence compared to older children and young adults. Among children eligible for SMC, the incidence was lowest for approximately 3 weeks after treatment administration and increased subsequently, suggesting a gradual loss of protection. At the end of the high transmission period, a higher malaria incidence was recorded from the 3rd to 6th week after the week of administration of the fourth (final) SMC round.” Based on these results, the authors recommend “adjustment to reduce exposure before the next round, to increase protection of 5-9 years, and to cover the high transmission period completely.”
Malaria Consortium, in partnership with the National Malaria Control Programme, conducted a two-year phased SMC study in Nampula province [Mozambique], using sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ), or SPAQ, in children under five. Baker K & al., Phase One of a Hybrid Effectiveness-Implementation Study to Assess the Feasibility, Acceptability and Effectiveness of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique, Malaria J 2025 Feb 21, 24:56, https://doi.org/10.1186/s12936-024-05229-x reports that “[c]hildren who received SMC had 86% … lower hazards of developing clinical malaria during the peak transmission season compared with children in the comparison district. … SMC achieved high coverage of eligible children over four cycles (87.7%)…”
Kretchy IA & al., Enhancing the Uptake of Intermittent Preventive Treatment for Malaria in Pregnancy: A Scoping Review of Interventions and Gender-Informed Approaches, Malaria J, 2025 Feb 18, 24:49, https://doi.org/10.1186/s12936-025-05275-z is a report on 32 articles that discuss various methods of increasing patients’ acceptance of intermittent preventive treatment against malaria during their pregnancies (IPTp).
Although the title of Tshiongo JK & al.’s Intermittent Screening Using Ultra-Sensitive Malaria Rapid Diagnostic Test and Treatment with Pyronaridine-Artesunate Compared to Standard Preventive Treatment with Sulfadoxine-Pyrimethamine for Malaria Prevention in Pregnant Women in Kinshasa, DRC, Malaria J, 2025 Feb 21, 24:58, https://doi.org/10.1186/s12936-025-05260-6 mentions “preventive treatment,” the authors actually espouse diagnosing and treating asymptomatic malaria with a new regimen, which, according to their conclusion is “non-inferior” to the WHO recommended intermittent preventive treatment of pregnancy with sulfadoxine- pyrimethamine (IPTp-SP). They therefore hold it out as potential replacement in case of continuing reports of resistance to SP.
Another chemopreventive regimen was recently recommended by WHO for children under five years of age who are discharged from hospitals after treatment for severe malaria and who are anemic. Ndambo MK & al. report on the preparations for installing post discharge chemo-prevention using dihydroartemisinin-piperaquine. Their article, Conceptualizing the Implementation of Post-Discharge Malaria Chemoprevention in Malawi Using a Co-Design Approach, Malaria J, 2025 Feb 19, 24:51, https://doi.org/10.1186/s12936-025-05265-1, reports on the planning process, not the actual implementation.
Other
“Controlled human malaria infection (CHMI) involves the intentional infection of healthy individuals with malaria parasites, close observation of the volunteers, and clearance of the parasite at a predetermined endpoint. … Among other uses, CHMI has proven to be a useful tool for the evaluation of new malaria interventions, particularly vaccines and drugs.” Kessy EJ & Olotu AI, Controlled Human Malaria Infection: Overview and Potential Application in the Evaluation of Transmission-Blocking Interventions in Malaria-Endemic Areas, Malaria J, 2025 Feb 1, 24:33, https://doi.org/10.1186/s12936-025-05277-x advocates use of the technique in sub-Saharan Africa ion order to enhance research into interfering with malaria transmission by a variety of means.
Diagnosis
General diagnostics
Polymerase Chain Reaction (PCR) is considered the most reliable test for malaria infection. However, its requirements preclude its use in Rural settings in Africa and even for epidemiologic studies that may not require immediate results, the logistics of collecting and transporting enough blood specimens for meaningful statistical data can be daunting. Mediavilla A & al. explored the reliability of using dried blood spots instead of venous or capillary blood for this purpose. As they report in Evaluation of Dried Blood Spot Sampling for Real-Time PCR Malaria Diagnostics in a Rural Setting in Angola, Parasit Vectors. 2025 Feb 7; 18(1):44, https://doi.org/10.1186/s13071-025-06685-3, the reliability of PCR derived from dried blood spots is largely dependent on the amount of blood in the spots. The authors state that 50 μL or more is the minimum that will yield acceptable sensitivity and even at that level, some positive results (as determined by PCR on whole blood) will be missed.
Field diagnostics
Ngasala B & al. “explored the rate of false-positive and false-negative [rapid diagnostic test (mRDT or RDT)] results among asymptomatic persons >5 years old screened for malaria at schools and clinics in the rural Bagamoyo District using 18S ribosomal RNA real-time polymerase chain reaction (qPCR) as the reference test. As they report in Assessment of Malaria Rapid Diagnostic Tests and Histidine-Rich Protein 2 Deletions among Asymptomatic Children and Adults in Bagamoyo, Tanzania, Am J Trop Med Hyg. 2025 Jan 21: tpmd240209, https://doi.org/10.4269/ajtmh.24-0209, in “an area of low to moderate transmission in Tanzania, false-positive mRDTs are relatively common (12% of positive tests), and false-negative mRDTs are even more common (22% of negative tests), but hrp2/3 deletion causing false-negative mRDTs remains rare (<1% of negative tests).” This raises the question as to what the cause of the other false negative mRDTs was.
Christian M & al. used an RDT that measures both histidine-rich protein (HRT) and lactic dehydrogenase and report in Evaluation of CareStart™ Malaria HRP2/pLDH (Pf/PAN) Combo Rapid Diagnostic Test for Diagnosis of Plasmodium falciparum Infection in Malaria Co-Endemic Areas in Association with Parasite Density, Malaria J, 2025 Feb 10, 24:39, https://doi.org/10.1186/s12936-025-05276-y not only that the test ha very high sensitivity and specificity in comparison to microscopy, but that it is also indicative of high density parasitemia and therefore indicates urgency of treatment. {However, whereas with such high sensitivity and specificity the argument is that essentially all those testing positive with Pf/PAN have severe malaria, there is no indication of the severity of illness experienced by the patients who were the subjects of the study.}
New diagnostic methods
None this month
Treatment
Treatment results
Newborns are subject to malaria transmitted through the placenta if their mothers are not adequately treated for their infection. Kokori E & al., Prevalence, Characteristics, and Treatment Outcome of Congenital Malaria in Nigeria: A Systematic Review, Malaria J, 2025 Jan 22, 24:24, https://doi.org/10.1186/s12936-025-05257-1 is a review of all aspects of this situation in Nigeria, based on published papers on congenital malaria. The findings revealed significant inconsistency. “The prevalence of congenital malaria in Nigeria ranged from as low as 5.1% to as high as 96.3%. Clinical manifestations were often non-specific, with fever being the most common symptom. Treatment regimens included a variety of antimalarial drugs, such as chloroquine, sulfadoxine-pyrimethamine, amodiaquine, quinine, and artemisinin-based combination therapy. While treatment outcomes were generally positive, some studies reported complications and deaths.”
It is important to know whether individuals’ recurrent malaria infections are caused by reinfection, or therapeutic failure. The WHO recommends genotyping polymorphic markers … distinguishing recrudescences from reinfections. Recently, WHO proposed” changing the methodology. Mwesigwa A & al., Assessment of Different Genotyping Markers and Algorithms for Distinguishing Plasmodium falciparum Recrudescence from Reinfection in Uganda, Sci Rep. 2025 Feb 5; 15(1):4375, https://doi.org/10.1038/s41598-025-88892-7 compared the two methods and related them to the antiplasmodial therapy the patients received. The authors found discrepancies in the results when measured against two different therapeutic regimens and recommend resolving which one method is more reliable and using only that one.
Pleas see Tshiongo JK & al. Intermittent Screening Using Ultra-Sensitive Malaria Rapid Diagnostic Test and Treatment with Pyronaridine-Artesunate Compared to Standard Preventive Treatment with Sulfadoxine-Pyrimethamine for Malaria Prevention in Pregnant Women in Kinshasa, DRC, Malaria J, 2025 Feb 21, 24:58, https://doi.org/10.1186/s12936-025-05260-6 above under Prevention/Chemoprophylaxis.
Side effects and complications
None this month
Drug resistance
Osoti V & al. studied dried blood spots from asymptomatic schoolchildren in several communities in Kenya and report in Detection of Low Frequency Artemisinin Resistance Mutations, C469Y, P553L and A675V, and Fixed Antifolate Resistance Mutations in Asymptomatic Primary School Children in Kenya, BMC Infect Dis. 2025 Jan 16; 25:73, https://doi.org/10.1186/s12879-025-10462-z that many of them displayed one or another genetic mutation that has been associated with artemisinin resistance, although none of the mutations mentioned in the title, nor any of the others studied manifested themselves in a high percentage of the specimens.
After the finding of a mutation in P. falciparum that is associated with artemisinin resistance in Senegal, Wade A & al. embarked on a study, Monitoring Molecular Markers Associated with Antimalarial Drug Resistance in South-East Senegal from 2021 to 2023, J Antimicrob Chemother. 2025 Jan 23: dkaf006, https://doi.org/10.1093/jac/dkaf006. They report that over a three-year period, in an unknown total number of patients diagnosed with P. falciparum infection, none of the parasites obtained from the patients caried the specific mutation. The authors nonetheless recommend continuing surveillance.
Rwanda stopped using chloroquine in the treatment of malaria more than 20 years ago, and while others have reported the disappearance of the genes associated with chloroquine resistance, Schallenberg E & al., found the genes in current years, as reported in Prevalence of Plasmodium falciparum Drug Resistance Markers pfcrt K76T and pfaat1 S258L in Southern Rwanda, 2010 to 2023, J Infect Dis. 2025 Feb 12: jiaf068, https://doi.org/10.1093/infdis/jiaf068. One of the artemisinin resistance gene mutations was also associated with the chloroquine resistant gene.
The spread of artemisinin resistance in Africa is now highly likely. The major recommendation on how to deal with this currently is to add a third drug to the regimen. Tarning J & al., Dose-Optimization of a Novel Co-Formulated Triple Combination Antimalarial Therapy: Artemether-Lumefantrine-Amodiaquine, Clin Pharmacol Ther. 2025 Feb 12, https://doi.org/10.1002/cpt.3582 reports on analytic work to develop optimal dosing. The authors propose a “drug-to-drug ratio of artemether-lumefantrine-amodiaquine (20:120:40 mg)…”
New drug research
Bouzón-Arnáiz I & al. report their laboratory research of a compound that they have identified as inhibiting protein metabolism in the malaria parasite in YAT2150 Is Irresistible in Plasmodium falciparum and Active Against Plasmodium vivax and Leishmania Clinical Isolates, Sci Rep. 2025 Jan 23; 15(1):2941, https://doi.org/10.1038/s41598-025-85346-y. They attempted to demonstrate resistance to the drug in the laboratory and failed to do so. They also report the compound to be active against the two other parasites mentioned in the title of the paper.
Zuma LK & al., Assessing the Efficacy of Iso-Mukaadial Acetate and Betulinic Acid Against Selected Plasmodium falciparum Glycolytic Pathway Proteins: in silico and in vitro Studies, BMC Chem. 2025 Jan 18; 19(1):16x, https://doi.org/10.1186/s13065-025-01380-x is another laboratory study of two potential drug candidates against P. falciparum. In their words, “[p]arasite inhibition studies confirmed potent antimalarial activity against the P. falciparum NF54 strains…”
Nur Aisyah A & al. report that the “combination of the active compounds curcumin and piperine (CP) is effective as an antimalarial; however, the solubility and bioavailability of CP are very low.” Therefore they formulated a preparation that can be delivered transdermally and report in Development of a Curcumin-Piperine Nanoparticle System Using Dissolving Microneedles for Transdermal Drug Delivery in Malaria Treatment: in vitro Evaluation, Int J Pharm. 2025 Jan 21; 671:125258, https://doi.org/10.1016/j.ijpharm.2025.125258 that the formulation had antiplasmodial activity and the delivery system was effective in the laboratory. The authors also state that they observed “no toxicity” but the abstract is silent on how that was tested.
Another new substance under investigation by Melo CR & al. is “CH3ISACN,” which has already been shown to have activity against Plasmodium in the laboratory. In Study of Antiplasmodial Activity, Toxicity, Pharmacokinetic Profiles of n-Methyl-isatin (CH3ISACN) Derivative, Exp Parasitol. 2025 Jan 28:108910, https://doi.org/10.1016/j.exppara.2025.108910 that there “was no behavioral change in the animals, [and on] histological study, no changes were found that would indicate intoxication in the organs of the animals.” The authors also state that it had “good theoretical oral bioavailability.”
Zinc pyrithione is a preparation widely used against dermatologic conditions; it has fungistatic and bacteriostatic properties. Rajendran V & Sivaraja YR investigated it possible effects on P. falciparum in the laboratory. As reported in Zinc Pyrithione Inhibits Blood Stage Parasites of Plasmodium falciparum and Its Combinatorial Effect with Dihydro-Artemisinin and Chloroquine In Culture, Parasitol Int. 2025 Feb 11: 103041, https://doi.org/10.1016/j.parint.2025.103041, the substance had more effect on the blood stage of the parasite than on the pre-erythrocytic stage. All the same, the apparent inhibitory effect was demonstrated in terms of morphological changes under the microscope rather than killing the parasite.
Plant extracts and traditional treatments
Okoh MP & al., Unveiling the Potential of Natural Resources-Derived Therapeutics for Improved Malaria Management: Computational to Experimental Studies, Adv Biol (Weinh). 2024 Dec 19: e2400282, https://doi.org/10.1002/adbi.202400282 “focuses on understanding preventive measures, mutation-based disease evolution, malaria-related biomarkers, and potential plant bioactive components for the treatment and management of malaria. The burden of malaria drug resistance has made it necessary for scientists to focus on alternative therapeutics, with particular interests in those involving plant-based bioactive components that could mediate biochemical pathways, consisting of metabolic interactions essential for parasitic inhibition… Additionally, this work discusses the barriers while developing drugs from phytochemicals and the steps needed to accelerate the development of new antimalarial from the lead compounds.”
Damé SM & al. studied the effects of eight plants used by folk medicine practitioners in Niger against malaria. In their paper, In vitro Antiplasmodial Activity and Chemical Composition of Combretum aculeatum, a Medicinal Plant from Niger, Chem Biodivers. 2025 Jan 30: e202401621, https://doi.org/10.1002/cbdv.20240162, they focus on the one with the most pronounced effect on P. falciparum in the laboratory. They found that the ”ethyl acetate extract of Combretum aculeatum (2a) demonstrated important antiplasmodial activity.” However, when they tried to further isolate the active component, its effects by itself were insufficient to account for the effect of the crude extract. Further work to find the most effective component is needed.
Other
“Informal Healthcare Providers (IHCPs), including Proprietary Patent Medicine Vendors (PPMVs), drug peddlers, traditional healers, and herbal drug sellers are often the first choice for malaria treatment, especially in urban slums.” Bamgboye EA & al. “explored the perceived malaria burden, IHCPs’ competence in malaria treatment, and reasons for visiting IHCPs in various urban settlements from both community member and provider perspectives.” As they report in Understanding Malaria Treatment Patronage from Informal Healthcare Providers in Nigerian Urban Settlements: Insights from Community Members and Providers, Malaria J, 2025 Jan 23, 24:26, https://doi.org/10.1186/s12936-025-05255-3, “malaria remains a significant health problem in these Nigerian cities. Patronage of IHCPs generally is driven by affordable treatment, perceived mildness of illness, and access to credit facilities. However, cultural belief was key to patronage of traditional healers and herbal drug sellers, largely among informal and slum residents. Furthermore, while IHCPs had a strong perceived competence in managing malaria cases, inadequate diagnosis and treatment were standard practices.”
Studying the immunity naturally acquired by children who had malaria, Mohammed AM & al. discovered “several differentially abundant proteins in children living in high malaria transmission areas relative to children in low transmission areas…” They found a particular “protein to be strongly associated with high malaria exposure” and conclude that this finding can “possibly be exploited to develop novel therapeutics against P. falciparum.” The paper is Malaria Exposure Remodels the Plasma Proteome of Ghanaian Children, BMC Infect Dis. 2025 Feb 3; 25(1):157, https://doi.org/10.1186/s12879-025-10495-4
Campaigns and Policies
Katile A & al. studied the impact of multidimensional interventions over three years in a Malian health district. They collected data from the health information system on malaria cases and interventions, distribution of ITNs, SMC, access to RDTs, and IPTp. The results, described in Population Impact of Malaria Control Interventions in the Health District of Kati, Mali, PLoS One. 2024 Dec 31; 19(12):e0289451, https://doi.org/10.1371/journal.pone.0289451 “showed the impact of SMC on reducing malaria cases in the population and the significant efforts in [ITN] distribution and malaria case diagnosis.”
In a low transmission area in Senegal, Ferriss EL & al. found that repeated mass drug administration reacting to infection diagnosed in community reduced but did not eliminate the incidence of malaria in the community over the four-year period studied. The paper is Evaluating Programmatic Reactive Focal Drug Administration Impact on Malaria Incidence in Northern Senegal: An Interrupted Time Series Analysis, Malaria J, 2025 Jan 25, 24:27, https://doi.org/10.1186/s12936-025-05245-5
“Studies have shown that ivermectin, used for the treatment of parasitic diseases, can kill malaria vectors that feed on the blood of treated people and thus might be an effective complementary vector control tool if administered widely to communities in malaria endemic regions. [Somé AF & al.] aimed to test the safety of repeated, high-dose ivermectin mass drug administration (MDA) and its efficacy for reducing malaria incidence among children when integrated with seasonal malaria chemoprevention (SMC) delivery. They report in Safety and Efficacy of Repeat Ivermectin Mass Drug Administrations for Malaria Control (RIMDAMAL II): a Phase 3, Double-Blind, Placebo-Controlled, Cluster-Randomised, Parallel-Group Trial, Lancet Infect Dis, 2025 Feb 5, https://doi.org/10.1016/S1473-3099(24)00751-5 that after two seasons, “high-dose ivermectin MDA integrated with SMC distributions at the study site did not reduce malaria incidence among children relative to placebo MDA …” despite some parameters, such as hemoglobin of the treated group, showing improvement. Hammam F & Maia MF, Beyond Mosquitoes and Malaria—Ivermectin in Africa, Lancet Infect Dis, 2025 Feb 4, https://doi.org/10.1016/S1473-3099(24)00835-1 is a related editorial.
Umugwaneza A & al. report that over the five year period they studied, “all malaria indicators showed improvement [in Rwanda]. Malaria incidence dropped from 345 to 40 cases per 1000 persons …, the severe malaria rate decreased from 112 to 10/100,000 persons …, and the mortality rate fell from 2.72 to 0.258 deaths /100,000 persons …. Among children under 5 years of age, incidence decreased significantly from 331 to 52/1,000 persons …, the severe malaria rate dropped from 214 to 29/100,000 persons …, and mortality declined from 5 to 0.453/100,000 persons …. They also describe the measures that had been undertaken in their report, Half-Decade of Scaling up Malaria Control: Malaria Trends and Impact of Interventions from 2018 to 2023 in Rwanda, Malaria J, 2025 Feb 12, 24:40, https://doi.org/10.1186/s12936-025-05278-w.
Given the current outlook of even more constrained resources for malaria control in Africa than heretofore, Ozodiegwu ID & al.’s paper, Co-creation and Application of a Framework for the De-Prioritization of Urban Communities During Insecticide-Treated Bed Net Mass Campaigns for Malaria Prevention and Control in Kwara State, Nigeria, BMC Glob Public Health. 2025 Feb 6; 3(1):11, https://doi.org/10.1186/s44263-025-00126-0 is especially relevant. The authors describe a process by which they used data that showed that malaria “prevalence varied significantly across the categories of formal, informal, and slum settlements, resulting in specific definitions developed …. Thirteen communities classified as formal settlements … were de-prioritized during the bed net distribution campaign.” At this point it is unknown whether this decision created adverse consequences.
Epidemiology
Climate change, biodiversity and environment
None this month
Risk factors
“Naturally acquired immunity to malaria results from repeated infection with Plasmodium parasites.” Kyei-Baafour E & al. “investigated antigenic targets of malaria protective antibodies in populations residing a malaria transmission hotspot in southern Ghana.” They report in Wider Antibody Breadth Against Multiple Plasmodium falciparum Antigens is Associated with Reduced Risk of Malaria in a Transmission Hotspot in Southern Ghana, Int J Infect Dis. 2025 Jan 29:107804, https://doi.org/10.1016/j.ijid.2025.107804 that they “found a significant association between higher IgG levels to [four parasite proteins] and protection from febrile malaria. A negative association between higher antibody levels to [the for proteins] and parasite density was also observed. Wider antibody breadth was associated with protection against febrile malaria and single, compared to multiple malaria episodes.” The authors conclude that their data support “the development of multivalent vaccines targeting P. falciparum surface antigens in high malaria endemic settings.”
According to Demelash K & al., Prevalence of Asymptomatic Malaria Infection and Associated Risk Factors in Mizan-Aman Town, Ethiopia: Community-Based Cross-Sectional Study, Malaria J, 2025 Feb 12, 24:41, https://doi.org/10.1186/s12936-024-05210-8, the prevalence of malaria among asymptomatic residents of the area studied was approximately 5 %. P. vivax predominated. “Low coverage of the IRS, ITN, and proximity of stagnant water in residences had an impact on asymptomatic malaria.”
Based on the Nigeria Malaria Indicator Survey (NMIS) 2021, Mhelembe T & al. report that the prevalence of malaria in children under age 5 was 37%. They then searched for underlying risk factors in report in Assessing the Influence of Socioeconomic and Environmental Variables on Malaria Risk in Nigerian Children Under 5 Years: A GLMM Approach, Malaria J, 2025 Feb 21, 24:55, https://doi.org/10.1186/s12936-025-05289-7 that the “following underlying risk factors for malaria in children were discovered in the study: altitude, anaemia level, age in months, fever status in the past 2 weeks, toilet facility, main wall material, main roof material, household wealth index, type of place of residence, sex of the child, mother’s education level, and knowledge of the preventative measures that can be used to prevent malaria.”
General epidemiology
Accuracy in surveying populations for malaria is of paramount importance. Martin AC & al., Implementation Outcomes of 1-3-7 Focus Investigation for Malaria in a Low Transmission Setting in Southern Province, Zambia: A Mixed Methods Study, PLOS Glob Public Health. 2025 Jan 17; 5(1):e0004179, https://doi.org/10.1371/journal.pgph.0004179 describes the attempt to use the so-called 1-3-7 focus investigation approach, which “is an implementation strategy that requires case reporting, case investigation/classification, and focal classification/response to be completed one, three, and seven days, respectively, after index case diagnosis.” Attempts to apply this method to the region of Zambia yielded modest results: “Focus investigation and reactive case detection completion doubled in areas using 1-3-7, from 20% to 42%. However, reactive case detection, which involved screening community members residing within 140 meter of index cases with a rapid diagnostic test, detected few parasitemic individuals, suggesting this may not be the most efficient day 7 response in this setting. Mobile phone network coverage was a common challenge …”
Based on their economic analysis, Schmit N & al. come to the conclusion in Quantifying the Potential Value of Entomological Data Collection for Programmatic Decision-Making on Malaria Control in Sub-Saharan African Settings, Malaria J, 2025 Jan 30, 24:31, https://doi.org/10.1186/s12936-025-05251-7 that while “entomological data collection should not delay implementation of interventions with demonstrated efficacy in most settings, … sustained investments into and use of entomological surveillance are nevertheless worthwhile and have broad value to national malaria programmes.”
Okongo B & al., Prevalence of Malaria and Associated Factors Among Febrile Children Under 15 Years at Bududa General Hospital, Eastern Uganda, Malaria J, 2025 Feb 7, 24:38, https://doi.org/10.1186/s12936-024-05218-0 reports that among 250 febrile children studied, the “prevalence of malaria was 111(44.4%). Among the children who tested positive for malaria, 98 (88.3%) had Plasmodium falciparum, 11 (9.9%) had Plasmodium malariae, and (1.8%) had Plasmodium ovale infection … with nearly half of the participants showing severe infections.”
Asmelash D, & al. conducted a meta-analysis of “24 cross-sectional studies with 19,169 participants from 10 Sub-Saharan Africa countries…” They report in The Burden of Asymptomatic Malaria Infection in Children in Sub-Saharan Africa: A Systematic Review and Meta-Analysis Exploring Barriers to Elimination and Prevention, J Epidemiol Glob Health. 2025 Feb 5; 15(1):17, https://doi.org/10.1007/s44197-025-00365-2 that overall prevalence of asymptomatic malaria in children under the age of 15 was 25%. “There was a higher prevalence of asymptomatic malaria in the 5–15 age group … compared with children under five” Furthermore, “families who never or sometimes used ITNs were 3.89 times more likely to have asymptomatic malaria infection compared to families who used ITNs consistently” {This is a quote from the paper; the abstract is potentially misleading on this point.} Also, “the overall prevalence of anemia in asymptomatic Plasmodium-infected children under the age of 15 was found to be 35%.” The authors comment on the implication of the high prevalence of asymptomatic infections on the effectiveness of control measures.
A population at particularly high risk of malaria is that of migrant workers. Tilaye T & al., Perceived Causes and Solutions for Malaria Prevalence Among Seasonal Migrant Workers in Northwest Ethiopia: A Qualitative Study, Malaria J, 2025 Feb 17, 24:47, https://doi.org/10.1186/s12936-024-05231-3 identifies “origin from highland areas, low health-seeking behaviour, working at night, and lack of use of [ITNs] as the perceived causes of high malaria prevalence among seasonal migrant workers.” The authors conclude that they have identified “the need for targeted interventions to address the specific factors contributing to high malaria prevalence among seasonal migrant workers and to overcome the challenges in implementing effective malaria prevention strategies in this vulnerable population. Further study should be conducted to include the views and positions of seasonal migrant workers, owners of the farm areas, host communities, and political leaders.”
Surveying 467 individuals of all ages, Mulamba C & al. “characterized the distribution of gametocyte carriage as a baseline for the clinical evaluation of a Pfs25-based transmission-blocking vaccine candidate in Bagamoyo, Tanzania.” They report in Plasmodium falciparum Gametocyte Burden in a Tanzanian Heterogeneous Transmission Setting, Malaria J, 2025 Feb 21, 24:54, https://doi.org/10.1186/s12936-025-05270-4 that “23.5% (110/467) of the participants tested positive for malaria parasites, with the majority of positives (> 92%) being Plasmodium falciparum. The overall gametocytaemia was 5.6%” and conclude that the “observed gametocyte densities and distribution across age groups suggest the need for malaria transmission-blocking interventions to target all populations in heterogeneous transmission settings.”
Congenital malaria occurs when newborns come to the world with the parasite having been transferred from the mother through the placenta. The prevalence of congenital malaria was explored by Tshiongo JK & al. in Congenital Malaria in Newborns of Mothers Living in Highly Endemic Parts of Kinshasa, Democratic Republic of Congo, Paediatr Int Child Health, 2025 Feb 24: 1-8, https://doi.org/10.1080/20469047.2025.2459964. Among 576 mothers delivered, 10.6% had placental malaria, but only 2.4% of the babies had malaria as detected by PCR. Notwithstanding the low rates, the existence of any congenital malaria is of concern, given the high birth rate in the country (over 6 per woman in 2022).
Spatiotemporal studies
Mulachew B & al., Magnitude of Urban Malaria and Its Associated Risk Factors in Damboya Town, Kambata Zone, Central Ethiopia, Parasite Epidemiol Control. 2024 Dec 9; 28:e00398, https://doi.org/10.1016/j.parepi.2024.e00398
Chacha GA & al., Prevalence and Drivers of Malaria Infection Among Asymptomatic and Symptomatic Community Members in Five Regions with Varying Transmission Intensity in Mainland Tanzania, Parasit Vectors. 2025 Jan 24; 18(1):24, https://doi.org/10.1186/s13071-024-06639-1
Namayanja C & al., Epidemiology, Clinical Spectrum, and Outcomes of Severe Malaria in Eastern Uganda: A Prospective Study, Malaria J, 2025 Feb 5, 24:37, https://doi/10.1186/s12936-024-05221-5
Tseha ST & al., Prevalence of Malaria and Associated Factors Among Febrile Cases Attending in Soyama Health Centre, Burji Special Woreda, Southern Ethiopia: A Retrospective and an Institution-Based Cross-Sectional Study, Malaria J, 2025 Feb 13, 24:43, https://doi.org/10.1186/s12936-025-05252-6