By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
The MMV (Medicines for Malaria Ventures) pipeline, which this reviewer accessed as a result of reviewing an article mentioned below under Treatment (Bestgen B & al.) is accessible at https://mmv.org/mmv-pipeline-antimalarial-drugs. It lists drugs in four categories: Research, Early Development, Product Development, and Access (i.e. approved, presumably recently).
On December 11, WHO published a news release, naming 17 sub-Saharan countries that now deploy one or another malaria vaccine at least in part of their country. The countries are Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d’Ivoire, DR Congo, Ghana, Kenya, Liberia, Malawi, Mozambique, Niger, Nigeria, Sierra Leone, South Sudan, and Sudan. “Since 2023, more than 12 million vaccine doses co-funded by Gavi, the Vaccine Alliance, and countries, have been procured and delivered by UNICEF to these countries.” https://www.who.int/news-room/feature-stories/detail/life-saving-malaria-vaccines-reach-children-in-17-endemic-countries-in-2024
On December 15, Laurie Zoloth, Professor of Bioethics at U. of Chicago Divinity School, published a Guest Essay in the New York Times under the title of For the Sake of 600,000 Children, Science Must Be Bold, promoting gene drive research. https://www.nytimes.com/2024/12/15/opinion/malaria-genetics-disease.html
“On 18 December 2024, the World Health Organization (WHO) prequalified the first diagnostic test for glucose-6-phosphate dehydrogenase (G6PD) deficiency which can help to safely deliver WHO-recommended treatments to prevent relapse of Plasmodium vivax (P. vivax) infection.” Individuals who are deficient in G6PD experience breakup of their red blood cells (hemolysis) if they take either primaquine or tafenoquine, which at this time are the only two drugs known to be effective in killing the liver stage of P. vivax. The hemolysis may be mild but also severe enough to lead to death. https://www.who.int/news/item/08-01-2025-who-prequalifies-diagnostic-test-to-support-safer-administration-of-p.-vivax-malaria-treatments
PEER REVIEWED ARTICLES (see notes after citations from non-peer-reviewed publications)
Alum EU & al., Malaria Pervasiveness in Sub-Saharan Africa: Overcoming the Scuffle, Medicine (Baltimore). 2024 Dec 6; 103(49):e40241, https://doi.org/10.1097/md.0000000000040241 does not readily fit into any of the headings in this review. It provides infromation about the current status of malaria control in Africa aimed at physicians in the US and elsewhere, who don’t readily encounter the disease in their practices.
Prevention
Vaccines
Both of the currently WHO-approved malaria vaccines have to be administered multiple times for maximum effectiveness. Venkatraman N & al. tested the R21-Matrix M vaccine with shorter than the recommended courses in volunteer adults and found that effectiveness remained even with as few as a series of two vaccines, albeit at a lower rate. The paper is R21 in Matrix-M Adjuvant in UK Malaria-Naive Adult Men and Non-Pregnant Women Aged 18-45 Years: An Open-Label, Partially Blinded, Phase 1-2a Controlled Human Malaria Infection Study, Lancet Microbe. 2025 Jan 9: 100867 https://doi.org/10.1016/s2666-5247(24)00083-1.
Olumide AT & al., Awareness, Acceptability and Factors Influencing Malaria Vaccine Uptake Among Caregivers of Children Under 5 in South-Western Nigeria, Child Care Health Dev. 2025 Jan; 51(1):e70029, https://doi.org/10.1111/cch.70029 is a prospective study, gauging caregivers’ (mostly mothers’) attitudes toward vaccinating their children before the vaccine was actually made available. Among 797 caregivers, barely more than a quarter were aware of the existence of the vaccine, but once made aware, 90% voiced acceptance and over 80% voiced willingness to pay for the vaccine. How that played out once the vaccine was released remains to be seen.
The effectiveness of vaccines is compromised if recommended schedule of administration is not followed. Bediako VB & al., Factors Associated with Vaccine Default in Southern Ghana Based on Data from the RTSS Malaria Vaccine Trial in Cape Coast, Sci Rep. 2025 Jan 2; 15:251, https://doi.org/10.1038/s41598-024-75408-y reports that in the area under study, “more than a third (38.43%) of children defaulted at least one dose of the malaria vaccine. Key predictors of defaults included sub-metro of residence, cost of traveling to health facilities, experience of adverse events, knowledge about the vaccine doses, caregiver’s employment status, and religion.” The authors “emphasize the need for targeted interventions to reduce defaults, mainly focusing on caregiver education on vaccines, reducing financial barriers to healthcare access, and addressing concerns about adverse events.”
There are problems inherent in the requirement for multiple doses of the currently WHO-endorsed malaria vaccines, as exemplified by one of the articles cited above. In search of a vaccine that may elicit long-term immunity, Roozen GVT & al. contribute a new article on the attenuation approach with P. falciparum parasites. In 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 they describe the immunologic response as well as protection against infection by a single administration of attenuated parasites in human volunteers. At this time the results described are only short term, but the authors are encouraged by the 90% infection-prevention and immunologic response in a small number of human volunteers.
Sibomana O & al. examine “the role of routine malaria vaccination in Africa as a key strategy toward malaria elimination, [explore] challenges and solutions for widespread vaccine implementation, and [discuss] future directions in the ongoing fight to eliminate malaria on the continent” in Routine Malaria Vaccination in Africa: A Step Toward Malaria Eradication? Malaria J, 2025 Jan 5, 24:1, https://doi.org/10.1186/s12936-024-05235-z
Al-Osaimi HM & al., A Systematic Review on Malaria and Dengue Vaccines for the Effective Management of These Mosquito Borne Diseases: Improving Public Health, Hum Vaccin Immunother. 2024 Dec 31; 20:2337985, https://doi.org/10.1080/21645515.2024.2337985 is a review of the literature relevant to the development and possible future direction of research of the vaccines against the two vector-borne diseases mentioned in the title.
Abraham IC & al. advocate the “potential integration of CRISPR/Cas9 gene drive technology with malaria vaccination efforts to enhance vector control and reduce transmission” in Integrating Malaria Vaccine and CRISPR/Cas9 Gene Drive: A Comprehensive Strategy for Accelerated Malaria Eradication, Malaria J, 2025 Jan 17, 24:17, https://doi.org/10.1186/s12936-025-05243-7. The authors acknowledge “[c]hallenges such as regulatory hurdles, community acceptance, ecological impacts, and sustainable funding…”
Vectors
According to Martin AC & al., [i]ndoor residual spraying (IRS) is a malaria control strategy [that has been] implemented before the rainy season… since 2008 [in Nchelenge District, Zambia, a holoendemic setting] with little impact on malaria incidence or parasite prevalence. Pre-rainy season IRS may not reduce the post-rainy season peak abundance of the major vector, Anopheles funestus.” The authors “assessed the impact of late-rainy season IRS on malaria prevalence, incidence, hazard, and vector abundance” and conclude in Impact of Late Rainy Season Indoor Residual Spraying on Holoendemic Malaria Transmission: A Cohort Study in Northern Zambia, J Infect Dis. 2024 Dec 19: jiae609 https://doi.org/10.1093/infdis/jiae609 that “[m]onthly tracking of incidence and prevalence did not demonstrate meaningful changes in holoendemic transmission intensity. However, hazard of infection, which provides greater power for detecting changes in transmission, demonstrated that late rainy season IRS reduced malaria risk.”
“Imported malaria from southern Mozambique drives low levels of disease transmission in KwaZulu-Natal, South Africa. Therefore, the South African Department of Health funded implementation of indoor residual spraying (IRS) in Mozambiquan districts identified as sources of malaria infection for border communities in KwaZulu-Natal.” Maharaj R & al., The Epidemiology of Malaria in Four Districts In Southern Mozambique Receiving Indoor Residual Spray as Part of a Cross-Border Initiative, Malaria J, 2025 Jan 21, 24:22, https://doi.org/10.1186/s12936-025-05258-0 is “a cross-sectional survey conducted in 6 sentinel sites in each of the … districts, focusing on children 6 months to < 15 years from selected households…Malaria prevalence in children younger than 5 years decreased significantly in all four districts.” However, overall prevalence was noted only in two of the districts. It is unclear why there was a difference in effect of the process.
Semakula HM & Mugagga F focused on refugee children in Predictors of Insecticide-Treated Nets [ITN] Utilization Among Children Under Five Years in Refugee Settlements in Uganda: Analysis of the 2018–2019 Uganda Malaria Indicator Survey, Malaria J, 2025 Jan 20, 24:20, https://doi.org/10.1186/s12936-025-05262-4. Based on data encompassing 598 children, the authors found that the “odds of children sleeping under ITN were higher if their mothers had secondary and higher education (8.1 times) as well as primary education (1.5 times). The odds of children sleeping under ITN reduced by 50% if their mothers were pregnant. Interestingly, the odds of children sleeping under ITN were 70% lower if their mothers knew that ‘not sleeping in nets’ caused malaria.” The authors “highlight areas of intervention that can increase ITN use in refugee settlements of Uganda.”
In SE Tanzania, Limwagu AJ & al. studied the effects of housing on the behaviors of two of the main Plasmodium-bearing Anopheles species. They report in The Bionomics of Anopheles arabiensis and Anopheles funestus Inside Local Houses and Their Implications for Vector Control Strategies in Areas with High Coverage of Insecticide-Treated Nets in South-Eastern Tanzania, PLoS One. 2024 Dec 5; 19(12):e0295482, https://doi.org/10.1371/journal.pone.0295482 that while “[f]ewer An. funestus were caught in houses with metal- than grass roofs and [in] houses with [than] without animals. Contrastingly, fewer An. arabiensis were caught from houses with screened eaves compared to houses with open eaves. The implications of these findings are unclear.
Namango IH & al. conducted a survey on the biting behaviors of the two locally active Anopheles species and report in A Matter of Timing: Biting by Malaria-Infected Anopheles Mosquitoes and the Use of Interventions During the Night in Rural South-Eastern Tanzania, PLOS Glob Public Health. 2024 Dec 31; 4(12):e0003864, https://doi.org/10.1371/journal.pgph.0003864 that biting is most prevalent between 10 PM and 5 AM, therefore concluding that pre-school age children are largely protected by ITNs if they sleep under them. Older children and adults are more likely to be awake or outdoors during some of those hours and therefore more prone to be bitten by a Plasmodium-infected mosquito.
“There are three Anopheles mosquito species in East Africa that are responsible for the majority of malaria transmission.” Kweyamba PA & al. undertook to assess their “competence” in housing and transmitting P. falciparum and report in Contrasting Vector Competence of Three Main East African Anopheles Malaria Vector Mosquitoes for Plasmodium falciparum, Sci Rep, 2025 Jan 17; 15(1):2286, https://doi.org/10.1038/s41598-025-86409-w that while “all three malaria vector species may contribute to malaria transmission in East Africa, … An. funestus [demonstrates] superior vector competence.” The implications of this finding are discussed in the paper.
“Small dam impoundments provide communities with a continuous supply of water for domestic and agricultural activities across sub-Saharan Africa and are considered vital to food security and climate change resilience. However, these permanent water bodies also create ideal breeding sites for mosquitoes in typically arid landscapes. [Zembere K & al. focus] on a specific dam impoundment and its vicinity, aiming to assess its spatial and temporal influence on indoor vector densities.” They use computer-based modeling, “estimating the effects of household structure (open/closed eaves), month, temperature and water proximity on malaria vector exposure” and in Small Dams Drive Anopheles Abundance During the Dry Season in a High Malaria Burden Area of Malawi, Med Vet Entomol. 2024 Dec; 38(4):375-392, https://doi.org/10.1111/mve.12733, they report a significant decline in capture rates of vectors as the months of the dry season progress. They advocate focusing control efforts during the times of vector abundance.
Kabula B & al. reared wild caught Anopheles gambiae (s.l.) larvae and when they grew to adulthood, they verified that the adults exhibited resistance to pyrethroids. Evidence of resistance was less than 90% mortality after exposure to the compound. In Pyrethroid-Resistant Malaria Vector Anopheles gambiae Restored Susceptibility After Pre-Exposure to Piperonyl-Butoxide: Results from Country-Wide Insecticide Resistance Monitoring in Tanzania, 2023, Malaria J, 2024 Dec 21, 23:395, https://doi.org/10.1186/s12936-024-05211-7 the authors claim that once the resistant population is exposed to piperonyl butoxide (PBO), they become once again sensitive to pyrethroids. {The evidence presented for this latter claim is not found in the abstract of the article.}
Boussougou-Sambe ST, & al. state that in Gabon, “little data on phenotypic insecticide resistance in Anopheles vectors are published, compromising the rational implementation of resistance management strategies. [The authors] assessed the susceptibility to pyrethroids, carbamates and organophosphates of Anopheles gambiae sensu lato (s.l.) and conclude in Resistance of Anopheles gambiae s.s. Against Commonly Used Insecticides and Implication of Cytochrome P450 Monooxygenase in Resistance to Pyrethroids in Lambaréné (Gabon), BMC Infect Dis. 2024 Oct 30; 24(1):1221, https://doi.org/10.1186/s12879-024-10021-y that there is “a role of cytochrome P450 monooxygenases in the pyrethroid-resistance of An. gambiae s.s. from Lambaréné. Combining PBO with pyrethroids, as done in second generation bednets, may be used to revert resistance.”
Kouamé JKI & al., Assessing Species Composition and Insecticide Resistance of Anopheles gambiae Complex Members in Three Coastal Health Districts of Côte d’Ivoire, PLoS One. 2024 Dec 10; 19(12):e0297604, https://doi.org/10.1371/journal.pone.0297604 reports that most of the vectors collected in the authors’ study belonged to An. coluzii, with all the rest to An. gambiae sensu stricto. The vast majority of the population “showed high resistance to pyrethroids. Clothianidin, chlorfenapyr, and PBO with pyrethroids increased mortality, indicating their potential use as an alternative for malaria vector control.”
Oruni A & al.also address the development of insecticide resistance in Temporal Evolution of Insecticide Resistance and Bionomics in Anopheles funestus, a Key Malaria Vector in Uganda, Sci Rep. 2024 Dec 30; 14:32027, https://doi.org/10.1038/s41598-024-83689-6. “Among bednets, only PBO-based nets (PermaNet 3.0 Top and Olyset Plus) and chlorfenapyr-based net (Interceptor G2) had high mortality rates. Mosquitoes were fully susceptible to chlorfenapyr and organophosphates, moderately resistant to clothianidin and resistant to carbamates.”
In view of the increased global awareness of the damage that microplastics create in water resources of the globe, Shilla DJ & al. investigated their possible effects of malaria vector resistance to insecticides. They describe their experiment in Insecticide Tolerance of the Malaria Vector Anopheles gambiae Following Larval Exposure to Microplastics and Insecticide, PLoS One. 2024 Dec 12; 19(12):e0315042, https://doi.org/10.1371/journal.pone.0315042. They “exposed first instar larvae of Anopheles gambiae s.s. to environmentally realistic concentrations of PET microplastics [MP] (1.0-7.5 μm) and a sub-lethal dose of insecticide mixed with microplastics, and quantified survival, development, and susceptibility of larvae over six generations. Adult mosquitoes from larvae exposed to these treatments were subsequently tested for insecticide resistance. Exposure to MPs decreased larval survival rates compared to the control; however, over six generations of exposure, survival rates significantly increased. Similarly, there was a higher survival rate of those larvae exposed to MPs mixed with insecticide compared to those exposed to just the insecticide, and survival increased further over the six generations. For the adult mosquito susceptibility tests, knockdown times (KDTs) indicated some level of insecticide tolerance when larvae had been previously exposed to MPs and insecticides.”
In a report on how to determine whether attractive sugar baits (ASBs) actually attract mosquitoes, Meza FC & al. describe the results obtained from camera-based studies in Scalable Camera Traps for Measuring the Attractiveness of Sugar Baits for Controlling Malaria and Dengue Vectors, Parasit Vectors. 2024 Dec 3; 17:499, https://doi.org/10.1186/s13071-024-06539-4. The authors conclude that “[u]sing camera traps to record still images of mosquitoes on ASBs offers reliable, reproducible and quantitative information on their attractiveness in various environmental conditions.”
“Larviciding is a valuable vector control tool with strong potential for regional scale-up. There is considerable evidence of its effectiveness, and the World Health Organization (WHO) recommends it as a supplemental intervention. However, malaria programmes hoping to implement larviciding face significant barriers, including (1) poor global technical, policy, and funding support; (2) fragmented implementation and experience; (3) high complexity of delivery and impact evaluation; and (4) limited access to the full range of WHO prequalified larvicide products.” Newby G & al., Larviciding for Malaria Control and Elimination in Africa Malaria J, 2025 Jan 15, 24:16, https://doi.org/10.1186/s12936-024-05236-y advocates greater deployment of this modality of vector control in combination with other measures.
Kamau A & al. are conducting a major study of the potential effects of attractive sugar baits for mosquitoes in a region of Kenya with up to 50% prevalence of malaria. As the title of their paper, Attractive Targeted Sugar Baits for Malaria Control in Western Kenya (ATSB-Kenya): Enrolment Characteristics of Cohort Children and Households indicates, the report, published in Malaria J, 2024 Dec 30, 23:403, https://doi.org/10.1186/s12936-024-05234-0, shows fair to poor utilization of ITNs and high malaria prevalence in children at the start of the study.
Tikhe CV & al., Chromobacterium Biopesticide Overcomes Insecticide Resistance in Malaria Vector Mosquitoes, Sci Adv. 2024 Dec 6; 10(49):eads3658, https://doi.org/10.1126/sciadv.ads3658 reports that a “biopesticide derived from the soil-dwelling bacterium Chromobacterium sp. Panama (Csp_P) kills insecticide-resistant Anopheles mosquitoes, regardless of their resistance mechanisms.” Further, the authors state that “field trials in Burkina Faso, conducted in diverse ecological settings and supported by a mathematical model, have now demonstrated its potential for malaria control in settings with widespread insecticide resistance.” Science Advances, a sister publication of Science, publishes articles that may not have undergone peer review (the publication’s disclosure is ambiguous in this regard).
“…insecticide resistance to the most used classes of insecticides is now pervasive across Africa. [Inorde to understand] the underlying mechanisms contributing to this phenomenon,” Worku N & al. compared “the microbiota composition of insecticide-resistant populations of Anopheles gambiae, An. coluzzii and An. arabiensis from Burkina Faso, and in the latter case additionally from Ethiopia, to insecticide-susceptible populations.” They report in Insecticide Resistant Anopheles from Ethiopia but not Burkina Faso Show a Microbiota Composition Shift Upon Insecticide Exposure, Parasit Vectors, 2025 Jan 20; 18(1):17, https://doi.org/10.1186/s13071-024-06638-2 that “An. arabiensis from Ethiopia demonstrates clear differences in microbiota composition in those dying from and those surviving insecticide exposure. To further understand resistance in this An. arabiensis population, [the authors] performed RNAseq and saw differential expression of detoxification genes associated with insecticide resistance and changes in respiration, metabolism and synapse-related ion channels.” No changes in microbiota were seen in any of the three species examined in Burina Faso.
Ochomo EO & al. report on a “prospective, cluster-randomised, controlled trial in Busia County, western Kenya … quantify the efficacy of a transfluthrin-based spatial repellent against human malaria infection following mass distribution of insecticide treated nets in Effect of a Spatial Repellent on Malaria Incidence in an Area of Western Kenya Characterised by High Malaria Transmission, Insecticide Resistance, and Universal Coverage of Insecticide Treated Nets (Part of the AEGIS Consortium): A Cluster-Randomised, Controlled Trial, Lancet, 2024 Dec 19, https://doi.org/10.1016/S0140-6736(24)02253-0. They found that “spatial repellents significantly reduced the hazard rate of first-time malaria infection by 33·4% … and the hazard rate of overall new malaria infections by 32·1% …. No reported adverse events and serious adverse events were deemed to be associated with the spatial repellent.” They conclude that their “trial provides the first evidence of a demonstrative spatial repellent protective efficacy in reducing risk of malaria infection in an African setting characterised by high malaria transmission, pyrethroid resistant malaria vectors, and high coverage of insecticide treated nets. Results support spatial repellent products as a beneficial component of malaria prevention.” Swai JK & Moore SJ, Beyond Repellents: Spatial Emanators for the Control of Malaria in Africa, Lancet. 2024 Dec 19: S0140-6736(24)02754-5, https://doi.org/10.1016/s0140-6736(24)02754-5 is an opinion piece commenting on the above, endorsing the notion that “spatial repellents provided additional protection from malaria infection, by either filling ITN protection gaps or enhancing ITN effectiveness by increasing mosquito mortality through exposure to two structurally different pyrethroids.”
Obembe A & al. state that a “national vector surveillance programme, mobilizing all stakeholders towards quality data generation and policy making, is required for effective data-driven country-wide vector control.” Their paper, Implementation of Malaria Vector Surveillance and Insecticide Resistance Monitoring Interventions in Nigeria, Glob Health Res Policy. 2024 Dec 31; 9:55, https://doi.org/10.1186/s41256-024-00397-4 “provides an analysis and suggested future directions for such synergized national malaria vector surveillance and insecticide resistance monitoring system currently being implemented by all research and policy stakeholders in Nigeria.”
Chemoprophylaxis
Diarra Y & al. “assessed coverage and acceptability of Seasonal Malaria Chemoprevention (SMC) in selected communities in the Northern part of Ghana” and report in Caregiver Acceptability of Seasonal Malaria Chemoprevention in Two Districts in the Upper West Region, Ghana: A Cross-Sectional Study, Malaria J, 2025 Jan 14, 24:14, https://doi.org/10.1186/s12936-024-05169-6 that among “495 caregivers providing care for 569 eligible children aged 3–59 months, … SMC coverage was 95.1% … Caregivers had a good level of knowledge of SMC … and a good perception of SMC … Seven out of ten caregivers … had good acceptability of SMC. For 7 out of 28 children who did not receive the SMC intervention, their caregivers intentionally refused them the intervention… Caregivers who practice Christianity or Islam had better acceptability than caregivers who practice African traditional religion”
Nuwa A & al. studied SMC administered to children under age 5. One of two regimens were administered to 3491children with villages with 390 children were the control group. As reported in Effectiveness of Sulfadoxine–Pyrimethamine Plus Amodiaquine and Dihydroartemisinin–Piperaquine for Seasonal Malaria Chemoprevention In Uganda: A Three-Arm, Open-Label, Non-Inferiority And Superiority, Cluster-Randomised, Controlled Trial, Lancet Infect Dis, 2025 Jan 5, https://doi.org/10.1016/S1473-3099(24)00746-1, both regimens were effective in reducing malaria infections n comparison with the control community, “with no safety concerns. There was no evidence of resistance selection by SMC.” There was no detectable difference in efficacy between the two regimens. ter Kuile FO, Expanding Seasonal Malaria Chemoprevention Beyond the Sahel Region, Lancet Infect Dis, 2025 Jan 5, https://doi.org/10.1016/S1473-3099(24)00766-7 is an accompanying editorial.
Funwei RI & al. conducted genetic surveillance on women receiving the WHO-recommended regimen of intermittent preventive treatment of pregnancy (IPTp-SP) in order to assess the development of resistance to the drugs used. In fact, Genetic Profiling of Plasmodium falciparum Antigenic Biomarkers Among Asymptomatic Pregnant Women on Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine from Southwest Nigeria, Placenta. 2024 Dec 22; 159:161-169, https://doi.org/10.1016/j.placenta.2024.12.016 discloses that the P. falciparum multidrug resistance-1 gene (Pfmdr-1) was present in 61.3% and 58.8% of isolates obtained at delivery and in placental cord blood, respectively. The authors conclude that “continuous molecular surveillance of resistant-parasites to sulphadoxine-pyrimethamine and ACTs is essential.”
According to Sarfo JO & al., Individual- and Community-Level Correlates of Intermittent Preventive Treatment of Malaria in Pregnancy In Ghana: Further Analysis of the 2019 Malaria Indicator Survey, Res Health Serv Reg. 2024 Dec 23; 3:22, https://doi.org/10.1007/s43999-024-00058-6 variations in “uptake of” (i.e. compliance with) IPTp-SP in various regions of Ghana are more related to characteristics of individuals, rather than geography. This was especially true in case of women who did not access antenatal care early in their pregnancy.
After a complex 13 month study of 724 children with sickle cell anemia, aged 6 months to 15 years, Idro R & al. conclude in Weekly Dihydroartemisinin–Piperaquine Versus Monthly Sulfadoxine–Pyrimethamine for Malaria Chemoprevention in Children with Sickle Cell Anaemia in Uganda and Malawi (CHEMCHA): A Randomised, Double-Blind, Placebo-Controlled Trial, Lancet Infect Dis, 2024 Dec 18, https://doi.org/10.1016/S1473-3099(24)00737-0 that “[m]alaria chemo-prophylaxis with weekly dihydroartemisinin–piperaquine in children with sickle cell anaemia is safe and considerably more efficacious than monthly sulfadoxine–pyrimethamine. However, monthly sulfadoxine–pyrimethamine was associated with fewer episodes of non-malaria-related illnesses, especially in children 5 years or older not receiving penicillin prophylaxis, which might reflect its antimicrobial effects. In areas with high P falciparum antifolate resistance, dihydroartemisinin–piperaquine should be considered as an alternative to sulfadoxine–pyrimethamine for malaria chemoprevention in children younger than 5 years with sickle cell anaemia receiving penicillin-V prophylaxis. However, there is need for further studies in children older than 5 years.” Williams TN & Ware RE, Malaria Prophylaxis in Sickle Cell Anaemia: Some Answers, More Questions, Lancet Infect Dis, 2024 Dec 20, https://doi.org/10.1016/S1473-3099(24)00745-X is an editorial commentary on the above, pointing out that despite the benefit of the changed regimen, “the incidence of unscheduled clinic visits with conditions not related to malaria, particularly lower respiratory tract events such as pneumonia or acute chest syndrome, was significantly higher in the dihydroartemisinin–piperaquine group than the sulfadoxine–pyrimethamine group … This is a particular concern considering that the absolute number of these events was more than ten times higher than that of clinical malaria.” Therefore, the authors urge caution in implementing the changed chemoprophylactic regimen.
Please see Treatment/New drugs for Gal IR & al., Drug Interaction Studies of Cabamiquine: Ganaplacide Combination Against Hepatic Plasmodium berghei, ACS Infect Dis. 2024 Dec 10, https://doi.org/10.1021/acsinfecdis.4c00563.
Other
Genetic engineering of parasites is one research effort in the abatement of the damage that malaria acuses to communities. Schmid M & al., Generation of a Genetically Double-Attenuated Plasmodium berghei Parasite that Fully Arrests Growth During Late Liver Stage Development, PLoS One. 2024 Dec 31; 19(12):e0316164, https://doi.org/10.1371/journal.pone.0316164 report the authors’ success in arresting the development of the mouse malaria parasite so that it is incapable of causing clinical infection.
Mahamar A & al. studied the efficacy of various regimens in preventing the transmission of malaria parasites from asymptomatic individuals found by microscopy to harbor P. falciparum gametocytes (the phase that then proliferates in the vector). Their results, described in their paper, Artemether-Lumefantrine-Amodiaquine or Artesunate-Amodiaquine Combined with Single Low-Dose Primaquine to Reduce Plasmodium falciparum Malaria Transmission in Ouelessebougou, Mali: A Five-Arm, Phase 2, Single-Blind, Randomised Controlled Trial, Lancet Microbe. 2024 Dec 16: 100966, https://doi.org/10.1016/j.lanmic.2024.100966 “support the effectiveness of artemether-lumefantrine alone or as part of [triple artesunate combination therapy] for preventing nearly all human-mosquito malaria parasite transmission within 48 h. By contrast, substantial transmission was observed following treatment with artesunate-amodiaquine. The addition of a single low dose of primaquine blocks transmission to mosquitoes rapidly regardless of schizonticide.”
Diagnosis
General diagnostics
Cordier C & al. claim to have developed new quantitative polymerase chain reaction (qPCR) tests that are specific to each Plasmodium species that infect humans (including P. knowlesi). However, it is unclear from the abstract of Implementation and Validation of a New qPCR Assay to Detect Imported Human Plasmodium Species, Microbiol Spectr. 2024 Dec 10: e0162224, https://doi.org/10.1128/spectrum.01622-24 how these tests are different from other PCR tests that have been in use.
Tamir Z & al. collected “835 peripheral blood and 372 placental blood samples … from 835 pregnant women attending first antenatal care or admitted for delivery. These samples were subjected to qPCR tests as well as microscopy and rapid diagnostic tests (RDTs). They report in Comparative Performance of Microscopy, Rapid Diagnostic Tests, and Multiplex Real-Time PCR for Detection of Malaria Parasites Among Pregnant Women in Northwest Ethiopia, Malaria J, 2025 Jan 20, 24:19, https://doi.org/10.1186/s12936-025-05256-2 that “[u]sing multiplex qPCR as a reference test, microscopy had a sensitivity of 73.8% … and 62.2% (95% CI: 46.5–76.2) to detect Plasmodium parasites in peripheral and placental blood samples, respectively, with a 100% … specificity in both samples. Similarly, the RDT had a sensitivity of 67.6% … and a specificity of 96.5% … for Plasmodium infection diagnosis in peripheral blood and a sensitivity of 62.2% … and a specificity of 98.8% … in placental blood samples.” Thus, the authors confirm the greater utility of qPCR, which has been demonstrated numerous times elsewhere.
Reviewing the abstract of Nagendra S & al., Diagnosis of Plasmodium Infections Using Artificial Intelligence Techniques Versus Standard Microscopy in a Reference Laboratory, J Clin Microbiol. 2024 Dec 10: e0077524, https://doi.org/10.1128/jcm.00775-24 leads to some confusion in that it claims at the same time that “miLab MAL {the AI technique studied} was accurate in identifying the absence of Plasmodium falciparum and exhibited higher sensitivity than the manual method” but also that “parasitemia by the manual method was on average six times higher than with miLab MAL.”
Field diagnostics
Okai T & al. “investigated the presence of P. falciparum with pfhrp2 and/or pfhrp3 gene deletions among infected residents in the Lake Victoria region, Kenya” in view of the fact that these deletions lead to false negatives in diagnosing malaria in histidine-rich-protein-dependent rapid diagnostic tests (RDTs), which are frequently used by community health workers. Plasmodium falciparum with pfhrp2 and pfhrp3 Gene Deletions in Asymptomatic Malaria Infections in the Lake Victoria Region, Kenya, Trop Med Health. 2024 Dec 18; 52(1):94, https://doi.org/10.1186/s41182-024-00664-7 is their article, in which they report testing 1920 finger-prick blood specimens among which 445 were RDT negative, but positive on PCR. Over 70% of the individuals in question had submicroscopic infection and over 80% of them were asymptomatic. The public health implications of missing asymptomatic infections are considerable.
“Rapid diagnostic tests (RDTs) based on the detection of Plasmodium falciparum histidine rich protein 2 (PfHRP2) are widely used for the diagnostic of P. falciparum in Africa. However, deletions of the pfhrp2 and pfhrp3 genes can lead to false negative test results and compromise appropriate case management. Due to the high burden of malaria in Mozambique,” da Silva C & al. conducted a genetic survey in the country and report in Molecular Surveillance of Plasmodium falciparum Histidine-Rich Protein 2/3 gene deletions in Mozambique, 2023, Malaria J, 2024 Dec 26, 23:402, https://doi.org/10.1186/s12936-024-05230-4 that the deletion in question exists in parasites prevalent in the country but not in a frequency that would necessitate changing current field diagnostic use of RDTs (fewer than 1% RDT-negative children among 2424 with malaria in the study).
“… disc microfluidic isothermal amplification integrating loop-mediated isothermal amplification (LAMP) and microfluidic chip technology were applied to develop rapid and precise detection with low resource requirements,” reported in Jiang N & al., A Rapid On-Site Detection Method for Plasmodium falciparum Carried by Mosquitoes Using Disc Microfluidic Isothermal Amplification, Am J Trop Med Hyg. 2024 Dec 31: tpmd240599, https://doi.org/10.4269/ajtmh.24-0599. The authors claim that this “rapid detection method based on disc microfluidic isothermal amplification was developed that could be used to detect P. falciparum carried by mosquitoes in a field setting under limited resource conditions.”
New diagnostic methods
de Queiroz LT & al. present evidence that a new kit using DNA analytic technology diagnosed P falciparum and P vivax correctly 100% of the time. They also state in Novel Isothermal Nucleic Acid Amplification Method for Detecting Malaria Parasites, Appl Microbiol Biotechnol. 2024 Dec 27; 108:544, https://doi.org/10.1007/s00253-024-13357-2 that the kit’s “high sensitivity, specificity, fast processing time, and operational simplicity position it as a valuable point-of-care diagnostic tool, particularly in resource-limited and remote malaria-endemic areas.” The work was done in Brazil, but should be applicable in Africa as well.
Other
“PAVON has developed a malaria microscopy competency training scheme to augment competency in malaria microscopy.” Diarra A & al., Pan African Vivax and Ovale Network (PAVON) Malaria Diagnostic Competency Training: Offering Training Opportunities to Impact Malaria Elimination Strategies in Sub-Saharan Africa, Trop Med Infect Dis. 2024 Dec 19; 9(12):308, https://doi.org/10.3390/tropicalmed9120308 describes the training methods and the results of the attendees’ evaluation. The authors conclude that “training was effective in raising the competency skills of participants and is open to NMPs (National Malaria Programs) for critical capacity building.”
Treatment
Treatment results
Using published data from clinical trials, Ciavarealla C & al. used modeling of various primaquine and tafenoquine regimens to estimate the likelihood of radical cure (i.e. prevent recurrence) to conclude in Quantifying Plasmodium vivax Radical Cure Efficacy: A Modelling Study Integrating Clinical Trial Data and Transmission Dynamics, Lancet Infect Dis, 2025 Jan 13, https://doi.org/10.1016/S1473-3099(24)00689-3 that single dose tafenoquine at 7.5 mg/kg body weight would achieve radical cure 87.5% of the time, while multi-dose regimens of primaquine wod be required to exceed that. The authors caution that the data are relevant to individuals with normal levels of glucose-6-phosphate dehydrogenase (G6PD); those with deficiency in the enzyme are at risk of severe complications, such as hemolytic anemia (red blood cells braking up), with either drug. In a commentary on the above article, Lacerda M & Cortez M, Efficacy of 8-Amino-quinolines for Plasmodium Vivax Malaria Radical Cure: Only One Part of the Problem, Lancet Infect Dis, 2025 Jan 3, https://doi.org/10.1016/S1473-3099(24)00771-0 reflect on two limiting factors: the reluctance of patients to continue primaquine after they become afebrile and the limited availability of tafenoquine which is highly, but not completely efficacious is reducing recurrence. On the other hand, the authors also claim that despite concerns, single dose tafenoquine is often tolerated by patients with modest G6PD deficiency.
Side effects and complications
Calculating doses of medications for children is a consistent task for physicians and others who administer drugs to them. Most of the time this is done by body weight Simeon S & al. undertook to study the dosing of the antimalarial lumefantrine (LF) in malnourished children. “Studies have … shown that severe malnutrition decreases LF bioavailability significantly.” As described in Optimizing Lumefantrine Dosing for Young Children in High-Malaria-Burden Countries Using Pharmacokinetic-Pharmacodynamic Simulations, Open Forum Infect Dis. 2024 Oct 17; 11(11):ofae627, https://doi.org/10.1093/ofid/ofae627, the authors used the metric of the antibiotic concentration of the drug in the patients’ bloodstream and concluded that only 75% achieved therapeutic concentration if the WHO-recommended dose regimen was followed and 77% were malaria-free after six weeks. Using simulation of increased dosing and extending the regimen by two days they concluded that 97% of children would reach the necessary 200 ng/mL lumefantrine and 88% would be malaria free for 42 days. {Neither the abstract nor the article address whether side effects (dermatologic or gastrointestinal) would increase in these scenarios.}
Drug resistance
Martinez-Vega R & al., Regional Action Needed to Halt Antimalarial Drug Resistance in Africa, Lancet. 2024 Dec 11: S0140-6736(24)02706-5, https://doi.org/10.1016/s0140-6736(24)02706-5 appears to be a call to action in a medical publication geared to physicians world-wide in general.
It is generally known that P. falciparum is resistant to chloroquine, but the drug is still being used against P. vivax, which is somewhat prevalent in East Africa. Abebe W & al., Prevalence of Molecular Markers of Chloroquine Resistance in Malaria Parasites in East Africa: A Systematic Review and Meta-Analysis, J Glob Antimicrob Resist. 2024 Dec 24: S2213-7165(24)00478-8, https://doi.org/10.1016/j.jgar.2024.12.019 is a literature review of the genetics of chloroquine resistance The article focuses on the genetics and while the prevalence of certain resistance genes was found to be high, they were not universal. Also, the article does not distinguish whether the analysis reflects a mix of Plasmodium species, or P. falciparum exclusively.
Dagnogo O & al., Prevalence and Genetic Diversity of Polymorphisms in pfcrt, pfdhfr-ts and pfk13 Propeller Genes of Plasmodium falciparum in Southern Côte d’Ivoire, Malaria World J 2025 Jan 6, 16:1, https://doi.org/10.5281/zenodo.14604138 is a study of P. falciparum genetics in order to ascertain resistant status in the geographic area mentioned. Based on their results, the authors conclude that “the prevalence of alleles associated with CQ chemoresistance … fell, while that of alleles associated with pyrimethamine chemoresistance… increased … No mutations in mutant alleles of the K13 propeller gene conferring resistance to artemisinin derivatives were observed at any of the study sites. The study thus showed that the [artemisinin combination therapies] used for first-line treatment of malaria in Côte d’Ivoire are still effective.”
According to Duarte D & al., “[i]ncreased copy number (CNV) of the P. falciparum gene plasmepsin 2 (pfpm2) have been reported to confer parasite tolerance to piperaquine (PPQ) and the multidrug resistance-1 (pfmdr1), resistance to mefloquine (MEF) and decreased susceptibility to lumefantrine (LUM).” Among 102 isolates from patients with malaria, they found either one or the other genetic change approximately 9% of the time. As they state in Low Prevalence of Copy Number Variation in pfmdr1 and pfpm2 in Plasmodium falciparum Isolates from Southern Angola, Malaria J, 2025 Jan 10, 24:5, https://doi.org/10.1186/s12936-024-05240-2, this is the first time that there is evidence of genetic predisposition to drug resistance among P. falciparum in southern Angola.
New drug research
Ganaplacide is a promising antimalarial that has been the subject of advanced clinical trials (e.g. Sangana R & al., J Clin Pharmacol. 2024 Sep 29, https://doi.org/10.1002/jcph.6138). Gal IR, et al. report on combining it with cabamiquine (a drug proposed as an effective chemoprophylaxis, e.g. van der Plas JL, Lancet Infect Dis, 2023 Jul 3, https://doi.org/10.1016/S1473-3099(23)00212-8) in Drug Interaction Studies of Cabamiquine: Ganaplacide Combination Against Hepatic Plasmodium berghei, ACS Infect Dis. 2024 Dec 10, https://doi.org/10.1021/acsinfecdis.4c00563. Since the two drugs have very different modes of action the authors anticipated that they would be effective together. They studied the combination in rodents and demonstrated effectiveness in preventing infection by the rodent-specific Plasmodium berghei. In addition, in vitro studies led to the conclusion that the combination was not toxic to human liver cells. This article could fit in the Prevention/Chemoprophylaxis category as well
Medicines for Malaria Venture has sponsored a number of new antimalarial research projects. Bestgen B & al., Safety, Tolerability, Pharmacokinetics, and Antimalarial Activity of MMV533: A Phase 1a First-in-Human, Randomised, Ascending Dose and Food Effect Study, and a Phase 1b Plasmodium Falciparum Volunteer Infection Study, Lancet Infect Dis, 2024 Dec 18, htps://doi.org/10.1016/S1473-3099(24)00664-9 is a report of a compound as yet unnamed drug under research, used in Phase 1a & 1b volunteer human studies in Australia. The article concludes “acceptable safety and tolerability for single oral MMV533 doses up to 160 mg in non-immune healthy volunteers. [The authors] showed a long half-life, a low propensity for resistance selection, and successfully characterised MMV533 pharmacokinetic–pharmacodynamic parameters. These findings suggest that MMV533 would be a suitable longacting partner drug in a fixed dose combination for the treatment of acute uncomplicated malaria.” With regard to clinical efficacy, seven volunteers in Phase 1b were infected with P. falciparum, five of whom had complete clearance of the parasite on a single dose of the compound; in two, who received a lower dose of the drug there was recrudescence after apparent clearance {this information is in the article, not the abstract}. It is of interest that the article contains only a single published reference (in 2021, unavailable to the reviewer) to this drug in addition to a scientific presentation in mid-2024. Dondorp AM, MMV533, a Promising New Antimalarial on the Horizon, Lancet Infect Dis, 2024 Dec 18, https://doi.org/10.1016/S1473-3099(24)00730-8 is a commentary on the above article.
The success of using multiple drugs simultaneously to combat infection depends on the ability of the various drugs to have different mechanisms so that the infectious agent cannot escape by means of being resistant to one or another drug administered. Reporting a multi-institutional study, Zhang Z & al., The Plasmodium falciparum NCR1 Transporter is an Antimalarial Target that Exports Cholesterol from the Parasite’s Plasma Membrane, Science Advances, 2024 Dec 18, 10(51) https://doi.org/10.1126/sciadv.adq6651 describes a way to interfere in a novel way with the parasite’s ability to maintain integrity of its cellular membrane. The paper is actually a structural analysis of the parasite’s relevant enzyme, but it mentions MMV009108, which is a promising inhibitor of the enzyme. There is of course a long way before the drug may be ready for use.
Testing a new antimalarial (N-89), Matsumori H & al. applied it transdermally (td) to mice infected by species-specific parasites. In their paper, The Antimalarial Activity of Transdermal N-89 Mediated by Inhibiting ERC Gene Expression in P. berghei-Infected Mice, Parasitol Int. 2024 Dec 29: 103026, https://doi.org/10.1016/j.parint.2024.103026, they state that tdN-89 resulted in diminished parasitemia in all nine mice tested, with three of them completely cured.
Plant extracts and traditional treatments
“In Ghana, the government has integrated herbal medicine into the formal healthcare system in response to widespread use of traditional remedies. However, empirical evidence supporting the contribution of integrated healthcare to malaria control remains limited. [Ampomah IG & al.] employed a phenomenological qualitative research design to explore the experiences of medical doctors and pharmacists from the coastal, forest and savannah regions of Ghana regarding the integration of modern and herbal medicine in the treatment and control of malaria.” After interviewing 26 healthcare professionals (physicians and pharmacists), they report in Integrating Modern and Herbal Medicines in Controlling Malaria: Experiences of Orthodox Healthcare Providers in Ghana, Arch Public Health. 2024 Dec 23; 82:240, https://doi.org/10.1186/s13690-024-01472-5 that “while medical doctors believed that the intervention has not significantly contributed to reducing malaria prevalence in Ghana, pharmacists viewed the presence of herbal clinics within government hospitals as an effective and sustainable alternative for treating malaria.” The authors’ conclusion seems to favor the pharmacists’ view and they call on the government to “enhance the effectiveness of an integrated health system, thereby increasing the contribution of herbal medicine towards achieving a malaria free nation.”
Other
Bacteria and fungi have been enlisted in the fight against infection in many situations. Bamgbose T & al.’ paper, Antiplasmodial Activity of Probiotic Limosilactobacillus fermentum YZ01 in Plasmodium berghei ANKA Infected BALB/c Mice, J Trop Med. 2024 Dec 12; 2024:6697859, https://doi.org/10.1155/jotm/6697859 draws attention the way in which probiotic bacteria mitigate the effects of mouse malaria. Mice receiving prolonged probiotic treatment exhibited delayed parasitaemia onset, reduced mortality rates, and a more robust immune response compared to control groups. “These outcomes suggest that probiotic intervention not only tempers the pathological effects of malaria but also enhances host resilience against infection. This study underscores the role of gut microbiota in infectious disease pathogenesis and supports probiotics as a promising adjunct therapy for malaria management.”
Campaigns and Policies
The focus of Banda P & al.’s article, Determining Household Out of Pocket Payments, Incidence of Catastrophic Expenditures and Impoverishment Among Patients with Malaria in Zambia’s Path Towards Universal Health Coverage, PLoS One. 2024 Dec 10; 19(12):e0312906, https://doi.org/10.1371/journal.pone.0312906 is the economic impact of malaria on families in Zambia, where according to government policy, there are no “user fees for accessing primary malaria health care services and virtually no user fees at all levels of care if referred through the referral system.” The authors studied over 2000 households querying their out of pocket (OOP) expenses incurred as the result of the illness in the family and catastrophic health expenses (CHE). They conclude that “[i]ncidence of CHE and impoverishment were reflected at all levels. In terms of CHE, the poorest contributed almost 30% while the wealthier quintile contributed about 10%. Similarly, impoverishment effects of OOPs are more pronounced in the poorest quintile. The OOP composed mainly of transport, followed by diagnosis and medicines and was lowest for Insecticide-treated bed nets (ITNs) payments.”
Egypt’s journey to becoming malaria-free is heralded by Amisu BO & al., Achieving Malaria-Free: Egypt’s Journey to WHO Certification and Global Implications for Disease Control, Trop Med Health. 2024 Dec 27; 52:101, https://doi.org/10.1186/s41182-024-00666-5. “Egypt’s journey involved early initiatives to reduce human-mosquito contact, the establishment of malaria control stations, and comprehensive outbreak management strategies. This country’s success serves as an exemplar for other African nations, emphasizing the need for adaptable, community-focused approaches to disease control. Despite challenges such as drug-resistant malaria strains and pesticide-resistant mosquitoes, Egypt’s experience demonstrates the potential for successful malaria elimination through coordinated efforts and innovative solutions.”
Ba KC & al. document in Effect of Mass Drug Administration on Malaria Incidence in Southeast Senegal During 2020–22: A Two-Arm, Open-Label, Cluster-Randomised Controlled Trial, Lancet Infect Dis, 2025 Jan 9, https://doi.org/10.1016/S1473-3099(24)00741-2 that the reduction in malaria incidence in the area studied was modest (126/1000 vs 146/1000) in comparison with adjacent communities, where mass drug administration (MDA) did not occur. The authors conclude that “three cycles of MDA with dihydroartemisinin–piperaquine plus single, low-dose primaquine was safe and reduced malaria burden during the intervention year. However, its sustained effect was weak and continuation of MDA or another transmission-reducing strategy could be required.” von Seidlein L, Another antimalarial mass drug administration? Lancet Infect Dis, 2025 Jan 9, https://doi.org/ 10.1016/S1473-3099(24)00764-3 is an editorial apparently skeptical of MDA, accompanying the above article. {The tone of the two-sentence abstract is negative, but the article itself is unavailable to the reviewer.}
Based on survey responses by 270 households, Ofori Boateng M & al. argue in Health Literacy and Household Financial Loss on Malaria Treatment for Children Under Five in Ghana: A Patients’ Perspective, Int Health. 2025 Jan 3; 17(1):77-83, https://doi.org/10.1093/inthealth/ihae022 that while the most knowledgeable families spend more on the care of their child with malaria than those with less knowledge, ultimately the latter groups will end up spending more because of reinfections. {There is no evidence presented either in the abstract or the article in support of this argument.}
Epidemiology
Climate change, biodiversity and environment
Zheng JX & al. “utilized advanced machine learning techniques, specifically the Extreme Gradient Boosting (XGBoost) model, to examine the impact of climate factors on malaria incidence” in three districts in southeastern Tanzania. They describe the results in Deciphering the Climate-Malaria Nexus: A Machine Learning Approach in Rural Southeastern Tanzania, Public Health. 2024 Dec 6; 238:124-130, https://doi.org/10.1016/j.puhe.2024.11.013. “Analysis revealed considerable heterogeneity in malaria incidence across southeastern Tanzania, with Kibiti experiencing the highest number of cases (15,308) over the study period. Seasonal peaks corresponded with rainy periods, though incidence rates varied by district. Incorporating lagged climate variables and seasonal trends significantly improved forecast accuracy, with the one-month lag model” yielding the most reliable result. The authors conclude that their “study demonstrates the utility of machine learning …, providing a data-driven framework to guide targeted, climate-informed malaria control strategies.”
Risk factors
Travel to areas where malaria is endemic is a well-known risk factor for inhabitants of countries where malaria has been eliminated or never been a problem. Less recognized is the risk carried by travelers within a country’s borders. Assefa M & al. studied this in the case of highland inhabitants of Ethiopia who travel to the malaria endemic areas at lower altitudes. They report in Population Travel Increases the Risk of Plasmodium falciparum Infection in the Highland Population of Gardula Zone, South Ethiopia: A Longitudinal Study, PLoS One. 2024 Dec 20; 19(12):e0315900, https://doi.org/10.1371/journal.pone.0315900 that “people traveling in May and November, those participants who had no formal education and agricultural workers, had a greater risk of developing malaria infection. Low bed net ownership (63.2%) and use (52.9%) have been documented among highland populations.”
Emmanuel AB & al. studied risk factors among 1215 pregnant women attending antenatal care (ANC) clinics in three districts by means of questionnaires. As reported in Factors Associated with Malaria in Pregnancy Among Women Attending ANC Clinics in Selected Districts of the Ashanti Region, Ghana, Malaria J, 2025 Jan, 24:8, https://doi.org/10.1186/s12936-025-05244-6, “[p]regnant women aged 17–25 years were 10.26 times more likely to have malaria compared to other age groups … Women with no formal education had higher odds of malaria, being 15.10 times more likely to have malaria compared to those with tertiary education …. Women not using insecticide-treated bed nets (ITNs) were 20 times more likely to have malaria compared to those who used ITNs….”
Using data from a national survey in 2021, Mhelembe T & al., Determining the Risk Factors of Malaria and Anemia in Children Between 6 and 59 Months Using the Joint Generalized Linear Mixed Model on the 2021 Nigeria Malaria Indicator Survey Dataset, Front Public Health, 2025 Jan 6, 12:1503884, https://doi.org/10.3389/fpubh.2024.1503884 reports the “following underlying risk factors for [both] malaria and anemia in children …: region, altitude, age of child in months, toilet facility of the household, main wall material used for the house, main roof material used for the house, children under five who slept under a mosquito net, whether the child had fever in last 2 weeks before the survey took place, place of residence where the child resides, household wealth index, sex of child, and mother’s education level.” {The abstract is silent on how these risk factors influence the presence of absence of malaria.}
Countries that have eliminated malaria remain at risk of recurrence in populations near borders of others that have not yet been able to do so (e.g. Egypt and Sudan or China and Myanmar). Fambirai T & al., Factors Associated with Contracting Border Malaria: A Systematic and Meta-Analysis, PLoS One. 2025 Jan 3; 20(1):e0310063, https://doi.org/10.1371/journal.pone.0310063 is a review of twelve articles on the subject, with the following results: “night outdoor activities …, engaging in forestry activities …, working in mines …, access to poor housing structure … cross-border movement … [and not using] insecticide-treated nets … were all significantly associated with contracting malaria within border regions. The use of insecticide-treated nets … and indoor residual spraying … were protective.”
Being a displaced person in an African refugee camp is a major risk factor for malaria. Two recent articles deal with this topic. Debash H & al., Prevalence and Associated Factors of Malaria Among the Displaced Population in Refugee Camps in Africa: A Systematic Review and Meta-Analysis, Malaria J, 2025 Jan 14, 24:15, https://doi.org/10.1186/s12936-025-05246-4 cites a prevalence between 24.7 – 47.2% in the various papers reviewed. Over 99% of these were P. falciparum infections. “Lack of insecticide-treated mosquito net utilization … and living near mosquito breeding sites … were risk factors of malaria.” Abdul-Rahman T & al., Improving Diagnostics and Surveillance of Malaria Among Displaced People in Africa, Int J Equity Health, 2025 Jan 21; 24(1):22, https://doi.org/10.1186/s12939-025-02378-6 states that “addressing malaria in displaced populations in Africa requires comprehensive and well-coordinated strategies. Advanced diagnostic and surveillance technologies are essential for promptly identifying and treating malaria, providing chances to monitor and control its spread effectively.”
General epidemiology
Berlin E & al, Surveillance for Action: Operationalizing Private Sector Surveillance and Service Delivery across the Malaria Transmission Continuum, Am J Trop Med Hyg. 2024 Apr 23; 112(1_Suppl):66-69, https://doi.org/10.4269/ajtmh.23-0447 “describes available evidence and lessons learned from the Greater Mekong subregion and sub-Saharan Africa on mapping and geolocating private providers; adding private providers to national digital registries; strengthening regulation, training, and supervision; providing feedback; and subsidizing commodities. Reporting tools should be electronic, aligned or integrated with existing national systems, and adapted to meet private sector needs. A strong enabling environment is also required, including regulatory systems that mandate private providers be registered and report into national surveillance systems. Where possible, existing systems and government personnel should be used to train, supervise, and mentor private providers.” Yé Y & Prosnitz D, Harnessing Malaria Surveillance Data for Transformative Malaria Control and Elimination, Am. J. Trop. Med. Hyg., 2025 Jan; 112(Suppl 1): 1–2 https://doi.org/10.4269/ajtmh.24-0817 is an editorial relating to the above and seven other related articles. The editorial concludes: “Given the critical role malaria surveillance plays in control and elimination efforts, funding for surveillance remains insufficient, limiting the ability of countries to implement required actions to strengthen and sustain reliable surveillance systems. We hope the challenges and opportunities discussed in this supplement will serve as a call to action for increased funding for malaria surveillance – from point of service collection to analysis and interpretation of data – which will help countries adopt emerging technologies to sustain current gains and strive for further improvement.”
“Asymptomatic malaria infection is now recognized as a potential threat to malaria control. However, its prevalence and its dynamics are poorly documented especially in a perennial context of high seasonal transmission.” Telfils R & al. conducted a study of 377 individuals “in southern Benin to investigate the dynamics of asymptomatic malaria infection and to identify factors influencing it.” As reported in Dynamics of Submicroscopic and Microscopic Asymptomatic Malaria Infection and Associated Factors: A Longitudinal Study in South Benin, PLoS One. 2024 Dec 12; 19(12):e0311217, https://doi.org/10.1371/journal.pone.0311217, the “human infectious reservoir consisted primarily of asymptomatic submicroscopic infections … followed by asymptomatic microscopic infections … and symptomatic infections … The prevalence of asymptomatic infection was highly related to age-group 5-15 years …and > 15 years … compared to the under 5 years old group.”
Guamene TJR & al. compared vector prevalence and species as well as propensity to bit during wet and dry seasons in two regions of Côte d’Ivoire. They report in Malaria Transmission in the Coastal Zone and in the Centre of Côte d’Ivoire During the Dry Season, Malaria J, 2024 Dec 24, 23:400, https://doi.org/10.1186/s12936-024-05176-7 that biting behavior abated and captured mosquitoes were negative for parasites in the dry season in the Central Region (dry savanna). Along the coast, the trend appeared to be in the opposite direction.
Kimani FT & al., Malaria Prevalence, Transmission Potential and Efficacy of Artemisinin-Based Combination Therapy in the Kenyan Central Highlands: A Zone Previously Characterized as Malaria-Free, Malaria J, 2025 Jan 13, 24:10, https://doi.org/10.1186/s12936-024-05214-4 is a report of very low but significant prevalence of malaria in an area of Kenya that recently reported recurrence of the disease. Some but not all of the infected individuals had traveled to areas in the country with known malaria. The article includes a thorough analysis of the vectora in the region as well as genetic characteristics of the infective parasite. Aside from a brief mention of seasonal variations, the article is silent on the question whether climate change is playing a role here.
In what is essentially a spatiotemporal study, Sisay M & al., Prevalence of Malaria and Associated Factors Among Pregnant Women in East Dembia District Northwest Ethiopia, BMC Pregnancy Childbirth. 2024 Dec 26; 24(1):866, https://doi.org/10.1186/s12884-024-07083-w lists the following risk factors in the District studied: unprotected source of water …, utilization insecticide-treated bed net …, stagnant water less than 1 [km] distance from home … were significantly associated with malaria among pregnant women.” Ownership bed net was negatively associated with malaria illness. Most infections were caused by P. falciparum, with about 21% by P. vivax and 5% mixed infections.
Similar to the above, Boundenga L & al., Epidemiology and Diversity of Plasmodium Species in Franceville and their Implications for Malaria Control, Sci Rep. 2024 Dec 30; 14:31977, https://doi.org/10.1038/s41598-024-83487-0, reports P. vivax for the first time in Gabon. The authors also report the presence of both P. ovale species, frequently in combination with P. falciparum.
Spatiotemporal studies
Esayas E & al., Impact of Nighttime Human Behavior on Exposure to Malaria Vectors and Effectiveness of Using Long-Lasting Insecticidal Nets in the Ethiopian Lowlands and Highlands, Parasit Vectors. 2024 Dec 18; 17:520, https://doi.org/10.1186/s13071-024-06607-9
Diriba D & al., Spatial Analysis and Mapping of Malaria Risk Areas Using Geospatial Technology in the Case of Nekemte City, Western Ethiopia, Int J Health Geogr. 2024 Dec 19; 23:27, https://doi.org/10.1186/s12942-024-00386-3
Alemu A & al., Malaria Burden and Associated Risk Factors Among Malaria Suspected Patients Attending Health Facilities in Kaffa Zone, Southwest Ethiopia, Malaria J, 2024 Dec 23, 23:397, https://doi.org/10.1186/s12936-024-05228-y
Biteghe-Bi-Essone JC & al., Microscopic Malaria Infection and Its Determinants in Urban and Rural Populations Living in South-East Gabon, J Parasitol Res. 2024 Dec 26;2024:8263358, https://doi.org/10.1155/japr/8263358
Mwesigwa A & al., Temporal Changes in Plasmodium falciparum Genetic Diversity and Multiplicity of Infection Across Three Areas of Varying Malaria Transmission Intensities in Uganda, Trop Med Health. 2024 Dec 30; 52:103, https://doi.org/10.1186/s41182-024-00672-7
Ajibaye O & al., Prevalence and Factors Associated with Childhood Malaria and Anaemia in Osun State, Nigeria: A Baseline Household Malariometric Study, Malaria J, 2025 Jan 13, 24:11, https://doi.org/10.1186/s12936-024-05238-w