By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
From: https://www.news-medical.net/news/20250601/US-funding-freeze-halts-malaria-prevention-and-genomic-research.aspx?utm_source=news_medical_newsletter&utm_medium=email&utm_campaign=malaria_newsletter_3_june_2025 “The ‘catastrophic’ freeze on US funding for malaria has halted prevention programmes across Africa and also threatens to stall advances in genomic research, says Jane Carlton, director of the Johns Hopkins Malaria Research Institute.
The US President’s Malaria Initiative (PMI) is one of numerous USAID-supported programmes to see its funding terminated under US President Donald Trump’s sweeping reforms this year.
From eco-friendly bacterial pellets that kill mosquito larvae, to gene-drive mosquitoes that suppress wild populations, scientists are developing an arsenal of promising new technologies to combat malaria.
….
“The dissolution of the President’s Malaria Initiative [PMI – a five-year programme to combat malaria in 15 African countries] is catastrophic. Modeling [reported in a leaked USAID memo] shows its collapse could cause 18 million new cases and 160,000 deaths yearly. Already, Uganda reports clinics rationing rapid tests, and Ethiopia’s PMI office halted bed net distributions mid-campaign.
Stockouts of artemisinin-based drugs are rising and five African countries have less than three months’ supply. This isn’t just a health crisis; it’s economic. Malaria costs Africa US$12 billion yearly in lost productivity.”
According to ScienceAdviser (https://www.science.org/content/article/researchers-question-reliability-abbott-s-rapid-malaria-tests), WHO “sent an internal memo [to its six regional offices on 30 April] about potential problems with a major company’s malaria tests after scientists reported issues with test sensitivity and warned it could delay patients’ access to critical treatment.
Abbott’s Bioline rapid diagnostic tests (RDTs) for malaria are used by health workers around the world, particularly in remote areas where lab techniques such as microscopy and DNA detection aren’t available. Investigations at several institutions in Southeast Asia suggest at least some of these RDTs fail to detect infections or show faint test lines for some positive cases.”
On 3 Jun, EurekAlert published the following article (https://www.eurekalert.org/news-releases/1086019):
Safety Monitoring Committee Clears Clinical Trial to Advance to Younger Age Groups
Physician-scientists at Groupe de Recherche Action en Santé (GRAS) in Burkina Faso have successfully completed initial safety evaluations in 30 adult Burkinabés as the first phase of a clinical trial of Sanaria® PfSPZ-LARC2 Vaccine, which is designed to prevent infection with Plasmodium falciparum malaria. The clinical trial is being conducted in collaboration with Sanaria Inc., Seattle Children’s Research Institute (SCRI) and the University of Maryland School of Medicine. Following its review, the independent Safety Monitoring Committee has endorsed proceeding to the next phase of the trial, which will test PfSPZ-LARC2 Vaccine in younger individuals who are 11–19 and 6–10 years old. Crucially, the initial data in adults confirmed the vaccine was safe, fully attenuated, and caused no malaria infections. Etc…
PEER REVIEWED ARTICLES (see notes after citations from non-peer-reviewed publications)
Prevention
Vaccines
While Copeland NK & al., Efficacy of RTS,S/AS01E Only Seen In Baseline Parasitemic and Not Baseline Aparasitemic Plasmodium falciparum-Exposed, Drug-Treated Kenyan Adults, J Infect Dis. 2025 May 29: jiaf274, https://doi.org/10.1093/infdis/jiaf274 states that vaccine efficacy was actually “negative” for P. falciparum-negative individuals in comparison with placebo (rabies vaccine), the abstract also contains the following statement: “In RTS,S/AS01E recipients, there were no statistical differences in anti-circumsporozoite (CS) antibody titers in baseline Pf-positive or Pf-negative participants, or in susceptibility to infection during the post-vaccination follow-up period” {emphasis added by reviewer}.
Fuentes E & al., Role of Malaria Exposure and Off-Target Responses on RTS,S/AS02(A) Vaccine Immunogenicity and Protection in Mozambican Children, NPJ Vaccines. 2025 Jun 6; 10:116, https://doi.org/10.1038/s41541-025-01167-0 is an article that is somewhat troublesome to interpret, because the WHO-approved variant of the vaccine is the RTS,S/AS01E, which uses a different adjuvant. While the article reports that that “naturally acquired PfCSP {P. falciparum circumsporozoite protein} IgG levels pre-vaccination were positively associated with RTS,S immunogenicity,” it is questionable whether the result can be extrapolated to the other vaccine preparation.
“The COVID-19 pandemic has emphasized the potential of mRNA vaccines in fighting pandemics, owing to their rapid development, strong immunogenicity and adaptability. However, a drawback is their dose-limiting reactogenicity and inability to generate durable humoral immunity.” Fougeroux C & al., A Modular mRNA Vaccine Platform Encoding Antigen-Presenting Capsid Virus-Like Particles Enhances the Immunogenicity of the Malaria Antigen Pfs25, Nat Nanotechnol. 2025 May 14, https://doi.org/10.1038/s41565-025-01889-1 is a report on enhancing the longevity of effectivity of vaccines based of P. falciparum sporozoites.
Bushi G & al., Determinants of Malaria Vaccine Acceptance: A Systematic Review and Meta-Analysis of Awareness, Acceptance, Hesitancy, and Willingness to Pay, Immun Inflamm Dis. 2025 May; 13(5):e70205, https://doi.org/10.1002/iid3.70205 is yet another study of public acceptance of the RTS,S vaccine. Eighteen studies with 21,975 participants [reported] 32% awareness …, 83% acceptance …, 14% hesitancy …, and 58% [willingness to pay]. Key determinants of acceptance included age, where younger adults (18-24 years) showed lower acceptance …. Employment, particularly farmers, had higher acceptance rates …. Lower socioeconomic status and larger family sizes were associated with decreased acceptance.”
Qu Z & al. have constructed a mathematical model of the timing of vaccination against malaria, using known factors of seasonality of infections and numerous others. They conclude in Mathematical Modeling of Malaria Vaccination with Seasonality and Immune Feedback, PLoS Comput Biol. 2025 May 12; 21(5):e1012988, https://doi.org/10.1371/journal.pcbi.1012988 that “[w]hen implementing a three-dose primary vaccination series, seasonally targeted campaigns can prevent significantly more cases per vaccination than constant year-long programs in regions with strong seasonal variation in transmission. In such scenarios, the optimal vaccination interval aligns with the peak in infected mosquito abundance and precedes the peak in malaria transmission. In contrast, seasonal booster programs may provide limited advantages over year-long vaccination.”
Two articles chronicle the current status of vaccination against malaria: Chen J & al., Malaria Vaccines: Current Achievements and Path Forward, Vaccines (Basel). 2025 May 19; 13(5):542, https://doi.org/10.3390/vaccines13050542 is yet another review of the current status of vaccination against malaria, including a review of new vaccine research. Notwithstanding its unrevealing abstract, Serrano-Coll H & Aristizábal-Parra LK’s article, Plasmodium and Host Immunity: Evasion Strategies and Advances in Malaria Vaccination, Scand J Immunol. 2025 Jun; 101(6):e70034, https://doi.org/10.1111/sji.70034 contains short but excellent summaries of malaria vaccines currently in use and some of them in development, while the main body of the paper discusses details of the immune response.
Vectors
“Indoor residual spraying (IRS) is an effective intervention for reducing mosquito vector density and malaria transmission. Uganda Prison Services (UPS) routinely implements IRS for malaria control in main {emphasis added} prison facilities.” Byaruhanga J & al., Impact of Indoor Residual Spraying on Malaria Incidence in Ugandan Prisons: An Interrupted Time Series Analysis, Malaria J, 2025 May 25, 24:163, https://doi.org/10.1186/s12936-025-05422-6 compares malaria infection rates in two prisons where IRS was administered versus two in the same regions without IRS over a five-year period. “The average monthly malaria incidence rate for the study period was much lower among the intervention facilities (7.1 and 13.3 cases per 1000 population per month for the central and northern regions, respectively) than among the comparison facilities (177.0 and 170.6 cases per 1000 population per month for the central and northern regions, respectively). The post-IRS intervention periods had lower malaria incidence rates than the pre-IRS periods across the intervention facilities in both regions.”
WHO approved clothianidin for IRS against Anopheles mosquitoes. Within two years, a report disclosed that even before the agent was introduced in Cameroon, more than half of An. gambiae gtested were resistant to it, while other Anopheles species were sensitive. Krezanoski P & al., Adjusting Vector Surveillance for Human Behaviors Reveals Anopheles funestus Drove a Resurgence in Malaria Despite IRS with Clothianidin in Uganda, Sci Rep. 2025 May 22; 15:17728, https://doi.org/10.1038/s41598-025-00623-0 reports that when clothianidin was introduced in Uganda, malaria incidence rose. The authors came to the conclusion that resistance by An. funestus (as demonstrated by increased biting of human volunteers) was the cause. When the agent used in IRS was switched back to an organophosphate, malaria rates dropped again.
Donacho DO & al. report on the utilization and factors influencing the use of insecticide treated nets (ITNs) among pregnant women in Determinants of Long-Lasting Insecticide-Treated Bed Net Utilization Among Pregnant Women in Gechi District, Buno Bedele Zone South West Ethiopia: A Community-Based Cross-Sectional Study, Environ Health Insights. 2025 May 11; 19:11786302251335135, https://doi.org/10.1177/11786302251335135. Among 422 randomly selected pregnant women in the geographic area studied, the vast majority (93.9%) owned ITNs but only about half of those (46.5%) used the nets while asleep at night. “The low level of utilization was significantly associated with women’ education, parity, antenatal care (ANC) attendance, and family size.”
Similarly, based on the 2022 Ghana Demographic and Health Survey, Awunyo W & al., Ownership and Utilization of Mosquito Bed Net Among Pregnant Women in Ghana: A National Population-Based Survey, Trop Med Health. 2025 May 9; 53:66, https://doi.org/10.1186/s41182-025-00739-z reports much greater ownership (80.1%) than utilization (47.6%) of bed nets by pregnant women. “… pregnant women [who already had children], had a partner with secondary level education … and higher educational status … had higher odds of mosquito bed net use. However, pregnant women who belonged to middle [and higher] wealth quintiles … had decreased odds of mosquito bed net use. In addition, pregnant women who had female household heads …, resided in the rural areas …, [who already had children] had higher odds of mosquito bed net ownership. Meanwhile, pregnant women with active health insurance … had lesser odds of mosquito bed net ownership.”
Decrying the underutilization of ITNs by pregnant and lactating mothers and small children (50-52%) Carshon-Marsh R & Di Ruggiero E, Improving the Utilization of Insecticide-Treated Nets for Malaria Prevention Among Pregnant Women, Lactating Mothers and Children in Sierra Leone: A Commentary, Malaria J, 2025 Jun 10, 24:185, https://doi.org/10.1186/s12936-025-05429-z is an article that recommends “frameworks like Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) [which offer] a pathway to decode … complexities [inherent in non-use of ITN s], ensuring that global strategies resonate with local realities.”
“House screening (HS) of doors, eaves, and windows using wire-mesh has demonstrated potential in the integrated vector management of malaria. However, limited epidemiological data are available to guide its implementation across different ecological settings. In a 16-month randomized controlled trial (follow-up period) conducted across three agroecological areas … [in] northwestern Ethiopia, treatment houses were equipped with HS combined with insecticide-treated nets (ITNs), while control houses received ITNs only. The intervention led to a significant 2.3-fold reduction in indoor malaria vector density, the primary entomologic outcome, largely influenced by An. gambiae s.l. mosquitoes. Fewer blood-fed mosquitoes were found in screened houses, indicating reduced human bites, which translated to six-fold decline in malaria prevalence (0.7%), the primary epidemiologic outcome, compared to control houses (4.3%). The article is Belay AK & al., A Randomized Controlled Trial Combining House Screening and Insecticide-Treated Nets Reduces Malaria Transmission in Northwestern Ethiopia, Sci Rep. 2025 May 21; 15:17709, https://doi.org/10.1038/s41598-025-02943-7
“The decline in malaria deaths has recently stalled owing to several factors, including the widespread resistance of Anopheles vectors to the insecticides used in [ITNs]. One way to mitigate insecticide resistance is to directly kill parasites during their mosquito-stage of development by incorporating antiparasitic compounds into [ITN]s. This strategy can prevent onward parasite transmission even when insecticides lose efficacy.” Probst AS & al. state in In vivo Screen of Plasmodium Targets for Mosquito-Based Malaria Control, Nature, 2025 May 21, doi.org/10.1038/s41586-025-09039-2 that they have identified a class of compounds that will kill the parasite’s mosquito-borne stage, thereby demonstrating “the promise of incorporating [the] compounds into [ITN]s to counteract insecticide resistance and to reduce malaria transmission.
“Since the detection of the Asian mosquito Anopheles stephensi in Dijbouti in 2012, it has spread throughout the Horn of Africa. This invasive vector continues to expand across the continent and is a significant threat to malaria control programs. Vector control methods, including insecticide-treated nets and indoor residual spraying, have substantially reduced the malaria burden. However, the increasing prevalence of mosquitoes resistant to insecticides, including An. stephensi populations, undermines ongoing malaria elimination efforts.” Acford-Palmer H & al., Genome Wide Population Genetics and Molecular Surveillance of Insecticide Resistance in Anopheles stephensi Mosquitoes from Awash Sebat Kilo in Ethiopia, Sci Rep. 2025 May 12; 15:16443, https://doi.org/10.1038/s41598-025-95814-0 is “the first whole genome population genetics study of invasive An. stephensi, revealing genomic differences from South Asian populations, which can be used for future assessments of vector population dispersal and detection of insecticide resistance mechanisms … Evidence of ongoing selection was found in several loci, including genes previously associated with neonicotinoids, ivermectin, DDT, and pyrethroid resistance.”
Anopheles mosquitoes are showing increasing resistance to a class of insecticides used in ITNs, called pyrethroids, including permethrin and deltamethrin. Okoko M & al., Phenotypic and Genotypic Insecticide Resistance Profiles of Main Malaria Vectors in Kwale County, Coastal Kenya, Malaria J, 2025 Jun 13, 24:191, https://doi.org/10.1186/s12936-025-05437-z report this to be case in coastal Kenya as well. However, when the nets were treated with piperonyl butoxide (PBO), they regained their ability to kill both An. gambiae and An. funestus, the two main malaria vectors in the area.
Farrell SN & al. explored “the innovative control strategy targeting Plasmodium with antimalarials during the mosquito stages” in Identifying Antimalarials that Disrupt Malaria Parasite Transmission When Fed to the Mosquito, Int J Parasitol. 2025 May 29: S0020-7519(25)00096-7, https://doi.org/10.1016/j.ijpara.2025.05.005. “Three antimalarials showed activity against P. berghei in mosquitoes, apparently targeting specific stages of P. berghei development during transmission. Borrelidin, a threonyl-tRNA synthetase inhibitor, significantly reduced P. berghei sporozoite numbers. Azithromycin, an antibiotic targeting apicoplast protein synthesis, significantly lowered sporozoite infectivity in mice. T111, a next generation compound targeting the parasite electron transport chain, reduced sporozoite numbers in P. berghei … T111 also prevented sporozoite production in mosquitoes infected with human malaria, P. falciparum, even after very short exposure times.”
Ganesan P & al., Efficacy of Essential oil From Maranta arundinacea L. Against Immature Stages of Dengue, Filariasis, and Malaria Vectors and Four Mosquito Predators, Exp Parasitol. 2025 May 22:108964, https://doi.org/10.1016/j.exppara.2025.108964 states that “essential oil” of the arrowroot plant was found to be toxic to eggs of An. stephensi if the mosquito was exposed to it. The material didn’t kill pupae. Four arthropod predators of mosquitoes were also exposed to the oils but were unaffected by it.
Chemoprophylaxis
Seasonal malaria chemoprevention (SMC) of children is in annual use in Sahel countries. In Northern Benin, two different extensions of SMC were considered: either demographic – children aged 5-10 in the currently targeted departments would also receive SMC, or geographic to children under 5 in new eligible departments to the south. Lemant J & al., Supporting Evidence-Based Decisions About the Geographic and Demographic Extensions of Seasonal Malaria Chemoprevention in Benin: A Modelling Study, PLOS Glob Public Health. 2025 May 19; 5(5):e0004509, https://doi.org/10.1371/journal.pgph.0004509 predicts after computer modeling that “between 2024 and 2026 the geographic extension of SMC would avert at least four times more severe malaria cases and five times more direct malaria deaths per targeted child than the demographic extension.” In fact, the geographic extension was implemented in 2024.
Similar to the article from Mozambique by Nhampossa T & al. reported last month (and actually published earlier), Roh ME & al., Dihydroartemisinin-Piperaquine Versus Sulfadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy: A Systematic Review and Individual Participant Data Meta-Analysis, EClinicalMedicine, 2025 Apr 29; 83:103202, https://doi.org/10.1016/j.eclinm.2025.103202 is a review of six articles published from East Africa on comparing the two intermittent prophylactic treatment of pregnancy (IPTp) regimens. As the result of their meta-analysis of these studies, the authors conclude the following: “In areas with high P. falciparum sulfadoxine-pyrimethamine resistance, dihydroartemisinin-piperaquine offers superior antimalarial efficacy than sulfadoxine-pyrimethamine. However, replacing sulfadoxine-pyrimethamine with dihydroartemisinin-piperaquine alone may not lead to improved maternal and infant health outcomes. Instead, it could result in slightly reduced gestational weight gain and a modest increase in the risk of small-for-gestational age births, and poor infant growth by two months of age. Future research evaluating alternative strategies for IPTp are needed.”
Other
Zegene GM & al. studied 1883 households about their malaria prevention and treatment practices in SW Ethiopia by questionnaire. They report in Perceptions and Practices of Household Heads Toward Malaria: A Community Based Cross Sectional Study in Southwest Ethiopia, Malaria J, 2025 Jun 2, 24:176, https://doi.org/10.1186/s12936-025-05413-7 that many individuals do not finish the recommended antimalarial regimens and have inadequate knowledge of how malaria is transmitted. People with lower educational backgrounds and women in general gave fewer correct responses to the questions asked about prevention, including bed net use.
As a result of querying 316 individuals in rural Ghana, Botchway FA & al. report in Knowledge Attitudes and Practices Regarding Malaria and HIV in People Living in Rural Ghana, Health Sci Rep. 2025 May 19; 8(5):e70833, https://doi.org/10.1002/hsr2.70833 that “[m]ore than 94% of respondents in all categories indicated they knew the clinical signs/symptoms, transmission, and prevention of malaria. Although 66.0% of malaria-negative respondents and 62.2% of malaria-positive respondents preferred using mosquito nets to protect themselves, only 39.4% of malaria-negative respondents and 32.8% of malaria-positive respondents reported sleeping under a mosquito net the previous night. Mosquito coil as a malaria preventive method recorded the least preference with less than 7% in all categories.”
Likewise, in Northern Uganda, Echodu R & al., Household Practices and Infrastructure Associated with High Plasmodium falciparum Infection Rates Among Children Under Five Years Old in Northern Uganda, Malaria J, 2025 Jun 8, 24:181, https://doi.org/10.1186/s12936-025-05288-8 documents low rates of ITN use, unscreened thatch roof housing, and infrequent IRS to be associated with high rates of malarias infection among children age five years and under.
Diagnosis
General diagnostics
Payne RO & al. set out to see whether newer diagnostics (loop-mediated amplification assay [LAMP]) had sufficient sensitivity to support a change in diagnostic practice” from current practice of using rapid diagnostic tests (RDTs). Using a small number of human volunteers infected with P. falciparum, they report in Diagnosis of Plasmodium falciparum Malaria at Very Low Parasitaemias Using a Commercially Available LAMP Assay and RDT, Trans R Soc Trop Med Hyg. 2025 May 20: traf050. https://doi.org/10.1093/trstmh/traf050 that RDTs detected only 56% of infections whereas LAMP was 100% sensitive. Quantitative polymerase chain reaction (qPCR) was used to validate the results.
Alemayehu A & al. compared several diagnostic methods to histologic findings on placentae delivered by pregnant women. They found that rapid diagnostic tests (RDTs) and microscopy were both prone to miss the diagnosis of malaria proven by histology, while quantitative polymerase chain reaction (qPCR) was 100% sensitive and over 95% specific. The paper is Performance of Malaria Rapid Diagnostic Test, Microscopy, Polymerase Chain Reaction, and Histopathology to Diagnose Malaria Among Pregnant and Parturient Women Using Peripheral, Placental, and Cord Blood, and Placental Biopsy in Majang Zone of Gambella Region, Southwest Ethiopia, Malaria J, 2025 Jun 1, 24:175, https://doi.org/10.1186/s12936-025-05426-2.
Rojas E & al. tested five different computer diagnostic models for classification of “blood cells infected with Plasmodium spp. to support malaria diagnosis by optical microscope.” Based on reviewing over 27,000 blood specimens (!), they report that one of the models had excellent results. Their article in Computer Viewing Model for Classification of Erythrocytes Infected with Plasmodium spp. Applied to Malaria Diagnosis Using Optical Microscope, Medicina (Kaunas). 2025 May 21; 61(5):940, https://doi.org/10.3390/medicina61050940 mentions that this method is probably best suited for laboratories away from the field.
Field diagnostics
Lactate dehydrogenase (LDH)-based RDTs are being introduced in several countries where RDTs based on histidine-rich protein 2 (HRP2) is failing due to gene deletion in the DNA of the parasite. Demass TB & al. tested the accuracy of the new LDH-based test and report in Comparing the Diagnostic Accuracy of the Newly Introduced and Existing Malaria Tests in Northwest Ethiopia, PLoS One. 2025 May 7; 20(5):e0322366, https://doi.org/10.1371/journal.pone.0322366 that compared to microscopy, there is virtually full agreement between the study diagnostic and microscopy, so the authors declare LDH-based RDTs as exceeding threshold results recommended by WHO for diagnostic tests.
“Plasmodium falciparum Histidine-Rich Protein 2 (PfHRP2)-based malaria rapid diagnostic tests (mRDTs) [are] widely used in endemic regions where microscopy is sometimes not feasible. While these tests offer high sensitivity, persistent PfHRP2 antigenemia and gene deletions can cause false-positive and false-negative results, compromising their accuracy for malaria case management and surveillance.” In order to evaluate the accuracy of these mRDTs, Wasena SA & al. studied “data from a longitudinal birth cohort of 750 children followed monthly from birth to 36 months in a holoendemic region of Kenya.” As reported in Diagnostic Accuracy of PfHRP2-Based Malaria Rapid Diagnostic Tests and Antigenemia Persistence in Kenyan Children from a Holoendemic Region: Implications for Case Management and Surveillance, Exp Biol Med (Maywood). 2025 May 22; 250:10585, https://doi.org/10.3389/ebm.2025.10585, “mRDT showed a high sensitivity of 97.27% but a moderate specificity of 65.00% in acute febrile illness, indicating frequent false-positive results. The positive predictive value was low (35.10%), suggesting that confirmatory testing is needed, while the negative predictive value was high (98.89%), reinforcing the reliability of mRDTs [in this geographic area – added by reviewer] in ruling out malaria.”
“The emergence and spread of pfhrp2 gene-deleted parasites have prompted nationwide surveillance to monitor trends and potential hotspots for P. falciparum with pfhrp2 gene deletions.” Comparing diagnostic results with HRP2-sensitive RDTs with dual (HRP2-LDH) sensitive ones, Bredu DG & al. “evaluated the prevalence and distribution of P. falciparum with pfhrp2 gene deletions in Ghana in 2021” using blood spots collected from 160 health care facilities across 16 regions in the country. As they conclude in Prevalence of Plasmodium falciparum Parasites with pfhrp2 exon 2 Gene Deletion in Symptomatic Malaria Patients Across Ghana in 2021, Malaria J, 2025 May 28, 24:170, https://doi.org/10.1186/s12936-025-05419-1, “[n]o false negative sample was identified in this study, and less than 1% of parasites with pfhrp2 gene deletions (mainly from RDT positive samples) were found in the population. This finding offers assurance for the continued reliance on HRP2-based RDTs for malaria screening in public health clinics in Ghana.”
Acan D & al., Point-of-Care Evaluation of Malaria Rapid Diagnostic Test (mRDT) for Detection of Plasmodium falciparum Among Children Under 5 Years of Age Attending Panyadoli Health Center III in Kiryandongo Refugee Settlement, Mid-Western Uganda, J Parasitol Res. 2025 May 5; 2025:9956261, https://doi.org/10.1155/japr/9956261 reports on the comparison of RDT to microscopy in a refugee population. The prevalence among 380 children was 12.8% with RDT and 12.2% with microscopy. There was generally good agreement between the two methods. {These results seem very low in a population generally considered more subject to malaria than the general population.}
New diagnostic methods
None this month
Treatment
Treatment results
None this month
Side effects and complications
“Due to inadequate evidence about the safety of artemisinin-based combination therapy (ACT) in the first trimester, the World Health Organization (WHO) relied on … quinine, for first trimester malaria treatment despite its poor tolerability. For about two decades now, oral quinine and oral clindamycin have been the recommended treatment for uncomplicated malaria in the first trimester.” Gyebuni P & al. explored compliance with this recommendation through interviews with 26 physicians and other caregivers. They report in, Clinicians’ Experience with Quinine-Based Treatment of Malaria in the First Trimester of Pregnancy in Ghana: A Phenomenological Study Malaria J, 2025 Jun 5, 24:178, https://doi.org/10.1186/s12936-025-05342-5 that due to experience with side effects and patient resistance, there is significant reluctance among physicians to prescribe quinine. “Participants’ attitudes towards malaria treatment include “watchful waiting” and the tension to treat promptly amidst concerns about potential treatment risks. The novel findings of this study were ‘watchful waiting’ and the treatment of uncomplicated malaria in early pregnancy with intravenous artesunate.”
Guidelines
According to Amba MN & al.’s paper, Medication Errors in Malaria Management in Children: Insights from Pharmacovigilance Data in the Democratic Republic of Congo, BMC Pharmacol Toxicol. 2025 May 22; 26:108, https://doi.org/10.1186/s40360-025-00941-z, “[m]edication errors accounted for 65,9% of the 851 cases retrieved from [a pharmacovigilance database]. Children aged 2-11 years represented 55.2% of the study population. The choice of treatment, duration and dosage were the main prescription criteria for deviations.” The authors advocate health care provider training as well as publicizing the extent of pharmacovigilance.
Guidelines of malaria treatment include initiating therapy within 24 hours after the appearance of symptoms, especially in situations of severe malaria. Yet delays in treatment occur with some frequency. This is frequently caused by delayed diagnosis and is not always under the control of health care professionals. Even though Asiimwe JB & Kadubira E, Timeliness of Malaria Treatment in Children Under Five Years in Uganda: An Analysis of 2016 Demographic Health Survey Data, BMC Pediatr. 2025 May 24; 25:414, https://doi.org/10.1186/s12887-025-05768-5 uses ten year old data in their report, the point they make about the 41% of 4000+ children included in their analysis is that familial, often maternal decisions make the difference in quick versus delayed treatment. Those with better education, access to radio, good connectivity to local health workers, and those who tend to make joint decisions with the child’s father had children who had treatment initiated more rapidly than those who did not.
Another way that patients and caregivers influence adherence to treatment guidelines is by their following advice on dosage and timing of medications prescribed. Bawate C & al., Impact of Health Education Intervention on the Patients’ Adherence to Malaria Artemisinin-Based Combination Therapy in Kamuli District, Uganda, Malaria J, 2025 Jun 12, 24:189, https://doi.org/10.1186/s12936-025-05444-0 describes how on follow up of an education session adherence to the dosage regimen improved slightly, but significantly. The authors also caution that not all education is equally effective, asserting that “not all health workers explain clearly how to use the ACT medicines prescribed.”
Drug resistance
Olupot-Olupot P & al. tested parasites gathered from 200 blood spots and conclude in Comprehensive Analysis of Molecular Markers Linked to Antimalarial Drug Resistance in Plasmodium falciparum in Northern, Northeastern and Eastern Uganda, Malaria J, 2025 Jun 13, 24:190, https://doi.org/10.1186/s12936-025-05439-x that there is “rising partial artemisinin resistance and widespread antifolate resistance surpassing WHO thresholds in Northern, Northeastern, and Eastern Uganda. Emerging super-resistant parasites pose a serious threat to malaria control, necessitating urgent enhanced surveillance and alternative treatment strategies.”
“To address the current threat of antimalarial resistance, countries need innovative solutions for timely and informed decision-making. Integrating molecular surveillance for drug-resistant malaria into routine malaria surveillance in pre-elimination contexts offers a potential early warning mechanism for further investigation and response.” Kagoro FM & al., Factors Affecting Integration of an Early Warning System for Antimalarial Drug Resistance Within a Routine Surveillance System in a Pre-Elimination Setting in Sub-Saharan Africa, PLoS One. 2025 Jun 3; 20(6):e0305885, https://doi.org/10.1371/journal.pone.0305885 is a description of data management improvements that assist in tracking drug resistance by P. falciparum. {This paper could be cited under Epidemiology/General epidemiology as well.}
New drug research
Resistance by the Plasmodium parasite to current therapies “has spurred the need for new antimalarial drugs and strategies. Among the promising areas of research are heterocyclic compounds, which, due to their diverse and versatile chemical structures, are being investigated for their ability to disrupt the Plasmodium lifecycle. These compounds have potential as novel therapeutic agents that could enhance current treatment options.” The article reviewing progress in this area is Tahlan S & al., A Progress Report in Advancements of Heterocyclic Compounds as Novel Antimalarial Agents Over the Last 5 Years, Eur J Med Chem. 2025 May 5; 289:117393, https://doi.org/10.1016/j.ejmech.2025.117393
Sapanisertib is an experimental oral anticancer drug that has been found to inhibit certain enzymes in Plasmodium parasites. Gachuhi S & al.’ article, Medicinal Chemistry Progression of Sapanisertib, the Anticancer and Dual Plasmodium Phosphatidylinositol 4-Kinase Beta and cGMP-Dependent Protein Kinase Inhibitor, for Malaria, J Med Chem. 2025 May 16, https://doi.org/10.1021/acs.jmedchem.4c02799 reports that a chemical analog of the drug was effective in reducing parasitemia in the mouse model of malaria. The drug had a “good safety profile.”
Although it is uncertain why Hamid A & al. chose a particular compound to work with, they describe its effectiveness in their paper, Antiplasmodial Effect of Benzimidazole-Pyrazole Derivative Against Plasmodium berghei Infection in Mice Model, Bioorg Chem. 2025 May 28; 163:108634, https://doi.org/10.1016/j.bioorg.2025.108634. In addition to the mouse studies, they also report that the compound’s affinity for P. falciparum proteins is higher than that of chloroquine.
Kushawaha AK & al. synthesized “twenty-four carboline-triazole derivatives … using a molecular hybridization approach and evaluated [them] for their antimalarial activity against Plasmodium parasites. As described in their paper, Design, Synthesis and Evaluation of Novel Carboline-Triazole Hybrids as Promising Antimalarial Agents, Eur J Med Chem. 2025 Jun 5; 290:117514, https://doi.org/10.1016/j.ejmech.2025.117514, one of the compounds was found to be effective in two different mouse models.
Plant extracts and traditional treatments
Two articles deal with using the plant product of Artemisia annua in treatment of malaria, rather than purified artemisinins. Xu F & al.’s article, The Plant Matrix of Artemisia annua L. for the Treatment of Malaria: Pharmacodynamic and Pharmacokinetic Studies, PLoS One. 2025 May 7; 20(5):e0322835, https://doi.org/10.1371/journal.pone.0322835 is not the first to raise the question of efficacy of purified or synthetic artemisinin derivatives in comparison to the extract from the A. annua plant. In the authors’ studies on laboratory animals, extracts of leaves and stems of the plant that contained several compounds other than artemisinin (some identified by the authors) had significantly higher antimalarial effect than artemisinin alone. Vashisth D & Mishra S, Unlocking the Potential of Artemisia annua for Artemisinin Production: Current Insights and Emerging Strategies, 3 Biotech. 2025 Jun; 15(6):164, https://doi.org/10.1007/s13205-025-04332-3 argues that the purification process from the plant yields insufficient amount of the active drug and explores methods by which the plant can be induced to yield more. At the same time the article also states that “the use of whole plants (such as dried leaf powder) instead of purified artemisinin alone has been found to improve drug absorption in the body, improve its effectiveness, and help combat artemisinin resistance.”
Bunalema L & al. interviewed 102 traditional medicine practitioners to gather infromation about their use of herbal remedies for malaria. As they describe in Medicinal Plants Traditionally Used for Management of Malaria in Rural Communities of Uganda, BMC Complement Med Ther. 2025 Jun 4; 25:201, https://doi.org/10.1186/s12906-025-04946-3. “Vernonia amygdalina Del., Aloe vera (L) Burm. f, Vernonia grantii Oliv. and Justicia betonica L. were identified as important plant species that can be further studied to validate their safety, antiplasmodial and active bioactive phyto-chemicals that can provide novel lead compounds for malaria treatment. These plant species can also be conserved through cultivation for sustainable use.”
Tsouh Fokou PV & al., Natural Products as Transmission-Blocking Agents Against Malaria: A Comprehensive Review of Bioactive Compounds and Their Therapeutic Potential, Malaria J, 2025 May 26, 24:164, https://doi.org/10.1186/s12936-025-05395-6 “explores the potential of natural sources, including medicinal plants, marine organisms, and microorganisms—as reservoirs of novel bioactive compounds with anti-malarial properties. A comprehensive literature search identified promising natural products with gametocytocidal and sporontocidal activity, validated through advanced bioassays. The review also evaluates various methodologies, such as colorimetric, microscopy, and flow cytometry assays, for assessing transmission-blocking efficacy. The findings emphasize the potent gametocytocidal effects of certain plant extracts … and microbial products…. Despite promising in vitro and in vivo data, the transition of these compounds to clinical applications remains limited.”
Other
None this month
Campaigns and Policies
Mass drug administration (MDA) has been shown to greatly reduce the prevalence of malaria in communities, but its effects are usually not sustained unless other effective preventive measures are rigorously applied. Li M & al.’s article, A Non-Randomized, Open-Label Study to Assess the Impact of Rounds of Mass Drug Administration with Artemisinin-Piperaquine Plus Primaquine on Malaria in São Tome Island, Parasit Vectors. 2025 May 16; 18(1):177, https://doi.org/10.1186/s13071-025-06768-1 demonstrates once again that three rounds of ACT with piperaquine suppress the prevalence of the disease, but the sustainability of the reduction is not addressed.
Fernandes S & al. worked with “twelve experts working in the field of malaria during pregnancy, representing the disciplines of health economics, mathematical modelling, epidemiology and clinical medicine [to develop] a comprehensive disease policy model of malaria during pregnancy, including ten maternal and ten child health outcomes with four stratifiers.” Their article, Co-Developing a Comprehensive Disease Policy Model with Stakeholders: The Case of Malaria During Pregnancy, PLOS Glob Public Health. 2025 May 7; 5(5):e0003775, https://doi.org/10.1371/journal.pgph.0003775 is a description of the development process.
“Proactive community case management (proCCM), under which CHWs regularly visit households to screen, test and treat individuals for malaria, aims to improve timely case management, avert severe disease and potentially reduce transmission.” Rutagwera MI & al. “conducted a two-arm cluster-randomised controlled trial, comparing proCCM plus routine passive care to routine passive care only in Chadiza District, Eastern Province, Zambia, between April 2021 and May 2023…” They report in Impact of Proactive Malaria Community Case Management (proCCM) on Parasite Prevalence and Incidence from 2021 to 2023: A Randomised Controlled Trial in Chadiza District, Eastern Province, Zambia, BMJ Glob Health. 2025 May 24; 10(5):e017697, https://doi.org/10.1136/bmjgh-2024-017697 that “[n]o significant difference between arms in the change in parasite prevalence was estimated … However, there was a small, ongoing decline in malaria incidence each month in proCCM clusters compared with control clusters … [the] study suggests proCCM may modestly reduce malaria incidence over time in some settings with high baseline utilisation of routine facility and community case management.”
“In the context of high malaria burden and insufficient resources, several national malaria programs (NMPs) used subnational tailoring (SNT) as a tool for evidence-informed decision-making on their national malaria strategic plans and funding requests. SNT is a data-informed method of developing intervention plans that maximize health impact under limited resources across heterogenous areas and populations.” Onyango L & al. reviewed the process applied in five West African countries and report in Subnational Tailoring of Malaria Interventions for Strategic Planning and Prioritization: Experience and Perspectives of Five Malaria Programs, PLOS Glob Public Health. 2025 May 28; 5(5):e0003811, https://doi.org/10.1371/journal.pgph.0003811 that “SNT outputs were used to inform national strategic plans and prioritized plans, that the process incentivized improvements in data collection and data quality, and that NMPs were strongly motivated to grow their capacity to conduct more steps of the SNT analysis process internally. Major challenges included the lack of resources available to implement the full strategic plans as well as challenges with data quality and alignment of stakeholders.”
“The presence of a community effect in cluster randomized trials of malaria vector control interventions has led to the implementation of “buffer zones” around clusters to limit the potential for contamination between interventions.” Thickstun C & al. undertook to measure these buffer zones for campaigns implememnting IRS and ITN distribution. As they report in Inter-Cluster Contamination: A Semivariance Analysis of Community Effect Ranges of Malaria Vector Control Interventions in a Four-Armed Malaria Trial in Muleba, Tanzania, Malaria J, 2025 Jun 9, 24:184, https://doi.org/10.1186/s12936-025-05438-y, “[s]ignificant semivariogram model range estimates extended beyond the trial buffer sizes by a median average of 868 m in [ITN] intervention clusters and 1235 m for IRS clusters. This presents a contamination, or spillover, potential for all trialed intervention types that may reduce the statistical power to detect difference between trial arms.”
Eneh SC & al. Eliminating Malaria in Nigeria: Insights from Egypt’s Success and Pathways to Sustainable Eradication, Malaria J, 2025 Jun 9, 24:183, https://doi.org/10.1186/s12936-025-05391-w argues that by following Egypt’s example, Nigeria might also be able to eliminate malaria. “By adopting a holistic, multi-sectoral approach informed by Egypt’s success, Nigeria can significantly reduce its malaria burden, enhance health outcomes, and contribute to global malaria eradication efforts.”
Epidemiology
Climate change, biodiversity and environment
“The progress made against malaria has resulted in a nationwide reduction of the disease burden in Senegal. The observed overall low transmission levels are, however, marked by an important spatial heterogeneity with hotspots subsisting in several parts of the country.” Ndiaye A & al.’ s article, Spatiotemporal Analysis of Anopheles gambiae Larval Sites and Malaria Transmission in Djilakh, Central Senegal, Malaria J, 2025 May 26, 24:167, https://doi.org/10.1186/s12936-025-05388-5 is an analysis of environmental factors that create areas with persistent high malaria infection rates. “… mosquito breeding sites found within and in the vicinity of the study village consisted of natural temporary ponds, characterized by clay and clay-sandy soils. The analysis of meteorological and malaria morbidity indicated that malaria transmission is influenced by precipitation. The correlation between malaria morbidity and functioning breeding sites varied throughout the rainy season, depending on the size and stability of the existing breeding sites.”
According to Yao T & al.’s article, Spatiotemporal Patterns and Climate-Induced Macroeconomic Burden of Malaria in Sub-Saharan Africa, BMC Public Health. 2025 May 29; 25:1975, https://doi.org/10.1186/s12889-025-23190-5, “[t]he macroeconomic burden of malaria accounts for 1.58% of the total GDP in SSA {sub-Saharan Africa}, equating to USD 497.06 billion …, with weather conditions contributing 60% of the economic burden. The climate-related macroeconomic burden of malaria mortality varies dramatically across regions, with East Africa bearing the highest cost at USD 195.90 billion … For every 1 °C increase in temperature in SSA, the number of malaria incidences will rise by 16.30 … per 1,000 incidences, while malaria-related deaths per 100,000 incidences will increase by 5.79.
In December 2024, L’Initiative-Expertise France organized a workshop in Musanze, Rwanda, for National Malaria Control and Elimination Programmes (NMC/EPs) representatives from 19 sub-Saharan African countries. Caminade C & al.’s article,, Climate Change and Malaria Control: A Call to Urgent Action from Africa’s Frontlines, Malaria J, 2025 Jun 6, 24:179, https://doi.org/10.1186/s12936-025-05431-5 is a report on the meeting. “Malaria is a climate-sensitive vector-borne disease. Rainfall creates breeding sites suitable for the proliferation of Anopheles malaria vectors. Temperature directly affects the growth and biting rates of mosquitoes as well as the sporogonic cycle, that is the development of the malaria parasite within the mosquito’s body. Furthermore, habitat changes influence vector distribution and disease transmission dynamics. In addition, weather extremes also have multi-faceted impacts on malaria control and the epidemiology of the disease…. The workshop focused on surveillance, modeling, climate forecasting, and innovative control methods to mitigate climate change impacts on malaria. Participants shared challenges, experiences and best practices. Key challenges highlighted include shifts in malaria transmission seasons, disease spread to mid-altitude regions, and infrastructure damage from extreme weather. Additional factors, such as drug and insecticide resistance, the spread of Anopheles stephensi, and changes in vector behaviour, are exacerbating malaria transmission in African cities. Participants stressed the need for collaborative efforts to tackle these evolving threats. This comment reflects the expertise and insights of 19 NMCPs actively managing malaria control and aims at raising awareness, inform policy discussions, and strengthen global partnerships to address the intersection of malaria and climate change.”
Risk factors
According to Blanken SL & al., Anopheles Mosquito Exposure Is Associated with Age, Gender and Bed Net Use in Areas in Uganda Experiencing Varying Malaria Transmission Intensity, J Infect. 2025 May 16, https://doi.org/10.1016/j.jinf.2025.106508, “[a]dults and school-age children are at higher risk for receiving mosquito bites” than children under five. Yet the proclivity is further modified by sleeping under ITNs (lower) and being male (higher).
“Malaria presents a big threat to the health of refugees, internally displaced persons, returnees and other such persons affected by humanitarian emergencies…” Acan D & al., Prevalence of Malaria and Associated Risk Factors Among Febrile Under-Five Refugee Children Attending Panyadoli Health Centre III, Kiryandongo District, Mid-Western Uganda, Malaria J, 2025 May 25, 24:162, https://doi.org/10.1186/s12936-025-05404-8 is a study over three months in 2022 of children in a particular refugee camp that had a malaria prevalence rate of 12.6%. “The associated risk factors for malaria infection included: non-application of indoor residual spraying over the last 12 months …, history of malaria in …, and not sleeping under insecticide-treated nets …”
Mukabana LN & al. “investigated the socioeconomic and environmental factors driving [the] spatial heterogeneity” that is evident within specific regions of Tanzania. Their paper, Heterogeneous Malaria Transmission Patterns in Southeastern Tanzania Driven by Socio-Economic and Environmental Factors, Malaria J, 20254 May 29, 24:172, https://doi.org/10.1186/s12936-025-05418-2, describes the following: “Greater elevation and higher rainfall were positively associated with malaria infection …, while temperature showed no significant effect …. Households in densely vegetated areas had higher malaria infections compared to those in more developed, built-up areas. At the individual level, males had a higher prevalence … and displayed significantly greater odds of infection … than females … School-aged children (5–17 years) had a higher prevalence … compared to adults (18–60 years) … The probability of infection declined with increasing age …. Larger household sizes (more than four members) were positively associated with malaria infection …. Open-eave housing was associated with higher odds of malaria, whereas closed eaves … and metal roofs … were protective factors. Open water sources were positively associated with malaria infection compared to protected water sources … Lack of bed net use was positively associated with malaria but this was not statistically significant…”
General epidemiology
The Fulani people, who live in several countries in West Africa seem less susceptible to malaria than other ethnic groups within the same regions. Shahin T & al., Single-Cell Transcriptomics Reveals Inter-Ethnic Variation in Immune Response to Falciparum Malaria, Am J Hum Genetics, 2025 Mar 6, 112(3):709-23, https://doi.org/10.1016/j.ajhg.2025.01.020 is a study of this group compared to another, both of them in Burkina Faso. The authors “identify ethnic, cell-type-specific, and genetic regulatory effects on host immune responses” that may lead to an explanation for this lower susceptibility.
A study of 388 delivering mother/child pairs of which 62 infants were exposed to their mother’s malaria at birth, Tshiongo JK & al., Impact of Malaria in Pregnancy on Infant Neurodevelopment and Malaria Susceptibility During the First Year of Life in Kinshasa, the Democratic Republic of the Congo, Int J Infect Dis. 2025 May 15: 107927, https://doi.org/10.1016/j.ijid.2025.107927 is an article that expands on the already known effects of maternal malaria on infant development. “… exposed infants had a significantly lower birth weight … than those born of uninfected mothers … GM [gross motor skills] at 12 months [of age] showed no significant differences between groups … However, infants exposed to malaria infection had significantly lower ECL [early learning composite, a standard measure of infant development]. Infant malaria, malnutrition and LBW [low birth weight] were significantly associated with reduced GM scores.”
In “an observational cohort study in eastern Gambia to better understand the relative contribution of symptomatic- and asymptomatic malaria infections to the infectious reservoir,” Soumare HM & al., Asymptomatic School Children and Adults Are Important for the Human Infectious Reservoir for Plasmodium falciparum Malaria in an Area of Low Endemicity in The Gambia, J Infect. 2025 May 20: 106507, https://doi.org/10.1016/j.jinf.2025.106507 report on testing mosquitoes after they had bitten symptomatic and asymptomatic individuals. “More than “84% of mosquito infections occurred from asymptomatic individuals with patent infections, with the highest contribution from older children (40.3%), and adolescents and adults (45.5%).”
Minwuyelet A & al., Current Update on Malaria in Pregnancy: A Systematic Review, Trop Dis Travel Med Vaccines. 2025 May 22; 11(1):14, https://doi.org/10.1186/s40794-025-00248-1 is a review article, encompassing information from 139 articles in the English language. “Plasmodium falciparum is the leading cause of complications in pregnant women and is primarily found in Africa, while P. vivax is recognized as an emerging global threat, and causing serious consequences. … Malaria prevalence in pregnancy can reach 60% in sub-Saharan Africa and 36% globally, with placental malaria affecting up to 28% of cases. The disease causes serious complications such as maternal anemia, premature birth, and low birth weight, severe anemia and increased maternal and infant mortality. Prevention strategies like intermittent preventive treatment (IPTp), insecticide-treated nets (ITNs) and Indoor residual spray (IRS) are essential.”
Effective decision-making for malaria prevention and control depends on timely, accurate, and appropriately analyzed and interpreted data. Poor quality data reported into national health management information systems (HMIS) prevent managers at the district level from planning effectively for malaria in Ghana. [Asiedu A & al.] analyzed reports from a series of 3 data coaching visits conducted at 231 health facilities …” and report in Coaching Visits and Supportive Supervision for Primary Care Facilities to Improve Malaria Service Data Quality in Ghana: An Intervention Case Study, PLOS Glob Public Health. 2025 Jun 6; 5(6):e0003649, https://doi.org/10.1371/journal.pgph.0003649 that by “the third coaching visit, 98% of facilities had a functional data management system (a 26-percentage-point increase from the second to third coaching visit, p < 0.0001), 77% of facilities displayed wall charts, and 63% reported using data for decision-making and local planning. …. Data coaching provides support and mentorship to improve data quality, visualization, and use, modeling how other malaria programs can use HMIS data effectively at the local level.”
Grosso A & al. introduce the concept of “Force of Infection” (FOI) in An Integrative Review of the Combined Use of Mathematical and Statistical Models for Estimating Malaria Transmission Parameters, Malaria J, 2025 May 30, 24:173, https://doi.org/10.1186/s12936-025-05415-5. As explained in the body of the paper, the “FOI measures the per capita number of infections per unit time or, equivalently, represents the instantaneous probability of acquiring infection, that is, the rate (or hazard) of infection. Importantly, the FOI counts all new infections, whether symptomatic or asymptomatic.” The general argument of the authors is unfortunately beyond the comprehension of this reviewer.
Please see Kagoro FM & al., Factors Affecting Integration of an Early Warning System for Antimalarial Drug Resistance Within a Routine Surveillance System in a Pre-Elimination Setting in Sub-Saharan Africa, PLoS One. 2025 Jun 3; 20(6):e0305885, https://doi.org/10.1371/journal.pone.0305885 above, in Treatment/Drug resistance.
Spatiotemporal studies
Aminou EYYM & al., Burden of Malaria in Adults in Sahelian Niger: A Retrospective Study (2019-2021), Am J Trop Med Hyg. 2025 May 20: tpmd240613, https://doi.org/10.4269/ajtmh.24-0613.
Eyong JEE & al., Prevalence, Awareness, Treatment-Seeking Behaviours and Its Implications in the Control of Malaria in Dumbu Community, Donga-Mantung Division, North West Region, Cameroon, Malaria J, 2025 May 22, 24:161, https://doi.org/10.1186/s12936-025-05249-1.
Guery MA & al., Household Clustering and Seasonal Genetic Variation of Plasmodium falciparum at the Community Level in The Gambia, Elife. 2025 May 27; 13:RP103047, https://doi.org/10.7554/elife.103047
Zhou S & al., Changes in Malaria Patterns in Comoros from 2010 to 2021: A Comparative Study with Sub-Saharan Africa, Trop Med Infect Dis. 2025 May 19; 10(5):138, https://doi.org/10.3390/tropicalmed10050138