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By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
News
The European Vaccine Initiative (EVI) announced on 21 February that the “University of Oxford, the Clinical Research Unit of Nanoro and EVI have launched two new clinical trials to test a next‑generation multi-stage malaria vaccine designed to target two stages together two in the Plasmodium falciparum lifecycle. The trials include a Phase 1b study (VAC093) that will evaluate different combinations of R21 – the Malaria vaccine produced by the Serum Institute of India (SIIPL) and based on the R21 antigen developed by the University of Oxford - and the blood-stage vaccine candidates RH5.1and R78C developed by the Draper Lab, also at the University of Oxford. In addition, there is a Phase 2b study (VAC087) to generate the first efficacy data on R78C alone and in combination with the RH5.1 and R21 vaccines (all vaccines administered with Matrix-M® adjuvant).” https://www.euvaccine.eu/post/assessing-multi-stage-malaria-vaccines-new-clinical-trials-begin-in-burkina-faso
On 25 February, WHO published a 74-page technical document entitled Malaria case management Plasmodium vivax malaria, A field guide. It is available at https://www.who.int/publications/i/item/9789240120808
On 2 March, Gavi, the Vaccine Alliance, published an article that stated in part: “A year after the malaria vaccine began to be rolled out in Kebbi state, Nigeria, more than 200,000 children have received at least a first dose. Parents of those children say they can see the effects, with fewer bouts of illness rocking their households. State health workers say hospital records show a decline in malaria cases of as much as 50% among in-patients and out-patients.” https://www.gavi.org/vaccineswork/kebbi-malaria-vaccination-rolls-back-hospitalisations-deaths-children
Reported in https://healthpolicy-watch.news/uganda-extends-successful-malaria-intervention-to-older-children/ on 6 March: “After five years of focusing on malaria prevention through Seasonal Malaria Chemoprevention (SMC) in the Karamoja region in northeastern Uganda for children under the age of five, Uganda’s Health Ministry has decided to extend the intervention to children up to the age of 10. … Since it was introduced, there has been a modest 13% reduction in malaria cases in children aged three to 59 months, according to the Uganda Ministry of Health’s National Malaria Control Division.”
Peer Reviewed Articles
Prevention
Vaccines
For optimal disease prevention, WHO recommends adding a fourth dose of the RTS,S/AS01 vaccine after the initial series of three. Figueroa-Downing D & al., Timing of the Fourth Dose of RTS,S/AS01 Malaria Vaccine in Perennial Settings: A Modelling Study, Malaria J, 2026 Mar 13, https://doi.org/10.1186/s12936-026-05848-6 states that “at a baseline Plasmodium falciparum prevalence in 2–10 year olds … of 20%, the modeling suggests that the primary series is responsible for around 73–93% of the total uncomplicated and 74%-92% of severe cases averted regardless of fourth dose timing in perennial settings. … a fourth dose of the vaccine in this transmission setting could avert additional 8–38% of uncomplicated and 9–36% of severe malaria cases in addition to the primary series alone. While the number of cases averted varies by baseline prevalence, the authors find potential flexibility in timing this dose, especially when focused on 6 to 12 months following the primary series.”
Three articles focus on nanoparticles acting to improve vaccine effectiveness.D Shi & al. present the concept of a specially synthesized nanoparticle as vaccine carrier in their paper, A Plasmodium-Derived Nanoparticle Vaccine Elicits Sterile Protection Against Malaria in Mice, Nat Microbiol, 2026 Jan; 11(1):67-80, https://doi.org/10.1038/s41564-025-02209-y. They state that the “engineered vaccines elicited high titres of … antibodies, and three doses provided complete sterile protection against malaria in a mouse model.” Groves MR & Chen S, A Protein-Based Self-Assembled Nanoparticle Provides an Improved Malarial Vaccine, Trends Parasitol. 2026 Feb 28: S1471-4922(26)00038-3, https://doi.org/10.1016/j.pt.2026.02.002 is a commentary on the above article.
“Protein-subunit malaria vaccines typically elicit only modest and short-lived antibody responses without an effective delivery system. To address this limitation, carboxylated superparamagnetic iron-oxide nanoparticles (Fe3O4-COOH SPIONs) have been assessed as a carrier” for recombinant vaccine by Al-Abboodi A & al. in their article, Iron-Oxide Nanoparticles (SPIONs) Enhance Malaria Vaccine Antibody Response, Vaccine. 2026 Feb 18; 77:128353, https://doi.org/10.1016/j.vaccine.2026.128353. Through basic immunologic studies, they demonstrated more durable responses using the nanoparticles than byu using the vaccine without them.
Based on interviews of 2590 adults, Kretchy IA & al. explore the causes of vaccine hesitancy in Impact of Caregivers' Perceptions of Malaria on Their Hesitancy Toward Childhood Malaria Vaccination, Vaccine. 2026 Feb 27; 77:128389, https://doi.org/10.1016/j.vaccine.2026.128389. “The prevalence of malaria vaccine hesitancy was 44.8%. Greater perceived control and understanding was associated with increased hesitancy ... Other factors associated with vaccine hesitancy were caregivers' region of residence, marital status, ethnicity, housing structure, relationship with household head, employment status, having existing health conditions, and alcohol intake.”
Abiache Idang M & al., Knowledge, Attitudes and Factors Associated with the Awareness of Caregivers of Under-Five Children Regarding the Malaria Vaccine in the Tiko Health District, Cameroon: A Community-Based Cross-Sectional Study, PLOS Glob Public Health, 2026 Mar 4; 6(3):e0004659, https://doi.org/10.1371/journal.pgph.0004659 is a study that highlights some of the challenges inherent in the introduction of new vaccines. Among 410 caregivers of children aged 0 to 5 years, 60.7% “had heard of the malaria vaccine, (but) only 26.6% demonstrated adequate knowledge and 25.1% had positive attitudes. Healthcare workers were the primary source of vaccine information (35.4%). Caregivers whose children had a previous malaria episode were less likely to be aware of the vaccine …. Conversely, caregivers who trusted health workers … and those who routinely attended childhood immunization services … were more likely to be aware of the vaccine.”
Continuing in the topic of suboptimal reach of the vaccine to children, Malik EM & al. report in Suboptimal Uptake of the Malaria Vaccine in Sudan: What's Behind the Blinds? Malaria J, 2026 Mar 14, https://doi.org/10.1186/s12936-026-05855-7 that among 416 mothers or caregivers of under 5-year old children, only 256 children were judged eligible to receive the vaccine. It is unclear why this discrepancy. At any rate, while 57.7% of mothers claimed know about the vaccine, only 36.7% knew of the recommended doses. In fact, only 94 (36.7%) of the 256 eligible children had received the vaccine. The authors conclude that the “suboptimal uptake of the malaria vaccine was not attributed to vaccine hesitancy or behavioral and social determinants, but rather to limited educational efforts and a lack of focus on the malaria vaccine as a new intervention.”
The importance of healthcare workers’ (HCWs) recommendations in public acceptance of the malaria vaccine has been nearly a constant feature of articles on the subject of vaccine uptake. Esan DT & al.’s Perspective, Healthcare Workers' Beliefs, Readiness, and Acceptance of Malaria Vaccine in Southwest Nigeria: Addressing Misconceptions and Uptake Barriers, Malaria J, 2026 Mar 15, https://doi.org/10.1186/s12936-026-05852-w recounts the results of questionnaires submitted to 38 HCWs at work in six clinics at the time of the researchers’ visit. Th results indicated that while 76.3% of them had heard of the vaccine at the time of the study (April-May 2025), only 7.9% were ready to recommend it, while over 65% “did not recommend it at all.” Barriers to recommendations included “misinformation about the vaccine (71.1%) …safety issues (23.7%). … ‘lack of healthcare workers training’ (86.8%), ‘vaccine unavailability’ (73.7%), ‘patient mistrust’ (57.9%), and ‘cultural resistance’ (13.2%).”
Vectors
Govoetchian R & al. assert that an “expanded portfolio of more effective WHO-prequalified insecticides for indoor residual sparing (IRS) is needed to provide additional options to disease control.” In their paper, Control of Pyrethroid-Resistant Anopheles gambiae s.l. with Sovrenta® 15WP, a New Isoxazoline Insecticide for Indoor Residual Spraying, Malaria J 2026 Feb 27, https://doi.org/10.1186/s12936-026-05810-6, they describe testing “Sovrenta® 15WP, a wettable powder formulation of the newly discovered isoxazoline insecticide isocycloseram” compared to Actellic® 300CS, a WHO pre-qualified “pirimiphos-methyl IRS insecticide… The odds ratio describing the difference in overall mortality between Actellic® 300CS and Sovrenta® 15WP was 3.38 … in cement-walled huts, 2.49 … in mud-walled huts and 1.80 … when data for both hut wall substrate types was combined. Using recent WHO guidelines for determining non-inferiority, Sovrenta® 15WP was non-inferior and superior to Actellic®”.
A recurrent theme in articles analyzing the cause of high malaria rates in countries with active anti-malaria programs is utilization of effective supplies and services that are available. Begashaw DT & al., Utilization and Associated Factors of Long-Lasting Insecticide-Treated Nets Among Households in Gondar Zuria District, Northwest Ethiopia: A Mixed Methods Study, 2025, Malaria J, 2026 Mar 4, https://doi.org/10.1186/s12936-026-05839-7 is one such article. In an area where government-supplied insecticide treated nets (ITNs) are supposedly available to 100% of households, the authors found on their interviews of 700 households that the rate of ITN utilization was 55.3%. Utilization was higher among households that perceived high severity of the disease, with higher ITN to family size ratio and with a household member being a government employee. Negative correlations were “misconceptions about net safety, doubts about effectiveness, discomfort due to heat, and structural barriers such as lack of space for hanging nets.”
Ikeda E & al. explored ITN use in families that do not possess enough nets for everyone to sleep under one in Western Kenya. As reported in Who Uses the Only Mosquito Net? Sex and Age Disparities, Trop Med Health, 2026 Mar 6, https://doi.org/10.1186/s41182-026-00906-w, the “proportion of residents using ITNs was 91% in households with sufficient ITNs and 66% in households with insufficient ITNs. ITN availability averaged 1.7 persons per net … in households with sufficient ITNs and 4.4 persons per net in households with insufficient ITNs. … In households with insufficient ITNs, adult females and infants were typically prioritized for ITN use. Given that [P. falciparum] infection was negatively associated with ITN use, such prioritization represents an appropriate allocation strategy under conditions of limited net availability.”
Kulaya MB & al. “explored the temporal and spatial distribution of Anopheles species and their infection with Plasmodium in different transmission settings in two regions of Tanzania, one of the on the island of Zanzibar. They report in Longitudinal Surveillance of Anopheles Mosquitoes Across Different Settings in Tanga and Unguja: Increased Distribution of An. merus in Coastal and Inland Areas of Tanzania, Malaria J, 2026 Mar 6, https://doi.org/10.1186/s12936-026-05811-5 that An. merus, hitherto “not considered an important vector in Tanzania … was observed as the second most abundant species across coastal and inland areas of Tanga and Unguja during both wet and dry season. Combined with its observed infection with P. falciparum, the findings suggest An. merus may contribute to perennial transmission of malaria in the region.”
“Reliable tools are needed to control opportunistic outdoor biting and resting malaria vectors that remain beyond the reach of indoor targeted interventions. The attractive targeted sugar baits (ATSBs) have demonstrated effectiveness in some settings but have shown limited impact in other areas, in part due to differences in mosquito species' preferences and the presence of competing natural sugar sources.” Zembere K & al. “evaluated the sugar-feeding preferences of Anopheles gambiae …, to inform context specific sugar-based vector control interventions.” They report in Exploring the Importance and Preference of Sugar Feeding Behaviour of Malaria Vectors in Sugar Plantations of Southern Malawi, PLoS One, 2026 Mar 6; 21(3):e0344351, https://doi.org/10.1371/journal.pone.0344351 that “guava was found to be twice as attractive [for An. gambiae s.l.] as sugarcane (the reference fruit), followed by banana …, then mango, and melon.”
Assemie A & al., Species Occurrence and Seasonal Variation of Malaria Vectors in Hadiya Zone, Ethiopia, Biomed Res Int. 2026 Feb 18; 2026:4553611, https://doi.org/10.1155/bmri/4553611 is described below, under Epidemiology/Climate change etc.
Chemoprophylaxis
Based on extensive computer modeling, Braunack-Mayer L & al. assert in their article, Combining Seasonal Malaria Chemoprevention {SMC} with Novel Therapeutics for Malaria Prevention: A Mathematical Modelling Study, PLoS Comput Biol. 2026 Feb 26; 22(2):e1014021, https://doi.org/10.1371/journal.pcbi.1014021 that adding “therapeutics active against multiple stages of the parasite life cycle can improve the effectiveness of SMC…”
Similar to other reports, Inyangudo GN & al., Factors Influencing the Utilisation of Malaria Preventive Services During Pregnancy in Ile Ife, Nigeria: A Mixed Method Approach, Malaria J, 2025 Mar 11, https://doi.org/10.1186/s12936-026-05844-w documents significant under utilization of both the WHO-recommended Intermittent Preventive Treatment of pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) and ITNs. “Factors that influenced utilisation of (malaria prevention services) include out-of-stock commodities, lack of money, late and irregular (antenatal clinic) attendance due to insufficient funds for transportation, the distance to healthcare facilities, and pregnant women's preference for visiting mission houses (faith-based homes where spiritual and maternity services are provided) over attending antenatal care (ANC), and insufficient training of healthcare providers.”
Please see Kizza J & al., Recurrent Plasmodium falciparum Parasitemia and Drug Resistance Mutations During Intermittent Preventive Treatment of Malaria in Pregnancy in Uganda, J Infect Dis. 2026 Feb 13: jiag074, https://doi.org/10.1093/infdis/jiag074 under Treatment/Drug resistance.
Please see Matanda DJ & al., Extreme Weather Events and Malaria Prevention in Pregnancy: A Mediation Analysis of Antenatal Care and Sulfadoxine-Pyrimethamine Use in Two Malaria-Endemic Counties of Kenya, Malaria J, 2026 Mar 13, https://doi.org/10.1186/s12936-026-05859-3 under Epidemiology/Climate change.
Please see Forkuo Otoo BA & al., Incidence and Trends of Adverse Drug Reactions During Seasonal Malaria Chemoprevention Among Children: Evidence from Ghana’s Pharmacovigilance Database, 2015–2023, Malaria J, 2026 Mar 11, https://doi.org/10.1186/s12936-026-05851-x under Treatment/Side effects
Other
Gene drive projects are sometimes criticized if they are aimed at eliminating a species by making mosquitoes infertile. Another approach to gene drive is described in Carballar-Lejarazú R & al., Compound Effector Genes Suppress Malaria Parasite Infections in Gene-Drive Population Modification Strains of the African Malaria Mosquitoes, Anopheles gambiae and Anopheles coluzzii, G3 (Bethesda). 2026 Mar 3:jkag014, https://doi.org/10.1093/g3journal/jkag014. The article describes “four population modification gene-drive strains in Anopheles gambiae s.s. and An. coluzzii carrying compound effector genes … The compound effector molecule gene complexes significantly reduced both parasite prevalence and infection intensities in An. gambiae and An. coluzzii following challenge assays with the human malaria parasite, P. falciparum.”
Diagnosis
General diagnostics
Rapid diagnostic tests (RDTs) for malaria rely on detecting proteins that are specific to the parasite, such as histidine-rich protein 2 (PfHRP2) and lactic dehydrogenase (PfLDH). The latter was added to the original test strips as separate indicator line. Mandefro A & al., Performance of a Novel Plasmodium falciparum Rapid Diagnostic Test in Areas of Widespread hrp 2/3 Gene Deletion, Clin Infect Dis. 2026 Feb 4; 81(6):e491-e501, https://doi.org/10.1093/cid/ciaf212 describes experience with a “novel RDT” (05FK150), that combines the results of the two in a single line (that is positive if either or both proteins are present). The authors compare the sensitivity and specificity results with test kits that rely on multiple line indicators and assess them “comparative” at 77% sensitivity, using microscopy and polymerase chain reaction (PCR) results as benchmarks.
Minwuyelet A & al. studied the accuracy of RDTs and microscopy compared to PCR in a hospital setting in 274 participants, not all of whom had malaria. As reported in Diagnostic Challenges in Malaria Detection: A Comparative Diagnostic Performance of HRP2-Based Rapid Diagnostic Tests, Microscopy, and PCR at Bichena Primary Hospital, Northwest Ethiopia, Parasite Epidemiol Control, 2026 Feb 19: 33:e00485, https://doi.org/10.1016/j.parepi.2026.e00485, PCR detected the largest number of cases of parasitemia (23.4%). HRP2 based RDTs demonstrated 79.1% sensitivity and 94.9% specificity, while microscopy yielded 85.9% sensitivity and 100% specificity. The well-known situation of gene deletion as a cause of low sensitivity of RDTs is discussed in the conclusion.
Field diagnostics
None this month
New diagnostic methods
None this month
Treatment
Treatment results
Animut A & al. report on the outcomes of treatment of 417 children aged one month to 14 years admitted with severe malaria to a regional hospital. Treatment Outcome and Associated Factors of Severe Malaria Among Admitted Children in the Gambella Region, Southwest Ethiopia: A Retrospective Study Design, Malaria J, 2026 Mar 10, https://doi.org/10.1186/s12936-026-05828-w reports that all children received IV Artesunate. “The overall case fatality rate for severe malaria was 9.11%. High case fatality rates were also observed among children presenting with severe anemia 31.8%, convulsions 27%, pulmonary edema 19.7%, Coma 18.5%, acute kidney injury 18.4%, and comorbid illnesses 16.9%. The majority of the children (91.7%) admitted to the hospital had Plasmodium falciparum, which accounted for 34 (89.5%) of the deaths. Among the predictor variables assessed, convulsion, severe anemia, and comorbid illnesses were significantly associated with the outcome.”
Side effects and complications
Forkuo Otoo BA & al. report adverse drug effects (ADRs) during chemoprophylaxis of children aged 3 to 59 months in Incidence and Trends of Adverse Drug Reactions During Seasonal Malaria Chemoprevention Among Children: Evidence from Ghana’s Pharmacovigilance Database, 2015–2023, Malaria J, 2026 Mar 11, https://doi.org/10.1186/s12936-026-05851-x. “The most frequently reported ADRs were fever (22.7%), vomiting (21.5%), and diarrhoea (16.9%). Serious reactions accounted for 8.6% of cases, most often leading to prolonged hospitalization. The incidence of ADRs declined from 220.63 per 100,000 doses in 2015 to 0.34 in 2023.” There is no explanation of the very large drop in incidence of reported ADRs over eight years.
Guidelines
Chelangat SC & al., Facilitators and Barriers to Adherence to Severe Malaria Treatment Guidelines in Children at Mbale Regional Referral Hospital, Uganda: A Health Workers’ Perspective, Malaria J, 2026 Feb 26, https://doi.org/10.1186/s12936-026-05834-y is an analysis of the results of interviewing 21 hospital workers (doctors, nurses, pharmacists, etc.) about their adherence to clinical protocols in the treatment of children severely ill with malaria. The article (not the abstract) quotes a reference to the effect that “adherence to the severe malaria management guideline [is] low at 3%.” Interviewees indicated the following: “Barriers included structure resource constraints, staffing and work load issues; process, delayed referrals, delays in the lab, limited working hours in the lab and pharmacy, low CMEs attendance among nurses; patient related factors like patient financial limitations and poor patient cooperation.”
Drug resistance
“Intermittent preventive treatment with monthly sulfadoxine-pyrimethamine (IPTp-SP) is recommended during pregnancy in malaria-endemic countries. However, widespread resistance of Plasmodium falciparum to SP has compromised its efficacy, and the alternative dihydroartemisinin-piperaquine (DP) is under study.” Kizza J & al., Recurrent Plasmodium falciparum Parasitemia and Drug Resistance Mutations During Intermittent Preventive Treatment of Malaria in Pregnancy in Uganda, J Infect Dis. 2026 Feb 13: jiag074, https://doi.org/10.1093/infdis/jiag074 documents that in the geographic area studied, SP resistance was noted in approximately 25% of parasites collected as IPTp was commenced. Recurrent parasitemia was in the 50% range of the group given SP, whereas women in the groups that received DP or DP+SP, it was 5% or less. Thus, the authors conclude that “IPTp-SP had poor antimalarial preventive efficacy and selected for increased drug resistance, questioning the value of this intervention.” {The question arises whether this conclusion is valid universally or confined to certain geographic areas.}
Pratt S & al. identify genetic causes of partial drug resistance among malaria parasites in 50 travelers from Uganda in Novel Pfk13 and Pfubp1 Genotypes in African Plasmodium falciparum Isolates Exhibiting Reduced Susceptibility to the Antimalarials Artemisinin and Lumefantrine, mBio. 2026 Feb 25: e0367625, https://doi.org/10.1128/mbio.03676-25
The abstract of Connelly SV & al., Artemisinin Partial Resistance Mutations in Zanzibar and Tanzania Suggest Regional Spread and African Origins, 2023, J Infect Dis. 2026 Feb 18; 233(2):e491-e495, https://doi.org/10.1093/infdis/jiaf431 states: “Artemisinin partial resistance, driven by Plasmodium falciparum K13 mutations, threatens malaria control. Zanzibar is vulnerable to artemisinin partial resistance spread but lacks recent molecular surveillance. We sequenced samples in Zanzibar and mainland Tanzania collected from 2022 to 2024. K13 mutations were found in 2 of 1440 participants … in Zanzibar and 6 of 3762 … in mainland Tanzania. Based on whole genome sequencing data, K13 mutations appear to be of African origin with regional spread. Frequent parasite importation appears to maintain partner drug mutation frequencies similar to the mainland, where artemether-lumefantrine selects for mutations favoring artesunate-amodiaquine sensitivity. Ongoing molecular surveillance remains essential to track these patterns.”
New drug research
Nagar A & al., Plasmodium ARK1 Regulates Spindle Formation During Atypical Mitosis and Forms a Divergent Chromosomal Passenger Complex, Nature Comm, 2026 Feb 26, https://doi.org/10.1038/s41467-026-69460-7. Instead of referring to the Abstract, the following is quoted from a press release from the University of Nottingham, UK:
“…researchers from the University of Nottingham, … and international collaborators, have revealed that ARK1 acts as a 'traffic controller' during the parasite's unusual cell division and growth process. … Unlike human cells, the malaria parasite divides and grows in a unique, atypical way. The research team discovered that ARK1 is responsible for organising the 'spindle' -the molecular machinery that pulls genetic material apart to create new parasites. When the researchers turned off ARK1 in the lab, the results were striking. The parasite could no longer form proper spindles, causing its replication to fail, and crucially, parasites lacking ARK1 could not complete their development both in the host and the mosquito, effectively stopping the disease from being passed on. … What makes this discovery so exciting is that the malaria parasite's 'Aurora' complex is very different from the version found in human cells. This divergence is a huge advantage … It means we can potentially design drugs that target the parasite's ARK1 specifically, turning the lights out on malaria without harming the patient."
Riggle BA & al. studied a new potential drug for children with cerebral malaria and report in Safety, Tolerability, and Pharmacokinetics of 6-Diazo-5-Oxo-L-Norleucine (DON) in Malawian Adults with and Without Malaria: A Phase I Dose-Escalation Clinical Trial, J Infect Dis. 2026 Feb 26: jiag121, https://doi.org/10.1093/infdis/jiag121 that while the drug caused some dose-dependent gastrointestinal side effects, they resolved on stoppage of the drug. The authors conclude that “DON was well tolerated in healthy adults and adults with uncomplicated malaria. Higher doses were associated with transient gastrointestinal AEs. Pharmacokinetics were minimally influenced by malaria disease. These results provide critical data to guide dosing strategies for adjunctive DON in children” with cerebral malaria.
Moreno Abadia AC & al., conducted follow up studies in mice for a synthesized compound previously reported to have antimalarial property and report in In Vivo Antimalarial Activity and Toxicological Profile of LAFIS10, a Piperazine Derivative from Ursolic Acid, Trop Med Int Health, 2026 Mar 6, https://doi.org/10.1111/tmi.70115 that while the compound extended the survival of mice that had been inoculated with Plasmodium and reduced the parasite density, it did not cure the mice in the dosages tested and caused significant dose dependent hemolysis.
Plant extracts and traditional treatments
None this month
Other
None this month
Campaigns and Policies
Campaigns and Policies
“In (a) trial in Kenya, ivermectin mass drug administration (iMDA), delivered once a month for 3 months with approximately 64% population coverage, was shown to reduce malaria incidence by 26%. (Xie K & al.) aimed to assess the cost-effectiveness of iMDA as a supplementary vector control tool …” In Cost and Cost-Effectiveness of Ivermectin Mass Drug Administration for Malaria Control in Kwale County, Kenya: A Modelling Analysis of a Cluster-Randomised Trial, Lancet Glob Health. 2026 Mar; 14(3):e435-e443, https://doi.org/10.1016/s2214-109x(25)00470-x, the authors derive at a cost of US$11·83 per person, including costs incurred by loss of productivity. Then they document complex calculations that lead to the conclusion that “iMDA can be a cost-effective supplementary intervention for malaria control in settings with moderate malaria transmission and good insecticide-treated net coverage…”
In areas affected by civil or international conflict, “access to malaria care is severely hindered by displacement, insecurity, and disrupted health systems.” Omam L-A & al., Co-Creation of Community-Based Innovations to Improve Access to Malaria Treatment in Conflict-Affected Regions of Cameroon, Malaria J, 2026 Mar 12, https://doi.org/10.1186/s12936-026-05820-4 cites three initiatives implemented as a result of a workshop attended by governmental and private stakeholders in conflict-affected areas in Cameroon. These were the Community Health Participatory Approach (CoHPA) “model, which introduced internal community-led accountability mechanisms; a Health Voucher System that addressed both financial and transport barriers to care; and a supportive supervision model that aimed to improve CHW performance through bi-directional feedback and recognition.”
Sasie SD & al., Resurgence of Malaria in Ethiopia: A National Landscape Analysis of Systemic and Operational Gaps, Malaria J, 2026 Mar 12, https://doi.org/10.1186/s12936-026-05858-4 is a report of review of governmental and non-governmental malaria control actions in relationship to the fact that in 2024, Ethiopia experienced “more than 7.3 million confirmed cases and 1,157 deaths … representing the highest incidence recorded in the past seven years.” Based on review of 246 documents, the authors conclude that “Ethiopia’s malaria programme demonstrates foundational capacity to interrupt transmission but remains constrained by systemic, operational, and equity-related gaps. Strengthening real-time surveillance and data use, adapting vector control strategies in response to resistance patterns, institutionalizing recovery and learning mechanisms, and embedding community-centred prevention approaches are essential to support a resilient and sustainable malaria response.”
Epidemiology
Climate change, biodiversity and environment
Nshatsi NC & al. studied “community knowledge, perceptions, and practices related to the relationship between climate variability and malaria transmission in south-eastern Tanzania” by interviews and focus group discussion in a malaria endemic area. They report in Community Perceptions on Climate Change and Its Impacts on Malaria Transmission in South-Eastern Tanzania, Malaria J, 2026 Feb 26, https://doi.org/10.1186/s12936-026-05835-x that 86% of survey respondents, “approximately two-thirds (67.5%) recognized a link between climate change and malaria transmission. Perceived vulnerability was high, with 59.5% reporting increased risk of vector-borne diseases and 70% indicating higher malaria occurrence during the rainy season compared to the dry season.” The authors recommend “integrating community perspectives and local knowledge into climate-adaptation and malaria-control strategies to enhance locally relevant and community-centered resilience.”
Although the primary conclusions of Assemie A & al., Species Occurrence and Seasonal Variation of Malaria Vectors in Hadiya Zone, Ethiopia, Biomed Res Int. 2026 Feb 18; 2026:4553611, https://doi.org/10.1155/bmri/4553611 deal with the preponderance of An. gambiae s.l. as the most abundant malaria vector in the area studied (43.8%) in contrast with other regions, where An. funestus is prevalent in the rainy season and An. arabiensis in the dry season, the authors also report that the findings of this study “demonstrate clear seasonal differences in the proportions of An. gambiae s.l. and An. funestus s.l. collected, indicating that changes between seasons strongly influence the presence and spatial distribution of malaria vectors in the Shashago area. These variations are likely linked to the distinct habitat preferences of the vector species, whose availability and suitability fluctuate with seasonal environmental conditions.”
Dolo RM & al. document the occurrence of a malaria epidemic in a desert environment after flooding caused by extreme and long rainfall in their paper, Extreme Rainfall, Flooding and Malaria in the Sahara: Outbreak Analysis in Kidal, Mali 2024, Malaria J, 2026 Mar 6, https://doi.org/10.1186/s12936-026-05833-z. The main victims of the epidemic were children under five.
Matanda DJ & al. report that extreme rainfall also prevents pregnant women to make four or more antenatal visits to their physicians. In Extreme Weather Events and Malaria Prevention in Pregnancy: A Mediation Analysis of Antenatal Care and Sulfadoxine-Pyrimethamine Use in Two Malaria-Endemic Counties of Kenya, Malaria J, 2026 Mar 13, https://doi.org/10.1186/s12936-026-05859-3 , they link this phenomenon to the difference in receikpt of tnhe full IPDp-SP regimen in women ecxplosed to weather shocks (49.5%) vs. those who had not been exposed to weather extremes (58.8%).
Risk factors
The presence of human immunodeficiency virus (HIV) is not usually reported as a risk factor for malaria, even though the impairment of immune systems in people living with HIV would lead one to think so. Moutombi Ditombi BC & al. “described the spectrum of malaria in people living with HIV (PLHIV) and HIV-negative adults in Gabon, where both diseases are endemic” in Clinical and Biological Features of Complicated and Asymptomatic Malaria Among PLHIV and HIV-Negative Adults: An Observational Study in Libreville, Gabon, PLoS One. 2026 Feb 17; 21(2):e0327068, https://doi.org/10.1371/journal.pone.0327068. The authors found that among 1192 individuals tested, “asymptomatic malaria was more frequent among HIV-negative participants (60.6% vs 25.0%), while severe malaria was significantly more common among HIV-positive patients (48.2% vs 12.1%) …”
Risk factors for malaria in newborns is the subject of Odediji SA & al., Socioeconomic Determinants and Maternal Malaria: Impact on Neonatal Parasitemia in Osun State, Southwest, Nigeria, Malaria J, 2026 Mar 4, https://doi.org/10.1186/s12936-025-05752-5. The authors conducted a “cross-sectional analysis of 85 mother-infant pairs … The prevalence of neonatal peripheral parasitemia was 8.2% (7/85). Maternal parasitemia strongly predicted neonatal infection. All positive neonates were born to mothers with positive microscopy (7/19), whereas no neonates from parasitemia negative mothers were infected …. No statistically significant associations were found between neonatal parasitemia and maternal education …, occupation …, insecticide treated net use …, or intermittent preventive therapy uptake.” Nonetheless the authors argue for a “need for larger studies with refined socioeconomic measures to fully elucidate these relationships.”
General epidemiology
“Despite major investments in control and treatment” of malaria, western sub-Saharan Africa faces “persistent transmission heterogeneity, with pockets of low but sustained incidence that often fuel larger seasonal outbreaks. Each year, during the hot and dry season, multiple low-transmission hotspots-ranging from 3 to 150 cases per 10,000 person-weeks-emerge in many peri-urban and rural-urban fringe zones …. These hotspots frequently precede widespread outbreaks that occur with the onset of the rainy season.” Harikripal & al., Rural-Urban Migration and Low-Transmission Endemicity of Malaria in Sub-Saharan Africa: A Statistical Inference Approach to Uncover Possible Mechanisms, J Epidemiol Glob Health. 2026 Feb 11, https://doi.org/10.1007/s44197-025-00513-8 concludes that “seasonal migration most accurately explains the low-transmission endemicity in dry months and their amplification into widespread rainy-season outbreaks. High seasonal migration maintained a low but persistent level of transmission, preventing local fade-out, and significantly intensified transmission once favourable ecological conditions returned during the rains.”
Kiyaga S & al. explored the utility of using genetic data from specimens obtained from 3563 symptomatic malaria cases … across Uganda during two collections in 2023,” They conclude in Accuracy of Plasmodium falciparum Genetic Data for Estimating Parasite Prevalence and Malaria Incidence in Uganda, Malaria J, 2026 Feb 21, https://doi.org/10.1186/s12936-026-05836-w that the method they use “can capture broad differences in transmission intensity reflected by parasite prevalence, but may have more limited ability to predict incidence.”
Diriba D & al. “identify malaria vulnerability hotspot areas in Abaya Woreda, West Guji, Ethiopia, using a comprehensive geospatial approach including GIS {Geographic Infromation System} and remote sensing techniques.” In Mapping Malaria Vulnerability Hotspots Using Multi-Criteria Decision Analysis, GIS, and Remote Sensing: A Case Study in Abaya Woreda, West Guji Zone, Ethiopia, Int J Health Geogr. 2026 Feb 27, https://doi.org/10.1186/s12942-026-00458-6 the authors reveal that “38.3% of the study area is highly vulnerable to malaria. These areas are closely associated with lower elevations, wetlands, water bodies, greater distances from health facilities, and high population density. Furthermore, 49.1% of the area was identified as moderately vulnerable, while only 12.6% exhibited low vulnerability.”
Atijosan A & al. also studied heightened malaria vulnerability. “Malaria incidence and mortality data from the Malaria Atlas Project, and population data from WorldPop, were integrated with indicators of Insecticide-Treated Net (ITN) access and usage, maternal education, and household wealth.” Htospots hotspots were “characterized by low ITN usage (82–85%), high maternal education deficits (89–91%), and household poverty (85–90%) while other areas exhibited low vulnerability with higher ITN coverage (≈92%) and better socio-economic profiles.” The article is Geospatial Mapping of Gender-Sensitive Malaria Vulnerability and ITN Usage Barriers in Zamfara State, Nigeria, Malaria J, 2026 Mar 2, https://doi.org/10.1186/s12936-026-05831-1. {Compare the “low ITN usage rate” here (82-85%) with that reported by Begashaw DT & al. above under Prevention/Vectors.}
Please see Sasie SD & al., Resurgence of Malaria in Ethiopia: A National Landscape Analysis of Systemic and Operational Gaps, Malaria J, 2026 Mar 12, https://doi.org/10.1186/s12936-026-05858-4 above in Campaigns and policies
Spatiotemporal studies
Tchuenkam PVK & al., Distribution of Falciparum and Non-Falciparum Malaria Among Symptomatic Malaria Patients in Dschang, West Region of Cameroon, PLoS One. 2026 Feb 24; 21(2):e0340824, https://doi.org/10.1371/journal.pone.0340824
Lake MW & al., Climate, Environmental, and Programmatic Correlates of Malaria Resurgence in Amhara, Ethiopia (2018–2024): A Bayesian Spatiotemporal Analysis, Malaria J, 2025 Mar 4, https://doi.org/10.1186/s12936-026-05847-7