By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
On 24 April the World Health Organization (WHO) announced that “[o]n World Malaria Day, Mali will join 19 other African countries in introducing malaria vaccines—a vital step towards protecting young children from one of the continent’s most deadly diseases. The large-scale rollout of malaria vaccines in Africa is expected to save tens of thousands of young lives every year.” On the same day, the WHO also published a short history of the introduction of dual action insecticide-treated nets (ITNs). For more information on the WHO World Malaria Day campaign, visit:
https://www.who.int/campaigns/world-malaria-day/2025
On 25 April, World Malaria Day, Le Monde, a major Parisian daily published an article entitled Malaria: What if the Answer Lies in a Plant That Is Already Used by African Communities? The article refers to a letter published in March in the Journal of the American Medical Association, advocating relying on botanical preparations of the Artemisia annua plant, which provided the original inspiration for the artemisinin calls of antimalarials, arguing the economic benefit of lesser cost in an era of constricting resources. In this context, please also see the article by Roesch C & al. below under Treatment.
On the same day, GAVI, the Vaccine Alliance published an “Insight Paper” entitled Rolling out vaccines to beat malaria together: time to harness the power of immunisation for a malaria-free future. It is available from the compiler of these reports, or at: https://media.malariaworld.org/Rolling_out_vaccines_to_beat_malaria_together_insight_paper_ac2ebe2932.pdf. The document includes an intriguing chart predicting the efficacy of combining vaccination with other preventive measures.
On 8 May, MalariaWorld published KFF’s (Kaiser Family Foundation) analysis of US funding of Global Health projects over the years up to the current year. The study is organized according to purposes, with malaria constituting a segment in it. The document is available from the reviewer or https://media.malariaworld.org/Breaking_Down_the_U_S_Global_Health_Budget_by_Program_Area_KFF_a1bdceffdb.pdf
“Health leaders from malaria-endemic African countries and global partners called today for intensified action to counter antimalarial drug resistance – a growing challenge that threatens to undermine hard-won progress against one of Africa’s deadliest diseases.
Meeting on the margins of the 78th World Health Assembly (on 20 May), the high-level gathering turned a spotlight on the urgent need for coordinated action to contain the spread of resistance to frontline malaria medicines.
…
To protect efficacy of AL and other artemisinin-based therapies, WHO has called for diversification of currently used ACTs (see below). One approach is the use of multiple first-line therapies, which could reduce drug pressure and delay resistance. Next-generation therapies may include triple ACT combinations or non-artemisinin-based drugs.
…
WHO-recommended artemisinin-based combination therapies
ACTs combine an artemisinin derivative (artesunate, artemether or dihydroartemisinin) with a partner drug. The role of the artemisinin compound is to reduce the number of parasites during the first 3 days of treatment, while the role of the partner drug is to eliminate the remaining parasites and cure the infection. WHO currently recommends 6 ACTs as first and second-line treatment for uncomplicated P. falciparum malaria:
- artemether-lumefantrine (AL)
● artesunate-amodiaquine (AS-AQ)
● artesunate-mefloquine (AS-MQ)
● artesunate-pyronaridine (AS-PY)
● artesunate+sulfadoxine-pyrimethamine (AS+SP)
● dihydroartemisinin-piperaquine (DHA-PPQ)
PEER REVIEWED ARTICLES (see notes after citations from non-peer-reviewed publications)
Prevention
Vaccines
The RTS,S/AS01E vaccine having been “administered to over two million children since 2019 through the Malaria Vaccine Implementation Programme (MVIP),” Haine V & al. report the safety and effectiveness of the vaccine in real-world settings in Safety of RTS,S/AS01E Malaria Vaccine up to 1 Year After the Third Dose in Ghana, Kenya, and Malawi (EPI-MAL-003): A Phase 4 Cohort Event Monitoring Study, Lancet Glob Health, 2025 Apr 24, https://doi.org/: 10.1016/S2214-109X(25)00096-8. “The first participant was enrolled on March 21, 2019. The cutoff date for the current analysis was 1 year after the third RTS,S/AS01E dose for each participant. In total, 44 912 children (19 993 in Ghana, 11 990 in Kenya, and 12 929 in Malawi) were included in the analysis…” The authors “found no evidence of vaccination being associated with an increased risk of meningitis, cerebral malaria, or mortality among vaccinated children, and no new safety risks were identified.” However the paper also verified the somewhat limited effectiveness of the vaccine, both in terms of incidence of disease and all-cause mortality.
Analyzing the results of the phase 3 trials of the two WHO endorsed malaria vaccines, Macià D & al. noticed discrepancies not only between the efficacies of the two vaccines, but within the same vaccine programs as well, both geographically and temporally (i.e. where the vaccine was administered and in what relationship to possible seasonality of infection). In The Effect of Disease Transmission on Time-Aggregated Treatment Efficacy Estimates: A Critical Analysis of Factors Influencing the RTS,S and R21 Malaria Vaccine Phase 3 Trials, Lancet Infect Dis. 2025 Apr 23: S1473-3099(25)00090-8, https://doi.org/10.1016/s1473-3099(25)00090-8 the authors “review all non-biological factors that can affect efficacy estimates in clinical trials, and particularly focus on one factor that has received little attention despite its importance and ease of identification: the interaction of waning vaccine protection with changes in transmission intensity over time. When efficacy varies over time, typically in the form of waning protection as is the case for R21 and RTS,S efficacy, variations in disease transmission, such as those due to seasonality, outbreak spread, or age-related susceptibility, can cause some periods of the follow-up to have a stronger contribution to the overall estimate than others.”
The currently WHO-endorsed malaria vaccines are based on the parasite’s circumsporozoite protein. Mandefro A & al. argue in Unveiling Mismatch of RTS S AS01 and R21 Matrix M Malaria Vaccines Haplotype Among Ethiopian Plasmodium falciparum Clinical Isolates, Sci Rep. 2025 Apr 29; 15:14985, https://doi.org/10.1038/s41598-025-00140-0 that the relatively low effectiveness of these vaccines may be due to that fact that this protein manifests multiple genetic variations which may not match the genetics of the protein used in creating the vaccine. They state that “none of the Ethiopian [P. falciparum circumsporozoite] haplotypes matched the vaccine haplotype.”
Feehan J & al., Recent Perspectives in Clinical Development of Malaria Vaccines, Nat Commun, 2025 Apr 15; 16:3565, https://doi.org/10.1038/s41467-025-58963-4 is a commentary on the benefits and shortcomings of the currently WHO-approved vaccines as well as a summary of other approaches to vaccine development, some more promising than others.
Studying the knowledge and attitude of a sample of 422 Nigerian nurses regarding vaccination of children against malaria, Adeleke OT & al. report in Nurses’ Knowledge and Willingness to Recommend Malaria Vaccination to Caregivers of Under-5 in Nigeria: A Nationwide Survey, Malaria J, 2025 May 5, 24:142, https:/./doi.org/10.1186/s12936-025-05383-w that nearly two out of every three nurses had poor knowledge and perception of the vaccines … Awareness of the malaria vaccine was the only factor that was found to be associated with their knowledge … The odds of willingness to promote the vaccine were about 21 times higher among nurses with high perceptions of efficacy than their counterparts who have low perceptions.”
Vectors
“Western Province, Zambia experiences persistent and residual malaria transmission despite high household coverage of core vector control interventions. … the dominant malaria vector Anopheles funestus sensu stricto (s.s.) bites opportunistically both indoors and outdoors and remains active throughout the night and into the late morning after the sun rises.” Using human landing catches, Chanda B & al. collected over 2300 female mosquitoes, of which 41% were the species studied. As they report in Daytime and Public Space Exposure to Anopheles funestus Bites in Western Province, Zambia: Implications for Malaria Surveillance and Control, Malaria J, 2025 Apr 18, 24:128, https://doi.org/10.1186/s12936-025-05363-0 these vectors bite outdoors up to 11 AM. The authors conclude that “[v]ector surveillance efforts should be extended to better characterize the full scope of transmission risk throughout the community and guide the development of new approaches to target transmission occurring outdoors, during the daytime, and in public spaces away from the home.”
“Indoor residual spraying (IRS) is a malaria control strategy implemented before the rainy season. Nchelenge District, Zambia, is a holoendemic setting where IRS has been conducted since 2008 with little impact on malaria incidence or parasite prevalence.” Nonetheless, Martin AC & al.’s article, Impact of Late-Rainy Season Indoor Residual Spraying on Holoendemic Malaria Transmission: A Cohort Study in Northern Zambia, J Infect Dis. 2025 Apr 15; 231(4):1020-1030, https://doi.org/10.1093/infdis/jiae609 reports that “[r]esiding in a household in a sprayed area was associated with a 52% reduction in infection hazard … but not with changes in incidence, prevalence, or vector abundance.” The authors assert that “[m]onthly tracking of incidence and prevalence did not demonstrate meaningful changes in holoendemic transmission intensity. However, hazard of infection, which provides greater power for detecting changes in transmission, demonstrated that late–rainy season IRS reduced malaria risk.”
VECTRON T500, a new indoor residual spraying (IRS) product containing the active ingredient broflanilide as a 50% wettable powder (WP), was previously shown to be efficacious in experimental hut trials. A two-arm non-inferiority cluster randomized controlled community trial was conducted [by Mbewe NJ & al.] VECTRON T500 was compared to [an] IRS product containing clothianidin 50% + deltamethrin 6.25% WP-SB). The authors report that An. gambiae s.l. was resistant to deltamethrin but susceptible to clothianidin and broflanilide. The residual efficacy was > 80% mortality for both products tested, on both mud and concrete walls, 12 months post spraying. The paper is A Noninferiority Cluster Randomised Evaluation of a Broflanilide Indoor Residual Spraying Insecticide, VECTRON T500, for Malaria Vector Control in Tanzania, Sci Rep. 2025 Apr 29; 15:15013 https://doi.org/10.1038/s41598-025-99809-9.
“Despite the demonstrated benefits of insecticide-treated nets (ITNs) usage in children under 5 years of age, nonuse is linked to higher mortality and morbidity rates. [Barrow A & al.] examined how child-, maternal-, household-, and community-level determinants influence ITN utilization among children under 5 in The Gambia for malaria prevention. As reported in Determinants of Insecticide-Treated Net Utilization for Malaria Prevention Among Under-Five Children in The Gambia: Evidence from National Survey, J Trop Med. 2025 Apr 14; 2025:6340482, https://doi.org/10.1155/jotm/6340482, the results raise many questions in that households with more educated parents and with wealthier households had statistically significantly less utilization of the ITNs. There were also significant inter-ethnic variations, which may have introduced some confounding effects.
“In March 2023, the Sierra Leone National Malaria Control Programme (NMCP) piloted its first school-based distribution (SBD) in Kono district, reaching 88,605 pupils in 531 schools with piperonyl butoxide-synergist (PBO) ITNs.” Esch K & al.’s article, Overcoming Practical Challenges to Pilot Sierra Leone’s First School-Based Distribution of Piperonyl Butoxide-Synergist ITNs: Findings from a 2023 Assessment in Kono District, Malaria J, 2025 May 9, 24:149, https://doi.org/10.1186/s12936-025-05369-8 describes the outcome of the event in terms of home ownership and use of the nets. One- to two-months post SBD, a significantly higher proportion of households in the intervention group owned at least one ITN (93% versus 69%,..) and at least one ITN per two people (42% versus 24%, …). Population ITN access was significantly higher in the intervention group than the control group (69% versus 46%, …). A higher proportion of the population also reported using an ITN the previous night in the intervention group (71%) than the control group (49%) …” Nonetheless, the authors point out that the results “were still below the NMCP’s 80% target.”
Endriyas M, & al. report on a “community-based cross-sectional study with repeated measures [of ITN use] in the Sidama region, southern Ethiopia. The first survey [of 1647 households] was conducted in February and March 2023, and the second was done from October to December 2023.” Their article, A Decline in the Coverage and Utilization of Long-Lasting Insecticidal Nets in Southern Ethiopia: A Repeated Cross-Sectional Study, PLoS One. 2025 Apr 24; 20(4):e0322342, https://doi.org/10.1371/journal.pone.0322342 cites data that show a decline in ITN ownership and use over the time period from a low level to an even lower level (30.5% to 19.9%). Over 50% of individuals in the households studied could not read or write. “… education of household heads, family size, and age of individuals were consistent predictors of [ITN] use.”
Syme T & al. tested the ability of the 20-wash method to predict the end-of-life performance of ITNs and report in Does Washing Insecticide-Treated Nets 20 Times for Experimental Hut Evaluations Provide a Suitable Proxy for Their End-of-Life Performance Under Household Conditions? Parasit Vectors. 2025 Apr 21; 18:148, https://doi.org/10.1186/s13071-025-06743-w that “the 20-wash method provided a suitable proxy for the end-of-life killing and sterilising performance of [three of the ITYNs tested] in experimental huts. In contrast, washing overestimated the end-of-life performance of [the fourth] for mortality and underestimated the personal protection of all field-aged ITNs.”
The findings reported in Kala Chouakeu NA & al., Assessing the Bio-Efficacy of Mosquito Nets in Santchou and Bertoua One Year After the Mass Distribution Campaign of 2019, J Med Entomol. 2025 May 6: tjaf014, https://doi.org/10.1093/jme/tjaf014 unfortunately reiterate other similar studies. In one community, usage of the nets was 70% or so (by self-reporting) with some 21% of the ITNs being unusable when inspected and tested. In the other community the usage was worse, 41%; of those used, 26% were damaged, 15% unusable. According to the authors, “[t]hese findings urgently require the National Malaria Control Program of Cameroon to improve public awareness on consistent and proper [ITN] usage and address the decline in [ITN] effectiveness…”
Barasa S & al. monitored the insecticide susceptibility status of malaria vectors in NW Ethiopia in view of the increasing frequency of reports of insecticide resistant mosquitoes. The major malaria vectors in Ethiopia … were susceptible to pirimiphos-methyl and propoxur. However, [they were] resistant to permethrin (mortality rate of 88.8%), alphacypermethrin (mortality rate of 67.5%), and deltamethrin (mortality rate of 73.8%). Although permethrin restoration was only 96% in permethrin resistant Anopheles mosquitoes, the efficacy of alphacypermethrin and deltamethrin was totally restored by pre-exposure to PBO [piperonyl butoxide].” The paper is, Assessing Insecticide Susceptibility Status of Anopheles Mosquitoes in Gondar Zuria District, Northwest Ethiopia, Sci Rep. 2025 Apr 25; 15:14452, https://doi.org/10.1038/s41598-025-96370-3
Hougbe SZ & al. collected insecticide resistance data starting from the 1990s and also from 2010 to 2024 for their paper, Two Decades of Insecticide Resistance in Benin: A Retrospective Analysis of Evolution and Drivers, Malaria J, 2025 May 17, 24:156, https://doi.org/10.1186/s12936-025-05403-9. “The earliest reported cases of insecticide resistance in Benin date back to 1963, involving organochlorines. Resistance to pyrethroids was first observed in 1999, initially limited in scope. However, from 2010 to 2024, resistance to all pyrethroids spread across all regions of Benin, reaching high levels.” The authors conclude that has insecticide resistance “has gradually expanded, now affecting all ecological environments in Benin. In this context, the National Malaria Control Programme should prioritize the use of new mosquito nets for future vector control campaigns in Benin.”
“Repellents have been in use for the prevention of Anopheles bites, but all these have a myriad of negative effects to the user, such as allergy and dermatitis. [Muthengi A & al.] sought to develop a plant-based Anopheles gambiae repellent for control of malaria, because it is eco-friendly and non-toxic.” As the authors report in Phytochemical Screening and Repellence Potencies of Bioactive Molecules of Plant Extracts Derived from Ocimum suave, Ocimum americanum and Eucalyptus citriodora against Anopheles gambiae, Malaria J, 2025 Apr 30, 24:237, https://doi.org/10.1186/s12936-025-05380-z preparations of the three plants they tested were effective in repelling the mosquito vector of malaria.
Anopheles gambiae and closely related species dominate the malaria vector population in Nigeria. Adeogun AO & al., Spatial Distribution and Geospatial Modeling of Potential Spread of Secondary Malaria Vectors Species in Nigeria Using Recently Collected Empirical Data, PLoS One. 2025 Apr 21; 20(4):e0320531, https://doi.org/10.1371/journal.pone.0320531is a summary of other, “secondary” vectors in the country, based on collections between 2020 and 2022. Interestingly, the recently troublesome species of An. stephensi is not among the four additional Anopheles species found during the course of this study. “Most species collected exhibited higher occurrences in the Northern parts of the country, albeit with lower numbers, while they seem confined to fewer locations in the southern parts – with higher densities.”
Abebe W & al., Prevalence of Anopheles stephensi in Horn of Africa: A Systematic Review and Meta-Analysis, BMC Infect Dis. 2025 Apr 27; 25:614, https://doi.org/10.1186/s12879-025-11022-1 is a review of 14 published studies on the subject. “… country-based analysis showed that the pooled prevalence of An. stephensi in Djibouti, Eritrea, Ethiopia, Kenya, Somaliland, and Sudan was 10.5%, 17.3%, 55.30%, 9.90%, 48.70%, and 24.63%, respectively.”
“Medicinal plants have been used in the traditional healthcare system of Ethiopia, including controlling human biting mosquitoes.” Teshome Z & al. interviewed 361 individuals in a region of the country about their knowledge of “plants used in the traditional control of mosquitoes and other arthropod vectors with … method of applications…” They document in Teshome Z & al., Ethnobotanical Study of Plants Used for Traditional Control of Mosquitoes and Other Arthropod Pests in the Ghibe Valley, Southwest Ethiopia, Trop Med Health. 2025 Apr 23; 53:56, https://doi.org/10.1186/s41182-025-00740-6 the 53 such plants that were mentioned by various percentage of interviewees and categorize them as insecticides versus repellents.
Changing the genetics of the vector mosquito to reduce its ability to transmit the disease (gene drive) has been subject of research for some time. Verkuijl SAN & al., A Suppression-Modification Gene Drive for Malaria Control Targeting the Ultra-Conserved RNA Gene mir-184, Nat Commun. 2025 Apr 25; 16:3923, https://doi.org/10.1038/s41467-025-58954-5 report on an approach that does not render the mosquito sterile or unfit to transmit the parasite, but kills the female soon after a blood meal, thereby reducing the ability to transmit the disease further. The modified genome also seems to breed true under laboratory conditions and in the opinion of the authors, gain the upper hand in a wild colony. Therefore the paper proposes linking this gene alteration to one (unspecified) one that prevents the mosquito from hosting the parasite.
Chemoprophylaxis
Ayamba EY & al. report on the implementation of seasonal malaria chemoprevention (SMC) in children in Evaluation of Seasonal Malaria Chemoprevention Implementation in the Upper East Region of Northern Ghana, Malaria J, 2025 Apr 15, 24:123, https://doi.org/10.1186/s12936-025-05322-9. Although they found an average implementation rate of 87% per treatment cycle, it fell short of the national goal of 90%. “Health system/programme (49%) and patient related factors (33%) were the main reasons reported for non-adherence. Significant predictors of adherence were household size …, sleeping under bed nets …, and indoor residual spraying (IRS) presence …”
Emphasizing the damage likely to be inflicted by the sharp reduction in foreign aid money for malaria control, Canana N & al. document that SMC is highly cost effective in the region the authors studied. “The study estimated a cost per targeted child of $6.05 and a cost per child who received full 3-day course of sulfadoxine-pyrimethamine in combination with amodiaquine (SPAQ) of $7.92. Furthermore, the cost per household with eligible children visited by a community distributor was $7.65 … In addition, the estimated cost was $93.50 per malaria case averted, $3286.59 per malaria death averted…” The article is Seasonal Malaria Chemoprevention in Northern Mozambique: A Cost-Effectiveness Analysis, Malaria J, 2025 May 21, 24:159, https://doi.org/10.1186/s12936-025-05401-x.
“Sulfadoxine-pyrimethamine (SP) is recommended for perennial malaria chemoprevention in young children in high burden areas across Africa. Mutations in the dihydropteroate synthase (dhps) gene … associated with sulfadoxine resistance vary regionally…” Mousa A & al., Impact of dhps Mutations on Sulfadoxine-Pyrimethamine Protective Efficacy and Implications for Malaria Chemoprevention, Nat Commun. 2025 May 8; 16:4268, https://doi.org/10.1038/s41467-025-58326-z is a report on “the duration of SP protection against parasites with different genotypes using a Bayesian mathematical model that accounts for variation in transmission intensity and genotype frequencies.” Their results showed different durations of protection based on the kind of mutation in the genome. The implications of these findings are unclear.
Natuhamya C & al., Effect of Knowledge of Sulfadoxine-Pyrimethamine (SP) as Prophylaxis for Malaria on Its Uptake for Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp): Application of Inverse Probability Weighted Regression Adjustment (IPWRA) Technique, PLoS One. 2025 Apr 15; 20(4):e0320893, https://doi.org/10.1371/journal.pone.0320893 asserts that those who possessed this knowledge were more likely to complete the three-dose regimen of IPTp. {However, the abstract is silent on how knowledge of the patient prior to the administration of IPTp was ascertained, while the body of the paper states that this was determined by patient interview after the treatment.}
“In Nigeria, malaria in pregnancy contributes to 70.5% of maternal morbidity and 41.1% of maternal mortality. … [WHO] recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) as a key strategy for malaria in pregnancy prevention. However, despite its proven effectiveness, pregnant women’s uptake of IPTp-SP remains unacceptably low.” Ogba P & al., Enhancing IPTp-SP Uptake: Community and Stakeholder Recommendations for Improving Access and Utilisation – Insights from a Study in Bayelsa – Nigeria, Malaria World J 2025 May 9, 16:9, https://doi.org/10.5281/zenodo.15351243 is a report of interviews and focus group discussions on how better uptake of the regimen may be accomplished. Recommendations included “[c]ommunity-wide education campaigns to raise awareness of IPTp-SP’s benefits; comprehensive training for healthcare providers …; integration of traditional birth attendants into the formal healthcare system; community-level distribution of IPTp-SP to improve access for pregnant women who do not attend antenatal care; government intervention to ensure the functionality of health centers; addressing workforce shortages, and guaranteeing a consistent supply of IPTp-SP.”
Sulfadoxine-pyrimethamine based IPTp may not be the right agents for all pregnant women. Nhampossa T & al., Acceptability of Dihydroartemisinin-Piperaquine as Malaria Intermittent Preventive Treatment for Pregnant Women Living with HIV in Southern Mozambique, BMC Public Health. 2025 May 2; 25:1633, https://doi.org/10.1186/s12889-025-22644-0 reports on a group of HIV-positive pregnant women for whom the combination is contraindicated because of their underlying infection. These women received dihydroartemisinin/piperaquine monthly. Despite the fact that this combination required tasking more medications and caused frequent side effects, the authors report high acceptability, primarily because of the women’s trust in their healthcare provider. However, the paper does not quantify actual compliance with the regimen, nor does it compare it with compliance with IPTp-SP in pregnant women without HIV.
Other
“The last malaria cases in near-elimination settings are often found in international border regions due to the presence of hard-to-reach populations, conflict, uneven intervention coverage, and human migration.” Topazian HM & al. used mathematical modeling “to estimate the effectiveness of border screening posts on total cases in malaria-endemic sub-Saharan Africa.” The authors conclude in Estimating the Potential Impact of Surveillance Test-And-Treat Posts to Reduce Malaria in Border Regions in Sub-Saharan Africa: A Modelling Study, Malaria J, 2025 Apr 18, 24:127, https://doi.org/10.1186/s12936-025-05367-w that “[b]order posts were most effective in low-transmission settings with high-transmission neighbours. Border posts alone in sub-Saharan Africa will not allow a country to reach elimination, particularly when considering feasibility and acceptability, but could contribute to broader control packages to targeted populations.”
In the course of reviewing 12 relevant publications of over 1000 initially screened, Firdaus MH & al., Effectiveness of Family Health Education in Malaria Elimination Programmes: A Scoping Review, Malaria J. 2025 May 7; 24:144, https://doi.org/10.1186/s12936-025-05371-0 examined “the effectiveness of malaria health education programmes using a socio-ecological framework, focusing on individual, family, and community-level influences.” The authors claim that at the “individual level, educational programmes significantly enhanced malaria knowledge and prevention behaviours. Within families, health education strengthened decision-making and reinforced preventive measures. At the community level, engagement in malaria-related initiatives improved collective action, though policy barriers limited widespread implementation.”
Diagnosis
General diagnostics
Ayandipo EO & al. report in Decline in Malaria Test Positivity Rates Following Capacity Building and Archiving of Malaria Rapid Diagnostic Test Cassettes in Oyo State, Nigeria: A Retrospective Review of Records, Malaria J, 2025 Apr 22, 24:132, https://doi.org/10.1186/s12936-025-05352-3 that in view of the reported great increase in malaria in the state studied, health facility personnel were trained in microscopy and rapid diagnostic test (RDT) kits were subjected to quality control. After this, the positivity rates declined significantly. In the Discussion section of the paper (not the Abstract) the authors concluded that the previous high rates represent inappropriate overdiagnosis of malaria.
Field diagnostics
Reporting on a comparison of RDT and microscopy, using quantitative polymerase chain reaction (qPCR) as control, Budodo R & al. Performance of Rapid Diagnostic Tests, Microscopy, and qPCR for Detection of Plasmodium Parasites Among Community Members with or Without Symptoms of Malaria in Villages Located in North-Western Tanzania, Malaria J. 2025 Apr 9; 24:115, https://doi.org/10.1186/s12936-025-05361-2 found microscopy to be less sensitive than RDT, though more specific. Both tests were less sensitive in situations of low density parasitemia than when parasites were more abundant.
The use of field diagnostics in malaria surveys is the focus of Stabler TC & al., Integrating Local Malaria Molecular Monitoring into Regular Malaria Indicator Surveys on Bioko Island: High Association Between Urban Communities and Low-Density Infections, Malaria J. 2025 May 7, 24:145, https://doi.org/10.1186/s12936-025-05374-x. The dependence of surveys on HRP2-dependent RDTs may yield misleading results, especially in low-density infection regions. The authors deployed a cartridge-based PCR kit usable in the field. However, the testing was done on dried blood spots in the laboratory. The results were the following: “26.5% of RDT (-) were positive by qPCR (i.e. suspected RDT false negatives), and 74.7% of RDT (+) results were positive for qPCR, suggesting 25.3% were suspected false RDT positives.” The kit also had a sensitivity for lower parasite burdens than RDT. While the article (not the abstract) calls the PCR kit “affordable,” it does not actually cite data on the cost of the kit.
Two articles comment on expanding the potential of RDTs by adding detection of lactic dehydrogenase (LDH) to their capacity.
Mandefro A & al. studied diagnostic accuracy in a geographic area in which many strains of P. falciparum are noted to have deletions at the hrp2/3 site. Their paper, Performance of a Novel P. falciparum Rapid Diagnostic Test in Areas of Widespread hrp2/3 Gene Deletion, Clin Infect Dis. 2025 Apr 24: ciaf212, https://doi.org/10.1093/cid/ciaf212 noted that the RDT that is sensitive to both HRP2 and LDH significantly “outperform[ed] conventional HRP2-only RDTs, making it a promising tool for enhancing malaria diagnosis in regions with high hrp2/3 deletion prevalence.”
“Histidine Rich Protein 2 (HRP2)/pan-Lactate Dehydrogenase (pLDH) combination rapid diagnostic tests (RDTs) may address the shortcomings of RDTs that detect HRP2 alone.” Kabbale KD & al. “utilized samples from two cross-sectional surveys conducted in 32 districts at 64 sites across Uganda between November 2021 and March 2023 that enrolled 6354 febrile participants [at or over] two years of age…” As reported in Field Evaluation of the Bioline Malaria Ag P.f/Pan Rapid Diagnostic Test: Causes of Microscopy Discordance and Performance in Uganda, Malaria J, 2025 May 1, 24:138, https://doi.org/10.1186/s12936-025-05379-6, the “Bioline Malaria Ag P.f/Pan combination RDT was found to be highly sensitive in Uganda and reliable for ruling out malaria. False negative RDT results were primarily due to low density P. falciparum infections, non-falciparum infections, or incorrect microscopy results. In contrast, false positive RDT results were common…”
New diagnostic methods
The limited reliability of field diagnostic tests such as RDTs and microscopy in untrained hands and the emergence of genetic alterations that interfere with diagnosis have prompted search for more reliable tests. Kona MP & al., Off-Grid Field-Deployable Molecular Diagnostic Platform for Malaria Surveillance, Parasit Vectors. 2025 Apr 23; 18:150, https://doi.org/10.1186/s13071-025-06779-y states that qPCR, which is the single most reliable test for each species of Plasmodium, can be configured in a way as to be deployable in the field even under resource constraints. The authors’ conclusion of the study of a particular brand of qPCR is that its “ability to provide rapid, on-site results reduces the need for centralized laboratory testing, facilitating timely decision-making in malaria control programs.”
Treatment
Treatment results
“The use of pre-referral injectable artesunate is among the strategies adopted to improve the outcome of childhood severe malaria in Nigeria.” Ibrahim OR & al. collected data on 137 children with severe malaria referred, of whom only 7 received the recommended injection. Tyey report in Pre-Referral Injectable Artesunate and Outcomes of Childhood Severe Malaria at a Secondary Health Facility in North-Central Nigeria: A Cross-Sectional Study, Malaria J, 2025 Apr 18, 24:129, https://doi.org/10.1186/s12936-025-05317-6 that “the presence of impaired consciousness increased the odds of a child receiving injectable artesunate.” However, there was apparently no discernible influence of the injection on the eventual outcome of the child’s clinical course. The authors also state that “most children with severe malaria had received pre-hospitalisation medications that were mostly inappropriate.”
“Africa bears the highest double burden of HIV and malaria worldwide. In 2023, an estimated 25.9 million people were living with HIV (PLHIV), and 246 million malaria cases were diagnosed in Africa. Malaria patients co-infected with HIV are considered at a higher risk of failing malaria treatment, according to the World Health Organization (WHO) guidelines. Takyi A & al., Efficacy of Artemisinin-Based Combination Therapy (ACT) in People Living with HIV (PLHIV) Diagnosed with Uncomplicated Plasmodium falciparum Malaria in Africa: a WWARN Systematic Review, Malaria J, 2025 May 16, 24:153, https://doi.org/10.1186/s12936-025-05393-8 is a “systematic literature review [that] aims to assess the treatment outcomes following artemisinin-based combination therapy (ACT) in PLHIV.” After reviewing “26 articles describing 19 studies … [representing] 2850 malaria episodes in PLHIV,” the authors conclude that “[l]imited data on ACT outcomes or drug exposure in PLHIV in Africa remains a reality to date, and the effect of antivirals appears inconsistent in the literature [due to] the heterogeneity in study designs… [and recommend] individual patient data meta-analysis to explore the impact of antiretroviral therapy on anti-malarial treatment.”
Two papers deal with primaquine as transmission blocking agent:
Getachew H & al. studied “the effectiveness of chloroquine (CQ) plus low-dose of PQ [primaquine] on recurrence and its transmission-blocking activity.” They tested CQ alone versus CQ+PQ and followed the test subjects for one year. As reported in Effect of Low-Dose Primaquine Treatment on Plasmodium vivax Recurrence and Transmission-Blocking Activity in Southwest Ethiopia: A Longitudinal Cohort Study, Malaria J, 2025 Apr 17, 24:125, https://doi.org/10.1186/s12936-025-05365-y, recurrences occurred in 70% of the CQ group vs. 46% in the CQ+PQ group. “Treatment regimen, high baseline parasitaemia and presence of gametocytaemia were risk factors for P. vivax recurrence… Adding PQ to CQ also reduced P. vivax transmission to mosquito vectors relative to CQ alone but did not result in a complete transmission-blocking effect by day 42 post-treatment.”
Yilma D & al., Safety and Efficacy of Single-Dose Primaquine to Interrupt Plasmodium falciparum Malaria Transmission in Children Compared with Adults: A Systematic Review and Individual Patient Data Meta-Analysis, Lancet Infect Dis. 2025 Apr 23: S1473-3099(25)00078-7, https://doi.org/10.1016/s1473-3099(25)00078-7 is a complex analysis of data in 23 published papers on thed subject, encompassing over 6000 patients. The authors conclude that “[r]egardless of malaria transmission intensity and age group, a single dose of 0·25 mg/kg primaquine is safe and efficacious for reducing P falciparum transmission. These findings underscore the need for primaquine formulations suitable for young children, and also provide supportive evidence to expand the use of single low-dose primaquine in regions with a moderate-to-high transmission rate that are threatened by artemisinin partial resistance.” Although the abstract mentions that “serious adverse events were similar between primaquine and no-primaquine groups,” there is no mentione of G6PD status of the patients studied.
Side effects and complications
None this month
Guidelines
Nkoma JD & al. reviewed 29 articles covering several East African countries and report great variability among countries in Adherence to Anti-Malarials Among Patients Diagnosed with Malaria in East Africa: A Systematic Review and Meta-Analysis, Malaria J, 2025 May 3, 24:140, https://doi.org/10.1186/s12936-025-05303-y. While Rwanda reported 100% adherence, it was less than 10% in Tanzania. Overall the percentage reported was about 70%.
Drug resistance
Martín Ramírez A & al. examined 350 blood specimens obtained from children without clinical malaria and state that over 90% of the samples were positive for P. falciparum (!). As reported in Mutational Profile of pfdhfr, pfdhps, pfmdr1, pfcrt and pfk13 Genes of P. falciparum Associated with Resistance to Different Antimalarial Drugs in Osun State, Southwestern Nigeria, Trop Med Health. 2025 Apr 8; 53:49, https://doi.org/10.1186/s41182-025-00732-6, the authors searched for genetic markers of resistance to a variety of antimalarials and found that although virtually all samples contained markers associated with resistance to one or another antimalarial and there were some that had two such markers, none demonstrated markers to all antimalarials.
“The emergence of Plasmodium falciparum resistance to artemisinin is a huge concern in Africa. [Milong Melong CS & al.] investigated and characterized mutations of Pfk13 propeller sequences from P. falciparum isolates across two endemic areas with different eco-geographical settings in Cameroon.” They report in Investigating Pfk13 Mutations in Plasmodium falciparum Natural Populations from Two Malaria-Endemic Areas of Cameroon, Trans R Soc Trop Med Hyg. 2025 Apr 12: traf040, https://doi.org/10.1093/trstmh/traf040 that while they found no genetic variants that predispose to artemisinin resistance, the variability raises the possibility that such mutations will emerge. Thus, continuing vigilance is urged.
Abebe W et al., Prevalence of Antimalaria Drug Resistance-Conferring Mutations Associated with Sulphadoxine-Pyrimethamineine-Resistant Plasmodium falciparum in East Africa: A Systematic Review and Meta-Analysis, Ann Clin Microbiol Antimicrob. 2025 Apr 16; 24:25, https://doi.org/10.1186/s12941-025-00795-7 is another paper exploring the genetic basis of drug resistance by P. falciparum.
Barman K & Goswami P’s review gives an “insight into the historical perspectives of drug-resistant malaria and the recent developments in malaria diagnosis and antimalarial drug discovery. Efforts have been made to update recent strategies formulated to combat and diagnose drug-resistant malaria.” Their paper, Recent Advances in Diagnostics and Therapeutic Interventions for Drug-Resistant Malaria, ACS Infect Dis. 2025 May 6, https://doi.org/10.1021/acsinfecdis.4c00962 also advocates an “inexpensive and portable diagnosis tool for rapid screening of drug resistance malaria among masses in the societal landscape…” without mentioning what that tool may be.
New drug research
Belda H & al., The Fast-Evolving FIKK Kinase Family of Plasmodium falciparum Can Be Inhibited by a Single Compound, Nature Microbiol, 2025 May 19, https://doi.org/10.1038/s41564-025-02017-4 is a basic science paper that identifies “a single compound that inhibits all” of a family of enzymes that play a role in the infectiousness of the parasite. “A pan-specific inhibitor could reduce resistance development and improve malaria control strategies.”
Plant extracts and traditional treatments
In view of the emerging parasite resistance to artemisinins coupled with historical efficacy of extracts of various Artemisia plants, Roesch C & al. studied extracts of two plants within the genus. They report in Assessment of the in vitro Activity and Selectivity of Artemisia afra and Artemisia annua Aqueous Extracts Against Artemisinin-Resistant Plasmodium falciparum, Malaria J, 2025 May 11, 24:150, https://doi.org/10.1186/s12936-025-05375-w that while there was “a substantially decreased in vitro activity of A. annua extracts when tested on artemisinin-resistant parasites mutated in the Pfkelch13 gene … compared to artemisinin-sensitive parasites, … the A. afra extracts [had] similar activity on the isolates tested whether they [were] sensitive or resistant to artemisinin… However, the molecular basis of this activity is unknown and may not present a sufficient selectivity, thus further characterization of A. afra is essential.”
Other
“Prompt diagnosis and effective treatment within 24 hours of fever onset is crucial for reducing malaria-related morbidity and mortality in under five children.” Omary H & al. “examined the prevalence of prompt care-seeking behaviors among under five febrile children in Tanzania and the associated determinants.” After studying the circumstances of 1050 febrile children under age 5, they report that the “prevalence of prompt care seeking for febrile children was 43.2%. Caregivers of female children had 18% less prevalences of seeking prompt care … compared to caregivers with their male children.” Caregivers under age 24 and those without primary education were less likely to seek prompt care than others. The article is in Towards Promoting Timely Treatment: Uncovering the Determinants of Prompt Malaria Care Seeking Behavior Among Febrile Children Under-Five Years in Tanzania, PLoS One. 2025 Apr 10; 20(4):e0319913, https://doi.org/10.1371/journal.pone.0319913.
Campaigns and Policies
“Community case management (CCM) combined with reactive test-and-treat (RTAT) for malaria was implemented by the National Malaria Elimination Program in a holoendemic region of Zambia.” Weynand A & al. “assessed the impact of CCM + RTAT activities on malaria care seeking, health facility cases, and hospital mortality” and report in Program Evaluation of Community Case Management with Reactive Test and Treat for Malaria in a High-Transmission Setting, Am J Trop Med Hyg. 2025 Apr 22: tpmd240405, https://doi.org/10.4269/ajtmh.24-0405 that “[p]ediatric patients admitted to the hospital with malaria during CCM + RTAT had less severe disease and shorter lengths of stay and in-hospital mortality was lower … [There was] wider catchment during CCM + RTAT than before or after. In this high malaria transmission setting, CCM + RTAT increased access to care, shifted malaria case burden from health facilities to community health workers, and improved in-hospital outcomes for malaria, likely from earlier referral. However, RTAT + CCM in this high-transmission area proved unsustainable because of excessive consumption of malaria commodities.
Ochieng W & al. assessed the economic viability of an expansion of malaria community case management (mCCM) from children to people of all ages in a rural district of Madagascar. They report in Bringing Malaria Diagnosis and Treatment Closer to the People: Economic Rationale for Expanding Malaria Community Case Management to All Ages in a Rural District in Madagascar, Malaria J, 2025 May 4, 24:141, https://doi.org/10.1186/s12936-025-05381-y that “[a]ge-expanded mCCM is highly cost-effective and can enhance malaria treatment access in resource-limited settings.” The article includes the details of the economic analysis.
Gallalee S & al. report on the results of implementing two focused campaigns aimed at subpopulations with higher rates of malaria than the general population. As described in Feasibility and Effectiveness of Tailored Interventions for Two Populations at High-Risk of Malaria in Senegal: Koranic School Children and Gold Miners, PLOS Glob Public Health. 2025 Apr 29; 5(4):e0004569, https://doi.org/10.1371/journal.pgph.0004569, targeted malaria interventions included “expansion of active community case management and distribution of [ITNs]. The measures were on “reported [ITN] usage and Plasmodium falciparum infection prevalence.” one instance, the effect was a significant increase in ITN use (as self-reported) whereas the prevalence of malaria dropped; in the other, the intervention did not result in change of behavior, nor in malaria prevalence. The authors surmise that the peripatetic lifestyle of gold miners may have confounded the outcome.
“Infectious diseases remain a significant public health challenge in low- and middle-income countries (LMICs), with HIV, tuberculosis (TB), and malaria contributing significantly to morbidity and mortality. Community Health Workers (CHWs) play a pivotal role in addressing these diseases, yet evidence on the costs and cost-effectiveness of CHW-led interventions remains fragmented.” O’Donovan J & al., Costs and Cost-Effectiveness of Community Health Worker Programs Focussed on HIV, TB and Malaria Infectious Diseases in Low- and Middle-Income Countries (2015-2024): A Scoping Literature Review, PLOS Glob Public Health. 2025 May 9; 5(5):e0004596, https://doi.org/10.1371/journal.pgph.0004596 is a report on 33 studies, the majority of which focused on sub-Saharan Africa, over half of those on malaria. “The majority demonstrated that CHW programs were cost-effective compared to alternative service delivery models, most commonly facility-based care. These programs were particularly effective in improving treatment adherence and targeting high-priority populations.” However, the cost-per-beneficiary calculations showed wide disparities, which the authors attribute to different methodologies of calculations among the studies.
Please see Ayandipo EO & al., Decline in Malaria Test Positivity Rates Following Capacity Building and Archiving of Malaria Rapid Diagnostic Test Cassettes in Oyo State, Nigeria: A Retrospective Review of Records, Malaria J, 2025 Apr 22, 24:132, https://doi.org/10.1186/s12936-025-05352-3 above, in Diagnostics/General
Epidemiology
Climate change, biodiversity and environment
Based on 18 years of climatic data, Armando CJ & al., Spatio-Temporal Modelling and Prediction of Malaria Incidence in Mozambique Using Climatic Indicators from 2001 to 2018, Sci Rep. 2025 Apr 8; 15:11971, https://doi.org/10.1038/s41598-025-97072-6 reports on a model that the authors claim provides a “predictive lead time of up to 4 months.”
Gbaguidi GJ & al., Unleashing the Power of Intelligence: Revolutionizing Malaria Outbreak Preparedness with an Advanced Warning System in Benin, West Africa, Arch Public Health. 2025 Apr 10; 83:102, https://doi.org/10.1186/s13690-025-01554-y is a report of “an advanced system for early detection and warning of malaria outbreaks in the northern part of Benin, employing monthly time series data pertaining to climatic variables.” Given that “[r]elative humidity and maximal temperature significantly influence malaria incidence in the northern region of Benin… [the authors’ model] forecasts 80% prediction rate for malaria incidence.”
Jalloh SW & al. compared “the forecasting performance of SARIMA and ANN models in forecasting malaria cases using malaria case data from 2018 to 2023.” They report in their paper, Forecasting Malaria Cases Using Climate Variability in Sierra Leone, Malaria J, 2025 May 20, 24:158, https://doi.org/10.1186/s12936-025-05389-4 that “strong positive correlation between precipitation (r = 0.68) and malaria cases was observed, while maximum temperature showed a moderate negative correlation (r = −0.45), and mean relative humidity demonstrated a moderate positive correlation (r = 0.55).” While the ANN (Artificial Neural Networks) model performed better in “predicting” infection rates in recent years, it was interesting that inputs into this model did not include climatic factors.
Risk factors
Dango JR & al. “followed a cohort of [444] children aged 1-59 months hospitalized for malaria to identify factors associated with mortality.” They report in Prognostic Factors for Death in Patients Hospitalised with Malaria in Pediatric Units at the Regional Hospital Centre in Dori, Burkina Faso, BMC Infect Dis. 2025 Apr 10; 25(1):498, https://doi.org/10.1186/s12879-025-10909-3 that “[s]ignificant prognostic factors included respiratory distress …, hypoglycemia …, shock …, altered consciousness …, acute gastroenteritis …, and hyperparasitemia…” In their conclusion the authors claim that some of these factors are “modifiable.”
“Efforts to eradicate malaria are complicated by the parasite’s intricate life cycle, which alternates between vertebrate hosts and mosquito vectors. Host-derived factors and parasite-sourced components exert crucial roles in regulating this biological process.” Li Y & al. Host Factors Influencing Sexual Differentiation and Transmission of Plasmodium: A Comprehensive Review, Acta Trop. 2025 Apr 25: 107634, https://doi.org/10.1016/j.actatropica.2025.107634 explores “the critical role of host-derived factors in shaping Plasmodium sexual differentiation and transmission. [The authors] examine how vertebrate and mosquito host-specific factors either promote or restrict parasite development, influencing the transition from vertebrates to mosquitoes. Understanding these host-mediated mechanisms is crucial for developing novel transmission-blocking strategies to reduce malaria prevalence. By highlighting key interactions between hosts and parasites, this review provides insights into potential interventions that could disrupt Plasmodium transmission and contribute to malaria control efforts.”
Using data from surveys of 19 countries, Zegeye AF & al. investigated “the spatial variation and multilevel determinants of malaria infection among pregnant women in Sub-Saharan Africa” and report in Spatial Variation and Multilevel Determinants of Malaria Infection Among :Pregnant Pregnant Women in Sub-Saharan Africa: Using Malaria Indicator Surveys, BMC Infect Dis. 2025 May 4; 25:654, https://doi.org/10.1186/s12879-025-11037-8 that the study “included a total of 107,712 pregnant women aged 15-49… The pooled prevalence of malaria among pregnant women was 28.31% … Factors associated with higher odds of malaria infection included advanced maternal age …, no formal education …, non-use of bed nets …, use of untreated bed nets …, no use of indoor residual spraying …, rural residence …, and residing in West Sub-Saharan Africa …”
Uwimana A & al. “examined data from three [demographic and health surveys] conducted in Rwanda, which included 10,411 children aged less than five years who were tested for malaria and 11,424 children who had anthropometric measurements.” They report in Exploring the Prevalence and Association Between Nutritional Status and Asymptomatic Malaria in Rwanda Among Under-5 Children: A Cross-Sectional Analysis, Malaria J, 2025 May 13, 24:152, https://doi.org/10.1186/s12936-025-05370-1 that the rate of asymptomatic malaria was 1.3% {much lower than in other reports from Africa – Reviewer’s comment} but among the children who were undernourished or stunted, the rate was significantly higher while the children of “the richest families” had a significantly lower rate of asymptomatic malaria. The authors conclude “that undernutrition indexes such as stunting and underweight as well as poor wealth index are significant risk factors for asymptomatic malaria in children under the age of five years. Malaria itself can worsen nutrition status, creating a vicious cycle.”
Abu Bonsra E & al., Factors Associated with Malaria in Pregnancy Among Women Attending ANC Clinic in Kwadaso Municipality, Ghana: A Health Facility Based Cross-Sectional Study, BMC Public Health. 2025 Apr 30, 25:1595, https://doi.org/10.1186/s12889-025-22810-4 is yet another risk factor study, this time among the 49.6% of pregnant women who tested positive in a municipal antenatal clinic. As in other studies, women whose family income is low and those who do not own or use ITNs had higher rates of malaria. “Additionally, environmental and preventive factors … and proximity to stagnant water, contributed to the likelihood of malaria.” However, women who had no education whatever fared better that those with at least Junior High School education; a finding that seems unusual.
General epidemiology
Tadesse Abebe M & al. reviewed 18 articles in their study, Delays in Seeking Healthcare and Its Determinants Among Malaria Patients in Ethiopia: A Systematic Review and Meta-Analysis, PLoS One. 2025 Apr 8, 20(4):e0320149, https://doi.org/10.1371/journal.pone.0320149. Delay was defined as self-reported delay of 24 hours or more after the illness became evident. In their study that included 7371 participants, 67% percent delayed, mostly for reasons of real or perceived access to care, financial worry, or illiteracy.
“Though Ethiopia has made a remarkable effort towards malaria prevention and control activities, malaria is occurring at epidemic levels in different regions. In Tigray, the health system including the surveillance system was damaged due to the war that erupted in November 2020, …. A noticeable lack of [reported] malaria is due to the humanitarian crisis (war).” Among other data, Hailemariam GG & al., The Impact of a Humanitarian Crisis on the Magnitude of Malaria in Tigray, Northern Ethiopia from 2014 to 2024, Malaria J. 2025 Apr 15; 24:122, https://doi.org/10.1186/s12936-025-05366-x reports that “Plasmodium falciparum (65.3%) was the predominant species, followed by Plasmodium vivax (34.7%). The highest transmission was recorded in 2024 (382,955 cases), while the lowest was in 2021 (19,110 cases). During the conflict, report completeness decreased by 83%.”
Mutala AH & al. studied the population of three districts in Ghana by obtaining blood samples from 1134 individuals. While 57% of the samples were positive for P. falciparum, about a third of those were obtained from individuals with no symptoms. Compared to qPCR, RDT was 65.7% specific. The samples were also tested for genetic deletions known to cause false negative RDT, but none of the samples obtained the mutation sought. The paper is The Burden and Diagnostic Challenges of Subclinical Plasmodium falciparum Infections in Southern Ghana, BMC Infect Dis. 2025 Apr 16; 25:543, https://doi.org/10.1186/s12879-025-10897-4.
Merga H & al., Urban Malaria in Sub-Saharan Africa: A Scoping Review of Epidemiologic Studies, Malaria J, 2025 Apr 19, 24:131, https://doi.org/10.1186/s12936-025-05368-9#Sec3 is a review of 32 “community-based studies conducted in urban settings of sub-Saharan African countries. This review found the prevalence of malaria between 0.06% and 58%. This heterogeneity in prevalence is due to differences in diagnostic methods, study design, population characteristics, diagnostic methods, and environmental factors. A majority of those reviewed studies reported the prevalence between 10 and 30% with Plasmodium falciparum and Plasmodium vivax the dominant species. The review identified key factors associated with urban malaria infection, including socioeconomic status, travel history, prior infection, proximity to water sources, availability of vegetation in the compound, temperature, humidity, livestock ownership, and ITN utilization.”
It is difficult to categorize Prall S & Lopes A, Erema po otjindjumba? Highlighting Cultural Models and Knowledge Gaps of Malaria in Rural Namibian Pastoralists, Malaria J, 20925 May 7, 24:143, https://doi.org/10.1186/s12936-025-05382-x. The authors studied two subpopulations of the country and discovered that misinformation or lack of knowledge about malaria was rampant among them. For example, “[f]ocus goups reported universal difficulty in discrimination between malaria and respiratory infections, the former of which was often only diagnosed at the hospital. Some recognized mosquitoes as the source of malaria, particularly the more formally educated Herero, but all also reported other causes. Notably these causes, including dietary and temperature-based origins, were considered unavoidable. Himba and Herero believed that malaria was infectious person-to-person and incorrectly believed that malaria was most common during the wintertime.” Based on the above, they conclude that “public health outreach and information campaigns are needed, particularly in rural groups with less formal education.”
Das S & al. assert that current methods of calculating malaria surveillance data are imprecise and recommend a method they deem yield more accurate results in Absolute Percentage Error-Based Method for Calculating the Aggregate Accuracy of Reported Malaria Surveillance Data, Am J Trop Med Hyg. 2025 Apr 22: tpmd240804, https://doi.org/10.4269/ajtmh.24-0804.
Please see Stabler TC & al., Integrating Local Malaria Molecular Monitoring into Regular Malaria Indicator Surveys on Bioko Island: High Association Between Urban Communities and Low-Density Infections, Malaria J. 2025 May 7, 24:145, https://doi.org/10.1186/s12936-025-05374-x above, in Diagnosis.
Spatiotemporal studies
Chacky F & al., Trends in Malaria Prevalence Among School-Age Children in Mainland Tanzania, 2015-2023: A Multilevel Survey Analysis, PLOS Glob Public Health. 2025 Apr 9; 5(4):e0004386, https://doi.org/10.1371/journal.pgph.0004386
Liu Q & al., Global, Regional and National Burden and Time Trends of Malaria in Children and Young Adolescents Under 15 Years from 1990 to 2021: A Worldwide Observational Study, BMC Infect Dis. 2025 Apr 17; 25:548. https://doi.org/10.1186/s12879-025-10949-9
White SJ & al., Epidemiology of Relapsing and Falciparum Malaria in the Highlands of Cameroon: An Integrated Community Survey of Human Infection and Vector Abundance, medRxiv [Preprint]. 2025 Apr 28: 2025.04.28.25326551, {article has not been peer reviewed} https://doi.org/10.1101/2025.04.28.25326551
Minwuyelet A &al., Retrospective Analysis of Malaria Prevalence over Ten Years (2015-2024) at Bichena Primary Hospital, Amhara Region, Ethiopia, PLoS One. 2025 Apr 29; 20(4):e0322570, https://doi.org/10.1371/journal.pone.0322570
Edusei MYA & al., Socio-Economic Inequalities in Malaria Prevalence Among Under-Five Children in Ghana Between 2016 and 2019: A Decomposition Analysis, Malaria J, 2025 May 8, 24:1347, hjttps://doi.org/10.1186/s12936-025-05349-y.
Dangbenon E & al., Spatial and Temporal Variation of Malaria Incidence in Children Under 10 Years in a Pyrethroid-Resistant Vector Area in Southern Benin, Malaria J, 2025 May 20, 24:157, https://doi.org/10.1186/s12936-025-05353-2.