By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
Leader
The Burkina Faso military government has called a halt to a long-standing genetic engineering project supported by the Gates Foundation. In a statement published on 22 August, officials urged Target Malaria, the initiative’s principal NGO, to halt “all activities” in the nation.
“All samples will be destroyed according to a strict protocol,” Samuel Pare, chief official at the higher education and research ministry, said in a Friday statement.
The move is part of a larger crackdown on foreign-backed NGOs functioning under the present junta.” https://africa.businessinsider.com/local/lifestyle/burkina-faso-says-no-to-bill-gates-plan-of-creating-modified-species-of-mosquitoes/xyk7xm8
On 4 September, Science (vol. 389 issue 6764) published an article about the events that led up to the government’s decision. Target Malaria released genetically engineered mosquitoes that would generate only male offspring on 11 August, followed a week later by a government raid of the laboratory, described by the scientists as “brutal, humiliating.” There continues to be speculation about the reason for these actions. https://www.science.org/doi/epdf/10.1126/science.aeb9850
…
On 9 September, WHO published the 225 page 2nd edition of Malaria Surveillance, Monitoring and Evaluation: A Reference Manual. It is available from this reviewer or at https://iris.who.int/bitstream/handle/10665/381864/9789240112476-eng.pdf?sequence=1
…
“The Global Fund is working with Country Coordinating Mechanisms (CCMs) and Principal Recipients (PRs) to reprioritize grant activities in Grant Cycle 7 (GC7) to safeguard and enable lifesaving interventions.
Due to the current challenging funding landscape for global health, GC7 allocations are being reduced to adjust to this new reality, requiring PRs to go through grant reprioritization and revision exercises. Some countries may need to reprioritize beyond Global Fund grants, planning health programs holistically. Reprioritization decisions must be made considering all sources of funding available: domestic and external.
These decisions are an opportunity to build momentum on integration, cost effectiveness and sustainability of HIV, TB and malaria programs, in support of countries’ primary health care services and health and community systems. “ https://resources.theglobalfund.org/en/gc7-reprioritization/
PEER REVIEWED ARTICLES (see notes after citations from non-peer-reviewed publications)
Of tangential relevance to prevention and treatment of malaria but of interest to us in the current funding climate are the findings of Stover J & al., Effects of Reductions in US Foreign Assistance on HIV, Tuberculosis, Family Planning, and Maternal and Child Health: A Modelling Study, Lancet Glob Health, 2025 Oct; 13(10):e1669-e1680, https://doi.org/10.1016/S2214-109X(25)00281-5:
“A complete cessation of US funding without replacement by other sources would lead to drastic increases in deaths from 2025 to 2030: 4·1 million (range 1·6-6·6) additional AIDS-related deaths across 55 countries, 606 900 (95% uncertainty interval [UI] 466 000-768 800) additional tuberculosis deaths across 79 countries, 40-55 million additional unplanned pregnancies and 12-16 million unsafe abortions across 51 countries, and 2·5 million (1·3-4·5) additional child deaths from causes other than HIV and tuberculosis across 24 countries. Restoration of funding for HIV treatment but not prevention would avoid most of the increase in deaths but still result in nearly 1 million more new HIV infections from 2025 to 2030.” Malaria is surely included in the last of those figures (2.5 million deaths of children).
Prevention
Glossop SE & al., Advances in Population-Based Interventions to Control Falciparum Malaria, Trans R Soc Trop Med Hyg, 2025 Sep 18: traf088, https://doi.org/10.1093/trstmh/traf088 is a comprehensive overview of the various preventive methods in use in countries where malaria is endemic.
Vaccines
In a study of the immune response to RTS,S vaccine, which targets circumsporozoite proteins, Friedman-Klabanoff DJ & al. discovered that in human volunteers during the experimental development of the vaccines, antibodies were detected not only to the peptide sequences used in vaccine development, but also sequences that were adjacent to them. As the authors state in Vaccine-Induced Antibodies to a C-Terminal Plasmodium falciparum Circumsporozoite Protein Epitope Are Associated with Protection, J Infect Dis. 2025 Aug 19: jiaf391, https://doi.org/10.1093/infdis/jiaf391, “antibody responses to the junctional region not contained in RTS,S suggest a cross-reactive, vaccine-induced response that provides additional benefit beyond antibodies targeting vaccine peptides.”
“The first WHO-approved malaria vaccines … target [a] part of the Plasmodium falciparum circumsporozoite protein (PfCSP), [that] displays a degree of polymorphism that may raise concerns about vaccine efficacy.” Baina MT & al., Genetic Polymorphism of Circumsporozoite Protein of Plasmodium falciparum Isolates in Children in Brazzaville, Republic of Congo, Malaria J, 2025 Aug 29, 24:279, https://doi.org/10.1186/s12936-025-05502-7 reports on an “investigation on Pfcsp gene polymorphisms in isolates” from [202 children infected with P. falciparum] in the Republic of Congo. The results highlight the degree of variation in natural parasite populations at gene loci relevant to vaccine-targeted epitopes of (PfCSP) antigen.” This is important because some of these genetic variances may affect the efficacy of one or another vaccine or both.
Gupta R & al. report the development of a ferritin-based (iron-containing) nanoparticle that was effective as a vaccine under laboratory conditions both in preventing infections of mice and transmission from infected mice. The paper’s title is A Combined Designed CSP and Pfs48/45 Infection and Transmission Blocking Vaccine for Malaria, NPJ Vaccines. 2025 Sep 2; 10:208, https://doi.org/10.1038/s41541-025-01262-2.
Jeong Y & al. assert that “[v]accine-driven evolution can erode the beneficial effects of vaccination and is a concern, especially for newly introduced vaccines. … Previous experimental work in rodent malaria demonstrated that evolution in vaccinated hosts resulted in increased parasite virulence, as measured by anemia…” In Understanding the Traits Underlying Vaccine-Driven Virulence Evolution in Malaria Parasites, BMC Biol. 2025 Aug 26; 23:267, https://doi.org/10.1186/s12915-025-02366-w, the authors “fitted a mathematical model of within-host malaria infection dynamics to experimental time series data from infections in mice inoculated with parasites that had evolved in either vaccinated mice or sham-vaccinated (control) mice.” The results were consistent with the “complexity of virulence, showing that parasite modulation of host responses can influence disease severity.” However, the is no mention that this result is translatable to the Plasmodium species that infect humans.
Osei-Tutu L & al., Sustained Efficacy of the RTS,S/AS01E Malaria Vaccine over 50 Months of Follow-Up When Used in Full-Dose or Fractional-Dose Regimens in Young Children in Ghana and Kenya: Final Results from an Open-Label, Phase 2b, Randomised Controlled Trial, Lancet Glob Health, 2025 Oct; 13(10):e1723-e1736, https://doi.org/10.1016/S2214-109X(25)00272-4 is perhaps the final paper to come out of the phase 2b trials in the two countries in 2017. It includes follow-up to late 2022. The authors state that efficacy of the vaccines among five different groups of recipients was between 36% and 51%. “Vaccine efficacy and impact and immune responses were maintained over 50 months of follow-up in groups who received additional vaccine doses after the fourth dose. The vaccine was well tolerated; only five serious adverse events were considered to be related to vaccination.”
Vectors
“Insecticide-treated net (ITN) coverage indicators allow country malaria programmes to understand the overall coverage of their ITN distribution activities and can be used to forecast the need for additional ITN procurement and to plan future distribution campaigns … mobile phone-based surveys (MPS) have emerged as a comparatively inexpensive alternative to large-scale household surveys.” Worges M & al., Assessing the External Validity of Mobile Phone Surveys for Monitoring ITN Coverage Indicators: A Comparison with Household Surveys in Tanzania, Malaria J, 2025 Aug 28, 24:277, https://doi.org/10.1186/s12936-025-05533-0 reports that when MPS was conducted in parallel with household surveys MPSs consistently underreported household ownership of ITNs. This was consistent in two surveys conducted five years apart. {This conclusion is largely in sync with Nuwasiima S & al., reported last month under Epidemiology, stressing the critical importance of accuracy in data collection.}
According to Hien H & al., the use of ITNs “remains low, influenced by textile preferences, with polyester nets being favored for comfort, despite their shorter lifespan compared to other materials. [The authors] aimed to understand community preferences for ITN fabrics across different environmental contexts to improve malaria control strategies.” They report in Assessing ITN Textile Preferences: A Comparative Study of Polyethylene and Polyester Nets Across Different Settings in Burkina Faso, PLoS One. 2025 Aug 22, 20(8):e0325580, https://doi.org/10.1371/journal.pone.0325580 that that 95.2% of participants had a “preference for a specific ITN fabric, with 93% … favoring polyester over polyethylene, citing superior comfort, breathability, and protection. Regional differences emerged, with rural areas and the [h]umid … zone showing a stronger preference for polyester nets, especially in larger sizes. …. Urban populations emphasized comfort and efficacy, while rural areas focused more on durability and size. Factors like ease of maintenance, comfort, and local climate were significant in shaping preferences.” The authors recommend “that malaria control programs prioritize polyester-based nets, offer larger sizes for rural populations, use smaller mesh sizes, and adopt rectangular designs to improve coverage and comfort.”
Oyweri J & al. compared the use of ITNs containing pyrethroids in one community versus the use of ITNs with piperonyl butoxide (PBO), which are now recommended by WHO because of the development of insecticide resistance. As reported in Net Ownership, Utilization and Malaria Burden in the Context of Piperonyl Butoxide-LLINs Intervention in Western Kenya, PLoS One. 2025 Aug 18, 20(8):e0329114, https://doi.org/10.1371/journal.pone.0329114, there was “higher ownership, usage, and lower malaria prevalence in the … clusters [using PBO] compared to the … clusters [using pyrethroids]. However, bedbug infestations and insufficient sleeping beds hindered net ownership and usage, limiting their overall effectiveness.”
The use of ITN by women who receive intermittent preventive treatment of pregnancy (IPTp) gave the further statistically significant protection against malaria according to Madukwe JC & al.’ s arfticle, Do Women Attending Antenatal Clinics Who Use Only Intermittent Preventive Treatment (IPTp) Have Higher Plasmodium falciparum Prevalence Compared to Those Who Used Both IPTp and Slept Under Insecticide-Treated Nets? Malaria J, 2025 Aug 28, 24:275, https://doi.org/10.1186/s12936-025-05532-1. The reduction in odds of contracting malaria during pregnancy was as high as 85% in favor of sleeping inside and under ITN, as reported by the authors.
The appearance of Anopheles stephensi in Africa caused an increase in susceptibility of urban residents to malaria. Based on collections of larval as well as adult mosquitoes, Degefa T & al., Bionomics of Anopheles stephensi Across the Urban–Rural Landscapes of Eastern Ethiopia, Malaria J, 2925 Aug 23, 24:274, https://doi.org/10.1186/s12936-025-05527-y documents that in Eastern Ethiopia at least, the vector thrives in rural areas as well and that they are efficient carriers of the parasites. The authors also state that the An. stephensi specimens collected “showed resistance to all tested insecticides.”
Abiy E & al. confirm that “[r]ecent studies have shown that [An. stephensi] are resistant to common public health insecticides, namely pyrethroids …, Carbamates …, and organophosphates… [The authors] assess the susceptibility of populations of An. stephensi from Ethiopia to novel chemical insecticides recently recommended for vector control.” In Susceptibility of the Invasive Malaria Vector Anopheles stephensi in Ethiopia to Novel Chemical Insecticides and Insect Growth Regulator, Sci Rep. 2025 Aug 18; 15:30268, https://doi.org/10.1038/s41598-025-15798-9 they state that that “populations of An. stephensi from Ethiopia were fully susceptible to the three novel chemical insecticides (broflanilide, chlorfenapyr and clothianidin) and an insect growth regulator ( Pyriproxyfen) resulted in complete oviposition inhibition. These findings suggest that the tested candidate chemical insecticides and insect growth regulator (IGR) can be used for indoor residual spraying (IRS) and larviciding.”
With the arrival of Anopheles stephensi in West Africa as well as the East, malaria in urban areas is becoming a focus of interest. Nonetheless, none of the species were found among close to 40,000 mosquitoes collected by Sabtiu ARM & al. and reported in Urban Malaria in Accra, Ghana: Transmission Risk and Influence of Irrigated Vegetable Farms, BMC Infect Dis. 2025 Aug 21, 25:1053, https://doi.org/10.1186/s12879-025-11403-6. A little over half the mosquitoes collected were of the Anopheles genus, mostly An. gambiae sensu lato. These were especially abundant in areas surrounding urban and suburban agricultural patches. Many of the collected mosquitoes were resistant to common insecticides used.
Kouadio KWU & al. carried out an “entomological surveillance … in two districts of western Burkina Faso to assess the impact of mass-distributed next-generation long-lasting insecticidal nets … on Anopheles gambiae s.l. populations, focusing on insecticide resistance trends and residual malaria transmission patterns…” The results showed not only persistence of parasite carrying mosquitoes, but also evidence that they continued to infect a significant percentage of the population with malaria. Their paper, Residual Malaria Transmission in Western Burkina Faso: Vector Behavior, Insecticide Resistance, and the Efficacy Limits of Next-Generation LLINs, Acta Trop. 2025 Sep 4: 107824, https://doi.org/10.1016/j.actatropica.2025.107824, “highlights the diversity and behavioral adaptability of the Anopheles gambiae s.l. complex.”
Tuwei M & al., MALDI-TOF MS for Identification of Afro-Tropical Secondary Malaria Vectors, Malaria J, 2025 Sep 2, 24:284, https://doi.org/10.1186/s12936-025-05549-6 lists six Anopheles species that the authors identified in both Kenya and Mozambique. “Secondary malaria vectors were considered as any Anopheline that did not pertain to Anopheles gambiae sensu lato (s.l.). or Anopheles funestus sensu lato (s.l.).” MALDI-TOF MS stands for Matrix-Assisted Laser Desorption, Ionization-Time of Flight Mass Spectrometry [which] has emerged as a promising solution” to identify these vectors. “This innovative technology, originally developed for microbial identification, works by analysing protein spectra from biological samples”
Prager M & al. conducted “a meta-analysis of four randomized controlled trials [in three countries including] Kenya, involving 6,745 participants, … to assess the efficacy of spatial repellents in reducing malaria infections.” They report in Efficacy of Spatial Repellents in Malaria Prevention: A Meta-Analysis of Randomized Controlled Trials, Am J Trop Med Hyg. 2025 Sep 4: tpmd250264, https://doi.org/10.4269/ajtmh.25-0264 that the “risk of malaria infection was lower with the use of spatial repellents … compared with controls …, resulting in a 52% risk reduction. However, there was considerable heterogeneity in the data in various papers reviewed, which may be confounding factor.
Metitsi Tesongang RD & al. investigated the potential of a low-cost eave screening technique to reduce human exposure to malaria vectors in a forested area of Cameroon. They describe in, A Low-Cost House Eave Screening Technique Complements Insecticide-Treated Nets in Reducing Indoor Human Exposure to the Bites of Anopheles Mosquitoes in a Malaria Endemic Area of South Forested Cameroon: Results from a Pilot Study, Exp Parasitol. 2025 Aug 23; 276:109006, https://doi.org/10.1016/j.exppara.2025.109006 how they conducted the pilot study. The results showed greatly reduced mosquito bites of people sleeping in the treated huts. The abstract cites no statistics on malaria infection rates and the paper is not available for review.
Anopheles funestus is one of the major vectors of malaria in Africa. Boddé M & al. studied is genomic variability and despite finding a great deal of variability of genomes within the species, they report in Genomic Diversity of the African Malaria Vector Anopheles funestus, Science, 2025 Sep 18; 389(6766):eadu3596, https://doi.org/10.1126/science.adu3596 that that “a promising gene drive target in Anopheles gambiae is highly conserved in An. funestus. These insights will enable more strategic insecticide usage and gene drive deployment, supporting malaria elimination.”
“Plants contain anthraquinoes. Flavonoids, glycosides, phenol, saponin, steroids, tannin, and terpenes that are target specific, rapidly biodegradable, ecofriendly, and less toxic to human health. The objective of [Assemie A & al.] was to evaluate the insecticidal activities of Azadirachta indica (neem) and Allium sativum L. (garlic) ethanol extracts against malaria vectors … They report in Insecticidal Activities of Plants Extract Against Malaria Vectors in Hadiya Zone, Ethiopia, J Parasitol Res. 2025 Aug 28; 2025:9980264, https://doi.org/10.1155/japr/9980264 that ethanol extract of A. sativum and A. indica are effective against An. gambiae s.l, An. pharoensis, and An. funestus.” A. sativum extract was the more effective in the reduction of malaria vectors.
Crateva adansonii is a species of small tree that is widely distributed in Africa and Asia. Ileke KD & al. tested its activity against malaria vector larvae and pupae and conclude that the “ethanolic extract of C. adansonii plant exhibited strong insecticidal activities against malaria vector. Use of plant product as plant-based mosquito control agent will help in reducing the eco-toxic effects of synthetic chemicals.” The paper is Bioactive Profiling, Larvicidal and Pupicidal Activities of Crateva adansonii Against Two Developmental Stages of Malaria Vector, Anopheles gambiae, J Parasit Dis. 2025 Sep; 49(3):735-746, https://doi.org/10.1007/s12639-025-01795-2. {Without access to the article beyond the abstract, it is unclear why the authors chose this plant to test.}
Please see Otieno FG & al., The Dissemination Potential of Microsporidia MB in Anopheles arabiensis Mosquitoes is Modulated by Temperature, Sci Rep. 2025 Aug 7, 15:28839, https://doi.org/10.1038/s41598-025-07414-7 under Epidemiology below.
Please see Otolorin GR & al., Integrated Vector Management for Malaria Control: A Review of Approaches and Effectiveness, Trans R Soc Trop Med Hyg. 2025 Aug 23, traf084, https://doi.org/10.1093/trstmh/traf084 under Campaigns and Policies below.
Chemoprophylaxis
Kambou SAE & al. tested 745 asymptomatic household members of children who were receiving the WHO-recommended seasonal malaria chemoprevention (SMC) for malaria. As reported in Patterns of Patent and Sub-Patent Plasmodium falciparum Infections in Household Members of Children Under Seasonal Malaria Chemoprevention Coverage in the Health District of Nanoro, Burkina Faso, Malaria J, 2025 Sep 1, 24:281, https://doi.org/10.1186/s12936-025-05453-z, school-age siblings of the treated children had particularly high rates of asymptomatic malaria (75.7%, of which about half were negative for rapid diagnostic testing [RDT] but positive for polymerase chain reaction [PCR]). Older household members had somewhat lower rates of infection. The authors recommend “the extension of the SMC intervention to school-aged children and the implementation of interventions such as testing and treatment of household members of children under SMC coverage.”
“In areas with seasonal malaria transmission, seasonal malaria chemoprevention (SMC) involves giving children a three-day course of sulfadoxine-pyrimethamine and amodiaquine once a month during the transmission season. This strategy has been used for ten years for children under five years of age.” Djedanem M & al., Status and Prospects of Seasonal Malaria Chemoprevention Among Children in Sahelian Countries: A Systematic Review and Meta-Analysis, PLOS Glob Public Health. 2025 Sep 12; 5(9):e0005124, https://doi.org/10.1371/journal.pgph.0005124 is an analysis of ten years’ worth of publications on the effectiveness of this approach. “Compared with control groups a reduction in the burden of malaria was observed in children receiving SMC. SMC appears to effectively reduce the incidence of malaria in children under five. However, it should be noted that SMC is always used alongside other prevention strategies, such as indoor residual spraying and long-lasting insecticide-treated nets.”
The “World Health Organization recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine. However, the effectiveness of IPTp with sulfadoxine-pyrimethamine has been threatened by widespread Plasmodium falciparum resistance.” Kakuru A & al. “hypothesized that a combination of both dihydroartemisinin-piperaquine and sulfadoxine-pyrimethamine would provide superior birth outcomes compared to either drug alone,” but as they report in Dihydroartemisinin-Piperaquine Plus Sulfadoxine-Pyrimethamine Versus Either Drug Alone for Intermittent Preventive Treatment of Malaria in Pregnancy: A Double-Blind, Randomized, Controlled Phase 3 Trial from Uganda, PLoS Med, 2025 Sep 18; 22(9):e1004582, https://doi.org/10.1371/journal.pmed.1004582 there was no evidence of improved birth outcomes in the combination group in comparison to the two individual regimens in a study of 2757 pregnant women. It is of interest that while the dihydroartemisinin- piperaquine regimen was significantly more effective against malaria during pregnancy, women who were in the sulfadoxine-pyrimethamine control group had slight but statistically significantly fewer adverse birth outcomes.
According to Arikawa S & al., Assessing Immunization Coverage in Southern Togo: Implications for Perennial Malaria Chemoprevention Delivery, BMC Public Health. 2025 Sep 2, 25:3035, https://doi.org/10.1186/s12889-025-24191-0, perennial malaria chemoprevention in children (PMC) is usually delivered with routine immunizations through the Expanded Program on Immunization (EPI) in Togo. Therefore the authors used immunization records to estimate the extent of the use of PMC in the geographic area they studied. They found that among 583 children, 60.7% were fully immunized. Presumably these children also received PMC. At the other end of the spectrum, 15.7% of children received no vaccines at all, for a variety of reasons. The question remains whether PMC was administered to any of the partially immunized children.
Other
Tamari N & al. address the influence of outdoor latrine construction features on the abundance of two types of mosquito vectors in Structural Features of Outdoor Latrines Influence the Abundance of Anopheles gambiae s.l. and Culex quinquefasciatus in a Village in Kisumu County, Western Kenya, Parasit Vectors. 2025 Aug 27; 18(1):364, https://doi.org/10.1186/s13071-025-07011-7. “Ventilated improved pit (VIP) latrines were associated with a 61% decrease in An. gambiae s.l. abundance … and a 62% decrease in Culex quinquefasciatus abundance …, compared with pit latrines.” The Culex species mentioned is a vector for a number of viral infections in humans as well as for avian malaria, but not human malaria.
In a unique departure from the approach of anti-malaria vaccines, Yadav M & al., Designing a Multi-Epitope Vaccine Against the Midgut-Specific Fibrinogen-Related Protein 1 (FREP1) of Anopheles stephensi to Enhance Protection Against the Malaria Parasite: A Step Beyond Traditional Vaccine Development Approaches, Biotechnol Lett. 2025 Sep 3; 47(5):93, https://doi.org/10.1007/s10529-025-03632-1 describes laboratory work on developing a vaccine against a protein in An. stephensi that is apparently critical for the survival of Plasmodium within the vector. Presumably the idea is that the mosquito acquires the vaccine by feeding on people who had been vaccinated with this preparation. This paper claims that the vaccine shows effectiveness against the protein in a bacterial model. {The Biotechnology Letters website does not claim that the short articles it publishes have undergone peer review. Nonetheless, PubMed includes citations from it without commenting on this fact.}
Antwi-Baffour S & al., Overview of the Host Immune Response to P. falciparum Malaria, J Parasit Dis. 2025 Sep; 49(3):548-564, https://doi.org/10.1007/s12639-025-01802-6 states that “the development of protective immunity against malaria is complex and influenced by various factors, including parasite diversity, host genetics, and prior exposure to the parasite. While some individuals develop partial immunity over time, others remain susceptible to severe disease. Understanding the intricacies of the host immune response to malaria is essential for the development of effective vaccines and therapies to combat this global health burden.”
Diagnosis
General diagnostics
None this month
Field diagnostics
None this month
New diagnostic methods
None this month
Treatment
Treatment results
Kamya MR & al. compared the results of treating uncomplicated falciparum malaria with four different artemisinin combination therapy (ACT) combinations and conclude in Efficacies of Artemether–Lumefantrine, Artesunate–Amodiaquine, Dihydroartemisinin–Piperaquine, and Artesunate–Pyronaridine for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Children Aged 6 Months to 10 Years in Uganda: A Randomised, Open-Label, Phase 4 Clinical Trial, Lancet Infect Dis, 2025 Aug 19, https://doi.org/ 10.1016/S1473-3099(25)00407-4 that “[a]rtemether–lumefantrine was associated with a higher risk of recurrent malaria than other antimalarial combinations tested, and K13 mutations were associated with delayed parasite clearance. Changes in first-line therapy for uncomplicated malaria must be considered in response to suboptimal efficacy of artemether–lumefantrine.”
Side effects and complications
None this month
Guidelines
Ibrahimi S & al. set out to measure adherence to national malaria diagnosis and treatment guidelines in four provinces of DRC. However, their paper, Assessment of Adherence to the National Malaria Guidelines in Treatment Management of Malaria Among Children Under Five in Integrated Community Case Management in the DRC, Glob Health Action. 2025 Dec; 18(1):2545628, https://doi.org/10.1080/16549716.2025.2545628, largely confines itself to the use of RDTs and administration of medications to children positive and negative on RDTs. It does not report whether the medications administered adhered to national guidelines or not.
Drug resistance
“When … beneficial alleles at multiple loci are present in a population but not linked together in any one individual, there is no general evolutionary result that determines whether recombination will speed up or slow down the emergence and evolution of genotypes carrying multiple beneficial alleles. … this evolutionary uncertainty means that when multiple types of drug resistance are present, we do not know whether recombination will act more strongly to (1) bring together single-resistant genotypes into multi-drug resistant (MDR) genotypes, or (2) break apart MDR genotypes into single-resistant genotypes.” Tran KT & al., Effects of Recombination on Multi-Drug Resistance Evolution in Plasmodium falciparum Malaria, PLoS Comput Biol. 2025 Aug 25; 21(8):e1013401, https://doi.org/10.1371/journal.pcbi.1013401 addresses this question through complicated modeling and conclude that “over a 15-year timeframe, triple artemisinin-combination therapies (ACT) strategies show the largest reductions in treatment failures and the longest delays until artemisinin resistance reaches a critical 1% threshold. Multiple first-line therapies (MFT) are second best…”
Using genetic studies of the mutations that render P. falciparum resistant to artemisinins, Gashema P & al., Mapping Plasmodium falciparum Mutations in Africa: A Critical Review of Emerging Drug Resistance and Implications for Malaria Control, Int J Infect Dis. 2025 Aug 28: 108033, https://doi.org/10.1016/j.ijid.2025.108033 predicts the rise of resistance from Eritrea as far South as Tanzania. Factors cited in the spread of resistance include “drug pressure …, misuse of antimalarial drugs …, and cross-border population movements.”
New drug research
Ajekiigbe VO & al. “discuss the potential advantages and challenges of repurposing Imatinib [currently used in treatment of a form of leukemia] for treating malaria, its pharmacokinetic profile, and its use in … patient populations, such as children and pregnant women” in The Emerging Role of Imatinib in Malaria Management: A Review of Evidence and Future Directions, Trop Dis Travel Med Vaccines. 2025 Aug 15; 11:28, https://doi.org/10.1186/s40794-025-00257-0. Based of the review of nine papers on the subject, the authors report a “decline in parasite density, pyrexia, parasite growth inhibition, and synergism with other anti-malarial medications like Artesunate. … Imatinib showed a favorable safety profile with no adverse drug-related events reported.”
Wen H & al. cite evidence from the literature that the use of nanoparticles joined to antiparasitic drugs can enhance the effectiveness of the drugs. In their paper, Effects of Artesunate-Loaded Nanoparticles on Plasmodium berghei Treatment in a Mouse Model, Acta Trop. 2025 Sep 4: 107823, https://doi.org/10.1016/j.actatropica.2025.107823, they report that in the mouse model, artesunates encapsulated in in nanoparticles of zinc-based metal-organic frameworks “showed stronger parasite clearance than the control non-encapsulated artemisinin at the same dose.” They state that their findings “pose opportunities for novel malaria therapeutic approaches…”
Plant extracts and traditional treatments
None this month
Other
Blocking the transmission of malaria from infected individuals to mosquitoes is actually a preventive measure, but two articles published this month review it in the context of the effectiveness of routine treatment of malaria to do so. Vanheer LN & al. used human volunteers infected by P. falciparum and treated by various regimens, followed by mosquito bites and testing of the mosquitos. “Artemether-lumefantrine (AL) was significantly more potent at reducing mosquito infection rates within 48 h than dihydroartemisinin-piperaquine … and sulfadoxine-pyrimethamine plus amodiaquine …, while this difference was near-significant for artesunate-amodiaquine …. and pyronaridine-artesunate … The addition of single low-dose primaquine … accelerated gametocyte clearance for any ACT.” The article is The Transmission Blocking Activity of Artemisinin-Combination, Non-Artemisinin, and 8-Aminoquinoline Antimalarial Therapies: A Pooled Analysis of Individual Participant Data, PLoS Med. 2025 Aug 14; 22(8):e1004683, https://doi.org/10.1371/journal.pmed.1004683. Kumsa T & al., Efficacy and Gametocyte Carriage in Plasmodium falciparum Cases Treated with Artemether-Lumefantrine Alone Versus with Single-Dose Primaquine in Ethiopia: A Randomized Controlled Study, Acta Trop. 2025 Aug 21: 107800, https://doi.org/10.1016/j.actatropica.2025.107800 is a randomized study of symptomatic patients in Ethiopia, of whom 106 were analyzed. When a single dose of primaquine was added to treatment with AL, gametocyte clearance as measured by microscopy was accelerated, though by day 14 all patients were found to be clear of gametocytes. This result is compatible with that of Vanheer & al.
Amaka JI & al. reviewed 27 published articles on the subject of self-medication for malaria in sub-Saharan Africa and report in Issues Associated with Malaria Self-Medication in Sub-Saharan Africa: A Systematic Literature Review and Meta-Analysis, Malaria World J, 2025 Sep 6, 16:16, https://doi.org/10.5281/zenodo.17054133 a “pooled prevalence of 55.3% of self-medication. Factors driving self-medication with antimalarials in the region include low-income level, cheap availability of non-prescription drugs, large family size, lack of health insurance, difficulty in accessing healthcare in formal settings and previous satisfactory use of specific drugs.” The authors discuss the implications in terms of emergence of resistance and other complications.
Campaigns and Policies
“Community Case management of malaria (CCMm) … involves providing malaria diagnosis and treatment within the community by trained community health volunteers (CHVs).” Lumumba S & al., Facilitators and Barriers of Community Case Management of Malaria Implementation in Homabay, Busia and Kakamega Counties, Kenya, PLoS One. 2025 Aug 21; 20(8):e0329709, https://doi.org/10.1371/journal.pone.0329709 reports on questionnaire responses and focus group discussion regarding the effectiveness of this approach. The study found that 72% of households had received a service on malaria, … with approximately 85% of the population being satisfied … Key initiatives that improved the effectiveness of CCMm included sensitization on malaria causes and preventive measures, training of CHVs on the management of malaria, and empowerment of CHVs [to perform RDTs]. The facilitators of CCMm included the availability of malaria commodities, a functional referral system, and support supervision from … Health Management Teams. Barriers … included myths and misconceptions surrounding the use of mosquito nets, stock outs of malaria commodities such as [RDT kits] and antimalarials, and inaccessible roads into the communities.”
The following is the entire abstract of Adugna T, Challenges to Malaria Elimination in Ethiopia by 2030: A Review, J Trop Med. 2025 Aug 19; 2025:3144857, https://doi.org/10.1155/jotm/3144857: “Malaria disease is a major health issue in Ethiopia, affecting three-fourths of the country’s land area and more than two-thirds of the population living below 2000 m altitude. Over 42 Anopheles species have been identified in the country, but Anopheles arabiensis was the only major malaria vector, accounting for the majority of illness and mortality. However, there is a new invasive malaria vector, Anopheles stephensi, which is strikingly similar to the primary vector. This species transmits both Plasmodium falciparum and Plasmodium vivax and has gained resistance to all four types of insecticides, such as A. arabiensis. Plasmodium falciparum and Plasmodium vivax accounted for the majority of malaria cases in the country. However, these species have evolved resistance to several antimalarial medications throughout the country, adding to the burden. Furthermore, the country has just had a long civil war, which has resulted in an alarming spike in malaria cases throughout the country. Even in a few regions, such as Amhara and Oromo, the disease is spreading rapidly and beyond the control of regional health bureaus. All of these issues constitute major impediments to the country’s malaria elimination aim. This article provides a comprehensive summary of the status of new and invading species, the status of insecticide-resistant malaria vectors, the ranges of drug-resistant Plasmodium species, the impacts of neglected Plasmodium vivax, and the impacts of civil war on Ethiopia’s malaria elimination aim.”
Otolorin GR, Castellanos ME, Adegboye OA & al., Integrated Vector Management for Malaria Control: A Review of Approaches and Effectiveness, Trans R Soc Trop Med Hyg. 2025 Aug 23, traf084, https://doi.org/10.1093/trstmh/traf084 is a literature review. The authors conclude that “[e]merging tools such as attractive targeted sugar baits, genetically modified mosquitoes and green-synthesized metallic nanoparticles offer more environmentally sustainable options [than those heretofore utilized]. Combining traditional and innovative methods, [integrated vector management] potentially provides a sustainable global malaria control and eradication solution.
Epidemiology
Climate change, biodiversity and environment
Kiragga A & al., Climate-Driven Malaria Mortality Among Children in Malaria-Endemic Areas of Uganda, BMC Public Health. 2025 Aug 18, 25:2825, https://doi.org/10.1186/s12889-025-23678-0 reports that in a particularly malaria-prone area in Uganda, the authors “found an increased mortality risk across all ages at a lag of 11 to 12 weeks following exposure to rainfall above 646 mm. Higher risks of malaria mortality were also observed at a lag of 5 to 11 weeks when temperatures ranged between 25.2 °C and 29.9 °C. Notably, the relative risk of malaria mortality in children under 5 years and children aged between 5 and 14 years was more sensitive to temperature than to rainfall … male children aged between 5 and 14 years were more vulnerable to temperature-related malaria mortality compared to females in that age group and children under 5 years.”
Petros LD & al. offer a mathematical model that they claim offers “improved prediction and control strategies under varying environmental conditions.” The model is primarily temperature-driven. The paper is Age-Structured Malaria Model with Temperature-Dependent Dynamics and Optimal Control Analysis Within a Partial Differential Equation Framework, PLoS One. 2025 Aug 20; 20(8):e0330158, https://doi.org/10.1371/journal.pone.0330158.
“Microsporidia MB, a vertically transmitted endosymbiont of Anopheles mosquitoes, shows strong potential as a malaria control agent due to its ability to inhibit Plasmodium development within the mosquito host. To support its deployment in malaria transmission reduction strategies, it is critical to understand how environmental factors, particularly temperature, influence its infection dynamics.” Otieno FG & al., The Dissemination Potential of Microsporidia MB in Anopheles arabiensis Mosquitoes is Modulated by Temperature, Sci Rep. 2025 Aug 7, 15:28839, https://doi.org/10.1038/s41598-025-07414-7 reports that even though the survival of mosquito larvae is optimal at 27°C, their higher infectivity rate with Microsporidia MB at 32°C make that temperature more ideal to use the microbial agent in efforts to control malaria in endemic regions.
Lutambi AM & al. “assessed the impact of climatic and environmental variables on malaria incidence to better understand spatial and temporal trends and their implications for the WHO targets” for 2030. Their paper, Modelling the Impact of Climatic and Environmental Variables on Malaria Incidence in Tanzania: Implications for Achieving the WHO’s 2030 Targets, PLOS Glob Public Health. 2025 Aug 20, 5(8):e0005075, https://doi.org/10.1371/journal.pgph.0005075 is a retrospective analysis over the years 2000 to 2020. While there was an overall decrease of incidence of malaria in the country over that time, some areas, such as those with enhanced vegetation index, and to a lesser degree higher temperatures, and higher aridity, stood out as sustaining more malaria than other areas. The authors recommend concentrating malaria control efforts to areas of highest prevalence, rather than instituting a uniform nationwide program.
De Marco CM & al., Habitat Drivers and Predicted Distribution Shifts of Anopheles coluzzii Under Climate Change: Results from the Systematic Review, Sci Total Environ. 2025 Aug 25; 992:179939, https://doi.org/10.1016/j.scitotenv.2025.179939 states that although An. coluzzii is a less prolific vector for malaria in most of Africa, its importance is likely to increase as climate change is occurring.
Risk factors
According to Toure AA & al., “[m]alaria remains a major health concern in rural Guinea, where children face fivefold higher infection risk compared to urban areas. While disparities between rural and urban regions have been documented, inequities within rural areas remain unexplored. Socioeconomic factors influence malaria risk, which varies according to season.” However, Inequity in the Transmission of Malaria Infection Among Children and Adolescents: A Cohort Study in Rural Guinea, Sci Rep. 2025 Aug 14; 15:29881, https://doi.org/10.1038/s41598-025-15600-w reports extremely complicated odds ratios of infection based on age of head of household, household wealth, age of the child and wet vs. dry season. “This study revealed significant seasonal and socioeconomic disparities in malaria transmission among children and adolescents in rural Guinea.”
According to Morlighem C & al., “[i]n low-transmission settings, the traditional distribution of malaria along vector suitability gradients is shifting to a new profile, with the emergence of hotspots where the disease persists. To support elimination in this context, it is essential that malaria risk maps consider not only environmental and climatic factors, but also societal vulnerabilities, in order to identify remaining hotspots and ensure that no contributing factors are overlooked…” In Integrating Vulnerability and Hazard in Malaria Risk Mapping: The Elimination Context of Senegal, BMC Infect Dis. 2025 Aug 18; 25:1031, https://doi.org/10.1186/s12879-025-11412-5, the authors classify factors into “vulnerability” (exposure, susceptibility, resilience) and “hazard” (climate & weather, vector habitat). According to models constructed based on the government’s data from 2017, addition of vulnerability factors to the usually invoked hazard factors created a better fit with the actual infection data for children five year old or younger. “Furthermore, models including only vulnerability factors outperformed those including only hazard factors.”
General epidemiology
The malaria elimination program on Bioko Island, a component of Equatorial Guinea, is hampered by what Stabler TC & al. regard as importation of parasites by infected visitors or migrants. In their paper, Regular Plasmodium falciparum Importation onto Bioko Island, Equatorial Guinea, Hampers Malaria Elimination from the Island, PLOS Glob Public Health. 2025 Aug 19, 5(8):e0004999, https://doi.org/10.1371/journal.pgph.0004999, they conclude that the majority of cases originate in the nearby Gabon. “To assess the impact of importation on the Bioko P. falciparum population, Cameroon and Gabon samples were used as a representative sample set for the suspected source of imported strains to Bioko due to their geographical proximity and admixture results. … overall mean relatedness of Bioko Island strains was lower than seen within Cameroon or within Gabon … Inter-group comparisons illustrated that relatedness of Bioko parasites was twice as high to Gabonese parasites as it was to those from Cameroon…”
“Congenital malaria (CM) [is] a rare condition where malaria parasites are transmitted from mother to child during pregnancy or delivery.” Odeniran PO & al. report on CM as reviewed from 35 articles, covering 9305 newborns in Congenital Malaria in Nigeria: A Systematic Review and Meta-Analysis, Parasitol Int. 2025 Aug 24; 110:103147, https://doi.org/10.1016/j.parint.2025.103147. They quote the prevalence of CM in this population to have been 12.7% with “high heterogeneity,” calling into question whether CM really is rare. “Subgroup analyses of maternal‑neonate pairings revealed maternal, … malaria parasitaemia [prevalence] of 25.5 %…”
Using specimens obtained in a ten-year-old survey, Gaither C & al. performed PCR testing for specific Plasmodium infections from 5050 asymptomatic mostly adult individuals. They found that 22.3% were positive, with P. falciparum and non-falciparum at 16.3% and 8.0%, respectively (some had mixed infections). Their article is Prevalence of Asymptomatic Non-Falciparum and Falciparum Malaria in the 2014-15 Rwanda Demographic Health Survey, PLoS One. 2025 Sep 11; 20(9):e0330480, https://doi.org/10.1371/journal.pone.0330480
Please see Sabtiu ARM & al., Urban Malaria in Accra, Ghana: Transmission Risk and Influence of Irrigated Vegetable Farms, BMC Infect Dis. 2025 Aug 21, 25:1053, https://doi.org/10.1186/s12879-025-11403-6 above, under Prevention/Vectors.
Spatiotemporal studies
Mohamud SM & al., The Prevalence of Malaria Among Pregnant Women at a Tertiary Care Hospital in Somalia: A Cross-Sectional Study, Biomed Res Int. 2025 Aug 24; 2025:6730167, https://doi.org/10.1155/bmri/6730167. Among 398 pregnant women, 59.8% had malaria, mostly caused by P. falciparum.