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Malaria: Causes, Symptoms, Diagnosis, Treatment & Prevention, Adama (2025)

Malaria is an acute infectious disease caused by the parasites called Plasmodia and spread by the the vector, the female anopheles mosquito. Control of this dreaded menace would therefore involve three living beings: Man (The host), Plasmodia (The agent), and Anopheles mosquito (The vector). And due to this reason alone, control of malaria is a formidable task. The international efforts on malaria control were highly successful in the late 50’s and early 60’s. However, due to various reasons, the malaria control programmes received setbacks all over the world and today it has come back with a vengeance. Control of malaria is possible only by concerted community efforts. Relying only on the government machinery for the control of this problem will only heighten the dangers. Ministerial Conference held in October, 1992 at Amsterdam evolved a Global Strategy for Malaria Control. The strategy broadly suggests de-emphasis on vector control and renewed emphasis on treatment. Early diagnosis and treatment; prevention of deaths; promotion of personal protection measures like use of ITMs; epidemic forecasting, early detection and control; monitoring, evaluation and operative research and integration of activity in Primary Health Centres are the salient aspects of this strategy. controlThe control of malaria involves control of 3 living beings and their environment. Man, the host is a moving target and can take the disease with him to far and wide. Mosquitoes are moving, highly adaptable and have shown resistance to insecticides. It is therefore important to target non-flying eggs and larvae. The parasite also is highly adaptable, hides in humans and mosquitoes and has also developed resistance to drugs. Therefore, for effective malaria control, target man first, control mosquitoes next and keep trying to tackle the parasite with development of effective drugs and vaccines. Control of malaria is a complex chain of measures that often complement one another. The diagram on the left depicts this control chain: For example, by taking personal protective measures, three things can be achieved – prevention of malaria in the given individual, thus reduced parasite load and reduction in spread, and by denying blood meal to the mosquito the egg laying is also hampered! In the recent years, more emphasis is being laid on early diagnosis and treatment, on personal protection especially with insecticide treated bednets and on biological vector control. By these means, it is intended to minimise use of potentially harmful chemical insecticides. Man, the Host: Treat the affected, protect the unaffected. Problem are compliance, accessibility and availability of treatment and protective measures, mostly due to poverty and backwardness. Parasite, the Agent: Ensure full treatment; kill the asexual forms and prevent the progression of disease, kill the sexual forms and prevent the spread to mosquitoes. Problem is Drug resistance

Mosquito, the Vector: Prevent breeding, prevent entry into houses, prevent bites to humans. Problems are resistance to insecticides and compliance by humans

Man’s Role in Malaria Control: Man is the most important link in the malaria control chain. He can be made to understand the problem and he can help in breaking the chain at multiple points. Therefore great emphasis should be laid on educating the people about malaria and its control, so that common people can effectively contribute in controlling this disease. This includes education of doctors about the need for early diagnosis and prompt treatment of malaria. Early diagnosis and treatment – treat early to reduce parasite load, hence spread; prevent deaths
Treat completely to prevent spread and relapse
Ensure compliance with complete treatment
Personal Protection- prevent malaria by using bed nets, insecticide sprays etc., and by chemoprophylaxis. Seek his help in mosquito control
1. Early diagnosis and treatment: This is a very important aspect of malaria control. In fact, early detection and treatment of the disease itself is enough to control this epidemic in its early stages. By this, the parasite load in the community is reduced, thereby reducing the transmission of the disease. Presumptive treatment of all cases of fever is very important. Tests for malarial parasite should be done in all cases of fever, and presumptive treatment with first full dose of chloroquine should be administered. Chloroquine is highly effective as schizonticidal against all species of malaria and is also gametocytocidal against all except P. Thus, by administering chloroquine to all cases of fever, it is possible to sterilize the gametocytes and thus prevent the spread to mosquitoes. Whenever resistance to chloroquine is known or suspected, second line anti malarials should be used to treat P. falciparum malaria.

2. Radical treatment: All confirmed cases of fever should be administered radical treatment with primaquine. A single dose of primaquine must be administered in P. falciparum malaria to sterilize the gametocytes. A 14 days course of primaquine should be administered in P. vivax infection to destroy the hypnozoites in the liver and thus to prevent relapse.

3. Ensure compliance: Complete treatment should be ensured. If the patient vomits the drugs within an hour of ingestion, the same should be repeated. Incomplete treatment fails to clear the parasitemia and thereby aids spread. Many patients fail to complete the treatment due to either negligence, lack of proper education or sometimes due to adverse effects.

4. Personal protection: Man should be encouraged to protect himself against malaria. Personal protection measures include protection against mosquito bites and chemoprophylaxis against malaria. Protection against mosquito bites: People living in endemic areas as well as travelers to such areas should be educated and encouraged to use protective measures against mosquito bites. These include closing the doors and windows in the evenings to prevent entry of mosquitoes into human dwellings; using mosquito repellant lotions, creams, mats or coils and regular use of bednets. Using bednets is one of the safest methods of preventing and controlling malaria. Now Insecticide Treated Bednets are available and it has been found in various studies that use of these ITMs leads to a 19% reduction in child mortality and 40-60% reduction in infection. As mentioned above, protection against mosquito bites, especially the use of mosquito nets, has a spiraling effect on malaria control. By this measure, blood meal is denied for the female mosquito and this prevents development of eggs and hence a reduction in mosquito population and transmission. For more details See Mosquito Control

Chemoprophylaxis: Travelers to endemic areas and high risk individuals living in endemic areas (pregnant, elderly, patients with end organ failure) should be started on chemoprophylaxis against malaria. This involves taking antimalarial drugs every week (some drugs may have to be taken everyday) so as to suppress malaria.

13/09/2022

A promising malaria vaccine was up to 80% effective at preventing the disease in young children who received a booster shot one year after their initial dose, exceeding a World Health Organization (WHO) target of 75% efficacy.
The clinical-trial results, published in The Lancet Infectious Diseases on 7 September1, add to data released last year, and show that immune responses — which waned over the year following the initial dose of vaccine — can be boosted back to initial levels.
Malaria vaccine shows promise — now come tougher trials
The findings offer hope that the vaccine, called R21, could be an effective weapon in the fight against malaria, which is one of the biggest killers of children globally.
But public-health officials will require results from a bigger trial — with more than ten times as many participants, spread across four African countries — before they can confirm R21’s safety and utility, and roll it out on a larger scale. “There is still more work to be done,” says Matshidiso Moeti, the WHO’s regional director for Africa, who is based in Brazzaville in the Republic of Congo. “But I think this is very positive news.”
Century-long search
Nearly a century of searching for effective malaria vaccines has yielded well over 100 candidates that have been tested in people, Adrian Hill, a vaccinologist at the University of Oxford, UK, told reporters during a press briefing.
So far, the only one shown to be successful is a vaccine called RTS,S, produced by London-based pharma giant GSK. After decades of development, RTS,S was approved by the WHO on 6 September for broad use in regions with significant malaria transmission. It has been administered to more than 800,000 children in Ghana, Kenya, and Malawi, and is about 70% effective at preventing malaria in children when combined with conventional antimalarial drugs.

13/09/2022

PATH has played a key role in the development and introduction of the groundbreaking first malaria vaccine. Now it is time to expand childhood vaccination, ensure the long-term supply of RTS,S, and advance the research of next-generation malaria vaccines.
In 2021, the World Health Organization (WHO) recommended the RTS,S vaccine against malaria for broader use. Two months later, the Gavi Board approved funding to support malaria vaccine roll-out in sub-Saharan Africa. Not only is this the first malaria vaccine to earn such a recommendation and support, but it’s also the world’s first vaccine against a parasite.
At PATH, we’ve been working on the development and implementation of RTS,S for more than 20 years—first with GlaxoSmithKline (GSK) on Phase 2 and Phase 3 clinical trials, and, since 2017, with WHO, GSK and the ministries of health in Ghana, Kenya, and Malawi on the pilot implementation and evaluation of the vaccine.
Next steps for the vaccine include funding decisions to support broader rollout and country decisions on whether to adopt the vaccine.
It has been a long road, and it is extremely exciting to finally be able to say that RTS,S could soon be available—alongside other malaria interventions—to protect more children at risk from the disease.
Read more for an exploration of the malaria vaccine’s potential impact and how we are working to expand access and ensure the long-term supply of the malaria vaccine.

13/09/2022

Treatment
Malaria is treated with prescription drugs to kill the parasite. The types of drugs and the length of treatment will vary, depending on:

Which type of malaria parasite you have
The severity of your symptoms
Your age
Whether you're pregnant
Medications
The most common antimalarial drugs include:

Chloroquine phosphate. Chloroquine is the preferred treatment for any parasite that is sensitive to the drug. But in many parts of the world, parasites are resistant to chloroquine, and the drug is no longer an effective treatment.
Artemisinin-based combination therapies (ACTs). ACT is a combination of two or more drugs that work against the malaria parasite in different ways. This is usually the preferred treatment for chloroquine-resistant malaria. Examples include artemether-lumefantrine (Coartem) and artesunate-mefloquine.
Other common antimalarial drugs include:
Atovaquone-proguanil (Malarone)
Quinine sulfate (Qualaquin) with doxycycline (Oracea, Vibramycin, others)
Primaquine phosphate

14/08/2022

Seasonal Malaria Chemoprevention (SMC), which combines amodiaquine (AQ) with sulfadoxine-pyrimethamine (SP), is an effective and promising strategy, recommended by WHO, for controlling malaria morbidity and mortality in areas of intense seasonal transmission. Despite the effectiveness of this strategy, a number of controversies regarding the impact of the development of malaria-specific immunity and challenges of the strategy in the context of increasing and expanding antimalarial drugs resistance but also the limited coverage of the SMC in children make the relevance of the SMC questionable, especially in view of the financial and logistical investments. Indeed, the number of malaria cases in the target group, children under 5 years old, has increased while the implementation of SMC is been extended in several African countries. This ambivalence of the SMC strategy, the increase in the prevalence of malaria cases suggests the need to evaluate the SMC and understand some of the factors that may hinder the success of this strategy in the implementation areas. The present review discusses the impact of the SMC on malaria morbidity, parasite resistance to antimalarial drugs, molecular and the immunity affecting the incidence of malaria in children. This approach will contribute to improving the malaria control strategy in highly seasonal transmission areas where the SMC is implemented.
Keywords: seasonal malaria chemoprevention, immunity, resistance, sulfadoxine-pyrimethamine, amodiaquine
Malaria is still a leading cause of morbidity and mortality despite all the efforts made to control the disease. Over 80% of malaria cases and 90% of malaria deaths occur in Africa and mainly in children.1 Although the incidence of malaria is declining in many parts of sub-Saharan Africa, it remains an important public health problem, especially in risk groups such as infants, children, and pregnant women. In this region of Africa, most of the malaria cases and deaths occur during or immediately after the rainy season (approximately from July to October) and children below 5 years of age are at the greatest risk; world malaria report 2021 data indicate that 60–75% in 2009–2017 still occurred in children aged under 5 years.1 In order to strengthen the fight against malaria in children, a new preventive strategy was developed and recommended by the World Health Organization (WHO) in 2012 following a report of the Technical Expert Group (TEG) of Preventive Chemotherapy. Seasonal Malaria Chemoprevention (SMC), previously referred to as Intermittent Preventive Treatment in children (IPTc), is defined as the intermittent administration of full treatment courses of an antimalarial drug to children during the peak of the malaria transmission season with the aim of preventing malaria-associated mortality and morbidity2 by a malaria prevention strategy in children living in the Sahel sub-regions of Africa.3,4 The Sahel stretches from Senegal on the Atlantic coast, through parts of Mauritania, Mali, Burkina Faso, Niger, Nigeria, Chad, and Sudan, to Eritrea on the Red Sea coast. According to the WHO policy recommendation, SMC involves the repeated administration of therapeutic doses of Sulfadoxine-Pyrimethamine (SP) and Amodiaquine (AQ) drugs at monthly intervals during the malaria transmission period in areas where malaria is endemic and seasonal.5–7 SP+AQ is a non-artemisinin combination treatment.
Mali was one of the first countries in the Sahel region to implement SMC in 2012, which has now been gradually rolled out to cover the entire country.8 As of 2020, 13 countries have adopted SMC (Benin, Burkina Faso, Cameroon, Chad, Gambia, Ghana, Guinea, Guinea Bissau, Mali, Niger, Nigeria, Senegal, and Togo) at different scales of implementation.9 Several studies in Africa have shown that this intervention is cost-effective, safe, and feasible for the prevention of malaria among children in areas with highly seasonal malaria transmission.10,11 The number of children reached with at least one dose of SMC has increased steadily from nearly 0.2 million in 2012 to about 33.5 million in 2020 in 13 countries in the African Sahel.1
Methodology
We considered as relevant all articles published online in PubMed by using the search terms “SMC” or “Seasonal malaria chemoprevention”. As a precursor term of the SMC strategy, we have also included the term “intermittent preventive treatment in children” or “IPTc” in our search. We concluded the literature research on April 5, 2022. Finally, we considered the studies eligible only if they met the following inclusion criteria: a) the articles were written in English and published by April 5, 2022, b) the study was carried out in Sahelian Africa region participants (except those used to discuss the review), and c) Sulfadoxine-Pyrimethamine and Amodiaquine, Dihydroartemisinin-Piperaquine should be used as antimalarial drugs.
The manuscripts with only abstracts available were excluded as we could not access the full text. We then reviewed the following: deployment and implementation progression, the impact of SMC on the prevalence of malaria cases in high-risk individuals, the factors affecting the effectiveness of the Seasonal Malaria Chemoprevention, and the interaction of the SMC with malaria immunity and the coverage of the SMC.
Results and Discussions
Specificity and Outcomes of the Selected Studies for Review
From the PubMed search using the specific terms mentioned above, 249 articles were found and 185 studies met the inclusion criteria, as presented in
Paper mining flowchart. *Others West Africa include Gambia, Nigeria, Ghana, Côte D’Ivoire, Guinea, Chad, and Mauritania.
Abbreviations: SMC, Seasonal Malaria Chemoprevention; IPTc, Intermittent Preventive Treatment in Children.
Although we sought out the bulk of articles on SMC with full texts, the reality of our review focused primarily on data collected in the Sahelian part of Africa where the SMC is the WHO recommendation. Of course, we have used some data from Nigeria and Ghana, parts of which have a seasonal malaria transmission pattern. We believe that focusing the review on articles published on studies conducted in Burkina Faso, Mali, Niger, and Senegal will essentially help to better show the effect of SMC on malaria morbidity, resistant genotypes, or immunity that we are looking for because at the moment the WHO requirements and recommendations are focused in this area.
The published studies on Seasonal Malaria Chemoprevention were predominantly conducted in West Africa (168/185, 90.8%). Three countries in the Sahelian regions (Senegal, Mali, and Burkina Faso) account for more than 80% (136/166) of the studies conducted in the West African region (Figure 2). The first pilot studies on the intermittent prevention treatment in children were carried out in Senegal in 2006,12 and Mali13 and Burkina Faso14 started this evaluation in 2008 as a multi-center study. Looking at the report from WHO,3 it is important to note that the results of the evaluations in Burkina Faso, Mali, and Senegal were extremely decisive in WHO’s decision to adopt this preventive strategy called SMC as one of the strategies that can contribute significantly to the reduction of malaria morbidity and mortality in the area where malaria transmission is seasonal. Many articles reflect the same topics. Then, to avoid redundancy many are not included in the list of author references.
Three countries accounting for more than 80% of the SMC studies in West Africa.
SMC Deployment and Implementation in Sub-Saharan Africa
The implementation of SMC in Sahelian countries has been gradual from a pilot phase in the various countries to a full-scale phase to the entire population of concerned countries. By organizing the implementation in this way, the actors learn from the lessons and failures and then improve the progress. This implementation process has been strongly supported by committed organizations (Medicines for Malaria Venture, Malaria Consortium, UNICEF, Global Fund, UNITAID, WHO, World Bank, PMI) alongside National Malaria Control Programs in Sub-Saharan Africa. This synergy remains today a winning combination in the implementation of SMC in Sub-Saharan Africa. Indeed, by bringing in their experience in program management, by building bridges between the different countries implementing this strategy and bringing additional financial and logistical resources, the scale up of SMC has been remarkable to reach the majority of eligible children in the Sahelian countries. Countries like Burkina Faso took about 6 years (2014 to 2019) to cover the country's entire health districts (about 70 health districts) with the support from the Malaria Consortium, USAID, PMI, Unitaid, Global Fund, and World Bank
Example of Seasonal Malaria Chemoprevention deployment and coverage in Burkina Faso (unpublished data from Malaria Consortium).
It is important that the organizational approach (3 days dose administration for each child during four cycles) is well respected by the parties implementing the strategy by putting in place procedures to better monitor planned activities. Although the WHO policy recommendation is for four monthly cycles, countries can set their own policies according to the local context. In that context five cycles are now implemented in several countries, including Burkina Faso (across the southern half of the country), in areas where the peak of transmission season is slightly longer. But the core of the SMC strategy still remains the 4 months of implementation. One of the expansion approaches of the SMC also concerns the targeted ages, with the option to extend above 5 years. There are some studies that have focused on older ages,15–19 with arguments related to the shift of the transmission curve in the tranche from 5 to 10 years. Senegal is a pilot country in extending the age target from 5 to 10 years.15,19 Confirmation of the interest of the extension of the age range is strongly awaited to further enlighten the scientific community on the cost-benefit of this extension. In addition, the potential benefit of expanding the age group eligible for preventive treatment needs to be weighed against its potential risks, including development of drug resistance and/or the risk of hindering acquisition or maintenance of immunity. However, the WHO Technical Advisory Committee felt that any adjustment should be tailored to the needs of each country and its context. This is especially important as countries should be supported to develop or revisit their strategies for greater effectiveness.
Impact of SMC on the Prevalence of Malaria Cases in High-Risk Individuals
Pilot Studies as a Proof of Concept of the SMC Strategies
To confirm SMC as a strategy that can positively influence the prevalence or incidence of malaria in a population of children at risk of malaria, pilot studies were conducted mainly in Burkina Faso, Mali, and Senegal, under the known names of intermittent preventive treatment in children. These studies, considered to be the “ancestors” of the SMC, involved more than 3,000 children in each of these countries. The results generated from those studies2,15,16,20 allowed WHO to recommend the strategy for scaling up in the Sahel while the following should be noted.
Indeed, results from studies in Senegal from Cissé et al's12 study showed a malaria reduction incidence of 86% among children who received seasonal intermittent preventive treatment. The same trends of malaria incidence rate reduction were confirmed in a case-control study in Mali with 3.2 episodes in the treatment group vs 5.8 episodes in the control group, with age-adjusted Protective Efficacy (PE) of 42.5% (95% CI=28.6–53.8%).13
A parallel study was conducted during the same period in Burkina Faso. Malaria incidence defined as fever or history of fever with parasitaemia ≥5,000/µL, assessed during this study, was estimated at 2.88 (95% CI=2.70–3.06) per child in the control arm versus 0.87 (95% CI=0.78–0.97) in the intervention arm with a protective efficacy (PE) of 70% (95% CI=66–74%) (p

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