Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes (Phillips, 2017). It is a major public health problem worldwide, particularly in sub-Saharan Africa where it is responsible for a significant proportion of morbidity and mortality. According to the World Health Organization (WHO), there were an estimated 229 million cases of malaria worldwide in 2019, with an estimated 409,000 deaths (Oladipo, 2022)
The symptoms of malaria include fever, headache, chills, and flu-like illness. If left untreated, it can progress to severe illness, often leading to death (Schantz-Dunn, 2009: Zekar, 2024). Children under 5 years of age and pregnant women are particularly vulnerable to the disease. Malaria is preventable and curable, but the lack of access to effective prevention and treatment measures remains a major obstacle to controlling the disease (Oladimeji, 2019).
History of Malaria
Malaria is a disease caused by the Plasmodium parasite (Phillips, 2017). It has been a major cause of illness and death for centuries, particularly in tropical and subtropical regions (Tangpukdee, 2009).
Origins and Spread
Malaria is believed to have originated in Africa, where it has been present for thousands of years. The disease was first described in ancient Chinese medical texts, and was later mentioned by Greek and Roman writers. It is thought that malaria was spread to Europe by the Roman armies, and then to the Americas by European explorers and colonizers (Loy, 2017; Sharp, 2020; Talapko; 2019).
The spread of malaria was facilitated by the expansion of human populations, the growth of trade and commerce, and the development of transportation infrastructure (Castro, 2017). For example, the transatlantic slave trade significantly contributed to the introduction of P. falciparum into the New World, where it thrived in tropical and subtropical climates (Castro, 2017).
The disease was particularly prevalent in regions with high Anopheles mosquito densities, as these vectors are responsible for transmission. In areas such as the Mississippi Valley and the Caribbean, malaria became endemic due to favorable ecological conditions, including stagnant water sources and humid environments that supported mosquito breeding (Phillips, 2017).
At its peak in the early 20th century, malaria affected nearly every continent, with an estimated 300 million cases per year globally.
Major Outbreaks and Historical Impact
Malaria has had a significant impact on human history. It has been responsible for countless deaths and has affected the course of wars, economic development, and social progress. Some of the major outbreaks of malaria include:
- The epidemic that swept through Rome in the 2nd century BC, which is believed to have contributed to the decline of the Roman Empire (Mertens, 2024).
- The outbreak that occurred during the construction of the Panama Canal in the early 20th century, which caused thousands of deaths and delayed the project by several years (Breedlove, 2021; Dunkel, 2020).
- The epidemic that affected the Allied forces during World War II, which led to the development of antimalarial drugs and the widespread use of insecticides (Arrow, 2004).
Malaria continues to be a major global health problem, particularly in sub-Saharan Africa (Sarpong, 2024; Oladipo, 2022). However, significant progress has been made in recent years in reducing the incidence of the disease and improving treatment options (Li, 2024).
Epidemiology
Global Prevalence
Malaria is a major public health concern worldwide, particularly in tropical and subtropical regions (Phillips, 2017). According to the World Health Organization (WHO), there were an estimated 229 million cases of malaria worldwide in 2019, resulting in 409,000 deaths.
The African region continues to bear the highest burden of malaria, accounting for approximately 94% of all malaria cases and deaths in 2019 (Oladipo, 2022). By 2022, this figure remained largely unchanged, with 95% of global malaria cases occurring in sub-Saharan Africa. Children under five years old are particularly vulnerable, representing approximately 80% of all malaria-related deaths (WHO, 2023).
Beyond Africa, malaria also poses a health threat in Southeast Asia, the Eastern Mediterranean, and parts of South America. In countries such as India, Indonesia, and Brazil, malaria transmission remains persistent despite ongoing control efforts. The Greater Mekong Subregion has seen a decline in malaria cases due to aggressive eradication programs, but drug-resistant Plasmodium falciparum strains continue to pose challenges.
Risk Factors
The risk of malaria is highest in areas with high transmission rates, such as sub-Saharan Africa, where the majority of cases occur (Duguma, 2022; Oladipo, 2022). Within this region, countries such as Nigeria, the Democratic Republic of the Congo, Uganda, and Mozambique bear the highest burden, contributing to nearly 50% of all malaria deaths worldwide (WHO, 2022).
Several socioeconomic and environmental factors increase malaria risk. Poor housing conditions, such as homes with open eaves, lack of window screens, and thatched roofs, allow mosquitoes to enter and facilitate disease transmission (Duguma, 2022; Oladipo, 2022). A study in sub-Saharan Africa found that people living in houses with improved structures had a 9–14% lower risk of malaria infection compared to those in poorly constructed homes.
Limited access to healthcare also contributes to high malaria prevalence. In remote rural areas, delayed diagnosis and inadequate treatment lead to severe malaria complications and increased mortality (Dlamini, 2017). Additionally, an estimated 33% of malaria-endemic countries lack sufficient healthcare facilities to provide rapid testing and treatment (WHO, 2021).
Inadequate mosquito control measures further heighten malaria risk. While insecticide-treated nets (ITNs) can reduce malaria cases by up to 50%, only 57% of at-risk populations in Africa had access to ITNs in 2022 (WHO, 2023). Moreover, insecticide resistance among Anopheles mosquitoes is spreading, particularly in West and East Africa, reducing the effectiveness of traditional vector control strategies (Sharma, 2015).
Individuals who live in or travel to high-risk malaria areas are particularly vulnerable. Non-immune travelers from malaria-free regions are at 5–10 times higher risk of developing severe malaria compared to local populations with partial immunity (Dlamini, 2017; Sharma, 2015).
Demographic Patterns
Malaria disproportionately affects vulnerable populations, including young children under the age of 5 and pregnant women. Due to their underdeveloped immune systems, children under five are at the highest risk of severe malaria and death. In 2019, children under the age of 5 accounted for 67% of all malaria deaths. The most affected countries include Nigeria, the Democratic Republic of the Congo, Tanzania, and Mozambique, which together contribute to nearly 50% of global child malaria deaths (WHO, 2022).
Pregnant women are also at increased risk of severe malaria, which can lead to complications. Malaria in pregnancy (MiP) is a major cause of maternal anemia, low birth weight, premature delivery, and infant mortality (Schantz, 2009; Oladimeji, 2019; Mbishi, 2024). Approximately 11 million pregnancies were affected by malaria in 2021, leading to an estimated 819,000 infants born with low birth weight (WHO, 2022). This is particularly concerning in sub-Saharan Africa, where 30% of maternal deaths in malaria-endemic regions are linked to complications from malaria infection.
Pathophysiology
Life Cycle of Plasmodium
Malaria is caused by the Plasmodium parasite, which is transmitted to humans through the bite of infected female Anopheles mosquitoes (Phillips, 2017).
There are five major Plasmodium species that cause malaria in humans:
- Plasmodium falciparum – the most lethal species, responsible for 99% of malaria deaths, primarily in sub-Saharan Africa.
- Plasmodium vivax – the most widespread species, prevalent in Asia and Latin America, with the ability to form dormant liver stages (hypnozoites) that cause relapses.
- Plasmodium ovale – found mainly in West Africa and the Pacific Islands, similar to P. vivax but less common.
- Plasmodium malariae – the least common species, known for its longest incubation period and ability to cause chronic low-level infections.
- Plasmodium knowlesi – a zoonotic species transmitted from macaques, primarily in Southeast Asia, capable of causing severe disease (Sato, 2021).
Once inside the human body, the Plasmodium parasite travels to the liver, where sporozoites invade hepatocytes (liver cells) and undergo a process called exoerythrocytic schizogony, multiplying and maturing into thousands of merozoites. This stage typically lasts 7–10 days for P. falciparum but can extend to several months for P. vivax and P. ovale due to dormant liver stages (White et al., 2014).
After maturation, merozoites are released into the bloodstream, where they invade red blood cells (erythrocytes) and initiate erythrocytic schizogony—a cycle of replication, rupture, and reinvasion that occurs every 48 hours for P. falciparum, P. vivax, and P. ovale, or 72 hours for P. malariae. This cycle leads to hemolysis (destruction of red blood cells) and the release of toxic hemozoin pigment and inflammatory cytokines, triggering classic malaria symptoms such as fever, chills, anemia, and organ dysfunction (Sato, 2021).
Severe malaria, primarily caused by P. falciparum, can result in cerebral malaria, multi-organ failure, and death, with a case fatality rate of 20% if left untreated (WHO, 2023).
Human Immune Response to Infection
The human immune system responds to Plasmodium infection by producing antibodies and activating innate and adaptive immune cells to target the parasite at various stages of its lifecycle (Long, 2017; Lopez, 2017). Macrophages and dendritic cells recognize the parasite and initiate the release of pro-inflammatory cytokines, while B cells produce antibodies against sporozoites, merozoites, and infected red blood cells. CD8+ T cells also play a role during the liver stage by destroying infected hepatocytes.
However, the Plasmodium parasite has evolved sophisticated immune evasion strategies. One of the most critical is antigenic variation, particularly in P. falciparum, which expresses a family of proteins called PfEMP1 (Plasmodium falciparum erythrocyte membrane protein 1) on the surface of infected red blood cells. The parasite regularly switches between different PfEMP1 variants—encoded by ~60 var genes—to avoid recognition by host antibodies, thereby prolonging infection and enabling immune escape (Gomes, 2016).
This ability to evade the immune response complicates the development of long-lasting immunity and often leads to chronic or recurrent malaria infections, especially in high-transmission areas where individuals may be reinfected multiple times per year. In fact, partial immunity typically develops only after repeated exposure over several years, and even then, it mostly protects against severe disease rather than infection itself (WHO, 2023).
In addition to immune evasion, Plasmodium parasites—especially P. falciparum—can cause vascular damage by adhering to the endothelial cells lining the blood vessels. This sequestration process involves PfEMP1 binding to ICAM-1, EPCR, and CD36 receptors, leading to localized inflammation, blockage of microcirculation, and disruption of the blood-brain barrier. These processes contribute to severe complications such as cerebral malaria, which is characterized by seizures, coma, and can be fatal in up to 20% of cases, even with treatment (Ndunge, 2022; WHO, 2023).
Clinical Presentation
Symptoms
The incubation period of malaria—the time from infection to the onset of symptoms—ranges from 9 to 30 days, depending on the Plasmodium species and host immunity. For example, P. falciparum typically has an incubation period of 9–14 days, P. vivax and P. ovale may take 12–18 days, and P. malariae can take 18–40 days. Moreover, P. vivax and P. ovale may form dormant liver stages (hypnozoites) that can cause relapses weeks to months after the initial infection (Bartoloni, 2012).
The clinical presentation of malaria can be categorized into uncomplicated and severe malaria.
- Uncomplicated malaria presents with non-specific flu-like symptoms including cyclical fever, chills, headache, sweating, muscle aches, nausea, vomiting, and diarrhea. These symptoms typically occur in a 48- or 72-hour cycle, depending on the species involved, due to the synchronized rupture of infected red blood cells. Because the early symptoms overlap with many other febrile illnesses—such as dengue, influenza, and typhoid—malaria is often misdiagnosed or overlooked, especially in non-endemic areas (Bartoloni, 2012; Mawson, 2013).
- Severe malaria, which is most commonly caused by P. falciparum, can rapidly progress and become life-threatening without prompt treatment. Severe manifestations include cerebral malaria, severe anemia, acute respiratory distress syndrome (ARDS), renal failure, hypoglycemia, and metabolic acidosis. According to the WHO, untreated P. falciparum infections can be fatal within 24 to 48 hours after the onset of severe symptoms.
Disease Progression
Severe malaria is a medical emergency that requires immediate intervention. It is primarily caused by Plasmodium falciparum and is characterized by complications such as persistent high fever (≥39°C), seizures, impaired consciousness or coma (cerebral malaria), severe anemia, acute respiratory distress syndrome (ARDS), metabolic acidosis, hypoglycemia, and multi-organ failure (White, 2022). Without prompt treatment, severe malaria can lead to death within 24 to 48 hours of symptom onset. Globally, P. falciparum is responsible for over 90% of malaria-related deaths, particularly among young children and pregnant women in sub-Saharan Africa (WHO, 2023).
Diagnosis
Malaria is diagnosed based on clinical symptoms, recent travel to endemic areas, and laboratory testing. Timely and accurate diagnosis is important for initiating appropriate treatment and reducing the risk of complications. (Oyegoke, 2022).
Laboratory Tests
Laboratory tests are the gold standard for malaria diagnosis. The two main types of tests are microscopy and rapid diagnostic tests (RDTs) (Calderaro, 2024).
Microscopy involves examining a blood smear under a microscope to detect the presence of malaria parasites. This method requires trained personnel and can be time-consuming. However, it remains the most reliable method for detecting low levels of parasitemia and identifying the species of malaria parasite (Azikiwe, 2012).
RDTs are simple, rapid, and easy-to-use diagnostic tests that detect specific malaria antigens in a patient’s blood. RDTs are particularly useful in remote areas where microscopy is not available. However, they have lower sensitivity than microscopy and cannot distinguish between different species of malaria parasite (Iwuafor, 2018; Zhu, 2020).
Imaging and Other Diagnostic Tools
Imaging and other diagnostic tools are rarely used for malaria diagnosis. However, they may be useful in certain cases, such as when there is suspicion of severe malaria complications (Maturana, 2023).
Imaging techniques such as ultrasound and computed tomography (CT) can detect abnormalities in the liver, spleen, and brain that may be associated with severe malaria (Zha, 2015). Other diagnostic tools, such as electrocardiography (ECG) and pulse oximetry, can help assess the severity of malaria complications and guide treatment (Soltanifar, 2015).
Treatment
Antimalarial Medications
Antimalarial medications are the primary treatment for malaria. The choice of medication depends on the type of malaria, the severity of the illness, and the age and health of the patient (Siqueira-Neto, 2023; Bitta, 2017). The most common antimalarial medications include artemisinin-based combination therapies (ACTs), chloroquine, and quinine (Sofeu-Feugaing, 2024). (Calderaro, 2024; Zekar, 2023)
ACTs are currently the most effective treatment for malaria and are recommended by the World Health Organization (WHO) as the first-line treatment for uncomplicated malaria. They are a combination of artemisinin, which rapidly reduces the number of parasites in the blood, and a longer-acting partner drug, which eliminates the remaining parasites (Hanboonkunupakarn, 2022; Rasmussen, 2021). According to WHO data, ACTs achieve cure rates of over 95% when used correctly and in areas without significant drug resistance. Common ACTs include artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine.
Chloroquine was once the mainstay of malaria treatment and remains effective against Plasmodium vivax and Plasmodium ovale in some regions. However, widespread resistance of P. falciparum to chloroquine has significantly limited its use. For example, resistance has been reported in over 80% of malaria-endemic countries in sub-Saharan Africa and Southeast Asia (Zhou, 2020).
Quinine is another older antimalarial medication that is still used in the treatment of severe or complicated malaria, especially when intravenous (IV) artesunate is not available. However, quinine treatment is associated with several side effects, including cinchonism (tinnitus, headache, nausea), hypoglycemia, and cardiac arrhythmias, making it less favorable for routine use (Achan, 2011). In many settings, IV artesunate has now replaced quinine for severe malaria due to superior efficacy and safety profiles.
Supportive Care
In addition to antimalarial medications, supportive care is a critical component of malaria treatment, especially in severe cases. Supportive care focuses on symptom management and the prevention or treatment of life-threatening complications (Arrow, 2004). Severe malaria, often caused by Plasmodium falciparum, can lead to complications such as cerebral malaria, severe anemia, acute kidney injury, respiratory distress, and metabolic acidosis.
Patients with severe malaria typically require hospitalization and intensive monitoring. Treatment often includes intravenous (IV) fluids to maintain hydration and correct electrolyte imbalances, blood transfusions to treat severe anemia (defined as hemoglobin <5 g/dL), and oxygen therapy to manage respiratory distress (Hodgson, 2016). Studies estimate that up to 25% of hospitalized malaria patients in high-burden regions may require blood transfusions, particularly children under five and pregnant women.
In cases where renal failure develops—a complication seen in up to 40% of adults with severe malaria—renal replacement therapy such as dialysis may be necessary. Continuous monitoring of blood glucose levels is also essential, as hypoglycemia is a common and dangerous complication, particularly when using quinine or artesunate.
Timely and appropriate supportive care can significantly reduce malaria mortality rates. According to WHO estimates, comprehensive management of severe malaria—including both antimalarial drugs and supportive interventions—can reduce case fatality rates from over 20% to below 1% when adequately administered.
Treatment Resistance
One of the major challenges in malaria treatment is the emergence and spread of drug-resistant strains of the parasite. Resistance to chloroquine, once the cornerstone of malaria therapy, has become widespread since the 1950s, particularly for Plasmodium falciparum, rendering the drug ineffective in most endemic regions (White, 2004). Today, chloroquine-resistant strains have been documented in more than 90% of P. falciparum–endemic countries.
More recently, there have been increasing concerns about resistance to artemisinin-based combination therapies (ACTs), especially in Southeast Asia and parts of East Africa (Ippolito, 2021). Delayed parasite clearance—an early sign of artemisinin resistance—has been observed in countries such as Cambodia, Thailand, and Rwanda. For example, studies in the Greater Mekong Subregion have shown treatment failure rates of over 20% with some ACTs.
To address the threat of resistance, appropriate use of antimalarial drugs is critical. This includes completing full treatment courses, avoiding monotherapy (especially artemisinin monotherapy), and adhering to national treatment guidelines. Surveillance systems like the WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) are essential for monitoring resistance patterns and guiding policy decisions.
In parallel, ongoing research and development efforts are focused on next-generation antimalarials. Promising new compounds include KAF156 (ganaplacide) and DSM265, which target different stages of the parasite life cycle. In addition, modifications to existing drugs and the development of triple ACTs (TACTs) aim to outpace resistance and extend the lifespan of current therapies (Siqueira-Neto, 2023).
Prevention and Control
Vector Control
Vector control is a critical component in preventing the spread of malaria, as the disease is transmitted by female Anopheles mosquitoes. Effective vector control strategies focus on reducing mosquito populations and minimizing human–vector contact. This can be achieved through environmental management, such as eliminating mosquito breeding sites—primarily stagnant water in containers, puddles, and drains—which disrupts the mosquito life cycle (Lobo, 2018).
One of the most widely used and cost-effective interventions is the use of insecticide-treated bed nets (ITNs). When used properly, ITNs can reduce malaria incidence by up to 50% and malaria mortality by approximately 20%, according to WHO estimates. Long-lasting insecticidal nets (LLINs), which remain effective for up to 3 years, are now standard in most endemic regions.
Indoor residual spraying (IRS) involves coating the walls and surfaces inside homes with long-acting insecticides, targeting mosquitoes that rest indoors after feeding. IRS can reduce mosquito populations for several months and is particularly effective in areas with seasonal malaria transmission. WHO data suggests that in regions where at least 80% of homes are treated with IRS, malaria transmission can be reduced significantly.
However, the emergence of insecticide resistance in mosquito populations poses a growing challenge. Resistance to pyrethroids—the only class of insecticides used in ITNs—has been reported in over 78 countries, prompting the development of next-generation bed nets and alternative insecticides.
Vaccination
Vaccination is an essential tool in the global effort to control and eventually eliminate malaria. The RTS,S/AS01 vaccine (also known as Mosquirix) is the first malaria vaccine to receive a positive scientific opinion from the European Medicines Agency and a recommendation for widespread use by the World Health Organization (WHO). It is specifically designed to target Plasmodium falciparum, the deadliest malaria parasite globally.
Clinical trials and pilot implementation programs have demonstrated that RTS,S/AS01 provides partial protection against malaria in children. According to a large Phase 3 trial involving over 15,000 children across seven African countries, the vaccine reduced clinical malaria cases by approximately 39% and severe malaria cases by 29% over four years in children who received four doses (Laurens, 2020). The protective effect is highest in the months immediately following vaccination and decreases over time, which is why a four-dose schedule is recommended: three doses administered at monthly intervals starting from 5 months of age, followed by a booster dose 15–18 months later.
Due to its moderate efficacy, RTS,S/AS01 is recommended by WHO for use in regions with moderate to high transmission, where the vaccine can have the greatest impact when used alongside other interventions such as insecticide-treated bed nets (ITNs) and antimalarial medications.
In 2021, pilot programs began in Ghana, Kenya, and Malawi. By 2023, over 2 million children had received at least one dose of the vaccine in these countries, demonstrating the feasibility and acceptability of large-scale malaria immunization.
Community Health Strategies
Community health strategies involve educating individuals and communities on malaria prevention and control. Key components include promoting the consistent and correct use of insecticide-treated bed nets (ITNs), encouraging participation in indoor residual spraying (IRS) campaigns, raising awareness about the importance of early diagnosis and treatment, and emphasizing prompt medical attention when symptoms appear (Awasthi, 2021). Studies have shown that community-based education campaigns can significantly increase ITN usage—from as low as 30% to over 70% in some regions—leading to substantial reductions in malaria incidence (Tizifa, 2018; Pryce, 2022).
Research and Development
New Treatment Approaches
Antimalarial drug development is an ongoing area of research aimed at addressing challenges such as drug resistance and parasite transmission. One major advancement has been the introduction of artemisinin-based combination therapies (ACTs), which combine artemisinin—a derivative of the Artemisia annua plant—with a longer-acting partner drug to improve efficacy and delay resistance development. ACTs are the first-line treatment for uncomplicated Plasmodium falciparum malaria in most endemic regions. Common formulations include artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine, with clinical trials reporting cure rates exceeding 95% when used appropriately. (Nguyen, 2023).
In addition to ACTs, new antimalarial compounds are being developed to target various stages of the parasite’s life cycle. Liver-stage drugs, such as tafenoquine and DSM265, aim to prevent progression to symptomatic disease. Tafenoquine, approved for use against P. vivax, allows for single-dose radical cure due to its long half-life. Other candidates, such as M5717 and KAF156, target the sexual (gametocyte) stage to block transmission from humans to mosquitoes. These therapies may support broader malaria control and elimination strategies when combined with existing treatments (Siqueira-Neto, 2023).
Vaccine Research
Developing a vaccine against malaria has been a major goal for many years. Several vaccine candidates are currently in development, and some have shown promising results in clinical trials (Stanisic, 2023; Siqueira-Neto, 2023; Effiong; 2022). One of the most advanced vaccine candidates is the RTS,S vaccine.
A newer vaccine, R21/Matrix-M, developed by the University of Oxford and the Serum Institute of India, has shown an efficacy of up to 77% in Phase 2 trials, exceeding the World Health Organization’s target efficacy of 75%. As of 2024, R21 is undergoing broader evaluation for licensure and deployment in endemic regions.
The continued advancement of malaria vaccine research offers a promising complement to existing control measures, such as vector control and chemoprevention, in the global effort to reduce and eventually eliminate malaria.
Socioeconomic Impact
Economic Burden
Malaria imposes a substantial economic burden on endemic countries, particularly in sub-Saharan Africa, where the disease remains highly prevalent. According to the World Health Organization (WHO), malaria is responsible for an estimated 1.3% annual loss in economic growth in countries with high transmission rates. The global economic cost of malaria—including expenditures on treatment, prevention efforts, and productivity losses due to illness and premature death—is estimated at approximately US$12 billion annually (Andrade, 2022).
Impact on Public Health Systems
Malaria places a significant burden on public health systems in endemic countries. It is one of the leading causes of morbidity and mortality, particularly among children under the age of five (Zekar, 2023). The burden on health systems is further compounded by the emergence of drug-resistant strains of malaria (Hyde, 2007). This has led to increased costs of treatment and the need for more expensive and complex interventions (Sturmberg, 2019).
The burden of malaria on public health systems also affects other health programs. The diversion of resources to malaria control and treatment can lead to a reduction in funding for other health programs, such as maternal and child health, HIV/AIDS, and tuberculosis. This can have a significant impact on the overall health of the population (Andrade, 2022).
Global Health Policies
International Initiatives
At the international level, there have been several initiatives aimed at reducing the burden of malaria. The Roll Back Malaria (RBM) partnership was launched in 1998 by the World Health Organization (WHO), the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF), and the World Bank. The partnership aims to coordinate global efforts to control and eliminate malaria by promoting the use of insecticide-treated bed nets, indoor residual spraying, and prompt diagnosis and treatment (Binka, 2000).
Another initiative is the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was established in 2002 (Hanefeld, 2014). The Global Fund provides financial support to countries to implement malaria control interventions, such as distributing insecticide-treated bed nets and providing antimalarial drugs (Li, 2024).
National Malaria Control Programs
At the national level, many countries have developed their own malaria control programs. These programs typically involve a combination of interventions, including the distribution of insecticide-treated bed nets, indoor residual spraying, and the provision of antimalarial drugs (Perera, 2022; Onyinyechi; 2023).
For example, in Nigeria, the National Malaria Elimination Programme (NMEP) was established in 2006. The NMEP aims to reduce the burden of malaria by promoting the use of insecticide-treated bed nets, indoor residual spraying, and the provision of antimalarial drugs. The program also focuses on improving malaria diagnosis and treatment, as well as strengthening health systems (Sokunbi, 2022; Ameyaw, 2020).
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