Malaria in their words: thematic analysis of online narratives from Sub-Saharan Africa

While the public health impacts of malaria in endemic regions of Africa are well documented, the profound personal and socioeconomic impacts remain insufficiently explored in broader discourse. Qualitative studies of lived experiences can illuminate these dimensions, humanizing malaria’s toll and informing more contextually grounded social and behavioral change interventions. We explored malaria-related narratives from GiveDirectly’s online repository of recipient stories, drawing on a phenomenological lens and rapid ethnographic assessment. The study included 160 narrative accounts from five countries, with Kenya (n = 121) and Uganda (n = 33) most represented. Through an inductive thematic analysis grounded in participants’ stories, we identified and organized recurring patterns in how malaria shapes daily life and individual responses, capturing both personal experiences and broader social dynamics. Two major thematic domains emerged from the analysis: perceived vulnerability contexts and experienced consequences. In their accounts of vulnerability contexts, participants associated malaria with housing conditions, particularly homes with compromised structures, and with occupational settings such as agricultural work and pre-dawn labor. Regarding consequences, participants detailed how malaria treatment created severe financial burdens, forcing tradeoffs between healthcare and basic needs. They described how concurrent infections within households rapidly overwhelmed both care capacity and financial resources, compelling difficult triage decisions between treating multiple ill family members, maintaining food security, and keeping children in school. Participants reported disrupted livelihoods through lost workdays, closed businesses, liquidated assets, and depleted savings. Educational impact extended beyond absenteeism to school dropout and deferred higher education from financial constraints or health sequelae from malaria. Some described lasting physical disabilities after severe infections, including mobility impairments, vision loss, and cognitive challenges, which led to social exclusion and diminished long-term well-being. This analysis reveals the complex biopsychosocial vulnerabilities experienced by individuals in malaria-endemic regions. The findings suggest that effective malaria interventions should extend beyond traditional public health approaches to include socioeconomic support and infrastructure improvements. These results emphasize the need for integrated strategies that address both the direct health impacts and broader socioeconomic consequences of malaria in endemic communities.