Malaria: a review on its current epidemiological status and management strategies

Malaria remains a global health concern, with Africa bearing the highest global burden of malaria, as Plasmodium falciparum malaria remains the leading cause of malaria-related mortality on the continent. The transmission dynamics of malaria are shaped by a combination of factors, including climate conditions, economic constraints, geographic variability, human activities, and security instability. Owing to repeated infections and widespread implementation of early interventions, there has been a notable rise in cases of clinically atypical malaria and asymptomatic Plasmodium carriers, which increases the risk of misdiagnosis and underdiagnosis. Despite these challenges, African nations have made substantial progress in malaria control and elimination. Key advancements include, increased distribution of insecticide-treated nets use, increased indoor residual spraying, widespread rapid diagnostic tests, intermittent preventive treatment in vulnerable populations, deployment of artemisinin-based combination therapies (ACTs), and of late, the deployment of malaria vaccines to children under 5 years. Between 2000 and 2022, the WHO African Region reported a 40% reduction in malaria incidence and a 60% decline in mortality. Nonetheless, the continent faces emerging threats that could hinder further progress. These include persistent poverty, the effects of climate change, inadequate healthcare infrastructure and coverage, increased outdoor transmission linked to changing mosquito behavior, the appearance of new vector species, and rising resistance to both antimalarial drugs and insecticides. To address these challenges, a multi-faceted strategy is essential. This includes cross-border prevention and control efforts, expansion of seasonal malaria chemoprevention programmes, identification of molecular markers of resistance, development of novel antimalarial agents, and scaled-up implementation of vaccines such as RTS,S/AS01 and R21/Matrix-M. Implementation of approaches employed by countries such as China in malaria elimination and strengthening global-Africa cooperation in the fight against malaria could further accelerate progress. This review aims to provide a comprehensive overview of global malaria with a focus on Africa and global efforts toward the continent's malaria elimination goals.