Recently published in the journal Frontiers, a new paper explores the state-of-play for interventions to reduce malaria-related morbidity and mortality among children in Africa.
The research, whose authorship included Jane Achan, Principal Advisor at Malaria Consortium, highlights the progress that has been achieved in this area, and where improvements could still be made. Its conclusions offer policymakers context-specific guidance on how to carry out these improvements in the journey towards malaria elimination.
“This paper highlights the critical need for systematic approaches for the continuous monitoring of the impact of different malaria interventions deployed including vector control, chemoprevention and vaccination,” says Achan, Principal Advisor at Malaria Consortium and co-author on the paper. “We also call for the use of context-specific data-driven decision-making and evidence to inform responses to emerging control challenges.”
The paper points to chemoprevention — the administration of antimalarial treatment courses to susceptible populations living in malaria-endemic areas, regardless of whether they have malaria or not — as a predictable, evidence-based approach to reduce cases in high-risk areas. Seasonal malaria chemoprevention (SMC), which involves giving children monthly courses of antimalarial medicines in locations where malaria is highly seasonal, has made a huge impact in alleviating the burden of malaria among young children. But research has found that the same approach for SMC won’t work for every country; for instance, in some regions, a certain number of courses for one country may not be enough to cover an entire malaria transmission season. Taking these variations into account is crucial for ensuring that optimal coverage is reached.
At the same time, perennial malaria chemoprevention (PMC) — which provides infants with preventive malaria drugs during routine immunisation visits — allows policymakers to integrate malaria control into existing healthcare infrastructure. Instead of launching expensive standalone programmes, governments can now build malaria prevention into broader child survival strategies.
Malaria Consortium’s work to conduct evaluations of how best to combine and roll out these programmes has directly fed into the development of national guidance and decision-making. In Nigeria, for example, the PMC Effect study is measuring the clinical effectiveness and operational feasibility of PMC in young children. Its findings are providing crucial data that can be used to address the evidence gap for PMC uptake and scale-up in Nigeria. In particular, the research is evaluating the effectiveness of combining PMC with other malaria prevention measures as part of the goal towards malaria elimination.
The approval of two malaria vaccines has been one of the most historic steps forward towards malaria elimination. However, the rollout in Africa has not been without hurdles. The research highlights that hesitancy towards the vaccine will hamper uptake, along with uneven and insufficient supply. The authors warn that decision makers should build vaccine sensitisation into national malaria control programmes’ planning, as Malaria Consortium has done in Uganda, prior to the rollout of malaria vaccination programmes. Similarly, chemoprevention programmes can be held back by a lack of community acceptance; solutions to address this require consistent engagement with training community members to build trust and address any misconceptions, particularly among caregivers.
Deploying a combined approach, including simultaneous delivery of chemoprevention strategies and vaccines, promises to be an effective approach, but it ultimately requires more research, as Malaria Consortium’s Zero Dose project in Togo is exploring. The programme aims to understand and address suboptimal vaccine coverage and zero-dose occurrences to ultimately improve vaccine uptake.
Antimalarial drug resistance presents an additional major and growing hurdle to be addressed. Doing so will require adopting efficient surveillance protocols. The authors also advise that delivering vaccines and medications to remote regions requires investment in cold chain storage and distribution networks.
Nevertheless, the shift from reactive to strategic malaria management represents a major governance win. By integrating malaria prevention into long-term health planning, African governments can address the immediate impacts of malaria alongside strengthening their entire healthcare infrastructure.
With the right investments and continued political commitment, malaria prevention strategies could serve as a model for broader public health decision-making in Africa.
