Malaria Control in Africa: Navigating the Intersection of Emerging Threats and Novel Interventions—A Comprehensive Review of Current Treatment, Vaccination, and Integrated Management Strategies
Malaria remains a formidable public health challenge in Africa, which bears over 94% of the global disease burden. While significant progress has been achieved through vector control measures, artemisinin-based combination therapies (ACTs), and the recent rollout of RTS,S/AS01 and R21/Matrix-M vaccines, these gains are increasingly threatened by emerging biological resistance, climate change, and funding constraints. This comprehensive review examines the current landscape of malaria treatment, vaccination, and integrated management in Africa, highlighting critical challenges and proposing a multi-faceted path forward that emphasizes locally-led solutions, synergistic interventions, and sustained investment.
Malaria, an ancient parasitic disease transmitted by Anopheles mosquitoes, continues to represent one of the most significant public health challenges of our time, with its heaviest toll exacted upon the African continent. In 2024, the WHO African Region accounted for an estimated 94% of global malaria cases and 95% of malaria-related deaths, with children under five years bearing the brunt of this burden—approximately 438,000 African children died from malaria in that year alone . These stark figures underscore a persistent crisis that has defied decades of global health efforts.
Yet, the narrative is not one of unrelenting failure. Between 2000 and 2022, the region reported a 40% reduction in malaria incidence and a 60% decline in mortality, achievements driven by the widespread distribution of insecticide-treated nets (ITNs), indoor residual spraying (IRS), the deployment of rapid diagnostic tests (RDTs), and the adoption of artemisinin-based combination therapies (ACTs) . More recently, the introduction of two WHO-recommended vaccines—RTS,S/AS01 and R21/Matrix-M—into routine immunization programmes across 25 African countries marks a transformative milestone in pediatric malaria prevention .
However, progress has plateaued. The WHO 2025 interim targets were not met, and the region remains off-track to achieve the 2030 Global Technical Strategy goals of a 90% reduction in malaria incidence and mortality . This stagnation is attributable to a confluence of emerging threats: the spread of partial artemisinin resistance, widespread insecticide resistance, diagnostic failures due to pfhrp2/3 gene deletions, climate change, humanitarian crises, and chronic underfunding . These challenges demand a critical reassessment of current approaches and a shift toward more integrated, context-specific, and resilient strategies.
This review provides a comprehensive analysis of the current state of malaria treatment, vaccination, and management across Africa. It critically…
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