What is being done?

 

The World malaria report 2025 highlights positive trends in the scale-up of effective prevention tools, including expansion of new-generation nets, the malaria vaccine and SMC, as well as the introduction of PMC. There has also been notable progress in providing timely diagnosis and treatment for young children. However, coverage of ITNs and intermittent preventive treatment of malaria in pregnancy (IPTp) continues to lag, underscoring areas needing further action.

■ Data show a positive shift towards timely and effective malaria care in the vulnerable population of children aged under 5 years. Across 21 sub-Saharan African countries, the proportion of febrile children who were taken to a health service provider and received a diagnosis increased from a median of 30% in baseline studies (2005–2011) to 47% in more recent surveys (2017–2024). Of the children who reached a health service provider and received an antimalarial drug, a median of 68% were treated with an ACT in the period 2017–2024, compared with 34% in 2005–2011. 

■ ACTs are the most effective and widely recommended treatment for uncomplicated malaria, especially for infections caused by P. falciparum, the parasite responsible for most malaria deaths in Africa.

■ To date, more than 3 billion ITNs have been distributed globally. In sub-Saharan Africa, although bed net usage has dramatically increased since 2000, just below half (47%) of those at risk of malaria were sleeping under an ITN in 2024, similar to levels seen since 2015. Among young children and pregnant women and girls, ITN use reached 53% in 2024, still well short of the goal of universal coverage. 

■ Most of the nets deployed since 2000 have been treated with insecticides from one class: the pyrethroids. To overcome rising mosquito resistance to insecticides, WHO recommends the use of pyrethroid–PBO and dual active ingredient ITNs, which offer greater protection against malaria compared with standard pyrethroidonly nets. In 2024, these more effective nets accounted for 84% of the 168 million nets shipped by manufacturers to sub-Saharan Africa, up from 10% in 2019.

■ WHO now recommends two vaccines – RTS,S/AS01 (RTS,S) and R21/Matrix-M (R21) – for use in malaria endemic areas. 

■ By the end of 2024, malaria vaccines had been introduced in 17 countries, with UNICEF delivering over 10.5 million doses and enabling vaccination of at least 2.1 million children during the year. By October 2025, 7 additional countries had implemented the vaccine. 

■ The RTS,S malaria vaccine was first introduced into childhood immunization programmes in selected areas of Ghana, Kenya and Malawi in 2019, as part of the WHO-coordinated Malaria Vaccine Implementation Programme, and showed a 13% reduction in all-cause mortality (excluding injury) and a 22% reduction in hospitalizations for severe malaria among children age-eligible for vaccination.

■ SMC has proven highly effective in protecting young children from malaria. The intervention involves administering monthly doses of antimalarial drugs during the peak malaria season to children aged under 5 years – the group most vulnerable to severe malaria. *

● Between 2012 and 2024, the average number of African children who were treated per cycle of SMC in 20 countries rose from about 170 000 to 54 million. Kenya introduced SMC for the first time in 2024.

■ PMC has also proven highly effective in protecting young children from malaria. The intervention involves providing scheduled doses of antimalarial drugs to children aged up to 2 years, reducing their risk of infection and severe disease.

 ● In 2024, at least eight countries implemented PMC, including Benin, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo, Mozambique, Nigeria, Sierra Leone and Togo. 

● In total, nearly 1 million children aged under 24 months received their first dose of PMC in 2024.

■ In 2024, in the 33 moderate to high transmission countries in the WHO African Region, there were an estimated 36 million pregnancies, of which an estimated 13 million (36%) were infected with malaria. 

■ The proportion of eligible pregnant women and girls in 34 African countries receiving a third dose of IPTp increased from 43% in 2023 to 45% in 2024, but coverage is still well below the target of 80%. 

■ Current levels of IPTp would result in low birthweight being averted in an estimated 530 000 neonates. If coverage of three doses of IPTp matched coverage of first antenatal care visits, low birthweight would be averted in an additional 161 000 neonates.