View source for Malaria

{{Short description|Mosquito-borne disease}}
{{Other uses}}
{{Distinguish|Miliaria}}
{{Good article}}
{{Pp-move|small=yes}}
{{Cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox medical condition
| name = Malaria
| pronounce = {{IPAc-en|m|ə|ˈ|l|ɛər|i|ə}}
| image = Malaria Parasite Connecting to Human Red Blood Cell (34034143483).jpg
| caption = [[Plasmodium|Malaria parasite]] connecting to a [[red blood cell]]
| field = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms = high fever every 24-72 hours depending on the parasite (typically up to 41-42 °C) , vomiting, headache, [[jaundice|yellow skin]]<ref name="Caraballo-2014" />
| complications = [[Epileptic seizure|seizures]], [[coma]],<ref name="Caraballo-2014" /> [[organ failure]], [[anemia]], [[cerebral malaria]]<ref>{{cite news |publisher=Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/malaria/symptoms-causes/syc-20351184 |title=Malaria |date= |access-date=2022-06-04 |archive-date=2022-07-02 |archive-url=https://web.archive.org/web/20220702235123/https://www.mayoclinic.org/diseases-conditions/malaria/symptoms-causes/syc-20351184 |url-status=live}}</ref>
| onset = usually 10–15 days post exposure, depends on the parasite<ref name="WHO-2014" />
| duration = 
| causes = ''[[Plasmodium]]'' transmitted by ''[[Anopheles]]'' [[mosquito]]es<ref name="Caraballo-2014" /><ref name="US 
| risks = 
| diagnosis = Examination of the blood, [[malaria antigen detection tests|antigen detection tests]]<ref name="Caraballo-2014" />
| differential = 
| prevention = [[Mosquito net]]s, [[insect repellent]], [[mosquito control]], medications<ref name="Caraballo-2014" />
| treatment = 
| medication = [[Antimalarial medication]]<ref name="WHO-2014" />
| frequency = 249 million (2022)<ref name="WHO-2023">{{cite book|last1=WHO|url=https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023|title=World Malaria Report 2023|date=2023|publisher=World Health Organization|isbn=978-92-4-008617-3|location=Switzerland|access-date=2024-07-22|archive-date=2024-07-18|archive-url=https://web.archive.org/web/20240718025316/https://www.who.int/teams/global-malaria-Programme/reports/world-malaria-report-2023|url-status=live}}</ref>
| deaths = 608,000 (2022)<ref name="WHO-2023" />
| alt = 
}}

'''Malaria''' is a [[Mosquito-borne disease|mosquito-borne infectious disease]] that affects [[vertebrate]]s and ''[[Anopheles]]'' [[mosquito]]es.<ref name="www.who.int-2">{{cite web |title=Vector-borne diseases |url=https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases |access-date=2022-04-24 |publisher=World Health Organization |archive-date=2023-01-04 |archive-url=https://web.archive.org/web/20230104001515/https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases |url-status=live}}</ref><ref>{{cite journal | vauthors=Dahalan FA, Churcher TS, Windbichler N, Lawniczak MK | title=The male mosquito contribution towards malaria transmission: Mating influences the ''Anopheles'' female midgut transcriptome and increases female susceptibility to human malaria parasites | journal=PLOS Pathogens | volume=15 | issue=11 | article-number=e1008063 | date=November 2019 | pmid=31697788 | pmc=6837289 | doi=10.1371/journal.ppat.1008063 | doi-access=free}}</ref><ref name="WHO-2014" /> Human malaria causes [[Signs and symptoms|symptoms]] that typically include [[fever]], [[Fatigue (medical)|fatigue]], [[vomiting]], and [[headache]]s.<ref name="Caraballo-2014" /><ref>{{cite journal | vauthors=Basu S, Sahi PK | title=Malaria: An Update | journal=Indian Journal of Pediatrics | volume=84 | issue=7 | pages=521–528 | date=July 2017 | pmid=28357581 | doi=10.1007/s12098-017-2332-2 | s2cid=11461451}}</ref> In severe cases, it can cause [[jaundice]], [[Epileptic seizure|seizures]], [[coma]], or [[death]].<ref name="Caraballo-2014" /><ref>{{cite web |title=Fact sheet about malaria |url=https://www.who.int/news-room/fact-sheets/detail/malaria |access-date=2024-05-10 |publisher=World Health Organization |archive-date=2020-05-02 |archive-url=https://web.archive.org/web/20200502021814/https://www.who.int/news-room/fact-sheets/detail/malaria |url-status=live}}</ref> Symptoms usually begin 10 to 15 days after being bitten by an infected ''Anopheles'' mosquito.<ref name="www.who.int-4">{{cite web |title=Fact sheet about malaria |url=https://www.who.int/news-room/fact-sheets/detail/malaria |publisher=World Health Organization |access-date=28 September 2023 |archive-date=2 May 2020 |archive-url=https://web.archive.org/web/20200502021814/https://www.who.int/news-room/fact-sheets/detail/malaria |url-status=live}}</ref><ref name="US CDC-2023" /> If not properly treated, people may have recurrences of the disease months later.<ref name="WHO-2014" /> In those who have recently survived an infection, reinfection usually causes milder symptoms.<ref name="Caraballo-2014" /> This partial [[Immunity (medical)|resistance]] disappears over months to years if the person has no continuing exposure to malaria.<ref name="Caraballo-2014">{{cite journal | vauthors=Caraballo H, King K | title=Emergency department management of mosquito-borne illness: malaria, dengue, and West Nile virus | journal=Emergency Medicine Practice | volume=16 | issue=5 | pages=1–23; quiz 23–24 | date=May 2014 | pmid=25207355 | url=http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=405 | url-status=live | s2cid=23716674 | archive-url=https://web.archive.org/web/20160801202316/http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=405 | archive-date=2016-08-01}}</ref> The mosquitoes themselves are harmed by malaria, causing reduced lifespans in those infected by it.<ref>{{cite journal | vauthors=Dawes EJ, Churcher TS, Zhuang S, Sinden RE, Basáñez MG | title=''Anopheles'' mortality is both age- and ''Plasmodium''-density dependent: implications for malaria transmission | journal=Malaria Journal | volume=8 | issue=1 | article-number=228 | date=October 2009 | pmid=19822012 | pmc=2770541 | doi=10.1186/1475-2875-8-228 | doi-access=free}}</ref>

Malaria is caused by [[protozoa|single-celled eukaryotes]] of the genus ''[[Plasmodium]]''.<ref name="www.who.int-4" /> In mammals, it is spread through bites of infected female ''Anopheles'' mosquitoes.<ref name="www.who.int-4" /><ref>{{cite journal | vauthors=Walter K, John CC | title=Malaria | journal=JAMA | volume=327 | issue=6 | page=597 | date=February 2022 | pmid=35133414 | doi=10.1001/jama.2021.21468 | s2cid=246651569 | doi-access=free}}</ref> The mosquito bite introduces the [[parasite]]s from the mosquito's [[saliva]] into the blood.<ref name="WHO-2014" /> The parasites travel to the [[liver]], where they mature and reproduce.<ref name="Caraballo-2014" /> Five species of ''Plasmodium'' commonly infect humans.<ref name="www.who.int-4" /> The three species associated with more severe cases are ''[[Plasmodium falciparum|P.&nbsp;falciparum]]'' (which is responsible for the vast majority of malaria deaths), ''[[Plasmodium vivax|P.&nbsp;vivax]]'', and ''[[Plasmodium knowlesi|P.&nbsp;knowlesi]]'' (a simian malaria that spills over into thousands of people a year).<ref name="WHO">{{cite web |title=Fact sheet about malaria |url=https://www.who.int/news-room/fact-sheets/detail/malaria |access-date=2024-02-19 |publisher=World Health Organization |archive-date=2020-05-02 |archive-url=https://web.archive.org/web/20200502021814/https://www.who.int/news-room/fact-sheets/detail/malaria |url-status=live}}</ref><ref>{{cite web |last=World Health Organization |title=Global Technical Strategy for Malaria 2016-2030 |url=https://www.who.int/docs/default-source/documents/global-technical-strategy-for-malaria-2016-2030.pdf |access-date=2024-02-19 |archive-date=2024-02-22 |archive-url=https://web.archive.org/web/20240222024003/https://www.who.int/docs/default-source/documents/global-technical-strategy-for-malaria-2016-2030.pdf |url-status=live}}</ref> ''[[Plasmodium ovale|P.&nbsp;ovale]]'' and ''[[Plasmodium malariae|P.&nbsp;malariae]]'' generally cause a milder form of malaria.<ref name="Caraballo-2014" /><ref name="www.who.int-4" /> Malaria is typically diagnosed by the [[histology|microscopic examination]] of blood using [[blood film]]s, or with [[Malaria antigen detection tests|antigen-based]] [[rapid diagnostic test]]s.<ref name="Caraballo-2014" /> Methods that use the [[polymerase chain reaction]] to detect the parasite's [[DNA]] have been developed, but they are not widely used in areas where malaria is common, due to their cost and complexity.<ref name="Nadjm-2012">{{cite journal | vauthors=Nadjm B, Behrens RH | title=Malaria: an update for physicians | journal=Infectious Disease Clinics of North America | volume=26 | issue=2 | pages=243–259 | date=June 2012 | pmid=22632637 | doi=10.1016/j.idc.2012.03.010}}</ref>

The risk of disease can be reduced by preventing mosquito bites through the use of [[mosquito net]]s and [[insect repellent]]s or with [[Mosquito control|mosquito-control measures]] such as spraying [[insecticide]]s and draining [[standing water]].<ref name="Caraballo-2014" /> Several medications are available to [[malaria prophylaxis|prevent malaria]] for travellers in areas where the disease is common.<ref name="WHO-2014" /> Occasional doses of the combination medication [[sulfadoxine/pyrimethamine]] are recommended in infants and after the first trimester of pregnancy in areas with high rates of malaria.<ref name="WHO-2014" /> As of 2023, two [[malaria vaccine]]s have been endorsed by the [[World Health Organization]].<ref name="WHO recommends R21-2023">{{cite web |title=WHO recommends R21/Matrix-M vaccine for malaria prevention in updated advice on immunization |url=https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization |access-date=8 December 2023 |date=2 October 2023 |archive-date=3 October 2023 |archive-url=https://web.archive.org/web/20231003232601/https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization |url-status=live}}</ref> The recommended treatment for malaria is a [[antimalarial medication#Artemisinin-based combination therapies (ACTs)|combination]] of [[antimalarial medication]]s that includes [[artemisinin]].<ref name="Rawat-2021">{{cite journal | vauthors=Rawat A, Roy M, Jyoti A, Kaushik S, Verma K, Srivastava VK | title=Cysteine proteases: Battling pathogenic parasitic protozoans with omnipresent enzymes | journal=Microbiological Research | volume=249 | article-number=126784 | date=August 2021 | pmid=33989978 | doi=10.1016/j.micres.2021.126784 | s2cid=234597200 | doi-access=free}}</ref>{{sfn|WHO|2022|p={{page needed|date=July 2024}}}}<ref name="Caraballo-2014" /><ref name="WHO-2014" /> The second medication may be either [[mefloquine]] (noting first its potential toxicity and the possibility of death), [[lumefantrine]], or sulfadoxine/pyrimethamine.<ref name="World Health Organization-2010">{{cite book |title=Guidelines for the treatment of malaria |date=2010|publisher=World Health Organization |location=Geneva |isbn=978-92-4-154792-5 |page=ix |edition=2nd}}</ref> [[Quinine]], along with [[doxycycline]], may be used if artemisinin is not available.<ref name="World Health Organization-2010" /> In areas where the disease is common, malaria should be confirmed if possible before treatment is started due to concerns of increasing [[drug resistance]].<ref name="WHO-2014" /> Resistance among the parasites has developed to several antimalarial medications; for example, [[chloroquine]]-resistant ''P.&nbsp;falciparum'' has spread to most malaria-prone areas, and resistance to artemisinin has become a problem in some parts of [[Southeast Asia]].<ref name="WHO-2014">{{cite web |title=Malaria Fact sheet N°94 |url=https://www.who.int/mediacentre/factsheets/fs094/en/ |publisher=World Health Organization |access-date=28 August 2014 |date=March 2014 |archive-url=https://web.archive.org/web/20140903002027/http://www.who.int/mediacentre/factsheets/fs094/en/ |archive-date=3 September 2014}}</ref>

The disease is widespread in the [[Tropics|tropical]] and [[subtropical]] regions that exist in a broad band around the [[equator]].<ref>{{cite book | vauthors=Baiden F, Malm KL, Binka F |chapter=Malaria | veditors=Detels R, Karim QA, Baum F, Li L, Leyland AH |title=Oxford Textbook of Global Public Health |date=2021 |pages=227–248 |isbn=978-0-19-881680-5 |doi=10.1093/med/9780198816805.003.0073 |edition=7th}}</ref><ref name="Caraballo-2014" /> This includes much of [[sub-Saharan Africa]], [[Asia]], and [[Latin America]].<ref name="WHO-2014" /> In 2023, some 263 million cases of malaria worldwide resulted in an estimated 597,000 deaths.<ref name="Daily 2025" /> Around 95% of the cases and deaths occurred in sub-Saharan Africa. Rates of disease decreased from 2010 to 2014, but increased from 2015 to 2021.{{sfn|WHO|2022|p={{page needed|date=July 2024}}}} According to UNICEF, nearly every minute, a child under five died of malaria in 2021,<ref name="UNICEF DATA-2">{{cite web |title=Malaria in Africa |url=https://data.unicef.org/topic/child-health/malaria/ |access-date=2023-11-02 |website=UNICEF Data |language=en-US |archive-date=2023-11-05 |archive-url=https://web.archive.org/web/20231105153727/https://data.unicef.org/topic/child-health/malaria/ |url-status=live}}</ref> and "many of these deaths are preventable and treatable".<ref name="UNICEF-2023">{{cite web |url=https://data.unicef.org/topic/child-health/malaria/ |title=Nearly every minute, a child under 5 dies of malaria |publisher=[[UNICEF]] |date=February 2023 |access-date=2023-09-10 |archive-date=2023-09-21 |archive-url=https://web.archive.org/web/20230921230733/https://data.unicef.org/topic/child-health/malaria/ |url-status=live}}</ref> Malaria is commonly associated with [[poverty]] and has a significant negative effect on economic development.<ref name="Gollin-2007" /><ref name="Worrall-2005" /> In [[Africa]], it is estimated to result in losses of [[United States dollar|US$]]12 billion a year due to increased healthcare costs, lost ability to work, and adverse effects on [[tourism]].<ref name="Greenwood-2005" /> The malaria caseload in India decreased by 69% from 6.4 million cases in 2017 to two million cases in 2023. Similarly, the estimated malaria deaths decreased from 11,100 to 3,500 (a 68% decrease) in the same period.<ref>{{cite news | url=https://www.business-standard.com/pti-stories/national/india-has-significantly-reduced-its-malaria-incidence-mortality-who-124121101285_1.html | title=India has cut malaria cases, deaths significantly, says WHO report | work=Business Standard | agency=Press Trust of India | date=11 December 2024}}</ref>

[[File:En.Wikipedia-VideoWiki-Malaria.webm|thumb|thumbtime=0:02|upright=1.3|Video summary ([[Wikipedia:VideoWiki/Malaria|script]])]]
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== Etymology ==
The term ''malaria'' originates from [[Middle Ages|Medieval]] {{langx|it|mala aria}} 'bad air', a part of [[miasma theory]]; the disease was formerly called ''ague'' or ''marsh fever'' due to its association with swamps and marshland.<ref>{{cite journal | vauthors=Reiter P | title=From Shakespeare to Defoe: malaria in England in the Little Ice Age | journal=Emerging Infectious Diseases | volume=6 | issue=1 | pages=1–11 | date=1999 | pmid=10653562 | pmc=2627969 | doi=10.3201/eid0601.000101}}</ref> The term appeared in English at least as early as 1768.<ref>{{cite book |vauthors=Sharpe S |date=1768 |title=A view of the customs, manners, drama, &c. of Italy, as they are described in the Frusta letteraria; and in the Account of Italy in English, written by Mr. Baretti; compared with the Letters from Italy, written by Mr. Sharp |location=London |publisher=W. Nicoll}}</ref> Malaria was once common in most of Europe and North America,<ref name="Lindemann-1999" /> where it is no longer endemic,<ref name="Gratz-2006" /> though imported cases do occur.{{sfn|Webb|2008|p={{page needed|date=July 2024}}}}
The scientific study of malaria is called malariology.<ref>{{cite web |title=Definition of MALARIOLOGY |website= Merriam-Webster Dictionary |url=https://www.merriam-webster.com/dictionary/malariology |language=en}}</ref>

==Signs and symptoms==
[[File:Symptoms of Malaria.png|thumb|upright=1.15|Main symptoms of malaria<ref name="Fairhurst-2015" />]]

Adults with malaria tend to experience chills and fever, classically in periodic [[paroxysmal attack]]s lasting around six hours, followed by a period of sweating and fever relief—as well as headache, fatigue, abdominal discomfort, and [[myalgia|muscle pain]].<ref name="Despommier-2019">{{cite book |url=https://parasiteswithoutborders.com/wp-content/uploads/2020/02/PD7thEditionLowResVersion5-11-2019.pdf |title=Parasitic Diseases |vauthors=Despommier DD, Griffin DO, Gwadz RW, Hotez PJ, Knirsch CA |date=2019 |publisher=Parasites Without Borders |edition=7 |location=New York |pages=110–115 |chapter=9. The Malarias |access-date=November 24, 2021 |archive-date=November 24, 2021 |archive-url=https://web.archive.org/web/20211124214329/https://parasiteswithoutborders.com/wp-content/uploads/2020/02/PD7thEditionLowResVersion5-11-2019.pdf |url-status=live}}</ref> Children tend to have more general symptoms: fever, cough, vomiting, and diarrhea.<ref name="Despommier-2019" />

Initial manifestations of the disease—common to infection with all malaria parasite species—are similar to [[flu|flu-like symptoms]],<ref name="Bartoloni-2012" /> and can resemble other conditions such as [[sepsis]], [[gastroenteritis]], and [[viral disease]]s.<ref name="Nadjm-2012" /> The presentation may include [[headache]], [[fever]], [[shivering]], [[arthralgia|joint pain]], [[vomiting]], [[hemolytic anemia]], [[jaundice]], [[hemoglobinuria|hemoglobin in the urine]], [[Retinopathy|retinal damage]], and [[convulsion]]s.<ref name="Beare-2006" />

The classic symptom of malaria is paroxysmal attacks—a cyclical occurrence of sudden coldness followed by shivering and then fever and sweating, occurring every two days ([[Fever#Types|tertian fever]]) in ''P.&nbsp;vivax'' and ''P.&nbsp;ovale'' infections, and every three days ([[quartan fever]]) for ''P.&nbsp;malariae''. ''P.&nbsp;falciparum'' infection can cause recurrent fever every 36–48 hours, or a less pronounced and almost continuous fever.<ref name="Ferri-2009" />

Symptoms typically begin 10–15 days after the initial mosquito bite, but can occur as late as several months after infection with some ''P. vivax'' strains.<ref name="Despommier-2019" /> Travellers taking preventative malaria medications may develop symptoms once they stop taking the drugs.<ref name="Despommier-2019" />

Severe malaria is usually caused by ''P.&nbsp;falciparum'' (often referred to as falciparum malaria). Symptoms of falciparum malaria arise 9–30 days after infection.<ref name="Bartoloni-2012" /> Individuals with cerebral malaria frequently exhibit [[neurological disorder|neurological]] symptoms, including [[abnormal posturing]], [[nystagmus]], [[conjugate gaze palsy]] (failure of the eyes to turn together in the same direction), [[opisthotonus]], [[seizure]]s, or [[coma]].<ref name="Bartoloni-2012" />

===Complications===
Malaria has several serious [[Complication (medicine)|complications]], including the development of [[respiratory distress]], which occurs in up to 25% of adults and 40% of children with severe ''P.&nbsp;falciparum'' malaria. Possible causes include respiratory compensation of [[metabolic acidosis]], noncardiogenic [[pulmonary edema]], concomitant [[pneumonia]], and severe [[anaemia]]. Although rare in young children with severe malaria, [[acute respiratory distress syndrome]] occurs in 5–25% of adults and up to 29% of pregnant women.<ref name="Taylor-2012" /> [[Coinfection]] of [[HIV]] with malaria increases mortality.<ref name="Korenromp-2005" /> [[Kidney failure]] is a feature of [[blackwater fever]], where haemoglobin from [[lysis|lysed]] red blood cells leaks into the urine.<ref name="Bartoloni-2012" />

Infection with ''P.&nbsp;falciparum'' may result in cerebral malaria, a form of severe malaria that involves [[encephalopathy]]. It is associated with retinal whitening, which may be a useful clinical sign in distinguishing malaria from other causes of fever.<ref name="Beare-2011" /> An [[Splenomegaly|enlarged spleen]], [[hepatomegaly|enlarged liver]] or [[hepatosplenomegaly|both of these]], severe headache, [[hypoglycemia|low blood sugar]], and [[hemoglobinuria|haemoglobin in the urine]] with [[kidney failure]] may occur.<ref name="Bartoloni-2012" /> Complications may include spontaneous bleeding, [[coagulopathy]], and [[circulatory shock|shock]].<ref>Davidson's Principles and Practice of Medicine/21st/351</ref>

Cerebral malaria can bring about death within forty-eight hours of the first symptoms of the infection being evident.

[[Pregnancy-associated malaria|Malaria during pregnancy]] can cause [[stillbirth]]s, [[infant mortality]], [[miscarriage]], and [[low birth weight]],<ref name="Hartman-2010" /> particularly in ''P.&nbsp;falciparum'' infection, but also with ''P.&nbsp;vivax''.<ref name="Rijken-2012" />

==Cause==
[[File:Life Cycle of the Malaria Parasite.jpg|thumb|upright=1.6|The life cycle of malaria parasites: Sporozoites are introduced by a mosquito bite. When they reach the liver, they multiply into thousands of merozoites. The merozoites infect red blood cells and replicate, infecting more and more red blood cells. Some parasites form gametocytes, which are taken up by a mosquito, continuing the life cycle.]]

Malaria is caused by infection with [[parasite]]s in the genus ''[[Plasmodium]]''.<ref name="US CDC-2022">{{cite web |publisher=CDC-Centers for Disease Control and Prevention |date=2022-03-22 |title=Malaria - About Malaria - Disease |url=https://www.cdc.gov/malaria/about/disease.html |access-date=2022-04-28 |language=en-US |archive-date=2023-05-24 |archive-url=https://web.archive.org/web/20230524132501/https://www.cdc.gov/malaria/about/disease.html |url-status=live}}</ref> In humans, malaria is caused by six ''Plasmodium'' species: ''[[Plasmodium falciparum|P.&nbsp;falciparum]]'', ''[[Plasmodium malariae|P.&nbsp;malariae]]'', ''[[Plasmodium ovale curtisi|P.&nbsp;ovale curtisi]]'', ''[[Plasmodium ovale wallikeri|P.&nbsp;ovale wallikeri]]'', ''[[Plasmodium vivax|P.&nbsp;vivax]]'' and ''[[Plasmodium knowlesi|P.&nbsp;knowlesi]]''.<ref name="Ashley-2018">{{cite journal | vauthors=Ashley EA, Pyae Phyo A, Woodrow CJ | title=Malaria | journal=The Lancet | volume=391 | issue=10130 | pages=1608–1621 | date=April 2018 | pmid=29631781 | doi=10.1016/S0140-6736(18)30324-6 | s2cid=208791451}}</ref> Among those infected, ''P.&nbsp;falciparum'' is the most common species identified (~75%) followed by ''P.&nbsp;vivax'' (~20%).<ref name="Nadjm-2012" /> Although ''P.&nbsp;falciparum'' traditionally accounts for the majority of deaths,<ref name="Sarkar-2009" /> recent evidence suggests that ''P.&nbsp;vivax'' malaria is associated with potentially life-threatening conditions about as often as with a diagnosis of ''P. falciparum'' infection.<ref name="Baird-2013" /> ''P.&nbsp;vivax'' proportionally is more common outside Africa.<ref name="Arnott-2012" /> Some cases have been documented of human infections with several species of ''Plasmodium'' from [[simian|higher apes]], but except for ''P.&nbsp;knowlesi''—a [[zoonosis|zoonotic]] species that causes malaria in [[macaques]]<ref name="Collins-2012" />—these are mostly of limited public health importance.<ref name="Collins-2009" />

The ''Anopheles'' mosquitos initially get infected by ''Plasmodium'' by taking a blood meal from a previously ''Plasmodium'' infected person or animal.<ref>{{cite web  | date=2023-06-28 |title=CDC - Malaria - FAQs |url=https://www.cdc.gov/malaria/about/faqs.html |access-date=2023-10-30 |publisher=Centers for Disease Control and Prevention |language=en-US |quote=Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken from an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person being bitten. |archive-date=2012-05-13 |archive-url=https://web.archive.org/web/20120513112631/http://www.cdc.gov/malaria/about/faqs.html |url-status=live}}</ref><ref>{{cite web  | date=2020-07-16 |title=CDC - Malaria - About Malaria - Biology |url=https://www.cdc.gov/malaria/about/biology/index.html |access-date=2023-10-30 |publisher=Centers for Disease Control and Prevention |language=en-US |quote=Thus the infected mosquito carries the disease from one human to another (acting as a "vector"), while infected humans transmit the parasite to the mosquito, In contrast to the human host, the mosquito vector does not suffer from the presence of the parasites. |archive-date=2021-01-27 |archive-url=https://web.archive.org/web/20210127071906/https://www.cdc.gov/malaria/about/biology/index.html |url-status=live}}</ref> Parasites are then typically introduced by the bite of an infected ''[[Anopheles]]'' mosquito. Some of these inoculated parasites, called "[[sporozoite]]s", probably remain in the skin,<ref>{{cite journal | vauthors=Ménard R, Tavares J, Cockburn I, Markus M, Zavala F, Amino R | title=Looking under the skin: the first steps in malarial infection and immunity | journal=Nature Reviews. Microbiology | volume=11 | issue=10 | pages=701–712 | date=October 2013 | pmid=24037451 | doi=10.1038/nrmicro3111 | doi-access=free}}</ref> but others travel in the bloodstream to the [[liver]], where they invade [[hepatocyte]]s.<ref name="Cowman-2016">{{cite journal | vauthors=Cowman AF, Healer J, Marapana D, Marsh K | title=Malaria: Biology and Disease | journal=Cell | volume=167 | issue=3 | pages=610–624 | date=October 2016 | pmid=27768886 | doi=10.1016/j.cell.2016.07.055 | s2cid=2524633 | doi-access=free}}</ref> They grow and divide in the liver for 2–10 days, with each infected hepatocyte eventually harboring up to 40,000 parasites.<ref name="Cowman-2016" /> The infected hepatocytes break down, releasing these invasive ''Plasmodium'' cells, called "[[merozoite]]s", into the bloodstream. In the blood, the merozoites rapidly invade individual [[red blood cell]]s, replicating over 24–72 hours to form 16–32 new merozoites.<ref name="Cowman-2016" /><!--The Cowman ref says "48 hours" but knowlesi takes 24 and malariae takes 72, so I'll need to find a better source for that--> The infected red blood cell lyses, and the new merozoites infect new red blood cells, resulting in a cycle that continuously amplifies the number of parasites in an infected person.<ref name="Cowman-2016" /> Over rounds of this infection cycle, a small portion of parasites do not replicate, but instead develop into early sexual stage parasites called male and female "[[gametocyte]]s". These gametocytes develop in the [[bone marrow]] for 11 days, then return to the blood circulation to await uptake by the bite of another mosquito.<ref name="Cowman-2016" /> Once inside a mosquito, the gametocytes undergo sexual reproduction, and eventually form daughter sporozoites that migrate to the mosquito's [[salivary gland]]s to be injected into a new host when the mosquito bites.<ref name="Cowman-2016" />

The liver infection causes no symptoms; all symptoms of malaria result from the infection of red blood cells.<ref name="Ashley-2018" /> Symptoms develop once there are more than around 100,000 parasites per [[milliliter]] of blood.<ref name="Ashley-2018" /> Many of the symptoms associated with severe malaria are caused by the tendency of ''P. falciparum'' to bind to [[blood vessel]] walls, resulting in damage to the affected vessels and surrounding tissue. Parasites sequestered in the blood vessels of the lung contribute to [[respiratory failure]]. In the brain, they contribute to [[coma]]. In the placenta they contribute to low birthweight and preterm labor, and increase the risk of abortion and stillbirth.<ref name="Ashley-2018" /> The destruction of red blood cells during infection often results in anemia, exacerbated by reduced production of new red blood cells during infection.<ref name="Ashley-2018" />

Only female mosquitoes feed on blood; male mosquitoes feed on plant nectar and do not transmit the disease. Females of the mosquito genus ''Anopheles'' prefer to feed at night. They usually start searching for a meal at dusk, and continue through the night until they succeed.<ref name="Arrow-2004" /> However, in Africa, due to the extensive use of bed nets, they began to bite earlier, before bed-net time.<ref>{{cite web |vauthors=Goldman JG |title=Malaria Mosquitoes Are Biting before Bed-Net Time |url=https://www.scientificamerican.com/podcast/episode/malaria-mosquitoes-are-biting-before-bed-net-time/ |access-date=2023-05-29 |website=Scientific American |archive-date=2023-05-29 |archive-url=https://web.archive.org/web/20230529022719/https://www.scientificamerican.com/podcast/episode/malaria-mosquitoes-are-biting-before-bed-net-time/ |url-status=live}}</ref> Malaria parasites can also be transmitted by [[blood transfusion]]s, although this is rare.<ref name="Owusu-Ofori-2010" />

===Recurrent malaria===
Symptoms of malaria can recur after varying symptom-free periods. Depending upon the cause, recurrence can be classified as either [[recrudescence]], [[relapse]], or reinfection. Recrudescence is when symptoms return after a symptom-free period due to failure to remove blood-stage parasites by adequate treatment.{{sfn|WHO|2015|p=4}} Relapse is when symptoms reappear after the parasites have been eliminated from the blood but have persisted as dormant [[Plasmodium#Life cycle|hypnozoites]]<ref>{{cite journal | vauthors=Markus MB | title=Malaria: origin of the term 'hypnozoite' | journal=Journal of the History of Biology | volume=44 | issue=4 | pages=781–786 | date=2011 | pmid=20665090 | doi=10.1007/s10739-010-9239-3 | s2cid=1727294}}</ref> in liver cells. Relapse commonly occurs between 8 and 24 weeks after the initial symptoms and is often seen in ''P.&nbsp;vivax'' and ''P.&nbsp;ovale'' infections.<ref name="Nadjm-2012" /> ''P.&nbsp;vivax'' malaria cases in [[temperate]] areas often involve [[overwintering]] by hypnozoites, with relapses beginning the year after the mosquito bite.<ref name="White-2011" /> Reinfection means that parasites were eliminated from the entire body but new parasites were then introduced. Reinfection cannot readily be distinguished from relapse and recrudescence, although recurrence of infection within two weeks of treatment ending is typically attributed to treatment failure.{{sfn|WHO|2015|p=41}} People may develop some [[premunity|immunity]] when exposed to frequent infections.<ref name="Tran-2012" />

==Pathophysiology==
{{further|Plasmodium falciparum#Pathogenesis}}
[[File:Maternal malaria placenta - cropped - very high mag.jpg|thumb|right|[[Micrograph]] of a [[placenta]] from a [[stillbirth]] due to maternal malaria. [[H&E stain]]. Red blood cells are anuclear; blue/black staining in bright red structures (red blood cells) indicate foreign nuclei from the parasites.]]
[[File:Red blood cells infected with malaria.jpg|thumb|Electron micrograph of a ''Plasmodium falciparum''-infected red blood cell (center), illustrating adhesion protein "knobs"]]

Malaria infection develops via two phases: one that involves the [[liver]] (exoerythrocytic phase), and one that involves red blood cells, or [[erythrocyte]]s (erythrocytic phase). When an infected mosquito pierces a person's skin to take a blood meal, sporozoites in the mosquito's saliva enter the bloodstream and migrate to the liver where they infect hepatocytes, multiplying asexually and asymptomatically for a period of 8–30 days.<ref name="Bledsoe-2005" />

After a potential dormant period in the liver, these organisms [[cellular differentiation|differentiate]] to yield thousands of merozoites, which, following rupture of their host cells, escape into the blood and infect red blood cells to begin the erythrocytic stage of the life cycle.<ref name="Bledsoe-2005" /> The parasite escapes from the liver undetected by wrapping itself in the [[cell membrane]] of the infected host liver cell.<ref name="Vaughan-2008" />

The parasites multiply asexually within red blood cells, periodically breaking out to infect new ones. This repeated cycle results in synchronized waves of merozoites escaping and invading red blood cells, which cause the characteristic fever patterns.<ref name="Bledsoe-2005" />

Some ''P.&nbsp;vivax'' sporozoites do not immediately develop into exoerythrocytic-phase merozoites, but instead, produce hypnozoites that remain dormant for periods ranging from several months (7–10 months is typical) to several years.<ref name="White-2011" /> After a period of dormancy, they reactivate and produce merozoites. Hypnozoites are responsible for long incubation and late relapses in ''P.&nbsp;vivax'' infections,<ref name="White-2011" /> although their existence in ''P.&nbsp;ovale'' is uncertain.<ref name="Richter-2010" />

The parasite is relatively protected from attack by the body's [[immune system]] because for most of its human life cycle it resides within the liver and blood cells and is relatively invisible to immune surveillance. However, circulating infected blood cells are destroyed in the [[spleen]]. To avoid this fate, the ''P.&nbsp;falciparum'' parasite displays adhesive [[protein]]s on the surface of the infected blood cells, causing the blood cells to stick to the walls of small blood vessels, thereby sequestering the parasite from passage through the general circulation and the spleen.<ref name="Tilley-2011" /> The blockage of the microvasculature causes symptoms such as those in placental malaria.<ref name="Mens-2010" /> Sequestered red blood cells can breach the [[blood–brain barrier]] and cause cerebral malaria.<ref name="Rénia-2012" />

===Genetic resistance===
{{Main|Human genetic resistance to malaria}}
Due to the high levels of [[death|mortality]] and [[morbidity]] caused by malaria—especially the ''P.&nbsp;falciparum'' species—it has placed the greatest [[Selection (biology)|selective pressure]] on the [[human genome]] in recent history. Several genetic factors provide some resistance to it including [[sickle cell trait]], [[thalassaemia]] traits, [[glucose-6-phosphate dehydrogenase deficiency]], and the absence of [[Duffy antigen]]s on red blood cells.<ref>{{cite journal | vauthors=Pierron D, Heiske M, Razafindrazaka H, Pereda-Loth V, Sanchez J, Alva O, Arachiche A, Boland A, Olaso R, Deleuze JF, Ricaut FX, Rakotoarisoa JA, Radimilahy C, Stoneking M, Letellier TD| title=Strong selection during the last millennium for African ancestry in the admixed population of Madagascar | journal=Nature Communications | volume=9 | issue=1 | article-number=932 | date=March 2018 | pmid=29500350 | pmc=5834599 | doi=10.1038/s41467-018-03342-5 | bibcode=2018NatCo...9..932P}}</ref><ref name="Kwiatkowski-2005" /><ref name="Hedrick-2011" />

The effect of sickle cell trait on malaria immunity illustrates some evolutionary trade-offs that have occurred because of endemic malaria. Sickle cell trait causes a change in the haemoglobin molecule in the blood. Normally, red blood cells have a very flexible, biconcave shape that allows them to move through narrow [[capillaries]]; however, when the modified [[hemoglobin S|haemoglobin&nbsp;S]] molecules are exposed to low amounts of oxygen, or crowd together due to dehydration, they can stick together forming strands that cause the cell to distort into a curved sickle shape. In these strands, the molecule is not as effective in taking or releasing oxygen, and the cell is not flexible enough to circulate freely. In the early stages of malaria, the parasite can cause infected red cells to sickle, and so they are removed from circulation sooner. This reduces the frequency with which malaria parasites complete their life cycle in the cell. Individuals who are [[homozygous]] (with two copies of the abnormal haemoglobin beta [[allele]]) have [[sickle-cell anaemia]], while those who are heterozygous (with one abnormal allele and one normal allele) experience resistance to malaria without severe anaemia. Although the shorter life expectancy for those with the homozygous condition would tend to disfavour the trait's survival, the trait is preserved in malaria-prone regions because of the [[heterozygote advantage|benefits]] provided by the heterozygous form.<ref name="Hedrick-2011" /><ref name="Weatherall-2008" />

===Liver dysfunction===
Liver dysfunction as a result of malaria is uncommon and usually only occurs in those with another liver condition such as [[viral hepatitis]] or [[chronic liver disease]]. The syndrome is sometimes called ''malarial hepatitis''.<ref name="Bhalla-2006" /> While it has been considered a rare occurrence, malarial hepatopathy has seen an increase, particularly in Southeast Asia and India. Liver compromise in people with malaria correlates with a greater likelihood of complications and death.<ref name="Bhalla-2006" />

=== Effects on vaccine response ===
Malaria infection affects the immune responses following [[vaccination]] for various diseases. For example, malaria suppresses immune responses to polysaccharide vaccines. A potential solution is to give curative treatment before vaccination in areas where malaria is present.<ref name="Cunnington-2010">{{cite journal | vauthors=Cunnington AJ, Riley EM | title=Suppression of vaccine responses by malaria: insignificant or overlooked? | journal=Expert Review of Vaccines | volume=9 | issue=4 | pages=409–429 | date=April 2010 | pmid=20370551 | doi=10.1586/erv.10.16}}</ref>

==Diagnosis==
{{Main|Diagnosis of malaria}}
[[File:5901 lores.jpg|thumb|The blood film is the [[gold standard (test)|gold standard]] for malaria diagnosis.]]
[[File:Plasmodium.jpg|thumb|Ring-forms and [[gametocyte]]s of ''Plasmodium falciparum'' in human blood]]

Due to the non-specific nature of malaria symptoms, diagnosis is typically suspected based on symptoms and travel history, then confirmed with a laboratory test to detect the presence of the parasite in the blood (parasitological test). In areas where malaria is common, the [[World Health Organization]] (WHO) recommends clinicians suspect malaria in any person who reports having fevers, or who has a current temperature above 37.5&nbsp;°C without any other obvious cause.<ref name="WHO-2021a">{{cite book |title=WHO Guidelines for Malaria |date=13 July 2021 |publisher=World Health Organization |chapter=5.1 Diagnosing Malaria (2015) |url=https://www.who.int/publications/i/item/guidelines-for-malaria |access-date=28 November 2021 |archive-date=18 March 2023 |archive-url=https://web.archive.org/web/20230318051541/https://www.who.int/publications/i/item/guidelines-for-malaria |url-status=live}}</ref> Malaria should be suspected in children with signs of [[anemia]]: [[Palmar pallor|pale palms]] or a laboratory test showing [[hemoglobin]] levels below 8 [[gram]]s per [[deciliter]] of blood.<ref name="WHO-2021a" /> In areas of the world with little to no malaria, the WHO recommends only testing people with possible exposure to malaria (typically travel to a malaria-endemic area) and unexplained fever.<ref name="WHO-2021a" />

In sub-Saharan Africa, testing is low, with only about one in four (28%) of children with a fever receiving medical advice or a rapid diagnostic test in 2021. There was a 10-percentage point gap in testing between the richest and the poorest children (33% vs 23%). Additionally, a greater proportion of children in Eastern and Southern Africa (36%) were tested than in West and Central Africa (21%).<ref name="UNICEF DATA-2" /> According to UNICEF, 61% of children with a fever were taken for advice or treatment from a health facility or provider in 2021. Disparities are also observed by wealth, with an 18 percentage point difference in care-seeking behaviour between children in the richest (71%) and the poorest (53%) households.<ref name="UNICEF DATA-2" />

Malaria is usually confirmed by the microscopic examination of [[blood film]]s or by [[antigen]]-based [[Malaria antigen detection tests|rapid diagnostic tests]] (RDT). Microscopy—i.e. examining [[Giemsa]]-stained blood with a [[light microscope]]—is the [[Gold standard (test)|gold standard]] for malaria diagnosis.<ref name="Ashley-2018" /> Microscopists typically examine both a "thick film" of blood, allowing them to scan many blood cells in a short time, and a "thin film" of blood, allowing them to clearly see individual parasites and identify the infecting ''Plasmodium'' species.<ref name="Ashley-2018" /> Under typical field laboratory conditions, a microscopist can detect parasites when there are at least 100 parasites per [[microliter]] of blood, which is around the lower range of symptomatic infection.<ref name="WHO-2021a" /> Microscopic diagnosis is relatively resource intensive, requiring trained personnel, specific equipment and a consistent supply of [[Microscope slide|microscopy slides]] and stains.<ref name="WHO-2021a" />

In places where microscopy is unavailable, malaria is diagnosed with RDTs, [[rapid antigen test]]s that detect parasite proteins in a [[fingerstick]] blood sample.<ref name="WHO-2021a" /> A variety of RDTs are commercially available, targeting the parasite proteins histidine rich protein 2 (HRP2, detects ''P. falciparum'' only), [[lactate dehydrogenase]], or [[aldolase]].<ref name="WHO-2021a" /> The HRP2 test is widely used in Africa, where ''P. falciparum'' predominates.<ref name="Ashley-2018" /> However, since HRP2 persists in the blood for up to five weeks after an infection is treated, an HRP2 test sometimes cannot distinguish whether someone currently has malaria or previously had it.<ref name="WHO-2021a" /> Additionally, some ''P. falciparum'' parasites in the Amazon region lack the ''HRP2'' gene, complicating detection.<ref name="WHO-2021a" /> Some ''P. falciparum'' species also have genetic deletions of the genes coding for the HRP2 antigen; leading to possible false negative results.<ref name="Daily 2025">{{cite journal |last1=Daily |first1=Johanna P. |last2=Parikh |first2=Sunil |title=Malaria |journal=New England Journal of Medicine |date=3 April 2025 |volume=392 |issue=13 |pages=1320–1333 |doi=10.1056/NEJMra2405313 |pmid=40174226 |pmc=12331251 }}</ref> Rapid tests also cannot quantify the parasite burden in a person.<ref name="Daily 2025" /> RDTs are fast and easily deployed to places without full diagnostic laboratories.<ref name="WHO-2021a" /> However they give considerably less information than microscopy, and sometimes vary in quality from producer to producer and lot to lot.<ref name="WHO-2021a" />

[[Serological test]]s to detect antibodies against ''Plasmodium'' from the blood have been developed, but are not used for malaria diagnosis due to their relatively poor sensitivity and specificity. Highly sensitive [[nucleic acid amplification test]]s have been developed, but are not used clinically due to their relatively high cost, and poor specificity for active infections.<ref name="WHO-2021a"/>

===Classification===
Malaria is classified into either "severe" or "uncomplicated" by the [[World Health Organization]] (WHO).<ref name="Nadjm-2012" /> It is deemed severe when ''any'' of the following criteria are present, otherwise it is considered uncomplicated.{{sfn|WHO|2015|p=73}}
* Decreased consciousness
* Significant weakness such that the person is unable to walk
* Inability to feed
* Two or more [[convulsions]]
* [[Low blood pressure]] (less than 70&nbsp;[[mmHg]] in adults and 50&nbsp;mmHg in children)
* [[respiratory distress|Breathing problems]]
* [[Circulatory shock]]
* [[Kidney failure]] or [[haemoglobin|hemoglobin]] in the urine
* Bleeding problems, or hemoglobin less than 50&nbsp;g/L (5&nbsp;g/dL)
* [[Pulmonary oedema]]
* [[Blood glucose]] less than 2.2&nbsp;mmol/L (40&nbsp;mg/dL)
* [[Acidosis]] or [[lactic acid|lactate]] levels of greater than 5&nbsp;mmol/L
* A parasite level in the blood of greater than 100,000 per [[microlitre]] (μL) in low-intensity transmission areas, or 250,000 per μL in high-intensity transmission areas

Cerebral malaria is defined as a severe ''P.&nbsp;falciparum''-malaria presenting with neurological symptoms, including coma (with a [[Glasgow coma scale]] less than 11, or a [[Blantyre coma scale]] less than 3), or with a coma that lasts longer than 30 minutes after a seizure.{{sfn|WHO|2015|p=3}}

==Prevention==
<!-- The list of methods seems to put the least cost-effective first. What's the reason for that? -->
[[File:Anopheles stephensi.jpeg|thumb|An ''[[Anopheles stephensi]]'' mosquito shortly after obtaining blood from a human (the droplet of blood is expelled as a surplus). This mosquito is a vector of malaria, and mosquito control is an effective way of reducing its incidence.]]
Methods used to prevent malaria include medications, mosquito elimination and the prevention of bites. As of 2023, there are two [[malaria vaccine]]s, approved for use in children by the WHO: [[RTS,S]] and [[Malaria vaccine#R21/Matrix-M|R21]].<ref name="WHO recommends R21-2023"/><ref name="www.who.int-3">{{cite web |title=Fact sheet about Malaria |url=https://www.who.int/news-room/fact-sheets/detail/malaria |access-date=6 May 2020 |publisher=World Health Organization |archive-date=2 May 2020 |archive-url=https://web.archive.org/web/20200502021814/https://www.who.int/news-room/fact-sheets/detail/malaria |url-status=live}}</ref> The presence of malaria in an area requires a combination of high human population density, high ''[[Anopheles]]'' mosquito population density and high rates of transmission from humans to mosquitoes and from mosquitoes to humans. If any of these is lowered sufficiently, the parasite eventually disappears from that area, as happened in North America, Europe, and parts of the Middle East. However, unless the parasite is eliminated from the whole world, it could re-establish if conditions revert to a combination that favors the parasite's reproduction. Furthermore, the cost per person of eliminating anopheles mosquitoes rises with decreasing population density, making it economically unfeasible in some areas.<ref name="World Health Organization-1958" />

Prevention of malaria may be more cost-effective than treatment of the disease in the long run, but the [[Capital cost|initial costs]] required are out of reach of many of the world's poorest people. There is a wide difference in the costs of control (i.e. maintenance of low endemicity) and elimination programs between countries. For example, in China—whose government in 2010 announced a strategy to pursue malaria elimination in the [[Chinese province]]s—the required investment is a small proportion of public expenditure on health. In contrast, a similar programme in Tanzania would cost an estimated one-fifth of the public health budget.<ref name="Sabot-2010" /> In 2021, the World Health Organization confirmed that China has eliminated malaria.<ref>{{cite web |title=From 30 million cases to zero: China is certified malaria-free by WHO |url=https://www.who.int/news/item/30-06-2021-from-30-million-cases-to-zero-china-is-certified-malaria-free-by-who |access-date=2022-08-11 |publisher=World Health Organization |archive-date=2023-03-14 |archive-url=https://web.archive.org/web/20230314171352/https://www.who.int/news/item/30-06-2021-from-30-million-cases-to-zero-china-is-certified-malaria-free-by-who |url-status=live}}</ref> In 2023, the World Health Organization confirmed that [[Azerbaijan]], [[Tajikistan]], and [[Belize]] have eliminated malaria.<ref>{{cite web |title=Countries and territories certified malaria-free by WHO |url=https://www.who.int/teams/global-malaria-programme/elimination/countries-and-territories-certified-malaria-free-by-who |access-date=2024-01-30 |publisher=World Health Organization |archive-date=2024-01-30 |archive-url=https://web.archive.org/web/20240130184957/https://www.who.int/teams/global-malaria-programme/elimination/countries-and-territories-certified-malaria-free-by-who |url-status=live}}</ref>

In areas where malaria is common, children under five years old often have [[anaemia]], which is sometimes due to malaria. Giving children with anaemia in these areas preventive antimalarial medication improves red blood cell levels slightly but does not affect the risk of death or need for hospitalisation.<ref>{{cite journal | vauthors=Athuman M, Kabanywanyi AM, Rohwer AC | title=Intermittent preventive antimalarial treatment for children with anaemia | journal=The Cochrane Database of Systematic Reviews | volume=1 | issue=1 | article-number=CD010767 | date=January 2015 | pmid=25582096 | pmc=4447115 | doi=10.1002/14651858.CD010767.pub2}}</ref>

===Mosquito control===
{{Further|Mosquito control}}
[[File:Mansprayingkeroseneoil.jpg|thumb|Man spraying kerosene oil in standing water, [[Panama Canal Zone]], 1912]]

[[Vector control]] refers to methods used to decrease malaria by reducing the levels of transmission by mosquitoes. For individual protection, the most effective [[insect repellent]]s are based on [[DEET]] or [[picaridin]].<ref name="Kajfasz-2009" /> However, there is insufficient evidence that mosquito repellents can prevent malaria infection.<ref>{{cite journal | vauthors=Maia MF, Kliner M, Richardson M, Lengeler C, Moore SJ | title=Mosquito repellents for malaria prevention | journal=The Cochrane Database of Systematic Reviews | volume=2018 | issue=2 | article-number=CD011595 | date=February 2018 | pmid=29405263 | pmc=5815492 | doi=10.1002/14651858.CD011595.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> [[Insecticide-treated net]]s (ITNs) and [[indoor residual spraying]] (IRS) are effective, have been commonly used to prevent malaria, and their use has contributed significantly to the decrease in malaria in the 21st century.<ref name="Fox-2022">{{cite journal | vauthors=Fox T, Furnival-Adams J, Chaplin M, Napier M, Olanga EA | title=House modifications for preventing malaria | journal=The Cochrane Database of Systematic Reviews | volume=2022 | issue=10 | article-number=CD013398 | date=October 2022 | pmid=36200610 | pmc=9536247 | doi=10.1002/14651858.CD013398.pub4}}</ref><ref>{{cite journal | vauthors=Pryce J, Richardson M, Lengeler C | title=Insecticide-treated nets for preventing malaria | journal=The Cochrane Database of Systematic Reviews | volume=11 | issue=11 | article-number=CD000363 | date=November 2018 | pmid=30398672 | pmc=6418392 | doi=10.1002/14651858.CD000363.pub3}}</ref><ref name="Pluess-2010" /> ITNs and IRS may not be sufficient to eliminate the disease, as these interventions depend on how many people use nets, how many gaps in insecticide there are (low coverage areas), if people are not protected when outside of the home, and an increase in mosquitoes that are resistant to insecticides.<ref name="Fox-2022" /> Modifications to people's houses to prevent mosquito exposure may be an important long term prevention measure.<ref name="Fox-2022" />

====Insecticide-treated nets====
[[File:Mosquitonet149.jpg|thumb|A mosquito net in use]]

Mosquito nets help keep mosquitoes away from people and reduce infection rates and transmission of malaria. Nets are not a perfect barrier and are often treated with an insecticide designed to kill the mosquito before it has time to find a way past the net. Insecticide-treated nets (ITNs) are estimated to be twice as effective as untreated nets and offer greater than 70% protection compared with no net.<ref name="Raghavendra-2011" /> Between 2000 and 2008, the use of ITNs saved the lives of an estimated 250,000 infants in Sub-Saharan Africa.<ref name="Howitt-2012" /> According to UNICEF, only 36% of households had sufficient ITNs for all household members in 2019.<ref name="UNICEF DATA">{{cite web |title=Malaria in Africa |url=https://data.unicef.org/topic/child-health/malaria/ |access-date=2023-10-31 |website=UNICEF Data |language=en-US |archive-date=2023-11-05 |archive-url=https://web.archive.org/web/20231105153727/https://data.unicef.org/topic/child-health/malaria/ |url-status=live}}</ref> In 2000, 1.7&nbsp;million (1.8%) African children living in areas of the world where malaria is common were protected by an ITN. That number increased to 20.3&nbsp;million (18.5%) African children using ITNs in 2007, leaving 89.6&nbsp;million children unprotected<ref name="Noor-2009" /> and to 68% African children using mosquito nets in 2015.<ref name="UNICEF-2015" /> The percentage of children sleeping under ITNs in sub-Saharan Africa increased from less than 40% in 2011 to over 50% in 2021.<ref name="UNICEF DATA-2" /> Most nets are impregnated with [[pyrethroid]]s, a class of insecticides with low [[toxicity]]. They are most effective when used from dusk to dawn.<ref>{{harvnb|Schlagenhauf-Lawlor|2008|p=[https://books.google.com/books?id=54Dza0UHyngC&pg=PA215 215]}}</ref> It is recommended to hang a large "bed net" above the center of a bed and either tuck the edges under the mattress or make sure it is large enough such that it touches the ground.<ref>{{cite book |title=Instructions for treatment and use of insecticide-treated mosquito nets |date=2002 |publisher=World Health Organization |hdl=10665/67573 |hdl-access=free |page=34}}</ref> ITNs are beneficial towards pregnancy outcomes in malaria-endemic regions in Africa but more data is needed in Asia and Latin America.<ref>{{cite journal | vauthors=Gamble C, Ekwaru JP, ter Kuile FO | title=Insecticide-treated nets for preventing malaria in pregnancy | journal=The Cochrane Database of Systematic Reviews | volume=2006 | issue=2 | article-number=CD003755 | date=April 2006 | pmid=16625591 | pmc=6532581 | doi=10.1002/14651858.CD003755.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref>

In areas of high malaria resistance, piperonyl butoxide (PBO) combined with pyrethroids in mosquito netting is effective in reducing malaria infection rates.<ref name="Gleave-2021">{{cite journal | vauthors=Gleave K, Lissenden N, Chaplin M, Choi L, Ranson H | title=Piperonyl butoxide (PBO) combined with pyrethroids in insecticide-treated nets to prevent malaria in Africa | journal=The Cochrane Database of Systematic Reviews | volume=5 | issue=5 | article-number=CD012776 | date=May 2021 | pmid=34027998 | pmc=8142305 | doi=10.1002/14651858.CD012776.pub3}}</ref>  Questions remain concerning the durability of PBO on nets as the effect on mosquito mortality was not sustained after twenty washes in experimental trials.<ref name="Gleave-2021" />

UNICEF notes that the use of insecticide-treated nets has been increased since 2000 through accelerated production, procurement and delivery, stating that "over 2.5 billion ITNs have been distributed globally since 2004, with 87% (2.2 billion) distributed in sub-Saharan Africa. In 2021, manufacturers delivered about 220 million ITNs to malaria endemic countries, a decrease of 9 million ITNs compared with 2020 and 33 million less than were delivered in 2019".<ref name="UNICEF-2023"/> As of 2021, 66% of households in sub-Saharan Africa had ITNs, with figures "ranging from 31 per cent in Angola in 2016 to approximately 97 per cent in Guinea-Bissau in 2019".<ref name="UNICEF-2023"/> Slightly more than half of the households with an ITN had enough of them to protect all members of the household, however.<ref name="UNICEF-2023"/>

A 2025 [[Malaria Atlas Project]] analysis estimated that malaria interventions in Africa prevented 1.57 billion cases from 2000–2024, with [[Mosquito net|insecticide-treated nets (ITNs)]] accounting for 72% of cases averted, which showed an increase from the previously reported 68% during the period of 2000-2015.<ref name="malariaatlas">{{Cite web |title=The changing impact of malaria control in Africa 2000-2025 – MAP |url=https://malariaatlas.org/project-resources/impact-of-control-2000-2025/ |access-date=2025-11-14 |website=malariaatlas.org}}</ref> The report warned that progress has slowed due to plateauing ITN coverage and emphasized that expanding ITN access remains essential, as vaccine efficacy improves as transmission declines, making ITNs critical to enabling vaccines to achieve their full impact.<ref name="malariaatlas" /> 

====Indoor residual spraying====
[[File:Mosquitoes-Killedy-By-DDT-Lake-Victoria.JPG|thumb|right|Walls where indoor residual spraying of DDT has been applied. The dead mosquitoes remain on the wall, eventually falling to the floor.]]

Indoor residual spraying is the spraying of insecticides on the walls inside a home. After feeding, many mosquitoes rest on a nearby surface while digesting the bloodmeal, so if the walls of houses have been coated with insecticides, the resting mosquitoes can be killed before they can bite another person and transfer the malaria parasite.<ref name="Enayati-2010" /> As of 2006, the [[World Health Organization]] recommends 12 insecticides in IRS operations, including [[DDT#Use against malaria|DDT]] and the pyrethroids [[cyfluthrin]] and [[deltamethrin]].<ref name="WHO-2006" /> This public health use of small amounts of DDT is permitted under the [[Stockholm Convention]], which prohibits its agricultural use.<ref name="van den Berg-2009" /> One problem with all forms of IRS is [[insecticide resistance]]. Mosquitoes affected by IRS tend to rest and live indoors, and due to the irritation caused by spraying, their descendants tend to rest and live outdoors, meaning that they are less affected by the IRS.<ref name="Pates-2005" /> Communities using insecticide treated nets, in addition to indoor residual spraying with 'non-pyrethroid-like' insecticides found associated reductions in malaria.<ref name="Pryce-2022">{{cite journal | vauthors=Pryce J, Medley N, Choi L | title=Indoor residual spraying for preventing malaria in communities using insecticide-treated nets | journal=The Cochrane Database of Systematic Reviews | volume=1 | issue=1 | article-number=CD012688 | date=January 2022 | pmid=35038163 | pmc=8763033 | doi=10.1002/14651858.CD012688.pub3}}</ref>  Additionally, the use of 'pyrethroid-like' insecticides in addition to indoor residual spraying did not result in a detectable additional benefit in communities using insecticide treated nets.<ref name="Pryce-2022" />

==== Housing modifications ====
Housing is a risk factor for malaria and modifying the house as a prevention measure may be a sustainable strategy that does not rely on the effectiveness of insecticides such as pyrethroids.<ref name="Fox-2022" /><ref>{{cite journal | vauthors=Tusting LS, Ippolito MM, Willey BA, Kleinschmidt I, Dorsey G, Gosling RD, Lindsay SW | title=The evidence for improving housing to reduce malaria: a systematic review and meta-analysis | journal=Malaria Journal | volume=14 | issue=1 | article-number=209 | date=June 2015 | pmid=26055986 | pmc=4460721 | doi=10.1186/s12936-015-0724-1 | doi-access=free}}</ref> The physical environment inside and outside the home that may improve the density of mosquitoes are considerations. Examples of potential modifications include how close the home is to mosquito breeding sites, drainage and water supply near the home, availability of mosquito resting sites (vegetation around the home), the proximity to live stock and domestic animals, and physical improvements or modifications to the design of the home to prevent mosquitoes from entering,<ref name="Fox-2022" /> such as [[window screen]]s.

In addition to installing window screens, house screening measures include screening ceilings, doors, and eaves. In 2021, the World Health Organization's (WHO) Guideline Development Group conditionally recommended screening houses in this manner to reduce malaria transmission.<ref name="WHO Guidelines for Malaria-2023">{{Cite web |date=October 16, 2023 |title=WHO Guidelines for Malaria |url=https://iris.who.int/bitstream/handle/10665/373339/WHO-UCN-GMP-2023.01-Rev.1-eng.pdf?sequence=1 |access-date=August 1, 2024 |website=WHO Guidelines for Malaria |archive-date=August 1, 2024 |archive-url=https://web.archive.org/web/20240801173122/https://iris.who.int/bitstream/handle/10665/373339/WHO-UCN-GMP-2023.01-Rev.1-eng.pdf?sequence=1 }}</ref> However, the WHO does point out that there are local considerations that need to be addressed when incorporating these techniques. These considerations include the delivery method, maintenance, house design, feasibility, resource needs, and scalability.<ref name="WHO Guidelines for Malaria-2023" />

Several studies have suggested that screening houses can have a significant effect on malaria transmission. Beyond the protective barrier screening provides, it also does not call for daily behavioral changes in the household.<ref name="Nalinya-2022">{{cite journal | vauthors=Nalinya S, Musoke D, Deane K | title=Malaria prevention interventions beyond long-lasting insecticidal nets and indoor residual spraying in low- and middle-income countries: a scoping review | journal=Malaria Journal | volume=21 | issue=1 | article-number=31 | date=February 2022 | pmid=35109848 | pmc=8812253 | doi=10.1186/s12936-022-04052-6 | doi-access=free}}</ref> Screening eaves can also have a community-level protective effect, ultimately reducing mosquito-biting densities in neighboring houses that do not have this intervention in place.<ref name="Nalinya-2022" />

In some cases, studies have used insecticide-treated (e.g., transfluthrin) or untreated netting to deter mosquito entry.<ref name="Nalinya-2022" /> One widely used intervention is the [[In2Care BV]] EaveTube. In 2021, In2Care BV received funding from the United States Agency for International Development to develop a ventilation tube that would be installed in housing walls.<ref name="USAID DIV Impacts-2024">{{Cite web |date=August 1, 2024 |title=Grant: In2Care EaveTubes |url=https://divportal.usaid.gov/s/project/a0gt0000001CEd2AAG/in2care-eavetubes-for-mosquito-control |access-date=August 1, 2024 |website=USAID DIV Impacts}}{{dead link|date=February 2025|bot=medic}}{{cbignore|bot=medic}}</ref> When mosquitoes approach households, the goal is for them to encounter these EaveTubes instead. Inside these EaveTubes is insecticide-treated netting that is lethal to insecticide-resistant mosquitoes.<ref name="USAID DIV Impacts-2024" /> This approach to mosquito control is called the Lethal House Lure method. The WHO is currently evaluating the efficacy of this product for widespread use.<ref>{{Cite web |title=Lethal house lures |url=https://www.who.int/groups/vector-control-advisory-group/summary-of-new-interventions-for-vector-control/lethal-house-lures |access-date=2024-08-01 |publisher=World Health Organization |language=en}}</ref>

==== Mass drug administration ====
[[Mass drug administration]] (MDA) involves the administration of drugs to the entire population of an area regardless of disease status.<ref>{{cite journal | vauthors=Webster JP, Molyneux DH, Hotez PJ, Fenwick A | title=The contribution of mass drug administration to global health: past, present and future | journal=Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences | volume=369 | issue=1645 | article-number=20130434 | date=2014 | pmid=24821920 | pmc=4024227 | doi=10.1098/rstb.2013.0434}}</ref> A subtype, known as seasonal malaria chemoproprophylaxis (or chemoprevention) involves giving those vulnerable to complications from malaria (such as young children under 5, or pregnant women) medications to prevent malaria.<ref name="Daily 2025" /> This may be done during certain seasons, where mosquitos are more likely to spread the disease. Malaria vaccination, when combined with seasonal chemoprevention has been shown to prevent more cases of malaria compared to vaccination alone.<ref name="Dicko 2024">{{cite journal |last1=Dicko |first1=Alassane |last2=Ouedraogo |first2=Jean-Bosco |last3=Zongo |first3=Issaka |display-authors=etal |title=Seasonal vaccination with RTS,S/AS01E vaccine with or without seasonal malaria chemoprevention in children up to the age of 5 years in Burkina Faso and Mali: a double-blind, randomised, controlled, phase 3 trial |journal=The Lancet Infectious Diseases |date=January 2024 |volume=24 |issue=1 |pages=75–86 |doi=10.1016/S1473-3099(23)00368-7|pmid=37625434 |doi-access=free }}</ref>

A 2021 Cochrane review on the use of community administration of [[ivermectin]] found that, to date, low quality evidence shows no significant effect on reducing incidence of malaria transmission from the community administration of ivermectin.<ref>{{cite journal | vauthors=de Souza DK, Thomas R, Bradley J, Leyrat C, Boakye DA, Okebe J | title=Ivermectin treatment in humans for reducing malaria transmission | journal=The Cochrane Database of Systematic Reviews | volume=2021 | issue=6 | article-number=CD013117 | date=June 2021 | pmid=34184757 | pmc=8240090 | doi=10.1002/14651858.CD013117.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref>

==== Mosquito-targeted drug delivery ====

One potential way to reduce the burden of malaria is to target the infection in mosquitoes, before it enters the mammalian host (during sporogeny).<ref>{{Cite journal |last=Kamiya |first=Tsukushi |date=December 2022 |title=Targeting malaria parasites inside mosquitoes: ecoevolutionary consequences |journal=Trends in Parasitology |volume=38 |issue=12 |pages=1031–1040|doi=10.1016/j.pt.2022.09.004 |pmid=36209032 |pmc=9815470}}</ref>  Drugs may be used for this purpose which have unacceptable toxicity profiles in humans. For example, aminoquinoline derivates show toxicity in humans,<ref name="WHO" /> but this has not been shown in mosquitoes. Primaquine is particularly effective against ''Plasmodium'' gametocytes. Likewise, pyrroloquinazolinediamines show unacceptable toxicity in mammals,<ref>{{Cite journal |last1=Li |first1=Qigui |last2=Kozar |first2=Michael P. |last3=Shearer |first3=Todd W. |last4=Xie |first4=Lisa H. |last5=Lin |first5=Ai J. |last6=Smith |first6=Kirsten S. |last7=Si |first7=Yuanzheng |last8=Anova |first8=Lalaine |last9=Zhang |first9=Jing |last10=Milhous |first10=Wilbur K. |last11=Skillman |first11=Donald R. |date=2007 |title=Pharmacokinetics, Safety, and Hydrolysis of Oral Pyrroloquinazolinediamines Administered in Single and Multiple Doses in Rats |journal=Antimicrobial Agents and Chemotherapy |language=en |volume=51 |issue=8 |pages=2898–2904 |doi=10.1128/AAC.00932-06 |issn=0066-4804 |pmc=1932520 |pmid=17562804}}</ref> but it is unknown whether this is the case in mosquitoes. Pyronaridine, thiostrepton, and pyrimethamine have been shown to dramatically reduce ookinete formation in ''P. berghei'', while artefenomel, NPC-1161B, and tert-butyl isoquine reduce exflagellation in ''P. Falciparum''.<ref>{{Cite journal |last1=Delves |first1=Michael |last2=Plouffe |first2=David |last3=Scheurer |first3=Christian |last4=Meister |first4=Stephan |last5=Wittlin |first5=Sergio |last6=Winzeler |first6=Elizabeth A. |last7=Sinden |first7=Robert E. |last8=Leroy |first8=Didier |date=2012-02-21 |title=The Activities of Current Antimalarial Drugs on the Life Cycle Stages of ''Plasmodium'': A Comparative Study with Human and Rodent Parasites |journal=PLOS Medicine |language=en |volume=9 |issue=2 |article-number=e1001169 |doi=10.1371/journal.pmed.1001169 |doi-access=free |pmid=22363211 |pmc=3283556 |issn=1549-1676}}</ref>

====Other mosquito control methods====
People have tried a number of other methods to reduce mosquito bites and slow the spread of malaria. Efforts to decrease mosquito larvae by decreasing the availability of open water where they develop, or by adding substances to decrease their development, are effective in some locations.<ref>{{cite journal | vauthors=Martello E, Yogeswaran G, Reithinger R, Leonardi-Bee J | title=Mosquito aquatic habitat modification and manipulation interventions to control malaria | journal=The Cochrane Database of Systematic Reviews | volume=2022 | issue=11 | article-number=CD008923 | date=November 2022 | pmid=36367444 | pmc=9651131 | doi=10.1002/14651858.CD008923.pub3}}</ref> Electronic mosquito repellent devices, which make very high-frequency sounds that are supposed to keep female mosquitoes away, have no supporting evidence of effectiveness.<ref name="Enayati-2007" /> There is a low certainty evidence that [[Fogging (insect control)|fogging]] may have an effect on malaria transmission.<ref>{{cite journal | vauthors=Pryce J, Choi L, Richardson M, Malone D | title=Insecticide space spraying for preventing malaria transmission | journal=The Cochrane Database of Systematic Reviews | volume=11 | issue=11 | article-number=CD012689 | date=November 2018 | pmid=30388303 | pmc=6516806 | doi=10.1002/14651858.CD012689.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> Larviciding by hand delivery of chemical or microbial insecticides into water bodies containing low larval distribution may reduce malarial transmission.<ref>{{cite journal | vauthors=Choi L, Majambere S, Wilson AL | title=Larviciding to prevent malaria transmission | journal=The Cochrane Database of Systematic Reviews | volume=8 | issue=8 | article-number=CD012736 | date=August 2019 | pmid=31425624 | pmc=6699674 | doi=10.1002/14651858.CD012736.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> There is insufficient evidence to determine whether larvivorous fish can decrease mosquito density and transmission in the area.<ref>{{cite journal | vauthors=Walshe DP, Garner P, Adeel AA, Pyke GH, Burkot TR | title=Larvivorous fish for preventing malaria transmission | journal=The Cochrane Database of Systematic Reviews | volume=2017 | issue=12 | article-number=CD008090 | date=December 2017 | pmid=29226959 | pmc=5741835 | doi=10.1002/14651858.CD008090.pub3 | collaboration=Cochrane Infectious Diseases Group}}</ref>

===Medications===
{{Main|Malaria prophylaxis}}

There are a number of medications that can help prevent or interrupt malaria in travellers to places where infection is common. Many of these medications are also used in treatment. In places where ''Plasmodium'' is resistant to one or more medications, three medications—[[mefloquine]], [[doxycycline]], or the combination of [[atovaquone/proguanil]] (''Malarone'')—are frequently used for prevention.<ref name="Tickell-Painter-2017" /> Doxycycline and the atovaquone/proguanil are better tolerated while mefloquine is taken once a week.<ref name="Tickell-Painter-2017">{{cite journal | vauthors=Tickell-Painter M, Maayan N, Saunders R, Pace C, Sinclair D | title=Mefloquine for preventing malaria during travel to endemic areas | journal=The Cochrane Database of Systematic Reviews | volume=2017 | issue=10 | article-number=CD006491 | date=October 2017 | pmid=29083100 | pmc=5686653 | doi=10.1002/14651858.CD006491.pub4}}</ref> Areas of the world with [[chloroquine]]-sensitive malaria are uncommon.<ref>{{cite web|title=Drug resistance in the Malaria Endemic World|url=https://www.cdc.gov/malaria/malaria_worldwide/reduction/drug_resistance.html|publisher=Centers for Disease Control and Prevention|access-date=4 January 2018|archive-date=9 December 2017|archive-url=https://web.archive.org/web/20171209163322/https://www.cdc.gov/malaria/malaria_worldwide/reduction/drug_resistance.html|url-status=live}}</ref> Antimalarial mass drug administration to an entire population at the same time may reduce the risk of contracting malaria in the population, however the effectiveness of mass drug administration may vary depending on the prevalence of malaria in the area.<ref name="Shah-2021">{{cite journal | vauthors=Shah MP, Hwang J, Choi L, Lindblade KA, Kachur SP, Desai M | title=Mass drug administration for malaria | journal=The Cochrane Database of Systematic Reviews | volume=2021 | issue=9 | article-number=CD008846 | date=September 2021 | pmid=34585740 | pmc=8479726 | doi=10.1002/14651858.CD008846.pub3}}</ref> Other factors such as drug administration plus other protective measures such as mosquito control, the proportion of people treated in the area, and the risk of reinfection with malaria may play a role in the effectiveness of mass drug treatment approaches.<ref name="Shah-2021" />

The protective effect does not begin immediately, and people visiting areas where malaria exists usually start taking the drugs one to two weeks before they arrive, and continue taking them for four weeks after leaving (except for atovaquone/proguanil, which only needs to be started two days before and continued for seven days afterward).<ref name="Freedman-2008" /> The use of preventive drugs is often not practical for those who live in areas where malaria exists, and their use is usually given only to pregnant women and short-term visitors. This is due to the cost of the drugs, [[adverse effect (medicine)|side effects]] from long-term use, and the difficulty in obtaining antimalarial drugs outside of wealthy nations.<ref name="Fernando-2011" /> During pregnancy, medication to prevent malaria has been found to improve the weight of the baby at birth and decrease the risk of [[anaemia]] in the mother.<ref>{{cite journal | vauthors=Radeva-Petrova D, Kayentao K, ter Kuile FO, Sinclair D, Garner P | title=Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment | journal=The Cochrane Database of Systematic Reviews | volume=2014 | issue=10 | article-number=CD000169 | date=October 2014 | pmid=25300703 | pmc=4498495 | doi=10.1002/14651858.CD000169.pub3}}</ref> The use of preventive drugs where malaria-bearing mosquitoes are present may encourage the development of partial resistance.<ref name="Turschner-2009" />

Giving antimalarial drugs to infants through intermittent preventive therapy can reduce the risk of having malaria infection, hospital admission, and anaemia.<ref>{{cite journal | vauthors=Esu EB, Oringanje C, Meremikwu MM | title=Intermittent preventive treatment for malaria in infants | journal=The Cochrane Database of Systematic Reviews | volume=2021 | issue=7 | article-number=CD011525 | date=July 2021 | pmid=34273901 | pmc=8406727 | doi=10.1002/14651858.CD011525.pub3}}</ref>

Mefloquine is more effective than sulfadoxine-pyrimethamine in preventing malaria for HIV-negative pregnant women. Cotrimoxazole is effective in preventing malaria infection and reduce the risk of getting anaemia in HIV-positive women.<ref>{{cite journal | vauthors=González R, Pons-Duran C, Piqueras M, Aponte JJ, Ter Kuile FO, Menéndez C | title=Mefloquine for preventing malaria in pregnant women | journal=The Cochrane Database of Systematic Reviews | volume=2018 | issue=11 | article-number=CD011444 | date=November 2018 | pmid=30480761 | pmc=6517148 | doi=10.1002/14651858.CD011444.pub3 | collaboration=Cochrane Infectious Diseases Group}}</ref> Giving Dihydroartemisinin/piperaquine and mefloquine in addition to the daily cotrimoxazole to HIV-positive pregnant women seem to be more efficient in preventing malaria infection than cotrimoxazole alone.<ref>{{cite journal |vauthors=Pons-Duran C, Wassenaar MJ, Yovo KE, Marín-Carballo C, Briand V, González R |date=26 Sep 2024 |title=Intermittent preventive treatment regimens for malaria in HIV-positive pregnant women |journal=The Cochrane Database of Systematic Reviews |volume= 2024|issue= 9|article-number= CD006689|doi=10.1002/14651858.CD006689.pub3 |pmc=11426187 |pmid=39324693 |collaboration=Cochrane Infectious Diseases Group}}</ref>

Prompt treatment of confirmed cases with artemisinin-based combination therapies (ACTs) may also reduce transmission.<ref>{{cite web|title=WHO gives indoor use of DDT a clean bill of health for controlling malaria|url=https://www.who.int/mediacentre/news/releases/2006/pr50/en/|archive-url=https://web.archive.org/web/20121022215922/http://www.who.int/mediacentre/news/releases/2006/pr50/en/|archive-date=2012-10-22|publisher=WHO|vauthors=Palmer J}}</ref>

=== Vaccines ===
{{main|Malaria vaccine}}

[[Malaria vaccine]]s have been another goal of research. The first promising studies demonstrating the potential for a malaria vaccine were performed in 1967 by immunising mice with live, radiation-[[Attenuator (genetics)|attenuated]] sporozoites, which provided significant protection to the mice upon subsequent injection with normal, viable sporozoites. Since the 1970s, there has been considerable progress in developing similar vaccination strategies for humans.<ref name="Vanderberg-2009" />

In 2013, WHO and the malaria vaccine funders group set a goal to develop vaccines designed to interrupt malaria transmission with malaria eradication's long-term goal.<ref>{{cite web |title=World Malaria Report 2013 |url=https://www.who.int/entity/malaria/publications/world_malaria_report_2013/wmr2013_no_profiles.pdf?ua=1 |access-date=13 February 2014 |publisher=World Health Organization |format=PDF}}</ref> The first vaccine, called [[RTS,S]], was approved by European regulators in 2015.<ref name="Walsh-2015" /> As of 2023, two [[malaria vaccine]]s have been licensed for use.<ref name="WHO recommends R21-2023"/> Other approaches to combat malaria may require investing more in research and greater primary health care.{{sfn|WHO|2020|p={{page needed|date=July 2024}}}} Continuing surveillance will also be important to prevent the return of malaria in countries where the disease has been eliminated.<ref>{{cite journal | vauthors=Mendis K | title=Eliminating malaria should not be the end of vigilance | journal=Nature | volume=573 | issue=7772 | page=7 | date=September 2019 | pmid=31485061 | doi=10.1038/d41586-019-02598-1 | bibcode=2019Natur.573....7M | doi-access=free}}</ref>

As of 2019 it is undergoing pilot trials in 3 sub-Saharan African countries—Ghana, Kenya and Malawi—as part of the WHO's Malaria Vaccine Implementation Programme (MVIP).<ref>{{cite web |author=World Health Organization |date=March 2020 |title=Q&A on the malaria vaccine implementation programme (MVIP) |url=https://www.who.int/malaria/media/malaria-vaccine-implementation-qa/en/ |access-date=6 May 2020 |publisher=WHO |archive-date=13 May 2020 |archive-url=https://web.archive.org/web/20200513074401/https://www.who.int/malaria/media/malaria-vaccine-implementation-qa/en/ |url-status=live}}</ref>
 
Immunity (or, more accurately, [[immune tolerance|tolerance]]) to ''P.&nbsp;falciparum'' malaria does occur naturally, but only in response to years of repeated infection.<ref name="Tran-2012" /><ref>{{cite journal | vauthors=Abuga KM, Jones-Warner W, Hafalla JC | title=Immune responses to malaria pre-erythrocytic stages: Implications for vaccine development | journal=Parasite Immunology | volume=43 | issue=2 | article-number=e12795 | date=February 2021 | pmid=32981095 | pmc=7612353 | doi=10.1111/pim.12795}}</ref> The highly [[polymorphism (biology)|polymorphic]] nature of many ''P.&nbsp;falciparum'' proteins results in significant challenges to vaccine design. Vaccine candidates that target antigens on gametes, zygotes, or ookinetes in the mosquito midgut aim to block the transmission of malaria. These transmission-blocking vaccines induce [[antibodies]] in the human blood; when a mosquito takes a blood meal from a protected individual, these antibodies prevent the parasite from completing its development in the mosquito.<ref name="Crompton-2010" /> Other vaccine candidates, targeting the blood-stage of the parasite's life cycle, have been inadequate on their own.<ref name="Graves-2006b" /> For example, [[Manuel Elkin Patarroyo|SPf66]] was tested extensively in areas where the disease was common in the 1990s, but trials showed it to be insufficiently effective.<ref name="Graves-2006a" />

As of 2020, the RTS,S vaccine has been shown to reduce the risk of malaria by about 40% in children in Africa.<ref name="www.who.int-3" /><ref name="WHO PP-2016">{{cite journal | vauthors= | title=Malaria vaccine: WHO position paper-January 2016 | journal=Relevé Épidémiologique Hebdomadaire | volume=91 | issue=4 | pages=33–51 | date=January 2016 | pmid=26829826 | url=https://www.who.int/wer/2016/wer9104.pdf?ua=1 | archive-url=https://web.archive.org/web/20200423102942/http://www.who.int/wer/2016/wer9104.pdf?ua=1 | archive-date=2020-04-23}}</ref>

The R-21/Matrix M malaria vaccine was found to reduce cases of malaria by 75% in areas with seasonal spread and by 68% in areas of year-round spread in children in sub-saharan Africa.<ref>{{cite journal |last1=Datoo |first1=Mehreen |last2=Dicko |first2=Alassane |last3=Tinto |display-authors=etal |first3=Halidou |title=Safety and efficacy of malaria vaccine candidate R21/Matrix-M in African children: a multicentre, double-blind, randomised, phase 3 trial |journal=The Lancet |date=February 10, 2024 |volume=403 |issue=10426 |pages=533–544 |doi=10.1016/S0140-6736(23)02511-4 |pmid=38310910 }}</ref> The R-21/Matrix M malaria vaccine was endorsed by the WHO for the prevention of malaria in children in 2023.<ref name="WHO 2023">{{cite web |title=WHO recommends R21/Matrix-M vaccine for malaria prevention in updated advice on immunization |url=https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization |publisher=WHO |language=en}}</ref>

Germany-based BioNTECH SE is developing an mRNA-based malaria vaccine BNT165<ref>{{cite web |title=Home |url=https://www.biontech.com/int/en/home.html |access-date=2023-08-03 |archive-date=2023-08-03 |archive-url=https://web.archive.org/web/20230803135340/https://www.biontech.com/int/en/home.html |url-status=live}}</ref> which has recently initiated a Phase 1 study [clinicaltrials.gov identifier: NCT05581641] in December 2022. The vaccine, based on the circumsporozoite protein (CSP) is being tested in adults aged 18–55 yrs at 3 dose levels to select a safe and tolerable dose of a three-dose schedule. Unlike GSK's RTS,S (AS01) and Serum Institute of India's R21/MatrixM, BNT-165 is being studied in adult age groups meaning it could be developed for Western travelers as well as those living in endemic countries. 

Another vaccine targeting the erythrocytic stage of the parasite is under development. It has provisionally been named RH5.1/Matrix-M, and there is hope that this combined with the pre-erythrocytic vaccine R21/Matrix-M will generate an even more effective second-generation vaccine against malaria.<ref>{{Cite journal |last=Natama |first=Hamtandi M. |last2=Salkeld |first2=Jo |last3=Somé |first3=Athanase |last4=Soremekun |first4=Seyi |last5=Diallo |first5=Salou |last6=Traoré |first6=Ousmane |last7=Rouamba |first7=Toussaint |last8=Ouédraogo |first8=Florence |last9=Ouédraogo |first9=Edouard |last10=Daboné |first10=K. Carine Sonia |last11=Koné |first11=Nadine A. |last12=Compaoré |first12=Z. Michael John |last13=Kafando |first13=Miguel |last14=Bonko |first14=Massa dit Achille |last15=Konaté |first15=Fabé |date=2025-05-01 |title=Safety and efficacy of the blood-stage malaria vaccine RH5.1/Matrix-M in Burkina Faso: interim results of a double-blind, randomised, controlled, phase 2b trial in children |url=https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00752-7/fulltext |journal=The Lancet Infectious Diseases |language=English |volume=25 |issue=5 |pages=495–506 |doi=10.1016/S1473-3099(24)00752-7 |issn=1473-3099 |pmid=39672183|doi-access=free }}</ref><ref>{{Cite web |date=2024-12-11 |title=First vaccine against blood-stage malaria is well-tolerated and offers effective protection {{!}} University of Oxford |url=https://www.ox.ac.uk/news/2024-12-11-first-vaccine-against-blood-stage-malaria-well-tolerated-and-offers-effective |access-date=2025-10-17 |website=www.ox.ac.uk |language=en}}</ref>

===Others===
Community participation and [[health education]] strategies promoting awareness of malaria and the importance of control measures have been successfully used to reduce the incidence of malaria in some areas of the developing world.<ref name="Lalloo-2006" /> Recognising the disease in the early stages can prevent it from becoming fatal. Education can also inform people to cover over areas of stagnant, still water, such as water tanks that are ideal breeding grounds for the parasite and mosquito, thus cutting down the risk of the transmission between people. This is generally used in urban areas where there are large centers of population in a confined space and transmission would be most likely in these areas.<ref name="Mehlhorn-2016" /> [[Intermittent preventive therapy]] is another intervention that has been used successfully to control malaria in pregnant women and infants,<ref name="Bardají-2012" /> and in preschool children where transmission is seasonal.<ref name="Meremikwu-2012a" />

==Treatment==
[[File:"British India", six stages of malaria. Wellcome L0022443.jpg|alt=Advertisement entitled "The Mosquito Danger". Includes 6 panel cartoon:#1 breadwinner has malaria, family starving; #2 wife selling ornaments; #3 doctor administers quinine; #4 patient recovers; #5 doctor indicating that quinine can be obtained from post office if needed again; #6 man who refused quinine, dead on stretcher.|thumb|An advertisement for [[quinine]] as a malaria treatment from 1927]]

Malaria is treated with [[antimalarial medication]]s; the ones used depend on the type and severity of the disease, the patient's weight and other medical factors.<ref>{{cite journal | vauthors=Hanboonkunupakarn B, White NJ | title=Advances and roadblocks in the treatment of malaria | journal=British Journal of Clinical Pharmacology | volume=88 | issue=2 | pages=374–382 | date=February 2022 | pmid=32656850 | pmc=9437935 | doi=10.1111/bcp.14474 | s2cid=220502723}}</ref> While [[antipyretics|medications against fever]] are commonly used, their effects on outcomes are not clear.<ref>{{cite journal | vauthors=Greenwood B | title=The use of anti-malarial drugs to prevent malaria in the population of malaria-endemic areas | journal=The American Journal of Tropical Medicine and Hygiene | volume=70 | issue=1 | pages=1–7 | date=January 2004 | pmid=14971690 | doi=10.4269/ajtmh.2004.70.1 | url=https://researchonline.lshtm.ac.uk/id/eprint/14970/1/The%20use%20of%20anti-malarial%20drugs%20to%20prevent%20malaria%20in%20the%20population%20of%20malaria-endemic%20areas.pdf}}</ref><ref name="Meremikwu-2012b" /> Providing free antimalarial drugs to households may reduce childhood deaths when used appropriately. Programmes which presumptively treat all causes of fever with antimalarial drugs may lead to overuse of antimalarials and undertreat other causes of fever. Nevertheless, the use of malaria rapid-diagnostic kits can help to reduce over-usage of antimalarials.<ref>{{cite journal | vauthors=Okwundu CI, Nagpal S, Musekiwa A, Sinclair D | title=Home- or community-based programmes for treating malaria | journal=The Cochrane Database of Systematic Reviews | volume=2013 | issue=5 | article-number=CD009527 | date=May 2013 | pmid=23728693 | pmc=6532579 | doi=10.1002/14651858.CD009527.pub2}}</ref><ref>{{cite web |title=Malaria-Malaria – Diagnosis & treatment |url=https://www.mayoclinic.org/diseases-conditions/malaria/diagnosis-treatment/drc-20351190 |publisher=Mayo Clinic |date=9 February 2023}}</ref>

===Uncomplicated malaria===
Simple or uncomplicated malaria may be treated with oral medications. Artemisinin drugs are effective and safe in treating uncomplicated malaria.<ref>{{cite journal | vauthors=McIntosh HM, Olliaro P | title=Artemisinin derivatives for treating uncomplicated malaria | journal=The Cochrane Database of Systematic Reviews | volume=1999 | issue=2 | article-number=CD000256 | date=1999-04-26 | pmid=10796519 | pmc=6532741 | doi=10.1002/14651858.CD000256 | collaboration=Cochrane Infectious Diseases Group}}</ref> Artemisinin in combination with other antimalarials (known as [[artemisinin-combination therapy]], or ACT) is about 90% effective when used to treat uncomplicated malaria.<ref name="Howitt-2012" /> The most effective treatment for ''P.&nbsp;falciparum'' infection is the use of ACT, which decreases resistance to any single drug component.<ref>{{cite journal | vauthors=Pousibet-Puerto J, Salas-Coronas J, Sánchez-Crespo A, Molina-Arrebola MA, Soriano-Pérez MJ, Giménez-López MJ, Vázquez-Villegas J, Cabezas-Fernández MT | title=Impact of using artemisinin-based combination therapy (ACT) in the treatment of uncomplicated malaria from ''Plasmodium falciparum'' in a non-endemic zone | journal=Malaria Journal | volume=15 | issue=1 | article-number=339 | date=July 2016 | pmid=27368160 | pmc=4930579 | doi=10.1186/s12936-016-1408-1 | s2cid=18043747 | doi-access=free}}</ref><ref name="Kokwaro-2009" /> Artemether-lumefantrine (six-dose regimen) is more effective than the artemether-lumefantrine (four-dose regimen) or other regimens not containing artemisinin derivatives in treating falciparum malaria.<ref>{{cite journal | vauthors=Omari AA, Gamble C, Garner P | title=Artemether-lumefantrine (four-dose regimen) for treating uncomplicated falciparum malaria | journal=The Cochrane Database of Systematic Reviews | volume=2006 | issue=2 | article-number=CD005965 | date=April 2006 | pmid=16625646 | pmc=6532603 | doi=10.1002/14651858.CD005965 | collaboration=Cochrane Infectious Diseases Group}}</ref><ref>{{cite journal | vauthors=Omari AA, Gamble C, Garner P | title=Artemether-lumefantrine (six-dose regimen) for treating uncomplicated falciparum malaria | journal=The Cochrane Database of Systematic Reviews | volume=2005 | issue=4 | article-number=CD005564 | date=October 2005 | pmid=16235412 | pmc=6532733 | doi=10.1002/14651858.CD005564 | collaboration=Cochrane Infectious Diseases Group}}</ref> Another recommended combination is [[dihydroartemisinin]] and [[piperaquine]].{{sfn|WHO|2015|p=9}}<ref name="Keating-2012" /><ref>{{cite journal | vauthors=Sinclair D, Zani B, Donegan S, Olliaro P, Garner P | title=Artemisinin-based combination therapy for treating uncomplicated malaria | journal=The Cochrane Database of Systematic Reviews | volume=2009 | issue=3 | article-number=CD007483 | date=July 2009 | pmid=19588433 | pmc=6532584 | doi=10.1002/14651858.CD007483.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> Artemisinin-naphthoquine combination therapy showed promising results in treating falciparum malaria but more research is needed to establish its efficacy as a reliable treatment.<ref>{{cite journal | vauthors=Isba R, Zani B, Gathu M, Sinclair D | title=Artemisinin-naphthoquine for treating uncomplicated ''Plasmodium falciparum'' malaria | journal=The Cochrane Database of Systematic Reviews | volume=2015 | issue=2 | article-number=CD011547 | date=February 2015 | pmid=25702785 | pmc=4453860 | doi=10.1002/14651858.CD011547 | collaboration=Cochrane Infectious Diseases Group}}</ref> Artesunate plus mefloquine performs better than mefloquine alone in treating uncomplicated falciparum malaria in low transmission settings.<ref>{{cite journal | vauthors=Bukirwa H, Orton L | title=Artesunate plus mefloquine versus mefloquine for treating uncomplicated malaria | journal=The Cochrane Database of Systematic Reviews | volume=2005 | issue=4 | article-number=CD004531 | date=October 2005 | pmid=16235367 | pmc=6532646 | doi=10.1002/14651858.CD004531.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> Atovaquone-proguanil is effective against uncomplicated falciparum with a possible failure rate of 5% to 10%; the addition of artesunate may reduce failure rate.<ref>{{cite journal | vauthors=Blanshard A, Hine P | title=Atovaquone-proguanil for treating uncomplicated ''Plasmodium falciparum'' malaria | journal=The Cochrane Database of Systematic Reviews | volume=1 | issue=1 | article-number=CD004529 | date=January 2021 | pmid=33459345 | pmc=8094970 | doi=10.1002/14651858.CD004529.pub3}}</ref> Azithromycin monotherapy or combination therapy has not shown effectiveness in treating ''Plasmodium falciparum'' or ''Plasmodium vivax'' malaria.<ref>{{cite journal | vauthors=van Eijk AM, Terlouw DJ | title=Azithromycin for treating uncomplicated malaria | journal=The Cochrane Database of Systematic Reviews | volume=2011 | issue=2 | article-number=CD006688 | date=February 2011 | pmid=21328286 | pmc=6532599 | doi=10.1002/14651858.CD006688.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> Amodiaquine plus sulfadoxine-pyrimethamine may achieve less treatment failures when compared to sulfadoxine-pyrimethamine alone in uncomplicated falciparum malaria.<ref>{{cite journal | vauthors=McIntosh HM, Jones KL | title=Chloroquine or amodiaquine combined with sulfadoxine-pyrimethamine for treating uncomplicated malaria | journal=The Cochrane Database of Systematic Reviews | volume=2005 | issue=4 | article-number=CD000386 | date=October 2005 | pmid=16235276 | pmc=6532604 | doi=10.1002/14651858.CD000386.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> There is insufficient data on chlorproguanil-dapsone in treating uncomplicated falciparum malaria.<ref>{{cite journal | vauthors=Amukoye E, Winstanley PA, Watkins WM, Snow RW, Hatcher J, Mosobo M, Ngumbao E, Lowe B, Ton M, Minyiri G, Marsh K | title=Chlorproguanil-dapsone: effective treatment for uncomplicated falciparum malaria | journal=Antimicrobial Agents and Chemotherapy | volume=41 | issue=10 | pages=2261–2264 | date=October 1997 | pmid=9333058 | pmc=164103 | doi=10.1128/AAC.41.10.2261}}</ref><ref>{{cite journal | vauthors=Bukirwa H, Garner P, Critchley J | title=Chlorproguanil-dapsone for treating uncomplicated malaria | journal=The Cochrane Database of Systematic Reviews | volume=2004 | issue=4 | article-number=CD004387 | date=October 2004 | pmid=15495106 | pmc=6532720 | doi=10.1002/14651858.CD004387.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> The addition of primaquine with artemisinin-based combination therapy for falciparum malaria reduces its transmission at day 3–4 and day 8 of infection.<ref>{{cite journal | vauthors=Graves PM, Choi L, Gelband H, Garner P | title=Primaquine or other 8-aminoquinolines for reducing ''Plasmodium falciparum'' transmission | journal=The Cochrane Database of Systematic Reviews | volume=2018 | issue=2 | article-number=CD008152 | date=February 2018 | pmid=29393511 | pmc=5815493 | doi=10.1002/14651858.CD008152.pub5 | collaboration=Cochrane Infectious Diseases Group}}</ref> Sulfadoxine-pyrimethamine plus artesunate is better than sulfadoxine-pyrimethamine plus amodiaquine in controlling treatment failure at day 28. However, the latter is better than the former in reducing gametocytes in blood at day 7.<ref>{{cite journal | vauthors=Bukirwa H, Critchley J | title=Sulfadoxine-pyrimethamine plus artesunate versus sulfadoxine-pyrimethamine plus amodiaquine for treating uncomplicated malaria | journal=The Cochrane Database of Systematic Reviews | volume=2006 | issue=1 | article-number=CD004966 | date=January 2006 | pmid=16437507 | pmc=6532706 | doi=10.1002/14651858.CD004966.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref>

Infection with ''P.&nbsp;vivax'', ''P.&nbsp;ovale'' or ''P.&nbsp;malariae'' usually does not require hospitalisation. Treatment of ''P.&nbsp;vivax'' malaria requires both elimination of the parasite in the blood with chloroquine or with artemisinin-based combination therapy and clearance of parasites from the liver with an [[8-aminoquinoline]] agent such as [[primaquine]] or [[tafenoquine]].<ref name="Waters-2011" /><ref>{{cite journal | vauthors=Rodrigo C, Rajapakse S, Fernando D | title=Tafenoquine for preventing relapse in people with ''Plasmodium vivax'' malaria | journal=The Cochrane Database of Systematic Reviews | volume=9 | issue=9 | article-number=CD010458 | date=September 2020 | pmid=32892362 | pmc=8094590 | doi=10.1002/14651858.CD010458.pub3}}</ref> These two drugs act against blood stages as well, the extent to which they do so still being under investigation.<ref>{{cite journal | vauthors=Markus MB | title=Putative Contribution of 8-Aminoquinolines to Preventing Recrudescence of Malaria | journal=Tropical Medicine and Infectious Disease | volume=8 | issue=5 | page=278 | date=May 2023 | pmid=37235326 | pmc=10223033 | doi=10.3390/tropicalmed8050278 | doi-access=free}}</ref>

To treat malaria during pregnancy, the [[World Health Organization|WHO]] recommends the use of quinine plus [[clindamycin]] early in the pregnancy (1st trimester), and ACT in later stages (2nd and 3rd trimesters).<ref>{{cite journal | vauthors=Tarning J | title=Treatment of Malaria in Pregnancy | journal=The New England Journal of Medicine | volume=374 | issue=10 | pages=981–982 | date=March 2016 | pmid=26962733 | doi=10.1056/NEJMe1601193 | url=https://ora.ox.ac.uk/objects/uuid:e67b1397-c8ed-493f-a61e-f265d8a41c11 | access-date=2023-01-15 | url-status=live | doi-access=free | archive-url=https://web.archive.org/web/20230426202218/https://ora.ox.ac.uk/objects/uuid:e67b1397-c8ed-493f-a61e-f265d8a41c11 | archive-date=2023-04-26}}</ref><ref name="Manyando-2012" /> There is limited safety data on the antimalarial drugs in pregnancy.<ref>{{cite journal | vauthors=Orton LC, Omari AA | title=Drugs for treating uncomplicated malaria in pregnant women | journal=The Cochrane Database of Systematic Reviews | volume=2008 | issue=4 | article-number=CD004912 | date=October 2008 | pmid=18843672 | pmc=6532683 | doi=10.1002/14651858.CD004912.pub3 | collaboration=Cochrane Infectious Diseases Group}}</ref>

===Severe and complicated malaria===
Cases of severe and complicated malaria are almost always caused by infection with ''P. falciparum''. The other species usually cause only febrile disease.<ref>{{cite journal | vauthors=Kochar DK, Saxena V, Singh N, Kochar SK, Kumar SV, Das A | title=''Plasmodium vivax'' malaria | journal=Emerging Infectious Diseases | volume=11 | issue=1 | pages=132–134 | date=January 2005 | pmid=15705338 | pmc=3294370 | doi=10.3201/eid1101.040519}}</ref> Severe and complicated malaria cases are medical emergencies since mortality rates are high (10% to 50%).<ref>{{cite journal | vauthors=Pasvol G | title=The treatment of complicated and severe malaria | journal=British Medical Bulletin | volume=75–76 | pages=29–47 | date=2005 | pmid=16495509 | doi=10.1093/bmb/ldh059 | doi-access=free}}</ref>

Recommended treatment for severe malaria is the [[Parenteral administration|intravenous]] use of antimalarial drugs. For severe malaria, [[parenteral]] artesunate was superior to quinine in both children and adults.<ref>{{cite web |publisher=Centers for Disease Control and Prevention |date=2022-04-11 |title=Malaria – Diagnosis & Treatment (United States) – Treatment (U.S.) – Artesunate dose 400 mg oral |url=https://www.cdc.gov/malaria/diagnosis_treatment/artesunate.html |access-date=2022-04-25 |language=en-US |archive-date=2016-10-29 |archive-url=https://web.archive.org/web/20161029044719/https://www.cdc.gov/malaria/diagnosis_treatment/artesunate.html |url-status=live}}</ref><ref name="Sinclair-2012" /> In another systematic review, artemisinin derivatives (artemether and arteether) were as efficacious as quinine in the treatment of cerebral malaria in children.<ref>{{cite journal | vauthors=Kyu HH, Fernández E | title=Artemisinin derivatives versus quinine for cerebral malaria in African children: a systematic review | journal=Bulletin of the World Health Organization | volume=87 | issue=12 | pages=896–904 | date=December 2009 | pmid=20454480 | pmc=2789363 | doi=10.2471/BLT.08.060327 | url=https://www.who.int/bulletin/volumes/87/12/08-060327/en/ | archive-url=https://web.archive.org/web/20160304051023/http://www.who.int/bulletin/volumes/87/12/08-060327/en/ | archive-date=2016-03-04}}</ref> Treatment of severe malaria involves supportive measures that are best done in a [[critical care unit]]. This includes the management of [[hyperpyrexia|high fevers]] and the seizures that may result from it. It also includes monitoring for [[respiratory depression|poor breathing effort]], low blood sugar, and [[hypokalemia|low blood potassium]].<ref name="Sarkar-2009" /> Artemisinin derivatives have the same or better efficacy than quinolones in preventing deaths in severe or complicated malaria.<ref>{{cite journal | vauthors=McIntosh HM, Olliaro P | title=Artemisinin derivatives for treating severe malaria | journal=The Cochrane Database of Systematic Reviews | volume=1998 | issue=2 | article-number=CD000527 | date=1998-07-27 | pmid=10796551 | pmc=6532607 | doi=10.1002/14651858.CD000527 | collaboration=Cochrane Infectious Diseases Group}}</ref> Quinine [[loading dose]] helps to shorten the duration of fever and increases parasite clearance from the body.<ref>{{cite journal | vauthors=Lesi A, Meremikwu M | title=High first dose quinine regimen for treating severe malaria | journal=The Cochrane Database of Systematic Reviews | volume=2004 | issue=3 | article-number=CD003341 | date=2004-07-19 | pmid=15266481 | pmc=6532696 | doi=10.1002/14651858.CD003341.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> There is no difference in effectiveness when using intrarectal quinine compared to intravenous or intramuscular quinine in treating uncomplicated/complicated falciparum malaria.<ref>{{cite journal | vauthors=Eisenhut M, Omari AA | title=Intrarectal quinine versus intravenous or intramuscular quinine for treating ''Plasmodium falciparum'' malaria | journal=The Cochrane Database of Systematic Reviews | volume=2009 | issue=1 | article-number=CD004009 | date=January 2009 | pmid=19160229 | pmc=6532585 | doi=10.1002/14651858.CD004009.pub3 | collaboration=Cochrane Infectious Diseases Group}}</ref> There is insufficient evidence for intramuscular arteether to treat severe malaria.<ref>{{cite journal | vauthors=Afolabi BB, Okoromah CN | title=Intramuscular arteether for treating severe malaria | journal=The Cochrane Database of Systematic Reviews | volume=2004 | issue=4 | article-number=CD004391 | date=October 2004 | pmid=15495107 | pmc=6532577 | doi=10.1002/14651858.CD004391.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> The provision of rectal artesunate before transfer to hospital may reduce the rate of death for children with severe malaria.<ref>{{cite journal | vauthors=Okebe J, Eisenhut M | title=Pre-referral rectal artesunate for severe malaria | journal=The Cochrane Database of Systematic Reviews | volume=2014 | issue=5 | article-number=CD009964 | date=May 2014 | pmid=24869943 | pmc=4463986 | doi=10.1002/14651858.CD009964.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref> In children with malaria and concomitant hypoglycaemia, sublingual administration of glucose appears to result in better increases in blood sugar after 20 minutes when compared to oral administration, based on very limited data.<ref>{{cite journal | vauthors=De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djärv T | title=First aid glucose administration routes for symptomatic hypoglycaemia | journal=The Cochrane Database of Systematic Reviews | volume=2019 | issue=4 | article-number=CD013283 | date=April 2019 | pmid=30973639 | pmc=6459163 | doi=10.1002/14651858.CD013283.pub2 | collaboration=Cochrane Metabolic and Endocrine Disorders Group}}</ref>

Cerebral malaria is the form of severe and complicated malaria with the worst neurological symptoms.<ref>{{cite journal | vauthors=Idro R, Marsh K, John CC, Newton CR | title=Cerebral malaria: mechanisms of brain injury and strategies for improved neurocognitive outcome | journal=Pediatric Research | volume=68 | issue=4 | pages=267–274 | date=October 2010 | pmid=20606600 | pmc=3056312 | doi=10.1203/pdr.0b013e3181eee738}}</ref> There is insufficient data on whether osmotic agents such as mannitol or urea are effective in treating cerebral malaria.<ref>{{cite journal | vauthors=Okoromah CA, Afolabi BB, Wall EC | title=Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria | journal=The Cochrane Database of Systematic Reviews | volume=2011 | issue=4 | article-number=CD004615 | date=April 2011 | pmid=21491391 | pmc=4018680 | doi=10.1002/14651858.CD004615.pub3 | collaboration=Cochrane Infectious Diseases Group}}</ref> Routine phenobarbitone in cerebral malaria is associated with fewer [[convulsion]]s but possibly more deaths.<ref>{{cite journal | vauthors=Meremikwu M, Marson AG | title=Routine anticonvulsants for treating cerebral malaria | journal=The Cochrane Database of Systematic Reviews | volume=2002 | issue=2 | article-number=CD002152 | date=2002-04-22 | pmid=12076440 | pmc=6532751 | doi=10.1002/14651858.CD002152 | collaboration=Cochrane Infectious Diseases Group}}</ref> There is no evidence that steroids would bring treatment benefits for cerebral malaria.<ref>{{cite journal | vauthors=Prasad K, Garner P | title=Steroids for treating cerebral malaria | journal=The Cochrane Database of Systematic Reviews | volume=1999 | issue=2 | article-number=CD000972 | date=1999-07-26 | pmid=10796562 | pmc=6532619 | doi=10.1002/14651858.CD000972 | collaboration=Cochrane Infectious Diseases Group}}</ref>

===Managing cerebral malaria===
Cerebral malaria usually makes a patient comatose. If the cause of the coma is in doubt, testing for other locally prevalent causes of encephalopathy (bacterial, viral or fungal infection) should be carried out. In areas where there is a high prevalence of malaria infection (e.g. tropical region) treatment can start without testing first.<ref name="US CDC-2022"/> To manage the cerebral malaria when confirmed the following can be done:

* People who are in coma should be given meticulous nursing care ( monitor vital signs, turn patient every 2 hours, avoid lying the patient in a wet bed etc.)
* A sterile urethral catheter should be inserted to help with urinating
* To aspirate stomach content, a sterile nasogastric tube should be inserted.
* In the occasion of convulsions, a slow intravenous injection of benzodiazepine is administered.<ref>{{cite book |title=A Practical Handbook (third edition) Management Of Severe Malaria |publisher=[[World Health Organization]] |year=2012 |isbn=978-92-4-154852-6 |pages=43–44}}</ref>

There is insufficient evidence to show that blood transfusion is useful in either reducing deaths for children with severe anaemia or in improving their [[haematocrit]] in one month.<ref>{{cite journal | vauthors=Meremikwu M, Smith HJ | title=Blood transfusion for treating malarial anaemia | journal=The Cochrane Database of Systematic Reviews | volume=1999 | issue=2 | article-number=CD001475 | date=1999-10-25 | pmid=10796646 | pmc=6532690 | doi=10.1002/14651858.CD001475 | collaboration=Cochrane Infectious Diseases Group}}</ref> There is insufficient evidence that iron chelating agents such as deferoxamine and deferiprone improve outcomes of those with malaria falciparum infection.<ref>{{cite journal | vauthors=Smith HJ, Meremikwu M | title=Iron chelating agents for treating malaria | journal=The Cochrane Database of Systematic Reviews | issue=2 | article-number=CD001474 | date=2003-04-22 | pmid=12804409 | pmc=6532667 | doi=10.1002/14651858.CD001474 | collaboration=Cochrane Infectious Diseases Group}}</ref>

===Monoclonal antibodies===
A 2022 clinical trial shows that a monoclonal antibody [[mAb L9LS]] offers protection against malaria. It binds the ''Plasmodium falciparum'' circumsporozoite protein (CSP-1), essential to disease, and makes it ineffective.<ref name="Nature Biotech-2022">{{cite journal | vauthors= | title=Lab-made antibody stops malaria | journal=Nature Biotechnology | volume=40 | issue=9 | page=1304 | date=September 2022 | pmid=36085505 | doi=10.1038/s41587-022-01480-2 | s2cid=252181345}}</ref>

===Resistance===
[[Drug resistance]] poses a growing problem in 21st-century malaria treatment.<ref name="Sinha-2014" /> In the 2000s (decade), malaria with partial resistance to artemisins emerged in Southeast Asia.<ref name="O'Brien-2011" /><ref name="Fairhurst-2012" /> Resistance is now common against all classes of antimalarial drugs apart from [[artemisinin]]s. Treatment of resistant strains became increasingly dependent on this class of drugs. The cost of artemisinins limits their use in the developing world.<ref name="White-2008" /> Malaria strains found on the Cambodia–Thailand border are resistant to combination therapies that include artemisinins, and may, therefore, be untreatable.<ref name="Wongsrichanalai-2008" /> Exposure of the parasite population to artemisinin monotherapies in subtherapeutic doses for over 30 years and the availability of substandard artemisinins likely drove the selection of the resistant phenotype.<ref name="Dondorp-2010" /> Resistance to artemisinin has been detected in Cambodia, Myanmar, Thailand, and Vietnam,<ref>{{cite journal|author=World Health Organization |title=Q&A on artemisinin resistance |journal=WHO Malaria Publications |year=2013 |url=https://www.who.int/malaria/media/artemisinin_resistance_qa/en/index.html |archive-url=https://web.archive.org/web/20160720075407/http://www.who.int/malaria/media/artemisinin_resistance_qa/en/index.html |archive-date=2016-07-20}}</ref> and there has been emerging resistance in Laos.<ref name="Briggs-2014">{{cite news|vauthors=Briggs H|date=2014-07-30|title=Call for 'radical action' on drug-resistant malaria|language=en-GB|publisher=BBC News|url=https://www.bbc.com/news/health-28569966|access-date=2023-02-23|archive-date=2023-02-23|archive-url=https://web.archive.org/web/20230223035718/https://www.bbc.com/news/health-28569966|url-status=live}}</ref><ref name="Ashley-2014" /> Resistance to the combination of artemisinin and piperaquine was first detected in 2013 in Cambodia, and by 2019 had spread across Cambodia and into [[Laos]], [[Thailand]] and [[Vietnam]] (with up to 80 percent of malaria parasites resistant in some regions).<ref>{{cite news|url=https://www.bbc.com/news/health-49017699|title=Resistant malaria spreading in South East Asia|vauthors=Gallagher J|date=2019-07-23|access-date=2019-07-25|language=en-GB|archive-date=2019-07-24|archive-url=https://web.archive.org/web/20190724221856/https://www.bbc.com/news/health-49017699|url-status=live}}</ref>

There is insufficient evidence in unit packaged antimalarial drugs in preventing treatment failures of malaria infection. However, if supported by training of healthcare providers and patient information, there is improvement in compliance of those receiving treatment.<ref>{{cite journal | vauthors=Orton L, Barnish G | title=Unit-dose packaged drugs for treating malaria | journal=The Cochrane Database of Systematic Reviews | volume=2005 | issue=2 | article-number=CD004614 | date=April 2005 | pmid=15846723 | pmc=6532754 | doi=10.1002/14651858.CD004614.pub2 | collaboration=Cochrane Infectious Diseases Group}}</ref>

==Prognosis==
[[File:Malaria world map - DALY - WHO2004.svg|thumb|upright=1.3|[[Disability-adjusted life year]] for malaria per 100,000 inhabitants in 2004{{div col|colwidth=10em}}
{{legend|#b3b3b3|   no data}}
{{legend|#ffff65|   <10}}
{{legend|#fff200|   10–100}}
{{legend|#ffdc00| 100–500}}
{{legend|#ffc600| 500–1000}}
{{legend|#ffb000|1000–1500}}
{{legend|#ff9a00|1500–2000}}
{{legend|#ff8400|2000–2500}}
{{legend|#ff6e00|2500–2750}}
{{legend|#ff5800|2750–3000}}
{{legend|#ff4200|3000–3250}}
{{legend|#ff2c00|3250–3500}}
{{legend|#cb0000|   ≥3500}}
{{div col end}}]]

When properly treated, people with malaria can usually expect a complete recovery.<ref name="US CDC-2010b" /> However, severe malaria can progress extremely rapidly and cause death within hours or days.<ref name="Trampuz-2003" /> In the most severe cases of the disease, [[fatality rate]]s can reach 20%, even with intensive care and treatment.<ref name="Nadjm-2012" /> Over the longer term, developmental impairments have been documented in children who have had episodes of severe malaria.<ref name="Fernando-2010" /> [[chronic (medicine)|Chronic]] infection without severe disease can occur in an immune-deficiency syndrome associated with a decreased responsiveness to ''[[Salmonella]]'' bacteria and the [[Epstein–Barr virus]].<ref name="Riley-2013" />

During childhood, malaria causes anaemia during a period of rapid brain development, and also direct brain damage resulting from cerebral malaria.<ref name="Fernando-2010" /> Some survivors of cerebral malaria have an increased risk of neurological and cognitive deficits, [[Emotional and behavioral disorders|behavioural disorders]], and [[epilepsy]].<ref name="Idro-2010" /> Malaria prophylaxis was shown to improve cognitive function and school performance in [[clinical trial]]s when compared to [[placebo]] groups.<ref name="Fernando-2010" />

==Epidemiology==
[[File:Relative incidence of Plasmodium (malaria) species by country of origin for imported cases to non-endemic countries.png|thumb|upright=1.3|left|Relative incidence of ''Plasmodium'' species by country of origin for imported cases to non-endemic countries<ref name="Tatem-2017">{{cite journal | vauthors=Tatem AJ, Jia P, Ordanovich D, Falkner M, Huang Z, Howes R, Hay SI, Gething PW, Smith DL | title=The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics | journal=The Lancet Infectious Diseases | volume=17 | issue=1 | pages=98–107 | date=January 2017 | pmid=27777030 | pmc=5392593 | doi=10.1016/S1473-3099(16)30326-7 | bibcode=2017LanID..17...98T}}</ref>]]

The WHO estimates that in 2021 there were 247 million total cases of malaria resulting in 619,000 deaths.{{sfn|WHO|2022|p={{page needed|date=July 2024}}}} Children under five years old were the most affected, accounting for 67% of malaria deaths worldwide in 2019.<ref name="WHO-2021">{{cite book|author=WHO|url=https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2021|title=World Malaria Report 2021|date=2021|publisher=World Health Organization|isbn=978-92-4-004049-6|location=Switzerland|access-date=2022-01-24|archive-date=2023-05-06|archive-url=https://web.archive.org/web/20230506225435/https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2021|url-status=live}}</ref> About 125 million pregnant women were at risk of infection each year; in [[Sub-Saharan Africa]], maternal malaria was associated with up to 200,000 estimated infant deaths yearly.<ref name="Hartman-2010" /> Since 2015, the WHO European Region has been free of malaria. The last country to report an indigenous malaria case was Tajikistan in 2014.{{sfn|WHO|2022|p={{page needed|date=July 2024}}}} There are about 1300–1500 malaria cases per year in the United States.<ref name="Taylor-2012" /> The United States eradicated malaria as a major public health concern in 1951,<ref>{{cite web |publisher=CDC-Centers for Disease Control and Prevention |title=Malaria – About Malaria – History – Elimination of Malaria in the United States (1947–1951) |url=https://www.cdc.gov/malaria/about/history/elimination_us.html |access-date=17 January 2020 |language=en-US |date=28 January 2019 |archive-date=4 May 2012 |archive-url=https://web.archive.org/web/20120504183309/http://www.cdc.gov/malaria/about/history/elimination_us.html |url-status=live}}</ref> though small outbreaks persist.<ref>{{cite web|publisher=Centers for Disease Control and Prevention|date=2019-01-28|title=Malaria – About Malaria – Malaria Transmission in the United States|url=https://www.cdc.gov/malaria/about/us_transmission.html|access-date=2021-09-03|language=en-US|archive-date=2022-07-19|archive-url=https://web.archive.org/web/20220719125248/https://www.cdc.gov/malaria/about/us_transmission.html|url-status=live}}</ref> Locally acquired mosquito-borne malaria occurred in the United States in 2003, when eight cases of locally acquired ''P. vivax'' malaria were identified in Florida, and again in May 2023, in four cases, as well as one case in Texas,<ref>{{cite web |last=Health Alert Network (HAN) |date=2023-06-26 |title=Locally Acquired Malaria Cases Identified in the United States |url=https://emergency.cdc.gov/han/2023/han00494.asp |access-date=2023-06-27 |publisher=Centers for Disease Control and Prevention |language=en-US |archive-date=2023-06-26 |archive-url=https://web.archive.org/web/20230626220921/https://emergency.cdc.gov/han/2023/han00494.asp |url-status=live}}</ref> and in August in one case in Maryland.<ref>{{cite news |date=2023-08-28 |title=Important Updates on Locally Acquired Malaria Cases Identified in Florida, Texas, and Maryland |language=en-US |publisher=Health Alert Network (HAN) – 00496 |url=https://emergency.cdc.gov/han/2023/han00496.asp |access-date=2023-08-28 |archive-date=2023-08-28 |archive-url=https://web.archive.org/web/20230828234211/https://emergency.cdc.gov/han/2023/han00496.asp |url-status=live}}</ref> About 900 people died from the disease in Europe between 1993 and 2003.<ref name="Kajfasz-2009" /> Both the global incidence of disease and resulting mortality have declined in recent years. According to the WHO and UNICEF, deaths attributable to malaria in 2015 were reduced by 60%<ref name="UNICEF-2015">{{cite book|title=Achieving the malaria MDG target: reversing the incidence of malaria 2000–2015 |url= http://www.unicef.org/publications/files/Achieving_the_Malaria_MDG_Target.pdf | author=UNICEF|publisher=WHO|access-date=26 December 2015|date=September 2015|isbn=978-92-4-150944-2|url-status=live|archive-url=https://web.archive.org/web/20160105025916/http://www.unicef.org/publications/files/Achieving_the_Malaria_MDG_Target.pdf|archive-date=5 January 2016}}</ref> from a 2000 estimate of 985,000, largely due to the widespread use of insecticide-treated nets and artemisinin-based combination therapies.<ref name="Howitt-2012" /> Between 2000 and 2019, malaria mortality rates among all ages halved from about 30 to 13 per 100,000 population at risk. During this period, malaria deaths among children under five also declined by nearly half (47%) from 781,000 in 2000 to 416,000 in 2019.<ref name="UNICEF DATA"/>

Malaria is presently endemic in a broad band around the equator, in areas of the Americas, many parts of Asia, and much of Africa. Eighty-five to ninety percent of malaria fatalities occur in Sub-Saharan Africa.<ref name="Layne-2006" /> An estimate for 2009 reported that countries with the highest death rate per 100,000 of population were [[Ivory Coast]] (86.15), [[Angola]] (56.93) and [[Burkina Faso]] (50.66).<ref name="Provost-2011" /> A 2010 estimate indicated the deadliest countries per population were Burkina Faso, [[Mozambique]] and [[Mali]].<ref name="Murray-2012" /> The [[Malaria Atlas Project]] aims to map global [[Endemic (epidemiology)|levels of malaria]], providing a way to determine the global spatial limits of the disease and to assess [[disease burden]].<ref name="Guerra-2007" /><ref name="Hay-2010" /> This effort led to the publication of a map of ''P.&nbsp;falciparum'' endemicity in 2010 and an update in 2019.<ref name="Gething-2011" /><ref>{{cite journal | vauthors=Weiss DJ, Lucas TC, Nguyen M, Nandi AK, Bisanzio D, Battle KE, Cameron E, Twohig KA, Pfeffer DA, Rozier JA, Gibson HS, Rao PC, Casey D, Bertozzi-Villa A, Collins EL, Dalrymple U, Gray N, Harris JR, Howes RE, Kang SY, Keddie SH, May D, Rumisha S, Thorn MP, Barber R, Fullman N, Huynh CK, Kulikoff X, Kutz MJ, Lopez AD, Mokdad AH, Naghavi M, Nguyen G, Shackelford KA, Vos T, Wang H, Smith DL, Lim SS, Murray CJ, Bhatt S, Hay SI, Gething PW | title=Mapping the global prevalence, incidence, and mortality of ''Plasmodium falciparum'', 2000–17: a spatial and temporal modelling study | journal=The Lancet | volume=394 | issue=10195 | pages=322–331 | date=July 2019 | pmid=31229234 | pmc=6675740 | doi=10.1016/S0140-6736(19)31097-9 | doi-access=free}}</ref><ref>{{cite journal | vauthors=Battle KE, Lucas TC, Nguyen M, Howes RE, Nandi AK, Twohig KA, Pfeffer DA, Cameron E, Rao PC, Casey D, Gibson HS, Rozier JA, Dalrymple U, Keddie SH, Collins EL, Harris JR, Guerra CA, Thorn MP, Bisanzio D, Fullman N, Huynh CK, Kulikoff X, Kutz MJ, Lopez AD, Mokdad AH, Naghavi M, Nguyen G, Shackelford KA, Vos T, Wang H, Lim SS, Murray CJ, Price RN, Baird JK, Smith DL, Bhatt S, Weiss DJ, Hay SI, Gething PW | title=Mapping the global endemicity and clinical burden of ''Plasmodium vivax'', 2000–17: a spatial and temporal modelling study | journal=The Lancet | volume=394 | issue=10195 | pages=332–343 | date=July 2019 | pmid=31229233 | pmc=6675736 | doi=10.1016/S0140-6736(19)31096-7 | doi-access=free}}</ref> As of 2021, 84 countries have endemic malaria.{{sfn|WHO|2022|p={{page needed|date=July 2024}}}}

The geographic distribution of malaria within large regions is complex, and malaria-afflicted and malaria-free areas are often found close to each other.<ref name="Greenwood-2002" /> Malaria is prevalent in tropical and subtropical regions because of rainfall, consistent high temperatures and high humidity, along with stagnant waters where mosquito larvae readily mature, providing them with the environment they need for continuous breeding.<ref name="Jamieson-2006" /> In drier areas, outbreaks of malaria have been predicted with reasonable accuracy by mapping rainfall.<ref name="Abeku-2007" /> Malaria is more common in rural areas than in cities. For example, several cities in the [[Greater Mekong Subregion]] of Southeast Asia are essentially malaria-free, but the disease is prevalent in many rural regions, including along international borders and forest fringes.<ref name="Cui-2012" /> In contrast, malaria in Africa is present in both rural and urban areas, though the risk is lower in the larger cities.<ref name="Machault-2011" />

According to the World Health Organization's 2023 World Malaria Report, there were an estimated 263 million malaria cases globally in 2023, up from 252 million in 2022. The number of malaria deaths stood at 597,000 in 2023, a slight decrease from 600,000 in 2022. The African region continues to bear a disproportionate share of the global malaria burden, accounting for approximately 94% of all cases and 95% of deaths.<ref>{{Cite web |title=Fact sheet about malaria |url=https://www.who.int/news-room/fact-sheets/detail/malaria?utm_source |access-date=2025-03-23 |publisher=World Health Organization |language=en}}</ref>
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===Climate change===
{{Further|Climate change and infectious diseases#Malaria}}
[[Climate change]] is likely to affect malaria transmission, but the degree of effect and the areas affected is uncertain.<ref name="Climate Change and Human Health—Risk and Responses">{{cite web|title=Climate Change And Infectious Diseases|url=https://www.who.int/globalchange/climate/en/chapter6.pdf|url-status=live|archive-url=https://web.archive.org/web/20160304063626/http://www.who.int/globalchange/climate/en/chapter6.pdf|archive-date=2016-03-04|work=Climate Change and Human Health—Risk and Responses|publisher=World Health Organization}}</ref> Greater rainfall in certain areas of India, and following an [[El Niño]] event is associated with increased mosquito numbers.<ref>{{cite web|title=Climate change and human health—risks and responses. Summary|url=https://www.who.int/globalchange/climate/summary/en/index5.html|archive-url=https://web.archive.org/web/20031225023503/http://www.who.int/globalchange/climate/summary/en/index5.html|archive-date=December 25, 2003|access-date=29 October 2018|publisher=World Health Organization}}</ref>

Since 1900 there has been substantial change in temperature and rainfall over Africa.<ref>{{Cite journal|vauthors=Hulme M, Doherty R, Ngara T, New M, Lister D|date=August 2001|title=African climate change: 1900-2100.|url=https://www.int-res.com/articles/cr/17/c017p145.pdf|journal=Climate Research|volume=17|issue=2|pages=145–68|doi=10.3354/cr017145|bibcode=2001ClRes..17..145H|doi-access=free|access-date=2020-09-08|archive-date=2021-06-30|archive-url=https://web.archive.org/web/20210630114729/https://www.int-res.com/articles/cr/17/c017p145.pdf|url-status=live}}</ref> However, factors that contribute to how rainfall results in water for mosquito breeding are complex, incorporating the extent to which it is absorbed into soil and vegetation for example, or rates of runoff and evaporation.<ref name="Smith-2020">{{cite journal | vauthors=Smith MW, Willis T, Alfieri L, James WH, Trigg MA, Yamazaki D, Hardy AJ, Bisselink B, De Roo A, Macklin MG, Thomas CJ | title=Incorporating hydrology into climate suitability models changes projections of malaria transmission in Africa | journal=Nature Communications | volume=11 | issue=1 | article-number=4353 | date=August 2020 | pmid=32859908 | pmc=7455692 | doi=10.1038/s41467-020-18239-5 | bibcode=2020NatCo..11.4353S}}</ref> Recent research has provided a more in-depth picture of conditions across Africa, combining a malaria climatic suitability model with a continental-scale model representing real-world hydrological processes.<ref name="Smith-2020" />

====Changes in geographic distribution====

Climate change has led to shifts in malaria-endemic regions, with the disease expanding into higher altitudes and previously malaria-free areas.<ref name=Caminade14>{{cite journal |vauthors=Caminade C, Kovats S, Rocklov J, Tompkins AM, Morse AP, Colón-González FJ, Stenlund H, Martens P, Lloyd SJ |title=Impact of climate change on global malaria distribution |journal=Proceedings of the National Academy of Sciences USA |volume=111 |issue=9 |pages=3286–91 |date=March 2014 |pmid=24596427 |pmc=3948226 |doi=10.1073/pnas.1302089111 |doi-access=free |bibcode=2014PNAS..111.3286C}}</ref>
Rising temperatures allow mosquitoes to survive in regions that were once too cold for them, including highland areas in Africa, South America, and parts of Asia.<ref name=Caminade14/>
A study analyzing malaria cases in Ethiopian and Colombian highlands found a strong correlation between increased temperatures and malaria incidence, demonstrating that climate change has made previously inhospitable areas suitable for transmission.<ref name=Siraj14>{{cite journal |vauthors=Siraj AS, Santos-Vega M, Bouma MJ, Yadeta D, Ruiz Carrascal D, Pascual M |title=Altitudinal changes in malaria incidence in highlands of Ethiopia and Colombia |journal=Science |volume=343 |issue=6175 |pages=1154–8 |date=March 2014 |pmid=24604201 |doi=10.1126/science.1244325 |bibcode=2014Sci...343.1154S}}</ref>

====Increased transmission season====

Malaria transmission is highly sensitive to temperature and rainfall patterns.<ref name=Siraj14/> Climate change has led to longer transmission seasons in tropical regions, where mosquitoes can breed year-round due to prolonged periods of high humidity and warm temperatures.<ref name=Sewe21>{{cite journal |vauthors=Colón-González FJ, Sewe MO, Tompkins AM, Sjödin H, Casallas A, Rocklöv J, Caminade C, Lowe R |title=Projecting the risk of mosquito-borne diseases in a warmer and more populated world: a multi-model, multi-scenario intercomparison modelling study |journal=Lancet Planet Health |volume=5 |issue=7 |pages=e404–14 |date=July 2021 |pmid=34245711 |pmc=8280459 |doi=10.1016/S2542-5196(21)00132-7}}</ref> Research suggests that in parts of sub-Saharan Africa, the malaria transmission season has lengthened by several months, particularly in regions where warming has pushed temperatures into the optimal range for ''Plasmodium falciparum'' development.<ref name=Sewe21/> In regions such as West Africa and parts of India, increasing temperatures and prolonged rainy seasons have contributed to a rise in malaria cases.<ref name=Sewe21/> Some studies predict that by 2050, many malaria-endemic areas will experience a 20–30% increase in transmission duration due to warming trends.<ref name=Caminade14/>

====Effects of extreme weather events====

Extreme weather events, such as heavy rainfall, flooding, and droughts, are increasing in frequency and intensity due to climate change, creating favorable conditions for malaria outbreaks.<ref name=Bouma96>{{cite journal |vauthors=Bouma MJ, van der Kaay HJ |title=The El Niño Southern Oscillation and the historic malaria epidemics on the Indian subcontinent and Sri Lanka: an early warning system for future epidemics? |journal=Tropical Medicine & International Health |volume=1 |issue=1 |pages=86–96 |date=February 1996 |pmid=8673827 |doi=10.1046/j.1365-3156.1996.d01-7.x}}</ref> Flooding provides ideal breeding grounds for mosquitoes by forming stagnant water pools, while droughts can also exacerbate malaria by forcing human populations to store water in open containers, which serve as mosquito habitats.<ref name=Bouma96/> This effect has been observed in parts of sub-Saharan Africa and South Asia, where prolonged drought periods were followed by spikes in malaria cases.<ref name=Bouma96/> A review of malaria outbreaks linked to climate variability found that El Niño events, which increase rainfall and temperatures in malaria-endemic regions, have been associated with significant surges in cases.<ref>{{cite journal |vauthors=Hay SI, Shanks GD, Stern DI, Snow RW, Randolph SE, Rogers DJ |title=Climate variability and malaria epidemics in the highlands of East Africa |journal=Trends in Parasitology |volume=21 |issue=2 |pages=52–53 |date=February 2005 |pmid=15664524 |pmc=3173848 |doi=10.1016/j.pt.2004.11.007}}</ref>

====Resistance and adaptation of vectors====

Higher temperatures accelerate the development of ''Plasmodium'' parasites within mosquitoes, potentially leading to increased transmission efficiency.<ref name=Shapiro17>{{cite journal |vauthors=Shapiro LL, Whitehead SA, Thomas MB |title=Quantifying the effects of temperature on mosquito and parasite traits that determine the transmission potential of human malaria |journal=PLOS Biology |volume=15 |issue=10 |article-number=e2003489 |date=October 2017 |pmid=29036170 |pmc=5658182 |doi=10.1371/journal.pbio.2003489 |doi-access=free}}</ref> Additionally, rising temperatures and changing environmental conditions have been linked to the spread of insecticide resistance in mosquito populations, complicating malaria control efforts.<ref name=Shapiro17/> A global survey found that ''Anopheles'' mosquitoes in Africa, Asia, and South America have developed increased resistance to commonly used insecticides such as pyrethroids.<ref>{{cite journal |vauthors=Suh PF, Elanga-Ndille E, Tchouakui M, Sandeu MM, Tagne D, Wondji C, Ndo C |title=Impact of insecticide resistance on malaria vector competence: a literature review |journal=Malaria Journal |volume=22 |issue=1 |article-number=19 |date=January 2023 |pmid=36650503 |pmc=9847052 |doi=10.1186/s12936-023-04444-2 |doi-access=free}}</ref>

===Urbanization and malaria trends===
Urbanization has a great effect on malaria. There are better healthcare and infrastructure in the cities which then reduce malaria. Whereas poorer areas with bad sanitation allow mosquitoes to thrive which then increase malaria.<ref>{{cite journal |vauthors=Agyemang-Badu SY, Awuah E, Oduro-Kwarteng S, Dzamesi JY, Dom NC, Kanno GG |year=2023 |title=Environmental Management and Sanitation as a Malaria Vector Control Strategy: A Qualitative Cross-Sectional Study Among Stakeholders, Sunyani Municipality, Ghana |journal=Environmental Health Insights |volume=17 |issue=17 |article-number=11786302221146890 |doi=10.1177/11786302221146890|pmid=36620305 |pmc=9817013 |bibcode=2023EnvHI..1711468A}}</ref> Some African cities have more malaria cases compared to suburban areas. In Bangkok, it has been shown that malaria has dropped due to better control.<ref>{{cite journal |vauthors=Sudathip P, Kongkasuriyachai D, Stelmach R, Bisanzio D, Sine J, Sawang S, Kitchakarn S, Sintasath D, Reithinger R |year=2019 |title=The Investment Case for Malaria Elimination in Thailand: A Cost-Benefit Analysis |journal=The American Journal of Tropical Medicine and Hygiene |volume=100 |issue=6 |pages=1445–1453 |doi=10.4269/ajtmh.18-0897|pmid=30994098 |pmc=6553898}}</ref>

===Global trends since 2000===
At the start of the 21st century, several global initiatives renewed efforts to control and eventually [[Eradication of malaria|eradicate malaria]]. In 2000, malaria control became a key objective of the United Nations [[Millennium Development Goals]],<ref>{{cite journal |vauthors=Sato S |date=January 2021 |title=''Plasmodium''-a brief introduction to the parasites causing human malaria and their basic biology |journal=Journal of Physiological Anthropology |volume=40 |issue=1 |article-number=1 |doi=10.1186/s40101-020-00251-9 |pmc=7792015 |pmid=33413683 |doi-access=free}}</ref> followed in 2015 by the [[Sustainable Development Goals]], which aim to end the malaria epidemic by 2030. From 2005 to 2014, global financing for malaria programmes rose sharply from about US $960 million to US $2.5 billion, largely driven by international donors and focused on the WHO African Region.<ref name=glopro/> This surge in funding, channelled through programmes such as the [[Global Fund to Fight AIDS, Tuberculosis and Malaria]]<ref>{{cite web | title=Results Report 2025 | website=The Global Fund to Fight AIDS, Tuberculosis and Malaria | date=2025-06-30 | url=https://www.theglobalfund.org/en/results/ | access-date=2025-11-03}}</ref> and [[Malaria No More]]<ref>{{Cite news | vauthors=Strom S |author-link=Stephanie Strom |date=April 1, 2011 |title=Mission Accomplished, Nonprofits Go Out of Business |newspaper=The New York Times |url=https://www.nytimes.com/2011/04/02/business/02charity.html |oclc=292231852 |access-date=2012-05-09 |url-status=live |archive-url=https://web.archive.org/web/20111225132828/http://www.nytimes.com/2011/04/02/business/02charity.html |archive-date=December 25, 2011}}</ref> supported an extensive scale-up of malaria control tools such as insecticide-treated nets, indoor spraying, rapid diagnostic tests, and artemisinin-based combination therapies, though overall resources remained below the estimated US $5 billion needed annually to meet global targets.<ref name=glopro>{{cite journal | last1=Cibulskis | first1=Richard E. | last2=Alonso | first2=Pedro | last3=Aponte | first3=John | last4=Aregawi | first4=Maru | last5=Barrette | first5=Amy | last6=Bergeron | first6=Laurent | last7=Fergus | first7=Cristin A. | last8=Knox | first8=Tessa | last9=Lynch | first9=Michael | last10=Patouillard | first10=Edith | last11=Schwarte | first11=Silvia | last12=Stewart | first12=Saira | last13=Williams | first13=Ryan | title=Malaria: Global progress 2000 – 2015 and future challenges | journal=Infectious Diseases of Poverty | publisher=Springer Science and Business Media LLC | volume=5 | issue=1 | date=2016-06-09 | issn=2049-9957 | doi=10.1186/s40249-016-0151-8 | doi-access=free | page=}}</ref> 

Between 2004 and 2015, the global scale-up of malaria control led to a dramatic rise in [[insecticide-treated net]] deliveries to endemic countries, from 6 million to nearly 190 million per year, with more than a billion distributed overall. As a result, household access to such nets in sub-Saharan Africa increased from 7 percent in 2005 to about two-thirds by 2015, though universal coverage targets remained unmet.<ref name=glopro/> By 2014, coverage of preventive malaria treatment during pregnancy had increased, with more than half of eligible women receiving at least one dose. However, many opportunities to deliver treatment were missed, and preventive drug programmes for children and infants were adopted in only a few countries.<ref name=glopro/>

Between 2005 and 2014, diagnostic testing for malaria increased sharply, particularly in the [[List of WHO regions#African Region (AFR)|WHO African Region]], where testing of suspected cases in the public sector rose from 36 to 65 percent, largely due to the spread of rapid diagnostic tests. Over the same period, treatment practices improved, with the share of children under five receiving [[artemisinin]]-based combination therapies increasing from under 1 percent in 2005 to about 16 percent in 2015, while use of older antimalarial drugs declined.<ref name=glopro/> From 2000 to 2015, global malaria cases declined from about 262 million to 214 million, a reduction of roughly 18 percent, with the WHO African Region accounting for nearly nine out of ten infections. During the same period, malaria deaths fell by almost half, from an estimated 839 000 to 438 000, reflecting major progress toward international targets to reduce disease incidence and mortality.<ref name=glopro/>

By 2015, a growing number of countries had moved closer to eliminating malaria. The number of nations with fewer than 1,000 cases rose from 13 in 2000 to 33, and 16 countries reported no locally transmitted cases. That same year, the [[List of WHO regions#European Region (EUR)|WHO European Region]] recorded zero indigenous infections for the first time, meeting the target set in the [[Tashkent Declaration]].<ref name=glopro/>

The progress made until 2015 stalled thereafter. From 2015 to 2022, case rates remained stable, followed by a slight rise in 2023 to 60.4 per 1,000, with sharp increases reported in Ethiopia, Madagascar, and Pakistan. Malaria deaths fell steadily until 2019, rose sharply in 2020 as a result of COVID-19 disruptions, and then declined again in the following years. While malaria remained most deadly for young children, their share of overall deaths had fallen. A small group of countries accounted for 95% of global cases, with Nigeria, the Democratic Republic of the Congo, Uganda, Ethiopia, and Mozambique together responsible for more than half.<ref>{{cite book|last1=WHO|url=https://www.who.int/teams/global-malaria-programme/|title=World Malaria Report 2024|date=2024|publisher=World Health Organization|isbn=978-92-4-010444-0 |location=Switzerland|access-date=2025-11-04}}</ref>

This stalling from 2015 was due to a combination of environmental, humanitarian, and biological challenges. Climate change created conditions that favored mosquito breeding and survival, with rising temperatures, shifting rainfall, and frequent floods expanding transmission zones. In Pakistan, for example, the 2022 floods led to an eightfold increase in malaria cases within two years.<ref name=glomal>{{cite web | title=Global Malaria Progress Stalled With Nearly 600,000 Deaths In 2023 | website=Health Policy Watch | date=2024-12-11 | url=https://healthpolicy-watch.news/global-malaria-progress-stalled/ | access-date=2025-11-04}}</ref> Conflicts and resulting humanitarian crises have also disrupted health services and displaced millions of people into areas with little access to prevention or treatment. At the same time, growing resistance to both insecticides and artemisinin-based therapies has made malaria harder to control and treat. These overlapping pressures—climate change, conflict, displacement, and resistance—have together undermined the progress achieved in earlier decades.<ref name=glomal/>

==History==
{{Main|History of malaria|Mosquito-malaria theory}}

[[File:Malaria pathogens.jpg|thumb|upright|Ancient malaria oocysts preserved in [[Dominican amber]]]]
Although the parasite responsible for ''P.&nbsp;falciparum'' malaria has been in existence for 50,000–100,000 years, the population size of the parasite did not increase until about 10,000 years ago, concurrently with advances in agriculture<ref name="Harper-2010"/> and the development of human settlements. Close relatives of the human malaria parasites remain common in chimpanzees. Some evidence suggests that the ''P.&nbsp;falciparum'' malaria may have originated in gorillas.<ref name="Prugnolle-2011"/>

References to the unique periodic fevers of malaria are found throughout history.<ref name="Cox-2002"/> Ancient Indian physician [[Sushruta]] believed that the disease was associated with biting insects,<ref>{{Cite book |last=Dziedzic |first=Nancy |url=https://books.google.com/books?id=3oJmDwAAQBAJ |title=Malaria |date=2009-11-20 |publisher=Greenhaven Publishing LLC |isbn=978-0-7377-4379-1 |language=en}}</ref> long before the Roman [[Columella]] associated the disease with insects from swamps.<ref name="Strong-1944" /> Hippocrates described periodic fevers, labelling them tertian, quartan, subtertian and quotidian.<ref name="Strong-1944">{{cite book| vauthors=Strong RP |title=Stitt's Diagnosis, Prevention and Treatment of Tropical Diseases|date=1944|publisher=The Blakiston Company|location=York, PA|page=3|edition=Seventh}}</ref> Malaria may have contributed to the decline of the [[Roman Empire]],<ref name="BBC News-2001"/> and was so pervasive in Rome that it was known as the "[[Roman Fever (disease)|Roman fever]]".<ref name="Sallares-2002"/> Several regions in ancient Rome were considered at-risk for the disease because of the favourable conditions present for malaria vectors. This included areas such as southern Italy, the island of [[Sardinia]], the [[Pontine Marshes]], the lower regions of coastal [[Etruria]] and the city of [[Rome]] along the [[Tiber]]. The presence of stagnant water in these places was preferred by mosquitoes for breeding grounds. Irrigated gardens, swamp-like grounds, run-off from agriculture, and drainage problems from road construction led to the increase of standing water.<ref name="Hays-2005"/>

[[File:Ronald Ross.jpg|thumb|left|British doctor [[Ronald Ross]] received the [[Nobel Prize for Physiology or Medicine]] in 1902 for his work on malaria.]]

Malaria is not referenced in the medical books of the [[Maya peoples|Mayans]] or [[Aztecs]]. Despite this, antibodies against malaria have been detected in some South American mummies, indicating that some malaria strains in the Americas might have a pre-Columbian origin.<ref>{{cite journal | vauthors=Rodrigues PT, Valdivia HO, de Oliveira TC, Alves JM, Duarte AM, Cerutti-Junior C, Buery JC, Brito CF, de Souza JC, Hirano ZM, Bueno MG, Catão-Dias JL, Malafronte RS, Ladeia-Andrade S, Mita T, Santamaria AM, Calzada JE, Tantular IS, Kawamoto F, Raijmakers LR, Mueller I, Pacheco MA, Escalante AA, Felger I, Ferreira MU | title=Human migration and the spread of malaria parasites to the New World | journal=Scientific Reports | volume=8 | issue=1 | article-number=1993 | date=January 2018 | pmid=29386521 | pmc=5792595 | doi=10.1038/s41598-018-19554-0 | bibcode=2018NatSR...8.1993R}}</ref> European settlers and the West Africans they [[Atlantic slave trade|enslaved]] likely brought malaria to the Americas starting in the 16th century.<ref>{{cite journal |vauthors=De Castro MC, Singer BH |title=Was malaria present in the Amazon before the European conquest? Available evidence and future research agenda |journal=J. Archaeol. Sci. |volume=32 |pages=337–40 |year=2005 |doi=10.1016/j.jas.2004.10.004 |issue=3|bibcode=2005JArSc..32..337D}}</ref><ref>{{cite journal | vauthors=Yalcindag E, Elguero E, Arnathau C, Durand P, Akiana J, Anderson TJ, Aubouy A, Balloux F, Besnard P, Bogreau H, Carnevale P, D'Alessandro U, Fontenille D, Gamboa D, Jombart T, Le Mire J, Leroy E, Maestre A, Mayxay M, Ménard D, Musset L, Newton PN, Nkoghé D, Noya O, Ollomo B, Rogier C, Veron V, Wide A, Zakeri S, Carme B, Legrand E, Chevillon C, Ayala FJ, Renaud F, Prugnolle F | title=Multiple independent introductions of ''Plasmodium falciparum'' in South America | journal=Proceedings of the National Academy of Sciences of the United States of America | volume=109 | issue=2 | pages=511–516 | date=January 2012 | pmid=22203975 | pmc=3258587 | doi=10.1073/pnas.1119058109 | doi-access=free | bibcode=2012PNAS..109..511Y}}</ref>

Scientific studies on malaria made their first significant advance in 1880, when [[Charles Louis Alphonse Laveran]]—a French army doctor working in the military hospital of [[Constantine, Algeria|Constantine]] in [[Algeria]]—observed parasites inside the red blood cells of infected people for the first time.<ref>{{cite journal |title=Malarial organisms in the blood |journal=Scientific American |url=https://books.google.com/books?id=zoE9AQAAIAAJ&pg=PA37 |date=21 January 1882 |publisher=Munn & Company |pages=37–38 |volume=46 |issue=3}}</ref> He, therefore, proposed that malaria is caused by this organism, the first time a [[protist]] was identified as causing disease.<ref name="The Nobel Foundation"/> For this and later discoveries, he was awarded the 1907 [[Nobel Prize for Physiology or Medicine]]. A year later, [[Carlos Finlay]], a Cuban doctor treating people with [[yellow fever]] in [[Havana]], provided strong evidence that mosquitoes were transmitting disease to and from humans.<ref name="Tan-2008"/> This work followed earlier suggestions by [[Josiah C. Nott]],<ref name="Chernin-1983"/> and work by [[Sir Patrick Manson]], the "father of tropical medicine", on the transmission of [[filariasis]].<ref name="Chernin-1977"/>

[[File:Tu Youyou 5012-1-2015.jpg|thumb|left|Chinese medical researcher [[Tu Youyou]] received the [[Nobel Prize for Physiology or Medicine]] in 2015 for her work on the antimalarial drug [[artemisinin]].]]

In April 1894, a Scottish physician, [[Ronald Ross|Sir Ronald Ross]], visited Sir Patrick Manson at his house on Queen Anne Street, London. This visit was the start of four years of collaboration and fervent research that culminated in 1897 when Ross, who was working in the [[Presidency General Hospital]] in [[Kolkata|Calcutta]], proved the complete life-cycle of the malaria parasite in mosquitoes.<ref name="Cox-2010" /> He thus proved that the mosquito was the vector for malaria in humans by showing that certain mosquito species transmit malaria to birds. He isolated malaria parasites from the salivary glands of mosquitoes that had fed on infected birds.<ref name="Cox-2010" /> For this work, Ross received the 1902 Nobel Prize in Medicine. After resigning from the [[Indian Medical Service]], Ross worked at the newly established [[Liverpool School of Tropical Medicine]] and directed malaria-control efforts in [[Egypt]], [[Panama]], [[Greece]] and [[Mauritius]].<ref name="CDC Malaria website"/> The findings of Finlay and Ross were later confirmed by a medical board headed by [[Walter Reed]] in 1900. Its recommendations were implemented by [[William C. Gorgas]] in [[Health measures during the construction of the Panama Canal|the health measures undertaken]] during construction of the [[Panama Canal]]. This public-health work saved the lives of thousands of workers and helped develop the methods used in future public-health campaigns against the disease.<ref name="Simmons-1979"/>

In 1896, [[Amico Bignami]] discussed the role of mosquitoes in malaria.<ref>{{cite web |title=Amico Bignami |url=https://www.whonamedit.com/doctor.cfm/2484.html |website=whonamedit.com |access-date=30 July 2019 |archive-date=30 July 2019 |archive-url=https://web.archive.org/web/20190730000452/https://www.whonamedit.com/doctor.cfm/2484.html |url-status=live}}</ref> In 1898, Bignami, [[Giovanni Battista Grassi]] and [[Giuseppe Bastianelli]] succeeded in showing experimentally the transmission of malaria in humans, using infected mosquitoes to contract malaria themselves which they presented in November 1898 to the [[Accademia dei Lincei]].<ref name="Cox-2010">{{cite journal | vauthors=Cox FE | title=History of the discovery of the malaria parasites and their vectors | journal=Parasites & Vectors | volume=3 | issue=1 | page=5 | date=February 2010 | pmid=20205846 | pmc=2825508 | doi=10.1186/1756-3305-3-5 | doi-access=free}}</ref>

[[File:Artemisia annua West Virginia.jpg|thumb|right|''Artemisia annua'', source of the antimalarial drug [[artemisinin]]]]

The first effective treatment for malaria came from the bark of [[Cinchona|cinchona tree]], which contains [[quinine]]. This tree grows on the slopes of the [[Andes]], mainly in [[Peru]]. The [[indigenous peoples of Peru]] made a [[tincture]] of cinchona to control fever. Its effectiveness against malaria was found and the [[Jesuit]]s introduced the treatment to Europe around 1640; by 1677, it was included in the [[London Pharmacopoeia]] as an antimalarial treatment.<ref name="Kaufman-2005"/> It was not until 1820 that the active ingredient, quinine, was extracted from the bark, isolated and named by the French chemists [[Pierre Joseph Pelletier]] and [[Joseph Bienaimé Caventou]].<ref name="Pelletier-1820"/><ref name="Kyle-1974"/>

Quinine was the predominant malarial medication until the 1920s when other medications began to appear. In the 1940s, chloroquine replaced quinine as the treatment of both uncomplicated and severe malaria until resistance supervened, first in Southeast Asia and South America in the 1950s and then globally in the 1980s.<ref name="Achan-2011"/>

The medicinal value of ''[[Artemisia annua]]'' has been used by Chinese herbalists in [[traditional Chinese medicines]] for 2,000 years.<ref>{{cite journal | vauthors=Ekiert H, Świątkowska J, Klin P, Rzepiela A, Szopa A | title=Artemisia annua - Importance in Traditional Medicine and Current State of Knowledge on the Chemistry, Biological Activity and Possible Applications | journal=Planta Medica | volume=87 | issue=8 | pages=584–599 | date=July 2021 | pmid=33482666 | doi=10.1055/a-1345-9528 | bibcode=2021PlMed..87..584E}}</ref><ref>{{cite journal | vauthors=Timóteo P, Wessels C, Righeschi C, Goris H, Bilia A |title=Evaluation of stability of constituents of herbal drug preparations from Artemisia annua L |journal=Planta Medica |date=24 August 2010 |volume=76 |issue=12 |doi=10.1055/s-0030-1264749 |bibcode=2010PlMed..7664749T}}</ref> In 1596, Li Shizhen recommended tea made from qinghao specifically to treat malaria symptoms in his "[[Compendium of Materia Medica]]", however the efficacy of tea, made with ''A.&nbsp;annua'', for the treatment of malaria is dubious, and is discouraged by the [[World Health Organization]] (WHO).<ref>{{cite book |title=WHO monograph on good agricultural and collection practices (GACP) for Artemisia annua L |date=2006 |publisher=World Health Organization |isbn=978-92-4-159443-1 |hdl=10665/43509 |hdl-access=free}}{{page needed|date=July 2024}}</ref><ref>{{cite journal | vauthors=van der Kooy F, Sullivan SE | title=The complexity of medicinal plants: the traditional Artemisia annua formulation, current status and future perspectives | journal=Journal of Ethnopharmacology | volume=150 | issue=1 | pages=1–13 | date=October 2013 | pmid=23973523 | doi=10.1016/j.jep.2013.08.021 | type=Review}}</ref> Artemisinins, discovered by Chinese scientist [[Tu Youyou]] and colleagues in the 1970s from the plant ''Artemisia annua'', became the recommended treatment for ''P.&nbsp;falciparum'' malaria, administered in severe cases in combination with other antimalarials.<ref name="Hsu-2006"/> Tu says she was influenced by a [[Chinese herbology|traditional Chinese herbal medicine]] source, ''The Handbook of Prescriptions for Emergency Treatments'', written in 340 by [[Ge Hong]].<ref>{{cite web | vauthors=Hao C |date=29 September 2011 |url=https://www.science.org/content/article/lasker-award-rekindles-debate-over-artemisinins-discovery |title=Lasker Award Rekindles Debate Over Artemisinin's Discovery |publisher=Science/AAAS |work=News: ScienceInsider |url-status=live |archive-url=https://web.archive.org/web/20140104214759/http://news.sciencemag.org/asia/2011/09/lasker-award-rekindles-debate-over-artemisinins-discovery |archive-date=4 January 2014}}</ref> For her work on malaria, [[Tu Youyou]] received the 2015 [[Nobel Prize in Physiology or Medicine]].<ref name="NobelPrize.org">{{cite web |title=Nobel Prize announcement |url=https://www.nobelprize.org/nobel_prizes/medicine/laureates/2015/press.pdf |website=NobelPrize.org |access-date=5 October 2015 |url-status=live |archive-url=https://web.archive.org/web/20151006112430/http://www.nobelprize.org/nobel_prizes/medicine/laureates/2015/press.pdf |archive-date=6 October 2015}}</ref>

''Plasmodium vivax'' was used between 1917 and the 1940s for [[malariotherapy]]—deliberate injection of malaria parasites to induce a fever to combat certain diseases such as tertiary [[syphilis]]. In 1927, the inventor of this technique, [[Julius Wagner-Jauregg]], received the Nobel Prize in Physiology or Medicine for his discoveries. The technique was dangerous, killing about 15% of patients, so it is no longer in use.<ref name="Vogel-2013"/>

[[File:GuadMarinesMalaria.gif|thumb|U.S. Marines with malaria in a field hospital on [[Guadalcanal]], October 1942]]

The first pesticide used for indoor residual spraying was [[DDT]].<ref name="US CDC-2010a"/> Although it was initially used exclusively to combat malaria, its use quickly spread to [[agriculture]]. In time, pest control, rather than disease control, came to dominate DDT use, and this large-scale agricultural use led to the evolution of [[pesticide resistance|pesticide-resistant]] mosquitoes in many regions. The DDT resistance shown by ''Anopheles'' mosquitoes can be compared to [[antibiotic resistance]] shown by bacteria. During the 1960s, awareness of the negative consequences of its indiscriminate use increased, ultimately leading to bans on agricultural applications of DDT in many countries in the 1970s.<ref name="van den Berg-2009"/> Before DDT, malaria was successfully eliminated or controlled in tropical areas like Brazil and Egypt by removing or poisoning the breeding grounds of the mosquitoes or the aquatic habitats of the larval stages, for example by applying the highly toxic arsenic compound [[Paris Green]] to places with standing water.<ref name="Killeen-2002"/>

===Names===
Various types of malaria have been called by the names below:{{citation needed|date=July 2024}}

{| class="wikitable sortable" border="1"
! Name !! Pathogen !! Notes
|-
| | algid malaria<ref>{{Cite journal |last1=Lacerda |first1=Marcus Vinícius Guimarães de |last2=Mourão |first2=Maria Paula Gomes |last3=Santos |first3=Pablo José Tomé dos |last4=Alecrim |first4=Maria das Graças Costa |date=Feb 2009 |title=Malária álgida: um diagnóstico sindrômico |journal=Revista da Sociedade Brasileira de Medicina Tropical |volume=42 |issue=1 |pages=79–81 |doi=10.1590/S0037-86822009000100017 |issn=0037-8682|doi-access=free |pmid=19287942}}</ref>|| ''[[Plasmodium falciparum]]'' || severe malaria affecting the [[cardiovascular system]] and causing [[chills]] and [[circulatory shock]]
|-
| bilious malaria || ''[[Plasmodium falciparum]]'' || severe malaria affecting the [[liver]] and causing [[vomiting]] and [[jaundice]]
|-
| cerebral malaria || ''[[Plasmodium falciparum]]'' || severe malaria affecting the [[cerebrum]]
|-
| congenital malaria || various [[Plasmodium|plasmodia]] || ''Plasmodium'' [[vertically transmitted infection|introduced from the mother]] via the [[fetal circulation]]
|-
| pernicious malaria || ''[[Plasmodium falciparum]]'' || severe malaria leading to grave illness
|-
| malignant malaria || ''[[Plasmodium falciparum]]'' || severe malaria leading to death
|-
| falciparum malaria, ''Plasmodium falciparum'' malaria,  || ''[[Plasmodium falciparum]]'' ||
|-
| ovale malaria, ''Plasmodium ovale'' malaria || ''[[Plasmodium ovale]]'' ||
|-
| quartan malaria, malariae malaria, ''Plasmodium malariae'' malaria || ''[[Plasmodium malariae]]'' || paroxysms every fourth day ([[wikt:quartan#Adjective|quartan]]), counting the day of occurrence as the first day
|-
| quotidian malaria || ''[[Plasmodium falciparum]]'', ''[[Plasmodium vivax]]'', ''[[Plasmodium knowlesi]]'' || paroxysms daily ([[wikt:quotidian#Adjective|quotidian]])
|-
| tertian malaria || ''[[Plasmodium falciparum]]'', ''[[Plasmodium ovale]]'', ''[[Plasmodium vivax]]'' || paroxysms every third day ([[wikt:tertian#Adjective|tertian]]), counting the day of occurrence as the first
|-
| transfusion malaria || various [[Plasmodium|plasmodia]] || ''Plasmodium'' introduced by [[blood transfusion]], [[needle sharing]], or [[needlestick injury]]
|-
| vivax malaria, ''Plasmodium vivax'' malaria || ''[[Plasmodium vivax]]'' ||
|-
|}

===Initial WHO program (1955–1969)===
[[File:L0074987 Malaria eradication - the world united against malaria (20675407876).jpg|thumb|right|1962 Pakistani postage stamp promoting malaria eradication program]]

In 1955 the WHO launched the Global Malaria Eradication Program (GMEP).<ref name="Duintjer-2009">{{cite journal | vauthors=Duintjer Tebbens RJ, Thompson KM | title=Priority Shifting and the Dynamics of Managing Eradicable Infectious Diseases | journal=Management Science | volume=55 | issue=4 | pages=650–663 | year=2009 | doi=10.1287/mnsc.1080.0965}}</ref> The program relied largely on DDT for mosquito control and rapid diagnosis and treatment to break the transmission cycle.<ref>{{cite journal | vauthors=Mendis K, Rietveld A, Warsame M, Bosman A, Greenwood B, Wernsdorfer WH | title=From malaria control to eradication: The WHO perspective | journal=Tropical Medicine & International Health | volume=14 | issue=7 | pages=802–809 | date=July 2009 | pmid=19497083 | doi=10.1111/j.1365-3156.2009.02287.x | s2cid=31335358 | doi-access=free}}</ref> The program eliminated the disease in "North America, Europe, the former [[Soviet Union]]",<ref name="Sadasivaiah-2007"/> and in "[[Taiwan]], much of the [[Caribbean]], the [[Balkans]], parts of northern Africa, the northern region of Australia, and a large swath of the South Pacific"<ref name="Gladwell-2001">{{cite news | vauthors=Gladwell M |author-link=Malcolm Gladwell |title=The Mosquito Killer |newspaper=The New Yorker |date=July 2, 2001 |url=http://gladwell.com/the-mosquito-killer/ |access-date=August 20, 2014 |archive-url=https://web.archive.org/web/20160416165010/http://gladwell.com/the-mosquito-killer/ |archive-date=April 16, 2016 }}</ref> and dramatically reduced mortality in [[Sri Lanka]] and India.<ref name="Harrison-1978"/>

However, failure to sustain the program, increasing mosquito tolerance to DDT, and increasing parasite tolerance led to a resurgence. In many areas early successes partially or completely reversed, and in some cases rates of transmission increased.<ref name="Chapin-1981">{{cite journal | vauthors=Chapin G, Wasserstrom R | title=Agricultural production and malaria resurgence in Central America and India | journal=Nature | volume=293 | issue=5829 | pages=181–185 | year=1981 | pmid=7278974 | doi=10.1038/293181a0 | s2cid=4346743 | doi-access=free | bibcode=1981Natur.293..181C}}</ref> Experts tie malarial resurgence to multiple factors, including poor leadership, management and funding of malaria control programs; poverty; civil unrest; and increased [[irrigation]]. The evolution of resistance to first-generation drugs (e.g. [[chloroquine]]) and to insecticides exacerbated the situation.<ref name="van den Berg-2008">{{cite web|url=http://www.pops.int/documents/ddt/Global%20status%20of%20DDT%20SSC%2020Oct08.pdf|title=Global status of DDT and its alternatives for use in vector control to prevent disease| vauthors=van den Berg H | date=October 23, 2008|publisher=[[Stockholm Convention on Persistent Organic Pollutants]]/[[United Nations Environment Programme]]|access-date=November 22, 2008|archive-url=https://web.archive.org/web/20101217022138/http://www.pops.int/documents/ddt/Global%20status%20of%20DDT%20SSC%2020Oct08.pdf|archive-date=December 17, 2010|df=mdy-all}}</ref><ref name="Feachem-2007">{{cite journal | vauthors=Feachem RG, Sabot OJ | title=Global malaria control in the 21st century: a historic but fleeting opportunity | journal=JAMA | volume=297 | issue=20 | pages=2281–2284 | date=May 2007 | pmid=17519417 | doi=10.1001/jama.297.20.2281}}</ref> The program succeeded in eliminating malaria only in areas with "high socio-economic status, well-organized healthcare systems, and relatively less intensive or seasonal malaria transmission".<ref name="Sadasivaiah-2007">{{cite journal | vauthors=Sadasivaiah S, Tozan Y, Breman JG | title=Dichlorodiphenyltrichloroethane (DDT) for indoor residual spraying in Africa: how can it be used for malaria control? | journal=The American Journal of Tropical Medicine and Hygiene | volume=77 | issue=6 Suppl | pages=249–263 | date=December 2007 | pmid=18165500 | doi=10.4269/ajtmh.2007.77.249 | doi-access=free}}</ref>

For example, in [[Sri Lanka]], the program reduced cases from about one million per year before spraying to just 18 in 1963<ref>{{cite book|title=The Coming Plague: Newly Emerging Diseases in a World Out of Balance|page=51| vauthors=Garrett L |url=https://books.google.com/books?id=v9RY2PVOtOMC&pg=PA51|year=1994|publisher=Farrar, Straus and Giroux|isbn=978-1-4299-5327-6|access-date=August 29, 2022|archive-date=October 19, 2021|archive-url=https://web.archive.org/web/20211019223243/https://books.google.com/books?id=v9RY2PVOtOMC&pg=PA51|url-status=live}}</ref><ref>{{cite news | url=https://www.nytimes.com/2010/12/28/health/28global.html | title=Malaria: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka |  vauthors=McNeil Jr DG | work=The New York Times | date=December 27, 2010 | access-date=February 7, 2017 | archive-date=January 4, 2017 | archive-url=https://web.archive.org/web/20170104050535/http://www.nytimes.com/2010/12/28/health/28global.html | url-status=live}}</ref> and 29 in 1964. Thereafter the program was halted to save money and malaria rebounded to 600,000 cases in 1968 and the first quarter of 1969. The country resumed DDT vector control but the mosquitoes had evolved resistance in the interim, presumably because of continued agricultural use. The program switched to [[malathion]], but despite initial successes, malaria continued its resurgence into the 1980s.<ref name="Harrison-1978">{{cite book|title=Mosquitoes, Malaria, and Man: A History of the Hostilities Since 1880|isbn=978-0-525-16025-0| vauthors=Harrison GA |url=https://books.google.com/books?id=mfkBr2oskyEC|year=1978|publisher=Dutton|access-date=August 29, 2022|archive-date=October 19, 2021|archive-url=https://web.archive.org/web/20211019210418/https://books.google.com/books?id=mfkBr2oskyEC|url-status=live}}</ref><ref>{{cite journal | vauthors=Karunaweera ND, Galappaththy GN, Wirth DF | title=On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs | journal=Malaria Journal | volume=13 | article-number=59 | date=February 2014 | pmid=24548783 | pmc=3943480 | doi=10.1186/1475-2875-13-59 | doi-access=free}}</ref>

Due to vector and parasite resistance and other factors, the [[Eradication of infectious diseases|feasibility of eradicating malaria]] with the strategy used at the time and resources available led to waning support for the program.<ref name="Nájera-2011">{{cite journal | vauthors=Nájera JA, González-Silva M, Alonso PL | title=Some lessons for the future from the Global Malaria Eradication Programme (1955-1969) | journal=PLOS Medicine | volume=8 | issue=1 | article-number=e1000412 | date=January 2011 | pmid=21311585 | pmc=3026700 | doi=10.1371/journal.pmed.1000412 | doi-access=free}}</ref> WHO suspended the program in 1969<ref name="Duintjer-2009"/><ref name="Nájera-2011"/> and attention instead focused on controlling and treating the disease. Spraying programs (especially using DDT) were curtailed due to concerns over safety and environmental effects, as well as problems in administrative, managerial and financial implementation.<ref name="Chapin-1981"/> Efforts shifted from spraying to the use of [[Mosquito net|bednets]] impregnated with insecticides and other interventions.<ref name="Sadasivaiah-2007"/><ref name="Rogan-2005">{{cite journal | vauthors=Rogan WJ, Chen A | title=Health risks and benefits of bis(4-chlorophenyl)-1,1,1-trichloroethane (DDT) | journal=The Lancet | volume=366 | issue=9487 | pages=763–773 | year=2005 | pmid=16125595 | doi=10.1016/S0140-6736(05)67182-6 | url=https://zenodo.org/record/1259797 | access-date=June 13, 2019 | url-status=live | s2cid=3762435 | archive-url=https://web.archive.org/web/20191017205259/https://zenodo.org/record/1259797 | archive-date=October 17, 2019}}</ref>

==Eradication efforts==
{{Main|Eradication of malaria}}

There have been two major global malaria eradication efforts: the first, led by the [[World Health Organization]] between 1955 and 1969, and the second, initiated by the United Nations in the 21st century through the [[Millennium Development Goals|Millennium]] and [[Sustainable Development Goals]]. Malaria has been eliminated or significantly reduced in many regions of the world, but remains widespread in others. Most of [[Europe]], [[North America]], [[Australia]], [[North Africa]] and the [[Caribbean]], along with parts of [[South America]], [[Asia]] and [[Southern Africa]], are now free from malaria,<ref>{{cite web |title=Malaria Elimination Group description and list of elimination countries |url=http://www.malariaeliminationgroup.org/resources/elimination-countries |archive-url=https://web.archive.org/web/20110727060254/http://www.malariaeliminationgroup.org/resources/elimination-countries |archive-date=27 July 2011 |access-date=2011-07-12}}</ref> while much of the central part of [[Africa]] continues to experience high levels of transmission.

==Society and culture==
=== Economic consequences ===
[[File:Saving Lives with SMS for Life.jpg|thumb|right|Malaria clinic in Tanzania]]

Malaria is not just a disease commonly associated with [[poverty]]; some evidence suggests that it is also a cause of poverty and a major hindrance to [[economic development]].<ref name="Gollin-2007"/><ref name="Worrall-2005"/> Although [[Tropics|tropical regions]] are most affected, malaria's furthest influence reaches into some temperate zones that have extreme seasonal changes. The disease has been associated with major negative economic effects on regions where it is widespread. During the late 19th and early 20th centuries, it was a major factor in the slow economic development of the American southern states.<ref name="Humphreys-2001"/>

A comparison of average per capita [[GDP]] in 1995, adjusted for [[purchasing power parity|parity of purchasing power]], between countries with malaria and countries without malaria gives a fivefold difference (US$1,526 versus US$8,268). In the period 1965 to 1990, countries where malaria was common had an average per capita GDP that increased only 0.4% per year, compared to 2.4% per year in other countries.<ref name="Sachs-2002"/>

Poverty can increase the risk of malaria since those in poverty do not have the financial capacities to prevent or treat the disease. In its entirety, the economic consequences of malaria has been estimated to cost Africa US$12&nbsp;billion every year. This includes costs of health care, working days lost due to sickness, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism.<ref name="Greenwood-2005"/> The disease has a heavy burden in some countries, where it may be responsible for 30–50% of hospital admissions, up to 50% of [[outpatient]] visits, and up to 40% of public health spending.<ref name="WHO-2003"/>

[[File:Malaria Patient, Nyangaton, Ethiopia (15151075077).jpg|thumb|Child with malaria in [[Ethiopia]]]]

Cerebral malaria is one of the leading causes of neurological disabilities in African children.<ref name="Idro-2010"/> Studies comparing cognitive functions before and after treatment for severe malarial illness continued to show significantly impaired school performance and cognitive abilities even after recovery.<ref name="Fernando-2010"/> Consequently, severe and cerebral malaria have far-reaching [[socioeconomic]] consequences that extend beyond the immediate effects of the disease.<ref name="Ricci-2012"/>

===Counterfeit and substandard drugs===
Sophisticated [[counterfeit drugs|counterfeits]] have been found in several Asian countries such as [[Cambodia]],<ref name="Lon-2006"/> [[China]],<ref name="Newton-2008"/> [[Indonesia]], [[Laos]], [[Thailand]], and [[Vietnam]], and are a major cause of avoidable death in those countries.<ref name="Newton-2006"/> The WHO said that studies indicate that up to 40% of artesunate-based malaria medications are counterfeit, especially in the Greater [[Mekong]] region. They have established a rapid alert system to rapidly report information about counterfeit drugs to relevant authorities in participating countries.<ref name="Parry-2005"/> There is no reliable way for doctors or lay people to detect counterfeit drugs without help from a laboratory. Companies are attempting to combat the persistence of counterfeit drugs by using new technology to provide security from source to distribution.<ref name="Gautam-2009"/>

Another clinical and public health concern is the proliferation of substandard antimalarial medicines resulting from inappropriate concentration of ingredients, contamination with other drugs or toxic impurities, poor quality ingredients, poor stability and inadequate packaging.<ref name="Caudron-2008"/> A 2012 study demonstrated that roughly one-third of antimalarial medications in Southeast Asia and Sub-Saharan Africa failed chemical analysis, packaging analysis, or were falsified.<ref name="Nayyar-2012"/>

===War===
[[File:"Don't go to Bed with Malaria Mosquito" - NARA - 514146.jpg|thumb|right|World War II poster]]
Throughout history, the contraction of malaria has played a prominent role in the fates of government rulers, nation-states, military personnel, and military actions.<ref name="Russell-2009"/> In 1910, [[Nobel Prize in Medicine]]-winner Sir [[Ronald Ross]] (himself a malaria survivor), published a book titled ''The Prevention of Malaria'' that included a chapter titled "The Prevention of Malaria in War". The chapter's author, Colonel C. H. Melville, Professor of Hygiene at [[Royal Army Medical College]] in London, addressed the prominent role that malaria has historically played during wars: "The history of malaria in war might almost be taken to be the history of war itself, certainly the history of war in the Christian era.&nbsp;... It is probably the case that many of the so-called camp fevers, and probably also a considerable proportion of the camp dysentery, of the wars of the sixteenth, seventeenth and eighteenth centuries were malarial in origin."<ref name="Melville-1910"/> In British-occupied India the cocktail [[Gin and tonic#History|gin and tonic]] may have come about as a way of taking quinine, known for its antimalarial properties.<ref>{{cite book |vauthors=Bryant BJ, Knights KM |title=Pharmacology for Health Professionals |date=2011 |publisher=Elsevier Australia |isbn=978-0-7295-3929-6 |page=895 |url=https://books.google.com/books?id=TQV6sLzYsOYC&pg=PA895}}</ref>

The Scottish attempt to build a canal near what is now the Panamanian one was largely defeated by malaria.  Starting with the establishment of "New Caledonia", The Darièn Gap Project drained the kingdom — not yet part of the United Kingdom — of most of its wealth.  The cost of the bail-out from London was the independence of Scotland.

Malaria was the most significant health hazard encountered by U.S. troops in the South Pacific during [[World War II]], where about 500,000 men were infected.<ref name="Bray-2004"/> According to Joseph Patrick Byrne, "Sixty thousand American soldiers died of malaria during the African and South Pacific campaigns."<ref name="Byrne-2008"/>

Significant financial investments have been made to procure existing and create new antimalarial agents. During [[World War I]] and World War II, inconsistent supplies of the natural antimalaria drugs [[cinchona bark]] and quinine prompted substantial funding into [[research and development]] of other drugs and vaccines. American military organisations conducting such research initiatives include the Navy Medical Research Center, [[Walter Reed Army Institute of Research]], and the [[U.S. Army Medical Research Institute of Infectious Diseases]] of the US Armed Forces.<ref name="Kakkilaya-2006"/>

Additionally, initiatives have been founded such as Malaria Control in War Areas (MCWA), established in 1942, and its successor, the Communicable Disease Center (now known as the [[Centers for Disease Control and Prevention]], or CDC) established in 1946. According to the CDC, MCWA "was established to control malaria around military training bases in the southern United States and its territories, where malaria was still problematic".<ref name="US CDC-2010c"/>

==Research==
The Malaria Eradication Research Agenda (malERA) initiative was a consultative process to identify which areas of research and development (R&D) must be addressed for worldwide eradication of malaria.<ref>{{cite journal | vauthors=Hall BF, Fauci AS | title=Malaria control, elimination, and eradication: the role of the evolving biomedical research agenda | journal=The Journal of Infectious Diseases | volume=200 | issue=11 | pages=1639–1643 | date=December 2009 | pmid=19877843 | doi=10.1086/646611 | doi-access=free}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/2010/malaria_20100326/en/|title=WHO {{!}} A research agenda for malaria eradication|publisher=World Health Organization|access-date=2016-03-07|archive-url=https://web.archive.org/web/20160307182232/http://www.who.int/dg/speeches/2010/malaria_20100326/en/|archive-date=2016-03-07}}</ref>

===Medications===
Malaria parasites contain [[apicoplast]]s, organelles related to the [[plastid]]s found in plants, complete with their own [[genome]]s. These apicoplasts are thought to have originated through the [[Endosymbiont|endosymbiosis]] of algae and play a crucial role in various aspects of parasite [[metabolism]], such as [[fatty acid biosynthesis]]. Over 400 proteins have been found to be produced by apicoplasts and these are now being investigated as possible targets for novel antimalarial drugs.<ref name="Kalanon-2010"/>

With the onset of drug-resistant ''Plasmodium'' parasites, new strategies are being developed to combat the widespread disease. One such approach lies in the introduction of synthetic [[pyridoxal]]-amino acid [[adduct]]s, which are taken up by the parasite and ultimately interfere with its ability to create several essential [[B vitamin]]s.<ref name="Müller-2010"/><ref name="Du-2011"/> Antimalarial drugs using [[Organometallic chemistry|synthetic metal-based]] [[coordination complex|complexes]] are attracting research interest.<ref name="Biot-2012"/><ref name="Roux-2012"/>
* (+)-SJ733: Part of a wider class of experimental drugs called [[spiroindolone]]. It inhibits the ATP4 protein of infected red blood cells that cause the cells to shrink and become rigid like the aging cells. This triggers the immune system to eliminate the infected cells from the system as demonstrated in a mouse model. As of 2014, a [[Phases of clinical research#Phase 1|Phase 1 clinical trial]] to assess the safety profile in human is planned by the [[Howard Hughes Medical Institute]].<ref name="John-2014">{{cite web|url=http://www.fiercebiotechresearch.com/story/new-malaria-drug-unleashes-immune-system-assault-infected-cells/2014-12-08|title=New malaria drug unleashes an immune system assault on infected cells | vauthors=John C |website=fiercebiotechresearch.com|date=8 December 2014|access-date=16 December 2014|url-status=live|archive-url=https://web.archive.org/web/20160404040409/http://www.fiercebiotechresearch.com/story/new-malaria-drug-unleashes-immune-system-assault-infected-cells/2014-12-08|archive-date=4 April 2016}}</ref>
* NITD246 and [[NITD609]]: Also belonged to the class of spiroindolone and target the ATP4 protein.<ref name="John-2014"/>

On the basis of molecular docking outcomes, compounds 3j, 4b, 4h, 4m were exhibited selectivity towards PfLDH. The post docking analysis displayed stable dynamic behavior of all the selected compounds compared to Chloroquine. The end state thermodynamics analysis stated 3j compound as a selective and potent PfLDH inhibitor.<ref name="Singh-2021">{{cite journal | vauthors=Singh R, Bhardwaj V, Purohit R | title=Identification of a novel binding mechanism of Quinoline based molecules with lactate dehydrogenase of ''Plasmodium falciparum'' | journal=Journal of Biomolecular Structure & Dynamics | volume=39 | issue=1 | pages=348–356 | date=January 2021 | pmid=31903852 | doi=10.1080/07391102.2020.1711809}}</ref>

===New targets===
Targeting ''Plasmodium'' liver-stage parasites selectively is emerging as an alternative strategy in the face of resistance to the latest frontline combination therapies against blood stages of the parasite.<ref name="Stanway-2019">{{cite journal | vauthors=Stanway RR, Bushell E, Chiappino-Pepe A, Roques M, Sanderson T, Franke-Fayard B, Caldelari R, Golomingi M, Nyonda M, Pandey V, Schwach F, Chevalley S, Ramesar J, Metcalf T, Herd C, Burda PC, Rayner JC, Soldati-Favre D, Janse CJ, Hatzimanikatis V, Billker O, Heussler VT | title=Genome-Scale Identification of Essential Metabolic Processes for Targeting the ''Plasmodium'' Liver Stage | journal=Cell | volume=179 | issue=5 | pages=1112–1128.e26 | date=November 2019 | pmid=31730853 | pmc=6904910 | doi=10.1016/j.cell.2019.10.030 | doi-access=free}}</ref>

In research conducted in 2019, using experimental analysis with knockout (KO) mutants of ''Plasmodium berghei'', the authors were able to identify genes that are potentially essential in the liver stage. Moreover, they generated a computational model to analyse pre–erytrocytic development and liver–stage metabolism. Combining both methods they identified seven metabolic subsystems that become essential compared to the blood stage. Some of these metabolic pathways are fatty acid synthesis and elongation, tricarboxylic acid, amino acid and heme metabolism among others.<ref name="Stanway-2019"/>

Specifically, they studied three subsystems: fatty acid synthesis and elongation, and amino sugar biosynthesis. For the first two pathways they demonstrated a clear dependence of the liver stage on its own fatty acid metabolism.<ref name="Stanway-2019"/>

They proved for the first time the critical role of amino sugar biosynthesis in the liver stage of ''P. berghei''. The uptake of N–acetyl–glucosamine appears to be limited in the liver stage, being its synthesis needed for the parasite development.<ref name="Stanway-2019"/>

These findings and the computational model provide a basis for the design of antimalarial therapies targeting metabolic proteins.<ref name="Stanway-2019"/><ref>{{cite journal | vauthors=Roy M, Rawat A, Kaushik S, Jyoti A, Srivastava VK | title=Endogenous cysteine protease inhibitors in upmost pathogenic parasitic protozoa | journal=Microbiological Research | volume=261 | article-number=127061 | date=August 2022 | pmid=35605309 | doi=10.1016/j.micres.2022.127061 | s2cid=248741177 | doi-access=free}}</ref>

===Genomic research===
The genome of ''Plasmodium falciparum'' was sequenced and published in the year 2002.<ref>{{cite journal | vauthors=Gardner MJ, Hall N, Fung E, White O, Berriman M, Hyman RW, Carlton JM, Pain A, Nelson KE, Bowman S, Paulsen IT, James K, Eisen JA, Rutherford K, Salzberg SL, Craig A, Kyes S, Chan MS, Nene V, Shallom SJ, Suh B, Peterson J, Angiuoli S, Pertea M, Allen J, Selengut J, Haft D, Mather MW, Vaidya AB, Martin DM, Fairlamb AH, Fraunholz MJ, Roos DS, Ralph SA, McFadden GI, Cummings LM, Subramanian GM, Mungall C, Venter JC, Carucci DJ, Hoffman SL, Newbold C, Davis RW, Fraser CM, Barrell B | title=Genome sequence of the human malaria parasite ''Plasmodium falciparum'' | journal=Nature | volume=419 | issue=6906 | pages=498–511 | date=October 2002 | pmid=12368864 | pmc=3836256 | doi=10.1038/nature01097 | bibcode=2002Natur.419..498G}}</ref>

A species of malaria plasmodium tends to have rather polymorphic antigens which can serve as immune system targets.  Some searches of ''P. falciparum'' genes for hotspots of encoded variations found sections of genes that when tested proved to encode for antigens.  When such antigens are used for vaccine targets a strain of plasmodium with a different allele for the antigen can sometimes escape the immune response stimulated by the vaccine.<ref name="Su">{{cite journal |last1=Su |first1=X |last2=Stadler |first2=RV |last3=Xu |first3=F |last4=Wu |first4=J |title=Malaria Genomics, Vaccine Development, and Microbiome |journal=Pathogens |date=18 August 2023 |volume=12 |issue=8 |page=1061 |doi=10.3390/pathogens12081061 |pmid=37624021 |pmc=10459703 |doi-access=free }}</ref>
 
Two related viruses, MaRNAV-1 and MaRNAV-2 in ''Plasmodium vivax'' and in avian Leucocytozoon respectively, were found through RNA-Sequencing of blood. The finding of a virus infecting a human malaria plasmodium is a first discovery of its kind.  It should lead to better understanding of malaria biology.<ref>{{cite journal | vauthors=Charon J, Grigg MJ, Eden JS, Piera KA, Rana H, William T, Rose K, Davenport MP, Anstey NM, Holmes EC | title=Novel RNA viruses associated with ''Plasmodium vivax'' in human malaria and Leucocytozoon parasites in avian disease | journal=PLOS Pathogens | volume=15 | issue=12 | article-number=e1008216 | date=December 2019 | pmid=31887217 | pmc=6953888 | doi=10.1371/journal.ppat.1008216 | doi-access=free}}</ref>

===Other===
A non-chemical vector control strategy involves genetic manipulation of malaria mosquitoes. Advances in [[genetic engineering]] technologies make it possible to introduce foreign DNA into the mosquito genome and either decrease the lifespan of the mosquito, or make it more resistant to the malaria parasite. [[Sterile insect technique]] is a genetic control method whereby large numbers of sterile male mosquitoes are reared and released. Mating with wild females reduces the wild population in the subsequent generation; repeated releases eventually eliminate the target population.<ref name="Raghavendra-2011"/>

[[Genomics]] is central to malaria research. With the [[whole genome sequencing|sequencing]] of ''P.&nbsp;falciparum'', one of its vectors ''Anopheles gambiae'', and the [[human genome]], the genetics of all three organisms in the malaria life cycle can be studied.<ref name="Aultman-2002"/> Another new application of genetic technology is the ability to produce [[Genetically modified organism|genetically modified]] mosquitoes that do not transmit malaria, potentially allowing [[biological control]] of malaria transmission.<ref name="Ito-2002"/>

In one study, a genetically modified strain of ''[[Anopheles stephensi]]'' was created that no longer supported malaria transmission, and this resistance was passed down to mosquito offspring.<ref>{{cite journal | vauthors=Gantz VM, Jasinskiene N, Tatarenkova O, Fazekas A, Macias VM, Bier E, James AA | title=Highly efficient Cas9-mediated gene drive for population modification of the malaria vector mosquito ''Anopheles stephensi'' | journal=Proceedings of the National Academy of Sciences of the United States of America | volume=112 | issue=49 | pages=E6736–E6743 | date=December 2015 | pmid=26598698 | pmc=4679060 | doi=10.1073/pnas.1521077112 | doi-access=free | bibcode=2015PNAS..112E6736G}}</ref>

[[Gene drive]] is a technique for changing wild populations, for instance to combat or eliminate insects so they cannot transmit diseases (in particular mosquitoes in the cases of malaria,<ref name="Imperial College-2021">{{cite news |url=https://www.imperial.ac.uk/news/227193/malarial-mosquitoes-suppressed-experiments-that-mimic/ |title=Malarial mosquitoes suppressed in experiments that mimic natural environments |date=28 July 2021 |access-date=21 November 2021 |archive-date=21 November 2021 |archive-url=https://web.archive.org/web/20211121005039/https://www.imperial.ac.uk/news/227193/malarial-mosquitoes-suppressed-experiments-that-mimic/ |url-status=live}}</ref> [[Zika virus|zika]],<ref name="Flam-2016">{{cite news | url=https://www.bloomberg.com/view/articles/2016-02-04/fighting-zika-virus-with-genetic-engineering | title=Fighting Zika Virus With Genetic Engineering | work=Bloomberg | date=4 February 2016 | vauthors=Flam F | url-status=live | archive-url=https://web.archive.org/web/20160606220755/http://www.bloomberg.com/view/articles/2016-02-04/fighting-zika-virus-with-genetic-engineering | archive-date=6 June 2016}}</ref> dengue and yellow fever).<ref name="Fletcher-2019">{{cite news | vauthors=Fletcher M |title=Mosquito gene-editing: can it wipe out malaria? |url=https://www.telegraph.co.uk/global-health/science-and-disease/mutant-mosquitoes-can-gene-editing-kill-malaria/ |work=The Telegraph |date=16 July 2019}}</ref> One example of this method was performed with ''Anopheles gambiae'', where the researchers induced a male-biased sex-distorter gene drive (SDGD). They induced the super-Mendelian inheritance of the I-Ppol nuclease, which is responsible for the shredding of the X-chromosome, and coupled it to a CRISPR-based gene drive.<ref name=as>{{Cite journal |last=Simoni |first=Alekos |last2=Hammond |first2=Andrew M. |last3=Beaghton |first3=Andrea K. |last4=Galizi |first4=Roberto |last5=Taxiarchi |first5=Chrysanthi |last6=Kyrou |first6=Kyros |last7=Meacci |first7=Dario |last8=Gribble |first8=Matthew |last9=Morselli |first9=Giulia |last10=Burt |first10=Austin |last11=Nolan |first11=Tony |last12=Crisanti |first12=Andrea |date=September 2020 |title=A male-biased sex-distorter gene drive for the human malaria vector Anopheles gambiae |url=https://www.nature.com/articles/s41587-020-0508-1 |journal=Nature Biotechnology |language=en |volume=38 |issue=9 |pages=1054–1060 |doi=10.1038/s41587-020-0508-1 |issn=1546-1696 |pmc=7473848 |pmid=32393821}}</ref> The nuclease was inserted into the ''doublesex'' gene, which acts to control the sexual differentiation of insects and determine whether they will become female or male.<ref>{{Cite journal |last=Price |first=Dana C. |last2=Egizi |first2=Andrea |last3=Fonseca |first3=Dina M. |date=2015-08-17 |title=The ubiquity and ancestry of insect doublesex |url=https://www.nature.com/articles/srep13068 |journal=Scientific Reports |language=en |volume=5 |issue=1 |doi=10.1038/srep13068 |issn=2045-2322 |pmc=4538375 |pmid=26278009}}</ref> By inducing this, the population of mosquitoes they were working with became male-only, so that there was a decrease in the population, and reportedly no resistance development<ref name=as/>

In a study conducted in 2015, researchers observed a specific interaction between malaria and co-infection with the [[nematode]] Nippostrongylus brasiliensis, a pulmonary migrating [[Parasitic worm|helminth]], in mice.<ref name="Griffiths-2015">{{cite journal | vauthors=Griffiths EC, Fairlie-Clarke K, Allen JE, Metcalf CJ, Graham AL | title=Bottom-up regulation of malaria population dynamics in mice co-infected with lung-migratory nematodes | journal=Ecology Letters | volume=18 | issue=12 | pages=1387–1396 | date=December 2015 | pmid=26477454 | doi=10.1111/ele.12534 | bibcode=2015EcolL..18.1387G | url=https://eprints.gla.ac.uk/113103/7/113103.pdf}}</ref>  The co-infection was found to reduce the [[virulence]] of the ''Plasmodium'' parasite, the causative agent of malaria. This reduction was attributed to the nematode infection causing increased destruction of [[erythrocytes]], or red blood cells. Given that ''Plasmodium'' has a predilection for older host erythrocytes, the increased erythrocyte destruction and ensuing [[erythropoiesis]] result in a predominantly younger erythrocyte population, which in turn leads to a decrease in ''Plasmodium'' population.<ref name="Griffiths-2015" /> Notably, this effect appears to be largely independent of the host's immune control of ''Plasmodium''.

Finally, a review article published in December 2020 noted a correlation between malaria-endemic regions and [[COVID-19]] case fatality rates.<ref name="Arshad-2020">{{cite journal | vauthors=Arshad AR, Bashir I, Ijaz F, Loh N, Shukla S, Rehman UU, Aftab RK | title=Is COVID-19 Fatality Rate Associated with Malaria Endemicity? | journal=Discoveries | volume=8 | issue=4 | pages=e120 | date=December 2020 | pmid=33365386 | pmc=7749783 | doi=10.15190/d.2020.17 | doi-access=free}}</ref> The study found that, on average, regions where malaria is endemic reported lower COVID-19 case fatality rates compared to regions without endemic malaria.

In 2017, a bacterial strain of the genus [[Serratia]] was genetically modified to prevent malaria in mosquitos<ref>{{cite journal | vauthors=Wang S, Dos-Santos AL, Huang W, Liu KC, Oshaghi MA, Wei G, Agre P, Jacobs-Lorena M | title=Driving mosquito refractoriness to ''Plasmodium falciparum'' with engineered symbiotic bacteria | journal=Science | volume=357 | issue=6358 | pages=1399–1402 | date=September 2017 | pmid=28963255 | pmc=9793889 | doi=10.1126/science.aan5478 | bibcode=2017Sci...357.1399W}}</ref><ref>{{cite journal | vauthors=Servick K |title=The microbes in a mosquito's gut may help fight malaria |journal=Science |date=28 September 2017 |doi=10.1126/science.aaq0811}}</ref> and in 2023, it has been reported that the bacterium [[Delftia tsuruhatensis]] naturally prevents the development of malaria by secreting a molecule called [[Harmane]].<ref>{{cite journal | vauthors=Huang W, Rodrigues J, Bilgo E, Tormo JR, Challenger JD, De Cozar-Gallardo C, Pérez-Victoria I, Reyes F, Castañeda-Casado P, Gnambani EJ, Hien DF, Konkobo M, Urones B, Coppens I, Mendoza-Losana A, Ballell L, Diabate A, Churcher TS, Jacobs-Lorena M | title=''Delftia tsuruhatensis'' TC1 symbiont suppresses malaria transmission by anopheline mosquitoes | journal=Science | volume=381 | issue=6657 | pages=533–540 | date=August 2023 | pmid=37535741 | doi=10.1126/science.adf8141 | bibcode=2023Sci...381..533H | hdl=10044/1/105278| hdl-access=free }}</ref><ref>{{cite journal | vauthors=Offord C |title=Microbe stops mosquitoes from harboring malaria parasite |journal=Science |date=3 August 2023 |doi=10.1126/science.adk1267}}</ref><ref>{{cite news |date=2023-08-04 |title=Chance discovery helps fight against malaria |language=en-GB |publisher=BBC News |url=https://www.bbc.com/news/health-66394117 |access-date=2023-08-04 |archive-date=2023-08-04 |archive-url=https://web.archive.org/web/20230804002648/https://www.bbc.com/news/health-66394117 |url-status=live}}</ref>

Other avenue that can contribute to understanding of malaria transmission, is the source of meal for the vector when they have the parasites. Its known that plant sugars are the primary source of nutrients for survival of adult mosquitoes,<ref>{{cite journal | vauthors=Foster WA | title=Mosquito sugar feeding and reproductive energetics | journal=Annual Review of Entomology | volume=40 | issue=1 | pages=443–474 | date=January 1995 | pmid=7810991 | doi=10.1146/annurev.en.40.010195.002303}}</ref> therefore utilising this link for management of the vector will contribute in mitigating malaria transmission.<ref>{{cite journal | vauthors=Gu W, Müller G, Schlein Y, Novak RJ, Beier JC | title=Natural plant sugar sources of ''Anopheles'' mosquitoes strongly impact malaria transmission potential | journal=PLOS ONE | volume=6 | issue=1 | article-number=e15996 | date=January 2011 | pmid=21283732 | pmc=3024498 | doi=10.1371/journal.pone.0015996 | doi-access=free | bibcode=2011PLoSO...615996G}}</ref><ref>{{cite journal | vauthors=Hien DF, Dabiré KR, Roche B, Diabaté A, Yerbanga RS, Cohuet A, Yameogo BK, Gouagna LC, Hopkins RJ, Ouedraogo GA, Simard F, Ouedraogo JB, Ignell R, Lefevre T | title=Plant-Mediated Effects on Mosquito Capacity to Transmit Human Malaria | journal=PLOS Pathogens | volume=12 | issue=8 | article-number=e1005773 | date=August 2016 | pmid=27490374 | pmc=4973987 | doi=10.1371/journal.ppat.1005773 | doi-access=free}}</ref>

In a 2018 study of 400 Kenyan school aged children, researchers were able to diagnose malaria with 100% sensitivity based on volatile biomarkers in the skin (molecules that cause odors). And the volatile biomarker signature of those with symptomatic and asymptomatic disease differed significantly. Thus introducing a possible new diagnostic test for the disease.<ref name="De Moraes 2018">{{cite journal |last1=De Moraes |first1=Consuelo M. |last2=Wanjiku |first2=Caroline |last3=Stanczyk |first3=Nina M. |last4=Pulido |first4=Hannier |last5=Sims |first5=James W. |last6=Betz |first6=Heike S. |last7=Read |first7=Andrew F. |last8=Torto |first8=Baldwyn |last9=Mescher |first9=Mark C. |title=Volatile biomarkers of symptomatic and asymptomatic malaria infection in humans |journal=Proceedings of the National Academy of Sciences |date=29 May 2018 |volume=115 |issue=22 |pages=5780–5785 |doi=10.1073/pnas.1801512115|pmid=29760095 |doi-access=free |hdl=20.500.11850/268864 |hdl-access=free |pmc=5984526 |bibcode=2018PNAS..115.5780D }}</ref>

==Other animals==
While none of the main four species of malaria parasite that cause human infections are known to have [[zoonosis|animal reservoirs]],<ref>{{cite web |title=Facts about malaria |url=https://www.ecdc.europa.eu/en/malaria/facts |publisher=European Centre for Disease Prevention and Control |date=9 June 2017 |access-date=16 July 2021 |archive-date=6 July 2021 |archive-url=https://web.archive.org/web/20210706064110/https://www.ecdc.europa.eu/en/malaria/facts |url-status=live}}</ref> ''[[Plasmodium knowlesi|P.&nbsp;knowlesi]]'' is known to infect both humans and non-human primates.<ref name="Collins-2012"/> Other non-human primate malarias (particularly ''P. cynomolgi'' and ''P. simium'') have also been found to have spilled over into humans.<ref>{{cite journal | vauthors=Brasil P, Zalis MG, de Pina-Costa A, Siqueira AM, Júnior CB, Silva S, Areas AL, Pelajo-Machado M, de Alvarenga DA, da Silva Santelli AC, Albuquerque HG, Cravo P, Santos de Abreu FV, Peterka CL, Zanini GM, Suárez Mutis MC, Pissinatti A, Lourenço-de-Oliveira R, de Brito CF, de Fátima Ferreira-da-Cruz M, Culleton R, Daniel-Ribeiro CT | title=Outbreak of human malaria caused by ''Plasmodium simium'' in the Atlantic Forest in Rio de Janeiro: a molecular epidemiological investigation | journal=The Lancet Global Health | volume=5 | issue=10 | pages=e1038–e1046 | date=October 2017 | pmid=28867401 | doi=10.1016/S2214-109X(17)30333-9 | doi-access=free}}</ref> Nearly 200 ''Plasmodium'' species have been identified that infect [[Plasmodium species infecting birds|birds]], [[Plasmodium species infecting reptiles|reptiles]], and [[Plasmodium species infecting mammals other than primates|other mammals]],<ref name="Rich-2006" /> and about 30 of them naturally infect non-human primates.<ref name="Baird-2009" /> Some malaria parasites of non-human primates (NHP) serve as [[model organism]]s for human malarial parasites, such as ''[[Plasmodium coatneyi|P.&nbsp;coatneyi]]'' (a model for ''P.&nbsp;falciparum'') and ''[[Plasmodium cynomolgi|P.&nbsp;cynomolgi]]'' (a model for ''P.&nbsp;vivax''). Diagnostic techniques used to detect parasites in NHP are similar to those employed for humans.<ref name="Ameri-2010" /> Malaria parasites that infect rodents are widely used as models in research, such as ''[[Plasmodium berghei|P.&nbsp;berghei]]''.<ref name="Mlambo-2008"/> [[Avian malaria]] primarily affects species of the order [[Passeriformes]], and poses a substantial threat to birds of [[Hawaii]], the [[Galapagos]], and other [[archipelago]]es. The parasite ''[[Plasmodium relictum|P.&nbsp;relictum]]'' is known to play a role in limiting the distribution and abundance of [[endemic birds of Hawaii|endemic Hawaiian birds]]. [[Global warming]] is expected to increase the prevalence and global distribution of [[avian malaria]], as elevated temperatures provide optimal conditions for parasite reproduction.<ref name="Lapointe-2012"/>

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<ref name="Du-2011">{{cite journal | vauthors=Du Q, Wang H, Xie J | title=Thiamin (vitamin B1) biosynthesis and regulation: a rich source of antimicrobial drug targets? | journal=International Journal of Biological Sciences | volume=7 | issue=1 | pages=41–52 | date=January 2011 | pmid=21234302 | pmc=3020362 | doi=10.7150/ijbs.7.41 | doi-access=free}}</ref>

<ref name="Enayati-2007">{{cite journal | vauthors=Enayati AA, Hemingway J, Garner P | title=Electronic mosquito repellents for preventing mosquito bites and malaria infection | journal=The Cochrane Database of Systematic Reviews | volume=2007 | issue=2 | article-number=CD005434 | date=April 2007 | pmid=17443590 | pmc=6532582 | doi=10.1002/14651858.CD005434.pub2 | veditors=Enayati A}}<!-- this was assessed by Cochrane as up-to-date as of March 2009--></ref>

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<ref name="Fernando-2010">{{cite journal | vauthors=Fernando SD, Rodrigo C, Rajapakse S | title=The 'hidden' burden of malaria: cognitive impairment following infection | journal=Malaria Journal | volume=9 | article-number=366 | date=December 2010 | pmid=21171998 | pmc=3018393 | doi=10.1186/1475-2875-9-366 | doi-access=free}}</ref>

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<ref name="The Nobel Foundation">{{Cite web |title=The Nobel Prize in Physiology or Medicine 1907: Alphonse Laveran |publisher=The Nobel Foundation |url=http://nobelprize.org/nobel_prizes/medicine/laureates/1907/laveran-bio.html |access-date=2012-05-14 |url-status=live |archive-url=https://web.archive.org/web/20120623113346/http://www.nobelprize.org/nobel_prizes/medicine/laureates/1907/laveran-bio.html |archive-date=2012-06-23}}</ref>

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<ref name="Parry-2005">{{cite journal | vauthors=Parry J | title=WHO combats counterfeit malaria drugs in Asia | journal=BMJ | volume=330 | issue=7499 | page=1044 | date=May 2005 | pmid=15879383 | pmc=557259 | doi=10.1136/bmj.330.7499.1044-d}}</ref>

<ref name="Pates-2005">{{cite journal | vauthors=Pates H, Curtis C | title=Mosquito behavior and vector control | journal=Annual Review of Entomology | volume=50 | pages=53–70 | year=2005 | pmid=15355233 | doi=10.1146/annurev.ento.50.071803.130439 | doi-access=free}}</ref>

<ref name="Pelletier-1820">{{Cite journal |vauthors=Pelletier PJ, Caventou JB |title=Des recherches chimiques sur les Quinquinas |trans-title=Chemical research on quinquinas |language=fr |journal=Annales de Chimie et de Physique |volume=15 |pages=337–65 |year=1820 |url=https://books.google.com/books?id=veE3AAAAMAAJ&pg=PA337}}</ref>

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<ref name="Perkins 2008">{{Cite journal |vauthors=Perkins MD, Bell DR |title=Working without a blindfold: The critical role of diagnostics in malaria control |journal=Malaria Journal |year=2008 |volume=1 |issue=Suppl 1 |page=S5 |pmid=19091039 |pmc=2604880 |doi=10.1186/1475-2875-7-S1-S5}}</ref>
Not in use-->

<ref name="Fairhurst-2015">{{cite book |doi=10.1016/B978-1-4557-4801-3.00276-9 |chapter=Malaria (''Plasmodium'' Species) |title=Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases |date=2015 | vauthors=Fairhurst RM, Wellems TE |pages=3070–3090.e9 |isbn=978-1-4557-4801-3}}</ref>

<ref name="Pluess-2010">{{cite journal | vauthors=Pluess B, Tanser FC, Lengeler C, Sharp BL | title=Indoor residual spraying for preventing malaria | journal=The Cochrane Database of Systematic Reviews | volume=2010 | issue=4 | article-number=CD006657 | date=April 2010 | pmid=20393950 | pmc=6532743 | doi=10.1002/14651858.CD006657.pub2 | veditors=Lengeler C}}</ref>

<ref name="Provost-2011">{{Cite news | vauthors=Provost C |url=https://www.theguardian.com/global-development/datablog/2011/apr/25/world-malaria-day-data#data |work=The Guardian |title=World Malaria Day: Which countries are the hardest hit? Get the full data |date=April 25, 2011 |access-date=2012-05-03 |url-status=live |archive-url=https://web.archive.org/web/20130801134855/http://www.theguardian.com/global-development/datablog/2011/apr/25/world-malaria-day-data#data |archive-date=August 1, 2013}}</ref>

<ref name="Prugnolle-2011">{{cite journal | vauthors=Prugnolle F, Durand P, Ollomo B, Duval L, Ariey F, Arnathau C, Gonzalez JP, Leroy E, Renaud F | title=A fresh look at the origin of ''Plasmodium falciparum'', the most malignant malaria agent | journal=PLOS Pathogens | volume=7 | issue=2 | article-number=e1001283 | date=February 2011 | pmid=21383971 | pmc=3044689 | doi=10.1371/journal.ppat.1001283 | veditors=Manchester M | doi-access=free}}</ref>

<ref name="Raghavendra-2011">{{cite journal | vauthors=Raghavendra K, Barik TK, Reddy BP, Sharma P, Dash AP | title=Malaria vector control: from past to future | journal=Parasitology Research | volume=108 | issue=4 | pages=757–779 | date=April 2011 | pmid=21229263 | doi=10.1007/s00436-010-2232-0 | s2cid=1422449}}</ref>

<ref name="Rénia-2012">{{cite journal | vauthors=Rénia L, Howland SW, Claser C, Charlotte Gruner A, Suwanarusk R, Hui Teo T, Russell B, Ng LF | title=Cerebral malaria: mysteries at the blood-brain barrier | journal=Virulence | volume=3 | issue=2 | pages=193–201 | year=2012 | pmid=22460644 | pmc=3396698 | doi=10.4161/viru.19013}}</ref>

<ref name="Ricci-2012">{{cite journal | vauthors=Ricci F | title=Social implications of malaria and their relationships with poverty | journal=Mediterranean Journal of Hematology and Infectious Diseases | volume=4 | issue=1 | pages=e2012048 | year=2012 | pmid=22973492 | pmc=3435125 | doi=10.4084/MJHID.2012.048}}</ref>

<ref name="Rich-2006">{{cite book |doi=10.1007/0-387-28295-5_6 |chapter=Evolutionary Origins of Human Malaria Parasites |title=Malaria: Genetic and Evolutionary Aspects |date=2006 | vauthors=Rich SM, Ayala FJ |pages=125–146 |isbn=978-0-387-28294-7}}</ref>

<ref name="Richter-2010">{{cite journal | vauthors=Richter J, Franken G, Mehlhorn H, Labisch A, Häussinger D | title=What is the evidence for the existence of ''Plasmodium ovale hypnozoites''? | journal=Parasitology Research | volume=107 | issue=6 | pages=1285–1290 | date=November 2010 | pmid=20922429 | doi=10.1007/s00436-010-2071-z | s2cid=2044783}}</ref>

<ref name="Rijken-2012">{{cite journal | vauthors=Rijken MJ, McGready R, Boel ME, Poespoprodjo R, Singh N, Syafruddin D, Rogerson S, Nosten F | title=Malaria in pregnancy in the Asia-Pacific region | journal=The Lancet Infectious Diseases | volume=12 | issue=1 | pages=75–88 | date=January 2012 | pmid=22192132 | doi=10.1016/S1473-3099(11)70315-2 | url=http://repository.unhas.ac.id/handle/123456789/9230 | access-date=2019-07-05 | archive-url=https://web.archive.org/web/20200123171807/http://repository.unhas.ac.id/handle/123456789/9230 | archive-date=2020-01-23 | url-access=subscription}}</ref>

<ref name="Riley-2013">{{cite journal | vauthors=Riley EM, Stewart VA | title=Immune mechanisms in malaria: new insights in vaccine development | journal=Nature Medicine | volume=19 | issue=2 | pages=168–178 | date=February 2013 | pmid=23389617 | doi=10.1038/nm.3083 | s2cid=8763732 | doi-access=free}}</ref>

<ref name="WHO-2003">{{Cite web |author=Roll Back Malaria WHO partnership |title=Economic costs of malaria |year=2003 |url=http://www.rollbackmalaria.org/cmc_upload/0/000/015/363/RBMInfosheet_10.pdf |publisher=[[World Health Organization|WHO]] |archive-url=https://web.archive.org/web/20091229044311/http://www.rollbackmalaria.org/cmc_upload/0/000/015/363/RBMInfosheet_10.pdf |archive-date=2009-12-29}}</ref>

<ref name="Melville-1910">{{Cite book | vauthors=Melville CH | veditors=Ross R |title=The Prevention of Malaria |chapter=The prevention of malaria in war |year=1910 |publisher=E.P. Dutton |location=New York |page=577 |chapter-url=https://archive.org/stream/pr00eventionofmalarossrich#page/576/mode/2up |url-status=live |archive-url=https://web.archive.org/web/20160312141333/http://archive.org/stream/pr00eventionofmalarossrich#page/576/mode/2up |archive-date=2016-03-12}}</ref>

<ref name="Roux-2012">{{cite journal | vauthors=Roux C, Biot C | title=Ferrocene-based antimalarials | journal=Future Medicinal Chemistry | volume=4 | issue=6 | pages=783–797 | date=April 2012 | pmid=22530641 | doi=10.4155/fmc.12.26}}</ref>

<ref name="Russell-2009">{{Cite book | vauthors=Russell PF |chapter=Communicable diseases Malaria |title=Medical Department of the United States Army in World War II |chapter-url=http://history.amedd.army.mil/booksdocs/wwii/Malaria/chapterI.htm |publisher=U.S. Army Medical Department Office of Medical History |year=2009 |access-date=2012-09-24 |url-status=live |archive-url=https://web.archive.org/web/20121009044343/http://history.amedd.army.mil/booksdocs/wwii/Malaria/chapterI.htm |archive-date=October 9, 2012}}</ref>

<ref name="Sabot-2010">{{cite journal | vauthors=Sabot O, Cohen JM, Hsiang MS, Kahn JG, Basu S, Tang L, Zheng B, Gao Q, Zou L, Tatarsky A, Aboobakar S, Usas J, Barrett S, Cohen JL, Jamison DT, Feachem RG | title=Costs and financial feasibility of malaria elimination | journal=The Lancet | volume=376 | issue=9752 | pages=1604–1615 | date=November 2010 | pmid=21035839 | pmc=3044845 | doi=10.1016/S0140-6736(10)61355-4}}</ref>

<ref name="Sachs-2002">{{cite journal | vauthors=Sachs J, Malaney P | title=The economic and social burden of malaria | journal=Nature | volume=415 | issue=6872 | pages=680–685 | date=February 2002 | pmid=11832956 | doi=10.1038/415680a | s2cid=618837}}</ref>

<ref name="BBC News-2001">{{Cite news |title=DNA clues to malaria in ancient Rome |date=February 20, 2001 |publisher=BBC News |url=http://news.bbc.co.uk/2/hi/science/nature/1180469.stm |url-status=live |archive-url=https://web.archive.org/web/20101102082257/http://news.bbc.co.uk/2/hi/science/nature/1180469.stm |archive-date=November 2, 2010}}, in reference to {{Cite journal |journal=Ancient Biomolecules |title=Biomolecular archaeology of malaria |vauthors=Sallares R, Gomzi S |volume=3 |issue=3 |year= 2001 |pages=195–213 |oclc=538284457}}</ref>

<ref name="Sallares-2002">{{Cite book | vauthors=Sallares R |title=Malaria and Rome: A History of Malaria in Ancient Italy |year=2002 |publisher=Oxford University Press |isbn=978-0-19-924850-6 |doi=10.1093/acprof:oso/9780199248506.001.0001}}</ref>

<ref name="Sarkar-2009">{{cite journal | vauthors=Sarkar PK, Ahluwalia G, Vijayan VK, Talwar A | title=Critical care aspects of malaria | journal=Journal of Intensive Care Medicine | volume=25 | issue=2 | pages=93–103 | year=2009 | pmid=20018606 | doi=10.1177/0885066609356052 | s2cid=20941166}}</ref>

<ref name="Simmons-1979">{{Cite book |vauthors=Simmons JS |title=Malaria in Panama |year=1979 |publisher=Ayer Publishing |isbn=978-0-405-10628-6 |url=https://books.google.com/books?id=arMN_3pqxDcC&pg=PP1 |access-date=2015-10-27 |archive-date=2023-01-13 |archive-url=https://web.archive.org/web/20230113002513/https://books.google.com/books?id=arMN_3pqxDcC&pg=PP1 |url-status=live}}</ref><!-- no page number needed, sourced information is presented passim -->

<ref name="Sinclair-2012">{{cite journal | vauthors=Sinclair D, Donegan S, Isba R, Lalloo DG | title=Artesunate versus quinine for treating severe malaria | journal=The Cochrane Database of Systematic Reviews | volume=2012 | issue=6 | article-number=CD005967 | date=June 2012 | pmid=22696354 | pmc=6532684 | doi=10.1002/14651858.CD005967.pub4 | veditors=Sinclair D}}</ref>

<ref name="Sinha-2014">{{cite journal | vauthors=Sinha S, Medhi B, Sehgal R | title=Challenges of drug-resistant malaria | journal=Parasite | volume=21 | page=61 | year=2014 | pmid=25402734 | pmc=4234044 | doi=10.1051/parasite/2014059}}</ref>

<ref name="Tan-2008">{{cite journal | vauthors=Tan SY, Sung H | title=Carlos Juan Finlay (1833-1915): of mosquitoes and yellow fever | journal=Singapore Medical Journal | volume=49 | issue=5 | pages=370–371 | date=May 2008 | pmid=18465043 | url=http://smj.sma.org.sg/4905/4905ms1.pdf | url-status=live | archive-url=https://web.archive.org/web/20080723150844/http://smj.sma.org.sg/4905/4905ms1.pdf | archive-date=2008-07-23}}</ref>

<ref name="Taylor-2012">{{cite journal | vauthors=Taylor WR, Hanson J, Turner GD, White NJ, Dondorp AM | title=Respiratory manifestations of malaria | journal=Chest | volume=142 | issue=2 | pages=492–505 | date=August 2012 | pmid=22871759 | doi=10.1378/chest.11-2655}}</ref>

<ref name="Tilley-2011">{{cite journal | vauthors=Tilley L, Dixon MW, Kirk K | title=The ''Plasmodium falciparum''-infected red blood cell | journal=The International Journal of Biochemistry & Cell Biology | volume=43 | issue=6 | pages=839–842 | date=June 2011 | pmid=21458590 | doi=10.1016/j.biocel.2011.03.012}}</ref>

<ref name="Trampuz-2003">{{cite journal | vauthors=Trampuz A, Jereb M, Muzlovic I, Prabhu RM | title=Clinical review: Severe malaria | journal=Critical Care | volume=7 | issue=4 | pages=315–323 | date=August 2003 | pmid=12930555 | pmc=270697 | doi=10.1186/cc2183 | doi-access=free}}</ref>

<ref name="Tran-2012">{{cite journal | vauthors=Tran TM, Samal B, Kirkness E, Crompton PD | title=Systems immunology of human malaria | journal=Trends in Parasitology | volume=28 | issue=6 | pages=248–257 | date=June 2012 | pmid=22592005 | pmc=3361535 | doi=10.1016/j.pt.2012.03.006}}</ref> <!-- needs page # -->

<ref name="Turschner-2009">{{cite journal | vauthors=Turschner S, Efferth T | title=Drug resistance in ''Plasmodium'': natural products in the fight against malaria | journal=Mini Reviews in Medicinal Chemistry | volume=9 | issue=2 | pages=206–2124 | date=February 2009 | pmid=19200025 | doi=10.2174/138955709787316074}}</ref>

<ref name="van den Berg-2009">{{cite journal | vauthors=van den Berg H | title=Global status of DDT and its alternatives for use in vector control to prevent disease | journal=Environmental Health Perspectives | volume=117 | issue=11 | pages=1656–1663 | date=November 2009 | pmid=20049114 | pmc=2801202 | doi=10.1289/ehp.0900785 | bibcode=2009EnvHP.117.1656V}}</ref>

<ref name="Vanderberg-2009">{{cite journal | vauthors=Vanderberg JP | title=Reflections on early malaria vaccine studies, the first successful human malaria vaccination, and beyond | journal=Vaccine | volume=27 | issue=1 | pages=2–9 | date=January 2009 | pmid=18973784 | pmc=2637529 | doi=10.1016/j.vaccine.2008.10.028}}</ref>

<ref name="Vaughan-2008">{{cite journal | vauthors=Vaughan AM, Aly AS, Kappe SH | title=Malaria parasite pre-erythrocytic stage infection: gliding and hiding | journal=Cell Host & Microbe | volume=4 | issue=3 | pages=209–218 | date=September 2008 | pmid=18779047 | pmc=2610487 | doi=10.1016/j.chom.2008.08.010}}</ref>

<ref name="Vogel-2013">{{cite journal | vauthors=Vogel G | title=The forgotten malaria | journal=Science | volume=342 | issue=6159 | pages=684–687 | date=November 2013 | pmid=24202156 | doi=10.1126/science.342.6159.684 | bibcode=2013Sci...342..684V}}</ref>

<ref name="Walsh-2015">{{cite news |url=https://www.bbc.com/news/health-33641939 |title=Malaria vaccine gets 'green light' |date=24 July 2015 | vauthors=Walsh F |newspaper=[[BBC News Online]] |url-status=live |archive-url=https://web.archive.org/web/20161221100819/http://www.bbc.com/news/health-33641939 |archive-date=21 December 2016}}</ref>

<ref name="Waters-2011">{{cite book |doi=10.1007/978-3-0346-0480-2_4 |chapter=8-Aminoquinolines: Primaquine and Tafenoquine |title=Treatment and Prevention of Malaria |date=2011 | vauthors=Waters NC, Edstein MD |pages=69–94 |isbn=978-3-0346-0479-6}}</ref>

<ref name="Weatherall-2008">{{cite journal | vauthors=Weatherall DJ | title=Genetic variation and susceptibility to infection: the red cell and malaria | journal=British Journal of Haematology | volume=141 | issue=3 | pages=276–286 | date=May 2008 | pmid=18410566 | doi=10.1111/j.1365-2141.2008.07085.x | doi-access=free}}</ref>

<ref name="White-2008">{{cite journal | vauthors=White NJ | title=Qinghaosu (artemisinin): the price of success | journal=Science | volume=320 | issue=5874 | pages=330–334 | date=April 2008 | pmid=18420924 | doi=10.1126/science.1155165 | s2cid=39014319 | bibcode=2008Sci...320..330W}}</ref>

<ref name="White-2011">{{cite journal | vauthors=White NJ | title=Determinants of relapse periodicity in ''Plasmodium vivax'' malaria | journal=Malaria Journal | volume=10 | article-number=297 | date=October 2011 | pmid=21989376 | pmc=3228849 | doi=10.1186/1475-2875-10-297 | doi-access=free}}</ref>

<ref name="WHO-2006">{{cite book |title=Indoor residual spraying : use of indoor residual spraying for scaling up global malaria control and elimination: WHO position statement |date=2006 |publisher=World Health Organization |hdl=10665/69386 |hdl-access=free}}</ref>

<ref name="World Health Organization-1958">{{cite book |author=World Health Organization |chapter=Malaria |title=The First Ten Years of the World Health Organization |year=1958 |chapter-url=http://whqlibdoc.who.int/publications/a38153_(ch12).pdf |publisher=World Health Organization |pages=172–87 |url-status=live |archive-url=https://web.archive.org/web/20110708165621/http://whqlibdoc.who.int/publications/a38153_(ch12).pdf |archive-date=2011-07-08}}</ref>

<!-- Not in use
<ref name="Wilson 2012">{{cite journal |vauthors=Wilson ML |title=Malaria rapid diagnostic tests |journal=Clinical Infectious Diseases |year=2012 |volume=54 |issue=11 |pages=1637–41 |doi=10.1093/cid/cis228 |pmid=22550113 |doi-access=free}}</ref>
Not in use-->

<ref name="Wongsrichanalai-2008">{{cite journal | vauthors=Wongsrichanalai C, Meshnick SR | title=Declining artesunate-mefloquine efficacy against falciparum malaria on the Cambodia-Thailand border | journal=Emerging Infectious Diseases | volume=14 | issue=5 | pages=716–719 | date=May 2008 | pmid=18439351 | pmc=2600243 | doi=10.3201/eid1405.071601}}</ref>

<ref name="Worrall-2005">{{cite journal | vauthors=Worrall E, Basu S, Hanson K | title=Is malaria a disease of poverty? A review of the literature | journal=Tropical Medicine & International Health | volume=10 | issue=10 | pages=1047–1059 | date=October 2005 | pmid=16185240 | doi=10.1111/j.1365-3156.2005.01476.x | doi-access=free}}</ref>}}

=== Sources ===
{{refbegin}}
* {{Cite book | vauthors=Schlagenhauf-Lawlor P |title=Travelers' Malaria |date=2008 |publisher=PMPH-USA |isbn=978-1-55009-336-0}}
* {{Cite book | vauthors=Webb JL |date=2008 |title=Humanity's Burden: A Global History of Malaria |doi=10.1017/CBO9780511808401 |publisher=Cambridge University Press |isbn=978-0-521-67012-8}}
* {{Cite book |title=Guidelines for the treatment of malaria |publisher=World Health Organization |date=2015 |isbn=978-92-4-154912-7 |hdl=10665/162441 |hdl-access=free |ref={{SfnRef|WHO|2015}}}}
* {{Cite book |title=Malaria Eradication: Benefits, Future Scenarios and Feasibility: A Report of the Strategic Advisory Group on Malaria Eradication |publisher=World Health Organization |date=2020 |hdl=10665/331795 |hdl-access=free |isbn=978-92-4-000367-5 |ref={{SfnRef|WHO|2020}}}}
* {{Cite book |title=World Malaria Report 2022 |publisher=World Health Organization |date=2022 |hdl=10665/365169 |hdl-access=free |isbn=978-92-4-006489-8 |ref={{SfnRef|WHO|2022}}}}
{{refend}}

== Further reading ==
{{refbegin}}
*{{cite journal |first=Marshall Albert |last=Barber |title=The history of malaria in the United States |journal=Public Health Reports |volume=44 |issue=43 |pages=2575–87 |date=1929 |doi=10.2307/4579430 |jstor=4579430 |url=}}
*{{cite book |editor-last=Bynum |editor-first=W.F. |editor2-first=C. |editor2-last=Overy |title=The Beast in the Mosquito: The Correspondence of Ronald Ross and Patrick Manson |publisher=Rodopi |location= |date=1998 |isbn=978-90-420-0721-5 |url={{GBurl|af_0DwAAQBAJ|pg=PR1}}}}
*{{cite book |first=Gordon |last=Harrison |title=Malaria: Mosquitoes, Malaria and Man. A History of the Hostilities since 1880 |publisher=Dutton |location= |date=1978 |isbn=0-525-16025-6 |oclc=3169237 |url=}} a major worldwide scholarly survey [https://archive.org/details/mosquitoesmalari00harr/page/n4/mode/1up online]
*{{cite magazine |last=Jarvis |first=B. |title=How Mosquitoes Changed Everything |magazine=[[The New Yorker]] |url=https://www.newyorker.com/magazine/2019/08/05/how-mosquitoes-changed-everything |access-date=8 August 2019 |date=29 July 2019 |archive-date=7 August 2019 |archive-url=https://web.archive.org/web/20190807195030/https://www.newyorker.com/magazine/2019/08/05/how-mosquitoes-changed-everything |url-status=live}}
*{{Cite book |title=Textbook of Parasitic Zoonoses |last=Karunaweera |first=Nadira D. |last2=Silva |first2=N. Hermali |publisher=Springer |year=2022 |editor-last=Parija |editor-first=Subhash Chandra |location=Singapore |pages=151-161 |chapter=Malaria |doi=10.1007/978-981-16-7204-0_14 |editor-last2=Chaudhury |editor-first2=Abhijit |isbn=978-981-16-7204-0}}
*{{cite journal |last1=Li |first1=Qilong |last2=Liu |first2=Tong |last3=Lv |first3=Kunying |last4=Liao |first4=Fulong |last5=Wang |first5=Jigang |last6=Tu |first6=Youyou |last7=Chen |first7=Qijun |title=Malaria: past, present, and future |journal=[[Signal Transduction and Targeted Therapy]] |date=2025 |volume=10 |issue=1 |pages=188 |doi=10.1038/s41392-025-02246-3 |doi-access=free |pmc=12170910}}
*{{cite journal |first=Maurizio |last=Malpede |title=Malaria and economic activity: Evidence from US agriculture |journal=American Journal of Agricultural Economics |volume=105 |issue=5 |pages=1516–42 |date=2023 |doi=10.1111/ajae.12363 |url=https://ideas.repec.org/a/wly/ajagec/v105y2023i5p1516-1542.html |url-access=subscription}}
*{{cite book |last1=Poser |first1=Charles M. |first2=George W. |last2=Bruyn |title=An Illustrated History of Malaria |publisher=Parthenon |date=1999 |isbn=1-85070-068-0 |oclc=537843745 |url=}} [https://muse.jhu.edu/pub/1/article/4623/summary online review of this book]
*{{cite book |editor1-last=Qidwai |editor1-first=Tabish |title=Falciparum Malaria: Diagnostic Tools, Therapeutic Advances, and Future Opportunities |date=2024 |publisher=Academic Press |isbn=978-0-323-95328-3 |language=en}}
*{{cite book |first=Sheldon J |last=Watts |chapter=6. Yellow Fever, Malaria and Development: Atlantic Africa and the New World, 1647 to 1928 |chapter-url={{GBurl|AVX7NInQraoC|p=213}} |title=Epidemics and history: disease, power, and imperialism |publisher=Yale University Press |date=1999 |isbn=0-300-08087-5 |oclc=55142577 |pages=213–268 |url={{GBurl|AVX7NInQraoC|pg=PR5}} |jstor=j.ctt1nq8qw}}
*{{cite journal |first=Louis L. |last=Williams |title=Malaria Eradication in the United States |journal=American Journal of Public Health and the Nation's Health |volume=53 |issue=1 |pages=17–21 |date=1963 |doi=10.2105/AJPH.53.1.17 |pmid=14000898 |pmc=1253858}}
*{{cite journal |title=Tightening the handle on malaria |journal=Nature Methods |volume=16 |issue=4 |page=271 |date=April 2019 |pmid=30923375 |doi=10.1038/s41592-019-0390-2 |type=Editorial |doi-access=free |quote=A day dedicated to raising awareness of the disease is a good opportunity to ask how far malaria research has come and which methods are needed for further breakthroughs.}}<!-- This is something of a very brief annual review of key research and should be supplanted by more up to date items when they emerge. -->
*{{cite report |author=WHO |title=Guidelines for the Treatment of Malaria |edition=2nd |year=2010 |publisher=World Health Organization |isbn=978-92-4-154792-5 |url=http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf |archive-url=https://web.archive.org/web/20100311024041/http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf |archive-date=March 11, 2010}}
*{{cite book |title=WHO Guidelines for Malaria |date=2023 |publisher=World Health Organization |hdl=10665/373339 |hdl-access=free |vauthors=Organization WH}}
{{refend}}

== External links ==
{{Sister project links |wikt=malaria |commons=Category:Malaria |n=Malaria |q=Malaria |s=Malaria |b=Malaria |voy=Malaria |v=Malaria}}
{{offline|med}}
* [https://www.who.int/news-room/fact-sheets/detail/malaria WHO site on malaria] ({{Webarchive|url=https://web.archive.org/web/20200502021814/https://www.who.int/news-room/fact-sheets/detail/malaria |date=2020-05-02}})
* [https://www.cdc.gov/parasites/malaria/index.html CDC site on malaria] ({{Webarchive|url=https://web.archive.org/web/20211128151730/https://www.cdc.gov/parasites/malaria/index.html |date=2021-11-28}})
* [https://www.paho.org/en/topics/malaria PAHO site on malaria] ({{Webarchive|url=https://web.archive.org/web/20211128172601/https://www.paho.org/en/topics/malaria |date=2021-11-28}})

{{Medical condition classification and resources
 | ICD11          = {{ICD11|1F40}}–{{ICD11|1F45}}
 | ICD10          = {{ICD10|B50}}–{{ICD10|B54}}
 | ICD9           = {{ICD9|084}}
 | DiseasesDB     = 7728
 | MedlinePlus    = 000621
 | OMIM           = 248310
 | eMedicineSubj  = med
 | eMedicineTopic = 1385
 | eMedicine_mult = {{eMedicine2|emerg|305}} {{eMedicine2|ped|1357}}
 | MeshName       = Malaria
 | MeshNumber     = C03.752.250.552
 | Orphanet       = 673
 | Scholia        = Q12156
 }}
{{Malaria}}
{{Chromalveolate diseases}}
{{Diseases of Poverty}}
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[[Category:Malaria| ]]
[[Category:Articles containing video clips]]
[[Category:Insect-borne diseases]]
[[Category:Infectious diseases with eradication efforts]]
[[Category:Plasmodium|*Malaria]]
[[Category:Protozoal diseases]]
[[Category:Tropical diseases]]
[[Category:Vaccine-preventable diseases]]