In MalariaWorld this week there is a discussion of the use of malaria rapid diagnostic tests (RDTs) in Republic of Congo. ‘Low practical knowledge but high willingness to use malaria rapid diagnostic tests among healthcare workers in the Republic of Congo’ by Baina et al is a survey of healthcare worker (HCW) knowledge about use of RDTs for malaria diagnosis. A total of 211 HCWs participated in the study. Nurses comprised the largest group (38%), followed by laboratory technicians (25%), midwives (19%), health assistants (5.7%) and Physicians (4.7%).

96% reported using RDTs, although only 36% had received specific training. General malaria knowledge was low, with just 9% scoring good. Most (90%) had poor understanding of target antigens and diagnostic procedures. 97% perceived RDTs as easy to use and 59% as reliable. In practice, 85.8% used both RDTs and microscopy, but only 7.6% followed national guidelines. No significant associations were found between knowledge, attitudes or practices and demographic or professional characteristics.

Following negative RDTs in symptomatic patients, healthcare workers demonstrated variable responses. 39% requested microscopy, and 27% prescribed antimalarials based on clinical suspicion. Similar observations were seen in studies in other countries. The routine use of confirmatory microscopy following negative RDTs, though sometimes necessary, also places a financial burden on the health system.

It is notable 73.9% prescribed antimalarial treatments after a positive test result so 26.1% did not which concerned the authors.  The authors opine that this gap may reflect persistent doubts about test reliability, limited adherence to guidelines, or reliance on clinical judgment over laboratory confirmation. They note that similar patterns have been reported in other African settings.

Although RDT usage is widespread among healthcare workers in Brazzaville department, significant gaps persist in their knowledge, attitudes, and practices regarding national diagnostic protocols. It seems clear that while they are used because they are easy to use, the HCWs do not necessarily understand them or always believe the result.

(An interesting footnote is that the main funder of the study was Abbott Rapid Diagnostics, even though their tests did not feature. The most popular RDTs used were two tests from Korean company SD followed by First Response, an Indian product. Abbott was highly favoured in the Internet search that we did to get the RDT picture because of Bioline tag. However, we do not think there is any connection to SD Bioline. And when searching for Abbott separately we found a paper ‘Investigating the Abbott-Bioline™ malaria antigen Pf/Pv rapid diagnostic test’ by Aung et el which has a surprisingly damning conclusion – ‘The Abbott-Bioline™ Malaria Ag Pf/Pv RDT that were obtained in 2024 failed to detect microscopically confirmed cases of malaria and is not fit for purpose. This test should no longer be used and should be replaced by one with adequate performance’.)

In MalariaWorld this week there is a report with data showing that malaria has declined this century in Bangladesh with seasonal variation of occurrence. ‘Long‑term associations between seasonal variability and malaria transmission in Bangladesh: a 16‑year national time‑series analysis’ by Akter et al is a retrospective ecological time-series study conducted using monthly malaria surveillance data from Bangladesh between January 2008 and December 2023.

Malaria incidence showed a marked long-term decline and a consistent seasonal pattern, with transmission peaking during the monsoon months (July–September). There were over 80,000 cases in 2008 and this has dropped to fewer than 20,000 annual cases 2018-2023. More cases are recorded in the months of June-September, peaking in July. This corresponds to the monsoon, rainy, season. The authors found a significant correlation with relative humidity and lagged rainfall.

It has been previously observed that malaria incidence is higher in rainy seasons and this is discussed in my book ‘Malaria is spread by mosquitos?’. The usual explanation based on the mosquito transmission hypothesis is that such conditions favour mosquito breeding increasing the number female Anopheles mosquitos looking for a blood meal. But it is very important to understand that correlation is not causation and this rule is particularly important when examining regular seasonal patterns. Many other factors vary with the calendar – such as harvest seasons. Also, water might be more likely to be contaminated during the rainy season.

The best news to take from this study is the decline of the incidence of malaria. This multiannual decline is unlikely to be correlated with any mosquito related factor. Malaria has declined in other Asian countries over the last 50 years. As incomes improve occurrence of malaria decreases.

However, the data in this paper show that the incidence has not continued to decline since 2018. And perhaps, unfortunately, if the current middle east crisis results in worldwide food shortages over then next few years the trend may reverse.

MalariaWorld remains on its shorter summer edition and contains no topic of interest not reported previously. Thankfully my email inbox had a thought-provoking article from ‘A Midwestern Doctor’ entitled ‘Why Medicine Won’t Cure You—and How That’s Finally Changing’. The anonymous writer’s substack is a great source of insight of what is wrong with the western medical system from within.

This article focuses mainly on the mental health drugs, SSRIs, and contains the following quotation – ‘When I was in high school, I observed a few discouraging events which led me to postulate: “no industry, organization or cause tasked with solving a problem will actually solve it because the problem disappearing threatens their economic livelihood or political power.” The article continues with reference to a Goldman-Sachs report from 2018 that asked ‘Is curing patients a sustainable business model?’

The same concern applies to malaria. When I worked for a company that produces emergency water treatment products, our sales manager was very envious of a competitor, Vestergaard Frandsen’s, lucrative business selling insecticide treated mosquito nets for malaria. We recently reported on the harm of profligate malaria net distribution and previously on their ineffectiveness at tackling malaria. And if they actually stopped malaria there would be no future business.

The same logic applies to all measures taken to tackle malaria – the drug manufacturers making vaccines, treatments, and prophylactics, the insecticide mosquito sprayers and all the novel research topics using AI, drones or genetically modified insects. What livelihood would they have if malaria were no longer a threat?

Recently, we have found fewer articles that examine the changes that might make a big difference, in particular examining improved nutrition. To address this deficiency, it is the goal of Understand Malaria to become a major funder of research that will discover how to eliminate malaria. And we will proudly state that our number one goal is to solve the problem and put ourselves (and the manufacturers of poisoned nets) out of the malaria business.

If you would like to support this work or know any potential donors who would like to support this research to permanently end the scourge of malaria by attacking he real underlying causes, please contact us.

In MalariaWorld this week the most interesting article again discusses the link between malaria and poverty. ‘Prevalence, determinants, and wealth‑related inequalities in malaria among under five children in Uganda: evidence from the malaria indicator survey’ by Mwebesa et al is a secondary analysis of data from the Uganda Malaria Indicator Survey (UMIS) 2018–2019 and finds results similar to the study from Nigeria discussed last week.

Almost 23 in every 100 children under five had malaria infection measured using rapid diagnostic tests (RTD). Regional variations in malaria prevalence and wealth-related inequalities were observed. The multilevel model identified several significant independent factors: older child age (aOR=2.12, 95% CI: 1.51–2.96, P<0.001), child’s anaemia (aOR=3.16, 95% CI: 2.33–4.29, P<0.001), and larger household size (aOR=1.98, 95% CI: 1.13–3.45, P<0.05) were positively associated with malaria in children under five years in Uganda. A negative concentration index (CIX=− 0.334, P<0.001) was also observed, indicating that higher malaria prevalence is concentrated among children in the poorest wealth quintile.

The richest quintile has just 11% of the number of cases observed in the poorest quintile. Anaemic children were over three times more likely to test positive. Anaemia is a strong indicator of malnutrition. Children in households with seven or more were more than twice as likely to test positive as those in households of three or fewer. Refugees were ten times more likely to test positive than urban dwellers. Rural dwellers were over three time more likely to test positive.

There is also detail of the prevalence by region and the regions with highest prevalence with over 50% positive also feature as the poorest areas (e.g. Bugosa, West Nile, Karamoja) found by Uganda National Household Survey 2023/24 reported last year in the Observer (source of picture). Similarly, the areas with lowest poverty (e.g. Kampala, Angole, Kigezi) have among the lowest number of cases.

Mosquitos do not discriminate against the poor. But as long as researchers retain the belief about mosquito malaria transmission they will not focus on measures that would really eliminate malaria. Malaria disappeared from Europe and North America when poverty declined and similarly is disappearing from Asia.

In MalariaWorld this week there is analysis of a demographic and health survey that found that poverty is the largest factor associated with malaria incidence of under-fives. ‘Identifying age-common and age-specific factors of Plasmodium infection in Nigerian children under five: Application of a cluster-aware multistage selection framework to the 2018 Nigeria Demographic and Health Survey’ by Choi et al was published in PLOS.

Children were classified as infected if either light microscopy or rapid diagnostic tests (RDT) was positive. Many factors were examined and some were found to be statistically significant to incidence of Plasmodium detection of children under five. Socioeconomic disadvantage was the strongest indicator. Children in the lowest wealth quintile had 80.7% higher prevalence than those in the richest quintile (PR=1.807; 95% CI: 1.467–2.224), and children whose mothers had no formal education had 55.8% higher prevalence than those with higher education (PR=1.558; 95% CI: 1.225–1.980). Maternal anaemia was associated with 22.5% higher prevalence (PR=1.225; 95% CI: 1.012–1.483). This may also be associated with a poorer diet. Rural residence was also associated with higher incidence.

Breastfeeding (PR=0.845; 95% CI: 0.764–0.934), and maternal internet use (PR=0.638; 95% CI: 0.475–0.857), were associated with lower prevalence of Plasmodium. The former is associated with better nutrition, and the latter may be associated with wealth (in 2018). Overweight-for-height (PR=0.761; 95% CI: 0.631–0.917) was also associated with lower prevalence of Plasmodium. It should be noted that the number of overweight children in the study was fewer than 3%.

Other factors had less effect. Curiously household insecticide-treated net (ITN) ownership was associated with more Plasmodium – 10.4% higher prevalence (PR=1.104; 95% CI: 1.017–1.198), while sleeping under an ITN was associated with 8.4% less (PR=0.916; 95% CI: 0.858–0.977). These differences are small and may be confounded with other factors.

There is a lot of information in these large population surveys and they always point to factors associated with poverty as the major factor indicating susceptibility to malaria.

The mass distribution of free insecticide treated nets (ITNs) is not immune from the law of unintended consequences. In MalariaWorld this week there is a news article from Nature called ‘The catch in repurposing malaria nets’. A study in southwest Madagascar shows how repurposed bed nets provide food and income to coastal households, while raising concerns about juvenile catches and the future of local fisheries.

More than three billion insecticide-treated mosquito nets have been distributed globally since 2004, with the majority received in sub-Saharan Africa over the past two decades. Fishers using repurposed mosquito nets in southwest Madagascar can land between 9 and 18 kilograms of fish in a single trip. A new study found that their catches contained hundreds of different forms of marine life, many of them only a few centimetres long. Their efficiency raises difficult questions about the future of the fisheries on which those communities depend.

Mosquito-net fishing, using discarded or new nets, has been documented across much of tropical Africa, including Kenya, Madagascar, Uganda and Tanzania. Conservationists have long argued that the practice can damage fisheries by capturing juvenile fish and other marine organisms before they reproduce. Around Lake Victoria in western Kenya, mosquito nets are used for fishing, but they have also been repurposed to protect crops, cover chicken coops, make ropes, football goals and even wedding veils.

More than half the fishers surveyed reported using mosquito nets because they had few alternatives. The very fine mesh allows the capture of a wide range of marine organisms, including small fish and shrimp, often with relatively little effort and without the need for specialised equipment.

Researchers found that fishers generally used old or surplus mosquito nets, meaning that bed-net coverage did not differ significantly between households that fished with mosquito nets and those that did not. Unlike conventional fishing gear, conservation scientists are concerned that insecticide-treated nets could have health risks to fishers or consumers.

“If unaddressed, we risk reduced effectiveness of malaria interventions, ecological damage to fish stocks and worsening public health outcomes in the next 10 to 20 years,” says Gabriel Dida, a public health researcher at Maseno University in Kenya.

What is not mentioned in the article is the unintended consequence of the damage that the free net distribution does to the business of traditional net makers, who hand make coarser nets that would not catch the juvenile fish. Why pay a local when the ‘do gooders’ give for free?

And as we have pointed out earlier (April 2025, November 2025, February 2026, April 2026) ITNs are not even effective at preventing malaria.

A theme in MalariaWorld this week is research questioning the effectiveness and/or safety of malaria drugs. The lead news article ‘Artemisinin resistance is rising in East Africa—leaving anti-malarials at risk of failure’. The medicalxpress article by Ryan O’Hare of Imperial College London, discussed a study, published in The Lancet Infectious Diseases, that maps the rise in artemisinin resistance in the region. They found that artemisinin partial resistance is now firmly established across most of Uganda and Rwanda and along the Ethiopia–Eritrea–Sudan border.

‘Survival differences and artemisinin resistance in severe malaria among HIV coinfected patients: data from Mozambique’ by de Sousa et al found that HIV positive patients have many risk factors for the development of parasite drug resistance.

‘Mapping the intellectual landscape of malaria drug repurposing: a systematic analysis of the 51 most cited studies’ by Tizhe et al examined studies of repurposing of anticancer agents, antivirals, and immunosuppressants because of the ‘escalating threat of Plasmodium falciparum resistance to artemisinin-based therapies.

‘Prevalence of antimalarial drug resistance markers and factors associated with Plasmodium falciparum infection in asymptomatic children prior to rectal artesunate implementation in Kapolowe Health District, Democratic Republic of the Congo’ by Luzolo Khote et al was carried out because concerns remain that its expanded use of rectal artesunate (RAS) followed by a full course of artemisinin-based combination therapy (ACT) may select for artemisinin-resistant Plasmodium falciparum strains.

‘Risk perceptions of high-dose primaquine and tafenoquine among Plasmodium vivax malaria stakeholders in Ethiopia: a qualitative study’ by Mwaura et al carried out a study because fears that novel regimens, such as 7-day high-dose primaquine regimen and single-dose tafenoquine, may improve treatment adherence and antirelapse effectiveness but can increase the risk of haemolysis in individuals with glucose-6-phosphate dehydrogenase deficiency. Fears of overdosing and drug-induced haemolysis also contributed to apprehension about the safety of these regimens.

‘Prevalence of molecular markers related to artemisinin partial resistance and ACT partner drug resistance in the Plasmodium falciparum population in Kongo Central, DRC’ by Stauning et al found potential marker of artemisinin partial resistance in 42% of the sequencing positive samples (PCR testing).

If you have any generic illness symptoms in a country with malaria, you will be tested for malaria by most clinics and hospitals using a Rapid Diagnostic test or microscopy if available. If positive you will be given a three-injection dose of an artesunate over 24 hours and a prescription for pills after that, or perhaps a course of treatment with novel drugs. There seems to be much doubt within the malaria research community about the effectiveness of such treatment.   

A study in MalariaWorld last week found a link between malaria and nutrition. ‘The gut microbiome in early life predicts malaria susceptibility’ by Dutton et al of the University of Florida studied infants from birth in malaria-endemic eastern Democratic Republic of Congo. Infant faecal samples were collected at six weeks, and at three, six and 12 months of age, as well as at passive malaria sick and post-treatment visits, and were subjected to full length 16S rRNA sequencing.

The study found significant differences in relative abundance of a number of bacterial species between those infants who never had a malaria visit from those who did, and malaria episodes resulted in gut dysbiosis. Healthy gut-associated Bifidobacterium breve and its metabolic partner Cutibacterium avidum, along with Megasphaera micronuciformis were associated with malaria resistance, whereas bacteria previously associated with pathogenic processes, including Streptococcus salivarius, Klebsiella pneumoniae, and Rothia mucilaginosa, associated with malaria susceptibility.

The faecal samples collected were tested using digital polymerase chain reaction (PCR) techniques to identify bacteria. These data were correlated with detailed survey information of both mothers and infants and malaria status. There are no other clear signals from the data collected. But clearly, the infants microbiome is linked to the quality of nutrition they receive. We reported another study linking gut microbiome to malaria in April 2026.

There is opportunity to investigate microbiome-targeted strategies to support resistance to malaria in early life. It would be useful to identify the foods eaten by breast feeding mothers and by growing infants that encourage development of malaria resistant guts.

Surprisingly, we can agreed with the headline of a blog post published in MalariaWorld this week, but for a different reason. The post with the same name was written by Fredros Okumu for Devex. Devex is described thus by Editor in chief Raj Kumar – ‘Devex is the platform for insider journalism on global development — independent, trusted, essential’. It is funded by globalist organisations including Gates Foundation, World Bank, UN, European Commission and WEF.

In earlier posts we have discussed this issue including Burkina Faso’s ending of gene-drive mosquito trials, possible releases of GM mosquitos in Nairobi by Gates Foundation, and a general dismissal of possible dangers of the effectiveness of this bizarre idea.

Unsurprisingly, Okumu is making the case that the dangers of ‘Frankenstein’ mosquitos are insignificant compared to the 610,000 annual worldwide deaths from malaria. He says conversations start with the technology and that they should start with the disease. Again, we agree. And the first question he should answer is how does he know for sure that malaria is spread by mosquitos, or is it a disease of malnutrition?

He states if gene drives work as intended, engineered mosquitos could spread genetic traits that selectively suppress populations of the most dangerous malaria mosquitos or make them unable to transmit the parasite. This argument runs counter to basic Darwinian evolution theory. There is no way that Gates’ freak mosquitos will outcompete well evolved natural mosquitos. If natural mosquitos can survive insecticides they can survive these freaks.

He says another thing we agree with ‘But what succeeds in a laboratory does not automatically succeed in the world’. He uses this as an argument for field trials rather than as a cue to forget about the idea.

Comically he states ‘When COVID-19 arrived, the world understood speed as a moral obligation. In the U.S., Operation Warp Speed accelerated the development, testing, and manufacturing of multiple vaccine candidates without abandoning safety. It meant that delay itself was recognized as a risk. Malaria deserves the same seriousness’. Clearly, he does not understand that COVID19 vaccines caused immeasurably more harm than the supposed virus, a fact we know too well because of the premature demise of a close relative.

On the plus side the gene drive mosquitos are at worst a costly folly, unlike the real dangers caused to babies by vaccines including those for malaria tested against vaccines for rabies.

An article in MalariaWorld this week again reinforces the suspicion that malaria is a generic illness that can be found if sought. It reminds one of the testing for COVID19 that happened in much of the world in 2020-2022. ‘Non-linear age dynamics of malaria infection and fine-scale environmental exposure in rural Uganda’ by Lang et al examined data for 4308 participants aged 5 to 90 years from 52 villages across three lakeside districts of Mayuge, Buliisa, and Pakwach, with enrollment between January 2022 to February 2024. The primary outcome was malaria infection status by rapid diagnostic test (RDT) and secondary outcomes included microscopy-confirmed infection with parasite density quantification and self-reported fever within the past month.

The most notable aspect of the study was the high prevalence of malaria especially as detected using RTDs (41.2% – lower by microscopy, the ‘gold standard’ – 32.3%). However, this did not directly relate to fever with just 11.2% of positive adults with fever. For children (5 to 10) it was 30.8%. What is also interesting is that many of RDT negative adults (5.8%) and children (16.3%) had fever. Positive tests are associated with higher levels of illness but not completely. And the significant number of asymptomatic plasmodium positive individuals casts doubt on the validity of such tests for diagnosing illness.

Plasmodia are likely organisms that consume dead blood cells. They are more likely in unwell than well people but and not exactly correlated with illness. This study confirms that many well people test positive and unwell people test negative. Unwell people are more likely to be tested which is what make studies like this, that also include tests of well people so interesting.

However, the belief in malaria and its cures is strong. A friend in Kenya was ill this week and went to hospital. A malaria test was positive and malaria drugs were prescribed. They didn’t cure the illness. But her belief in the medical establishment is strong and she complies. It will be difficult to end malaria in Africa when the belief in it is so culturally entrenched.