In MalariaWorld this week there is a study investigating the people’s opinion about malaria and its treatment in Ethiopia. In ‘The social experience of malaria treatment-seeking: pathways, gender, and inequality in Jimma Zone, Ethiopia’, Gerba et al interviewed people and conducted focus group studies on malaria and its treatment. While it is clear that the researchers are strong believers in the mosquito transmission hypothesis, the interviewees consider other causes to be more important. And they rely on traditional remedies as a first response.

Local terms for malaria, busa (seasonal fever), sekera (killer disease) and buda (evil eye), are related to how symptoms were recognized and interpreted.

Busa was widely used to refer to recurrent seasonal fevers, particularly those occurring during the rainy period. Many participants associated busa with environmental and seasonal changes rather than with mosquito bites. One woman explained: “Every year when the rains come, busa also comes. The children fall sick one after the other”. In western countries such an illness would be considered a cold or flu (on in 2020-2022 COVID19). Many households initially adopted a ‘wait-and-see’ approach before seeking biomedical care with this illness.

Sekera is a severe or life-threatening forms of illness, characterized by high fever, intense chills, weakness, and loss of speech. For many, the experience of sekera was not just a biological state but a state of total social paralysis; one participant noted that the illness: “Finishes a person”, and is associated with sudden deterioration and a high risk of death. Illness episodes labeled as sekera are treated with greater urgency and fear, often prompting families to seek stronger forms of intervention.

Buda was linked to spiritual harm, envy, and the evil eye. Some participants believed that malaria-like symptoms could result from social tension or spiritual attack rather than physical causes alone. An elderly woman explained “Malaria is not only about mosquitos. It is like buda; it comes when someone envies you, when your body is not protected. If it catches you, it can finish you”. In such cases, illness was understood not merely as a physical condition but as a reflection of social vulnerability.

Treatment usually begins with hot beverages and OTC medications. If symptoms worsen traditional herbal remedies would be used. Spiritual practices such as the use of holy water and prayer are used. If symptoms get very bad medical care at a clinic would be sought.

The authors reference similar observations in other African studies. In Ghana, Tanzania, Kenya, Burkina Faso, Uganda, and Malawi communities frequently use locally meaningful fever terms that do not neatly correspond to biomedical classifications. However, in the medical establishment the belief in the mosquito tall tale continues irregardless.

Picture. Spiritual healer or Sangoma from South Africa (Source—Ancient Origins).

One thing we can agree with establishment malaria researchers is that mosquito bites are not desirable. We don’t believe that disease is transmitted but mosquito bites are uncomfortable and itchy. Before travelling to Botswana a few years ago I prepared my own homemade natural mosquito repellent by dissolving 1% peppermint oil in coconut oil!

And today in MalariaWorld there is an interesting paper comparing natural and synthetic mosquito repellents. In ‘Do natural or synthetic excito-repellents work better? A study on coastal malaria vector Anopheles epiroticus in Ko Chang, Thailand’, Sukkanon et al compared the effectiveness of four synthetic and two natural mosquito repellents with field and laboratory strains of Anopheles epiroticus.

An insecticide-susceptible laboratory strain of An. Epiroticus and field strain of An. epiroticus derived from fed females collected using an entomological mount aspirator around the buffalo pen were used in the trial. Four synthetic and two natural repellent agents were used in the study. Three pyrethroids (deltamethrin, permethrin, alpha-cypermethrin) and DEET (N,N-diethyl-meta-toluamide) were the synthetics. Vetiver oil (extracted from the roots of the Vetiveria zizanioides plant) and citronella oil (extracted from lemongrass) were the natural repellents. They were dissolved in alcohol and soaked in paper in the studies.

Mosquitos were exposed to treated paper in contact studies, where mosquitos could contact the paper, and non-contact studies (paper behind a net). The chamber had an escape to another chamber and effectiveness of the repellent was measured by the number that escaped.

For the laboratory strain, 5% citronella oil was the most effective repellent for in both the non-contact (59.26%) and contact (52.73%) studies. Vetiver oil 5% achieved 40.38% in contact study. The best synthetic was deltamethrin at 42.11% in contact study. For the contact study with the field strain the synthetics were more effective – DEET 5%, 64.15% and deltamethrin 5%, 60.00%. The natural material were also effective at 5% in contact study – vetiver oil 48.14% and citronella oil 40.74%. High mortality rates were also observed for the mosquitos that did not escape in non-contact citronella oil study.

The authors concluded that pyrethroids, particularly deltamethrin and permethrin, along with DEET, showed enhanced efficacy against field populations as contact irritants, while natural repellents like citronella oil were more effective against laboratory strains as non-contact repellents.

In MalariaWorld this week there is reference to a paper that links malaria with a deficiency of micronutrients. ‘Burden and co-occurrence of anemia, micronutrient deficiencies, inflammation, and malaria among women, adolescents, and children in Madagascar: a national cross-sectional survey’ by Rohner et al is published in The Journal of Nutrition. Unfortunately, the full article is behind a paywall but interesting details are presented in the available summary.

Venous blood and urine were analysed for malaria, anaemia, inflammation, iron, zinc, iodine, fluoride, vitamins A, D, and B12, folate, riboflavin, and thiamine biomarkers. Malaria was detected in 4% to 14% of participants, and inflammation in 21% to 46% of participants. Anaemia affected 42% of PSC (preschool children) and about one-third of the older groups. Iron deficiency was most common in PSC (26%) and less frequent in adolescents and women (6%–16%). Zinc deficiency affected one-third of all groups. Riboflavin deficiency was highly prevalent, affecting 75% of PSC and nearly 90% of older groups. Vitamin A deficiency prevalence was 12% among PSC but rare in older groups, while folate deficiency affected 12% of adolescent girls and 21% of non-pregnant women. Other deficiencies were uncommon (iodine, vitamins B12 and D, and thiamine).

Micronutrient (MN) supplementation was considered in the article. Clearly many in Madagascar and elsewhere in Sub-Saharan Africa have a diet insufficient in nutrients and the level of anaemia is a notable marker. Madagascar faces very high rates of stunting and wasting, which are believed to be compounded by widespread deficiencies in zinc, iron, vitamin A, iodine, and other MNs. The authors consider malaria and inflammation as contributors to anaemia in Madagascar rather than as symptoms of malnutrition, with recent national surveys reporting persistent malaria transmission.

The bottom line is that the Plasmodia, considered the malaria parasites, and Anopheles mosquitos, considered their vector, remain present in countries without malaria. The main difference is that these countries do not have high incidence of malnutrition. Malaria disappeared when living standards improved. The same will happen when living standards improve in Madagascar and the rest of Sub-Saharan Africa where malaria remains a scourge.

In MalariaWorld today there is a reference to a draft manuscript looking at a cost-effectiveness analysis in Malaysia. ‘Cost-effectiveness of outdoor residual spraying, insecticide-treated nets, and their combination for zoonotic malaria control in Sabah, Malaysia: a comparative analysis’ by Firdaus et al compared the supposed reduction in the number of cases based on cost for different insecticide application programmes.

The paper stated that the cost of no intervention was MYR 3,913, of LLIN – MYR 18,089, of ORS – MYR 30,507 and of ORS + LLIN – MYR 39,765 (Exchange rate (2025): 1 MYR (Malaysian Ringgit) = US$0.23). The effectiveness was estimated by comparing the number of reported cases for the three interventions for January-December 2023 with the baseline which was the number of cases reported for the test areas for 2020-2021.

However, in our opinion the study is very flawed because of the variation of the number of baseline cases. For ORS area baseline was 15 cases with just two reported in test period and this was reported as a reduction of 13 cases as a cost of MYR 2,046 each. For ORS + LLIN there were seven at baseline and one in test so the six-case reduction cost MYR 5,975 per case. For LLIN baseline was five and zero in test so the five-case reduction cost MYR 2,835 per case.

Another major flaw in the study is that the effectiveness of no intervention was not measured and was assumed to be zero reduction of cases from the baseline period. Clearly there were far more cases reported in 2020-21 baseline period (27 in three areas) than in 2023 (three cases in the three areas). It would not be surprising if the reduction in a no intervention area for the study period would be similar to the test areas and therefore much more cost-effective. And their observed result that either ORS or LLIN is more effectives than the two together makes no sense if the interventions are effective. The fact that both together cost more is not a surprising result if they have no effect on the occurrence of malaria.

There is a trend in recent articles that malaria programmes whether insecticide as reported here or vaccines as reported in March are cost ineffective for reducing malaria cases. It makes us question how well malaria researchers actually understand the real causes and treatments for malaria.

In MalariaWorld this week there is a link to an article in The Conversation, ‘Illegal gold mining causes surges in malaria in the Amazon, and the association is far worse than we suspected’ by  de Angeli Dutra and Casagrande. Malaria cases reported have increased from around 5,000 to 20,000 annually in Yanomami indigenous territory since then president of Brazil, Jair Bolsonaro, deregulated gold mining in indigenous territories of Brazil in 2019.

Since that time the number of illegal gold miners in Yanomami territory, the largest Indigenous territory in the Amazon, had surged to 20,000, roughly two-thirds the number of the local Yanomami population. The picture from the article is of a man with a phrase in Portuguese painted on his back that translates to “Mining Kills,” from a protest against the increase of mining activities that are encroaching on his land, in front of the Ministry of Mines and Energy in Brasilia, Brazil, in 2022.

Three explanations are given for the surge in malaria cases. The first two are a hat tip to the unproven mosquito-plasmodium hypothesis. The miners’ activities create pools for mosquito breeding (as if there were not already enough water pools for mosquito breeding in the Amazon basin), and miners travel potentially bringing the illness from hotspots for malaria transmission across South America (it is not clear where these hotspots are).

The third explanation and, in the opinion of Understanding Malaria, the most likely reason is that small-scale gold miners often use mercury to cheaply and easily extract gold particles. This mercury is dumped into waterways across the region, poisoning the people who rely on the rivers for water and for fish, weakening their immune systems and making them more susceptible to malaria. The most likely cause of malaria is malnutrition – both absence of nutrients and poisoning, and there are few poisons more toxic to mammals than mercury.

I visited an artisanal gold mine in Kenya and the final purification step was mixing a slurry of the final densest dust with mercury to form an amalgam. The mercury was later burned off to leave the gold metal. The people who do this with no protection will be poisoned and mercury poisoning symptoms are similar to malaria symptoms.

The authors were shocked by the results. The relationship was far stronger than they had suspected. Every 0.03% increase in mining led to a 20-46% increase in malaria one to two years later, resulting in a 300% increase in malaria in the Yanomami territory between 2016-2023.

This is no surprise to Understanding Malaria. We covered the link between mining and malaria previously in August 2024. Mining operations expose people to many toxic materials they would not otherwise be exposed to.

In MalariaWorld this week there is a reference to a blog published by the United Nations Development Programme. ‘Why it is time to rewrite Africa’s malaria story’ by Aissata De of UNDP and Dr Michael Adekunle Charles, CEO of the RBM Partnership to End Malaria, makes the point that the lack of development fuels malaria.

The article opens with the point that if you woke up with severe fever, would you stay home from work? What if the choice meant losing a week’s wages, or deciding if you could afford the trip to a doctor at all? Clearly malaria, what ever its causes, has a more serious effect on people with the least. Malaria causes up to half a billion lost workdays each year and slows GDP growth by up to 1.3 percent. It accounts for half of preventable school absences, undermining learning and opportunity.

Recent analysis in Uganda found that districts with low development indicators are five times more likely to experience a high number of malaria cases. In Kapelebyong district in Uganda, malaria treatment can cost households a significant 120,000 shillings a year, often requiring long journeys to clinics facing staff and medicine shortages.

These establishment figures do promote the current activities that are not working, such as vaccines tested without placebo controls, and mosquito control. But it is promising that they are recognising that poverty, weak infrastructure, limited services, and environmental risk do not just coexist with malaria; they actively sustain it.

They call for a rethink of how malaria is tackled. I wonder would they go so far as to examine the mosquito transmission tall tale created by Ross, Grassi and others 125 years ago, and the related medical and mosquito control programmes that make so much money for Western and Chinese manufacturers and their African agents?

In MalariaWorld this week there is an interesting article. ‘Malaria incidence rose following the introduction of neonicotinoid-based IRS in selected districts in northern Ghana: An observational analysis’ by Coleman et al described how there was a significant increase in the occurrence of malaria (26%) when nicotinamide insecticides replaced organophosphates in IRS programmes in Ghana from 2015-2022.

A decrease had been seen earlier when pyrethroids were replaced with organophosphates and in one district the incidence decreased again when organophosphates were reintroduced instead of neonicotinoids. The reason given for the changes to the insecticide used was  Ghana’s insecticide resistance management plan, which promotes the rotation of insecticides with different modes of action to slow the development of resistance.

The paper contains no data on the effect on mosquito populations as a result of these changes. Clearly, the assumption based on the hypothesis that mosquitos spread malaria is that the increase when the neonicotinoid were introduced was due to reduced effectiveness at eliminating mosquitos. However, at the time of introduction to IRS programme neonicotinoids were already in widespread use for agriculture so they must be effective. The authors opine that the widespread use has caused resistance in Anopheles mosquitos. However, they also report that testing in 2017 found that Anopheles mosquitos were susceptible to Clothianidin, one of the commonly used neonicotinoids, in high usage cotton producing areas.

Clearly, there are health risks as a result of spraying potent toxins indoors. And a study ‘Effects of Neonicotinoid Pesticide Exposure on Human Health: A Systematic Review’ by Cimino et al found chronic neonic exposure and adverse developmental or neurological outcomes, including tetralogy of Fallot, anencephaly, autism spectrum disorder, and a symptom cluster including memory loss and finger tremor.

Perhaps instead malaria is an illness of poverty exacerbated by exposure to toxins. Perhaps what this study shows is that neonicotinoids are more harmful to human health than the other insecticide used.

MalariaWorld this week carried details an announcement by WHO (World Health Organization) on April 24 last week, the eve of World Malaria Day. The highlight of the article was the new prequalification of an artemether-lumefantrine treatment, that is the first antimalarial formulation designed specifically for the youngest malaria patients (<6 months).

The treatment, produced by Novartis and sold as Coartem Baby or Riamet Baby was approved by Swissmedic last year and reviewed in this column on July 11, 2025 ‘New Wonderdrug for Babies Tested without Control’. Its performance in terms of efficacy and side-effects was hardly a game changer.

WHO also, on April 14, 2026, prequalified three new rapid diagnostic tests (RDTs) designed to address emerging diagnostic challenges for malaria. These tests detect even more ‘cases’ of malaria than current tests many of which the WHO consider that there is a problem with false negatives, a failure to detect plasmodia parasite protein. This is curious since current RTDs already detect more malaria ‘cases’ than the gold standard microscopy method. Of course, the WHO would never consider false positives, which seem like the more likely outcome of the more sensitive tests to be an issue.

They also promote vaccines and bed nets in the announcement, whose ineffectiveness has been covered here over the last few weeks.

On the eve of World Malaria Day (April 25) there is a reference to a Nature editorial in MalariaWorld. ‘Malaria deaths should be falling — not rising’ has the subheading ‘The tools exist to end this killer disease. It is the money and the will that are lacking’. This is an interesting complaint considering just three weeks ago here it was reported here that vaccines are cost ineffective. The malaria expenditure costs with immunisation are over 20 times the cost without!

The Nature editorial starts by saying ‘There will be little to celebrate on World Malaria Day on 25 April. Global malaria cases, which stood at 238 million in 2018, had climbed to 282 million by 2024, the latest year for which figures are available. Deaths from the disease rose from 575,000 to 610,000 over the same period’. It goes on to say ‘Deplorably, this is happening despite the advent of vaccines. In October, it will be five years since the World Health Organization (WHO) recommended the world’s first malaria vaccine, RTS,S. This was hailed at the time as a tool that would “change the course of public health history” by WHO director-general Tedros Adhanom Ghebreyesus. A second vaccine, R21, was recommended two years later.’

Followers of this column are well aware that clinical trials of these vaccines were carried out without a placebo control, but instead with Rabies vaccines that would be expected to worsen the health of recipients. Under conventional medical treatment a course of malaria vaccinations does not begin unless there has been a bite by a suspect rabid animal because of the side-effects. We will not address broader questions concerning rabies here.

Malaria vaccines were tested in trials with Rabies vaccines used as controls instead of harmless placebos (Rabipur manufactured by GSK, Marburg, Germany and owned by Bavarian Nordic, Hellerup, Denmark was used as the control in RTS,S study). Abhayrab, manufactured by Indian Immunologicals Limited, was used as control in trial of R21.

There is a widespread belief that vaccines helped reduce the incidence of many diseases in the developed world, but careful analysis of data found that most of the decrease of incidence of these illnesses occurred before vaccines were introduced (see ‘Dissolving Illusions’ by Bystrianyk and Humphries). The Nature editorial even refers to the recent elimination of malaria in Egypt and Cabo Verde that was achieved without vaccines.

The real problem for the malaria business is addressed in the sub-heading, money. The article despairs that Robert F. Kennedy Jr has said that the United States will no longer contribute to Gavi, The Bill and Melinda Gates business that promotes vaccines in many countries. And we know that vaccines are cost ineffective and cannot be paid for with the scant resources of many of the affected countries.

As an aside, why is April 25 World Malaria Day? It was Africa Malaria Day from 2001 but we cannot find an explanation of the significance of this date. Please let us know in comments if you know.

An interesting article referenced in MalariaWorld this week found that household net use showed no significant association with malaria of children under five (CU5) after controlling for wealth index. ‘Risk factors for malaria among children under five living in net-owning households in Mozambique from the 2022–3 Demographic and Health Survey’ by Mooney et al examined household-level mosquito net use in Mozambique using 2022–3 national survey data.

The study published in Transactions of The Royal Society of Tropical Medicine and Hygiene, has results clearly stated in the abstract. Household net use showed no significant association with CU5 malaria after controlling for wealth index. Wealth index indicated a dose-response, where middle-resource households were 43% less likely (adjusted OR [aOR] = 0.57; 95% CI 0.38 to 0.84; P < .0048) and highest-resource households were 84% less likely (aOR = 0.16; 95% CI 0.09 to 0.27; P < .0001) compared with lowest-resource households.

Many studies continue to be published that claim a benefit from net use including in MalariaWorld this week. ‘Prevalence and factors associated with malaria amongst under-five children in Senga Hill District, Northern Province, Zambia, a community-based cross-sectional study’ by Arthur et al found that correct hanging of an ITN reduced the odds of being positive for malaria by 88%. And having two insecticide treated nests (ITNs) and indoor residual spraying (IRS) done in the last spraying season reduced odds of being malaria positive by 86%. These are similar percentage reductions to those seen in the Mooney study for the highest resource households.

However, the Arthur study did not analyse family wealth. To repeat the well know experimental axiom, correlation does not imply causation. The Mooney paper also states Causation cannot be inferred from a cross-sectional survey. They state that the findings are consistent with prior studies suggesting that wealthier households may benefit from improved housing conditions, access to healthcare and malaria- prevention resources.

In general wealthier families are more likely to buy mosquito nets and pay for insecticide spraying. Wealthier families are less likely to have children under five with malaria. But that does not imply that nets or insecticide spraying reduce the incidence of malaria. The cause of the decreased malaria could be the result of some other factor related to wealth. Wealthier families can afford better food, cleaner water, better built houses, and better sanitation. Could one or all of these factors be the reason for reduced malaria?

Despite the unconvincing evidence of their effectiveness nets continue to be promoted. A YouTube video reported in MalariaWorld this week by CGTN describes a government supported net distribution scheme in Uganda.

Originally posted April 17. Revised April 20.

https://usmalaria.com/nets-ineffective-at-preventing-malaria-but-are-promoted-anyway/