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.  

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.