Malaria: Causes, Symptoms, Treatment, and Prevention

Author: Arome David, BSc, MPH, Fellow – Media EIS

Reviewed by: Dr Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• Malaria is a disease caused by Plasmodium species transmitted through a bite from an infected female Anopheles mosquito.
• There are over 200 known Plasmodium species, but the deadliest is Plasmodium falciparum, which is responsible for most malaria-related deaths each year.
• The common symptoms of malaria are fever, chills, headache and tiredness.
• Stopping malaria spread requires more than just one approach; it demands a mix of the right diagnosis, vector control and treatment.  

Introduction

Malaria remains a life-threatening infection in many tropical countries, affecting about 263 million people and accounting for 597,000 deaths globally. Africa, especially Nigeria, harbours the bulk of the disease burden worldwide.

Despite decades of advancement in the treatment of this preventable and curable disease, malaria persists. However, the introduction of a malaria vaccine is a promising game-changer towards the eradication of the disease.   

What is malaria?

Malaria is a disease caused by a parasite called Plasmodium, spread through a bite from an infected female Anopheles mosquito. There are 200 Plasmodium species; only five are known to infect humans, including 

• Plasmodium falciparum
• Plasmodium ovale
• Plasmodium malariae 
• Plasmodium vivax
• Plasmodium knowlesi [1]. 

The deadliest of all is Plasmodium falciparum, responsible for the vast number of deaths recorded annually from malaria incidence. 

Common symptoms of malaria

Malaria in mild cases is usually characterised by high spiking in: 

•  Fever: an increase in body temperature above the normal 37.0°C
•  Chills: an intense feeling of cold and shivering
•  Malaise: feeling of weakness, discomfort and unwell
•  Headache: mild to severe pain around the head region
•  Myalgias: muscle pain or body pain    

In severe cases, the presenting symptoms are:

• Difficulty breathing
• Extreme tiredness and fatigue 
• Impaired consciousness
• Multiple convulsions
• Dark or bloody urine
• Jaundice: yellowing of the eyes and skin
• Abnormal bleeding

 Transmission of the malaria parasite

Malaria is not transmitted from person to person. The routes of transmission include:

•  Bite from an infected female Anopheles mosquito
• Blood transfusion harbouring the parasite
•  From mother to unborn child (Congenital malaria)

Diagnosis of Malaria

The common diagnostic tests for malaria infection include: 

Rapid Diagnostic Test (RDT)

RDT is a widely used diagnostic kit for uncomplicated malaria. This test looks for certain substances (called antigens) that the malaria parasite releases into the blood. If these antigens are found, it means the person has malaria. Blood for the test is commonly obtained from a finger prick. 

Microscopy

Microscopy remains the most reliable test for confirming malaria parasites. It is used for mild to severe cases of malaria. The test is usually carried out with two types of blood samples checked under the microscope. The thick sample shows the quantity of malaria parasite, while the thin sample identifies the type of malaria parasite [3].   

Treatment options for malaria

For decades, chloroquine has been used in malaria treatment, until resistance set in. The resistance gave way to the current artemisinin-based combination therapy (ACTs) in use. The commonly used ACTs for uncomplicated malaria treatment are:

• Artemether-Lumefantrine
• Artesunate-Amodiaquine
• Artesunate-Mefloquine
•  Dihydroxy-artemisinin piperaquine
•  Artesunate + sulphadoxine-pyrimethamine 
•   Artesunate-pyronaridine

These medications are taken by mouth.

In the treatment of complicated malaria, the patient’s condition is first checked, and the right malaria medicines are given (usually into the vein or muscles). Any complications caused by the illness are also treated, along with extra care to support recovery [4].

New Malaria Vaccine

The introduction of a new malaria vaccine is changing the narrative and offering an alternative option to treatment resistance. Though the use of the vaccine is still on a low key with a specific target on children, who suffer malaria the most. 

These vaccines do not give 100% protection, but they help reduce the chances of children getting very sick or dying from malaria. When used together with other measures like sleeping under insecticide-treated nets and treating malaria early, they make a big difference in keeping children safe.The new malaria vaccines are: 

RTS, S/AS01 Malaria Vaccine

The RTS, S/AS01 malaria vaccine was introduced after a successful pilot program in Ghana, Kenya, and Malawi. In October 2021, the World Health Organization (WHO) recommended the widespread use of the vaccine among children in malaria-affected regions with high cases of Plasmodium falciparum transmission. 

The vaccine has been shown to reduce malaria among children in endemic regions of the world. Between 2023 and 2025, about 18 million doses have been released into 12 African countries with high malaria risk. The vaccine is now being rolled out in routine childhood immunisation programmes across Africa.

R21/Matrix-M Malaria Vaccine

R21/Matrix-M is the newest of the malaria vaccines [5]. This was recommended by WHO in October 2023 as a safe and effective malaria vaccine. Both vaccines are shown to be safe and effective for preventing malaria in children. 

Prevention strategies for malaria

Chemoprophylaxis  

Chemoprophylaxis is medicine or drugs used for the prevention of malaria, especially among people, pregnant women, infants and travellers in high-risk malaria-affected regions.   

For example:

• Travellers to malaria-endemic regions may take mefloquine, doxycycline, or atovaquone-proguanil before, during, and after travel [6]. 
• Pregnant women in endemic areas should be given intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine. 

Non-drug Prevention Strategies  Use of Insecticide-Treated NetIt’s the most widely used prevention strategy in high-risk malaria transmission areas. It serves as a shield or barrier against mosquito bites. The insecticide-treated net kills, repels and reduces exposure to mosquitoes. 

Indoor Residual Spread (IRS)

 The IRS prevention method targets mosquitoes that stay inside the house. It involves the coating of the wall and spraying of surfaces with residual (long-lasting) insecticide. It kills mosquitoes as soon as they contact the spray surfaces. IRS does not prevent mosquito bites but targets adult mosquitoes that have fed on blood and rest on the treated surface. This, in turn, shortens the mosquito lifespan and prevents the transmission of the malaria parasite to another person

Use of Mosquito Repellent

The use of insect repellents such as mosquito coils, N, N-diethyl-meta-toluamide(DEET), and eucalyptus oil applied to the exposed skin protects against mosquito bites.  

Wearing of Protective Clothing

Wearing long-sleeved shirts, long pants and socks when staying outside, especially from dusk to dawn when mosquitoes are active, protects us against their bite.

Use of Window Screen

The window screen serves as a shield that prevents the entry of mosquitoes into the house. It blocks spaces where mosquitoes can easily navigate into the room, while the window remains open for fresh air.

Cleaning the Surroundings

Keeping the surroundings clean is another prevention strategy. This practice serves as a barrier to breeding sites of mosquitoes and stops them from multiplying around our homes.

Conclusion   

Although malaria treatment is threatened by resistance, hope is rekindled as a new malaria vaccine, offering long-lasting protection, is rolled out to high-risk countries. But to stop malaria spread requires more than just one approach; it demands a mix of the right diagnosis, vector control and treatment because not all fever is malaria.  

References

1.    Sato S. Correction to: Plasmodium—a brief introduction to the parasites causing human malaria and their basic biology. Journal of Physiological Anthropology. 2021 Jan 29;40(1). Available from: https://jphysiolanthropol.biomedcentral.com/articles/10.1186/s40101-020-00251-9

2.    Kavanaugh MJ, Azzam SE, Rockabrand DM. Malaria Rapid Diagnostic Tests: Literary Review and Recommendation for a Quality Assurance, Quality Control Algorithm. Diagnostics. 2021 Apr 25;11(5):768. Available from: https://www.mdpi.com/2075-4418/11/5/768

3.    Fitri LE, Widaningrum T, Endharti AT, Prabowo MH, Winaris N, Nugraha RYB. Malaria diagnostic update: From conventional to advanced method. Journal of Clinical Laboratory Analysis. 2022 Mar 4;36(4). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8993657/

4.    Adeel A. Recent updates in the WHO Guidelines for malaria case management. Sudanese Journal of Paediatrics. 2024;155–63. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11757681/

5.    Miura K, Yevel Flores-Garcia, Long CA, Zavala F. Vaccines and monoclonal antibodies: new tools for malaria control. Clinical microbiology reviews. 2024 Apr 24. Available from: https://journals.asm.org/doi/10.1128/cmr.00071-23

6.    DeVos E, Dunn N. Malaria Prophylaxis PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551639/

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published August 25, 2025