Malaria prevention in low- and middle-income countries

Malaria is a life threatening disease that is a huge burden in low- and middle- income countries (LMICs), disproportionately affecting children under five and those residing in rural areas. In 2024 the WHO Africa Region was home to 95% of all malaria cases and 95% of deaths. Malaria is a disease caused by a parasite transmitted by female Anopheles mosquitoes. It is both preventable and curable, so work is required to understand how it is still so prevalent and why preventive measures aren't working. New medical options are needed to improve adherence and to fit the lifestyles of those in the areas most effected.

Malaria is commonly misdiagnosed as the symptoms of malaria resemble many other illnesses and diseases. The difficulty with misdiagnosing malaria is that it needs to be treated within 24 hours or it can progress to an incredibly severe illness and even lead to death.

Malaria symptoms

Symptoms can be mild or life-threatening.

Mild symptoms are:

• Fever
• Chills
• Headache.

Severe symptoms include:

• Fatigue
• Confusion
• Seizures
• Difficulty breathing.

The malaria burden

• There were 282 million global cases of malaria in 2024, 9 million more than the year before
• Malaria disproportionately affects children under five and those residing in rural areas
• In 2024 the WHO Africa Region was home to 95% (265 million) of all malaria cases and 95% (579,000) of deaths
• In Africa, children under 5 years of age accounted for around 76% of malaria deaths in the Africa Region
• The estimated number of malaria deaths stood at 610,000 in 2024, 12,000 more than the year before.
• Three countries in the Africa Region accounted for over half of the malaria deaths: Nigeria (31.9%), the Democratic Republic of the Congo (11.7%) and Niger (6.1%).

Source: World Health Organisation's Malaria factsheet

LONGEVITY and malaria

The malaria burden can be reduced by tackling the issue of non-adherence to current malaria prevention regimens which require taking many tablets, and adding new tools to the control strategies currently available.

The LONGEVITY Project aims to broaden the long-acting technologies available for people in LMICs. We are exploring development of a microarray patch (MAP) that people can wear on their skin for a few hours but will continue to release relevant medication for a period of time after it's removed. MAPs could dramatically impact ease and tolerability of malaria prevention, especially in those most effected i.e. newborns, babies and children. This will simplify drug delivery to improve adherence, reduce transmission rates and support future strategies to eliminate the disease.

LONGEVITY's malaria journey

The below information shows the foundations of the journey that LONGEVITY takes from concept to project completion for our malaria work.

Drug identification

• Identify an existing, safe drug regimen that isn’t working well or could be improved to positively impact patients’ lives.

CELT Global Health Chemistry Team

• Use currently available drugs and various technologies to create formulations that are potentially long-acting
• Perform in-house stability studies to make sure the formulation is stable at ambient temperature over days and weeks
• Screen hundreds of potential formulations, following the leads that come from them.

Microarray patch testing

• Queen’s University Belfast School of Pharmacology receive leads from the CELT Global Health team
• Test whether these formulations work in a microarray format either alone or in combination with another medication
• Dose ranging to see how much of the drug(s) can go into the patch
• Test that the patch with the drug is durable and stable (i.e. doesn’t break on application to the skin, applies evenly).

Proof of concept

• When the above stages have been achieved, we will have proof of concept that the correct malaria preventing drug can be administered at the required dose through a microarray patch.

LONGEVITY’s Malaria community engagement findings

In 2023, the community and civil engagement team for LONGEVITY’s malaria work published ‘Preferences of patients and providers in high-burden malaria settings for long-acting malaria chemoprevention’ in The American Journal of Tropical Medicine and Hygiene.

The aim of this study, led by University of Nebraska Medical Centre and organised by Treatment Action Group, was to survey people and health care providers in LMICs to ascertain acceptability and feasibility of implementing long-acting malaria preventive therapy. This work was undertaken at the very beginning of the LONGEVITY project, so the focus was on injectables.

Patient surveys

These were 202 patients from Zambia and Kenya. Of the 32% of respondents taking daily oral medications, 45% missed a dose of oral medication within the past week and 25% missed a dose in the past 1 to 2 weeks. 97% of respondents reported having malaria in the past.

• 80% of patients indicated they would ‘definitely’ try malaria chemoprevention offered by injection
• 81% perceived injections to be more effective than other routes of administration
• Preferred injection dose
  • 52% monthly injection
  • 41% one injection every 2-months
  • 55% one injection every 3-months
  • Respondents in Zambia preferred monthly injections compared with Kenya (86% versus 39%)
  • Respondents in Kenya preferred every-3-month injection compared with Zambia (76% versus 66%)
• Perceived benefits
  • Improved effectiveness (87%)
  • Fewer side effects (76%)
  • Ease of administration (85%)
  • Discretion (75%)
• Concerns around long-acting injections
  • It may cause side effects
  • Side effects may last longer
• Parents
  • 84% of patients who were parents/guardians of children under 12 years would let their children receive an injection for malaria
  • This rises to 90% in parents/guardians of children over 12 years old
  • In both age groups of children, the main concern from parents was that side effects may last longer

Provider surveys

These were 215 providers from Zambia and Kenya. Most were nurses and 80% had worked in a malaria test-and-treat programme.

• Overall, providers indicated they would be more likely to prescribe a long-acting injectable product compared with an oral product for malaria chemoprevention in:
  • Adults (70%)
  • Adolescents aged 12 years and older (67%)
  • Children under 12 years (81%)
• Provider respondents supported long-acting injectable therapy irrespective of frequency
• Providers rated all proposed benefits associated with long-acting injectable products highly, with the highest being ‘improved public health’ (90%)
• The biggest barrier to implementation was deemed to be ‘potentially higher cost’ (69%)

Key Conclusions

• Long-acting malaria preventive therapies have high levels of acceptability and feasibility among both patients and providers
• Development and implementation of long-acting malaria preventive injections may improve health outcomes in high malaria burden areas.

Read our latest blog content

• CELT recognise World Malaria Day 2025
• An update on our malaria work for World Malaria Day 2024
• Invest, Innovate and Implement – How LONGEVITY can help deliver ZERO malaria
• Fighting on the front-line – Empowering communities to drive long-acting injectable innovation
• Saving lives through long-acting injectable innovation

 

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