Seasonal malaria chemoprevention (SMC) reduces malaria incidence in children under five in Sahelian countries. However, transmission persists at substantial levels and incidence is re-increasing. Addressing Plasmodium falciparum carriage could represent a relevant intervention to complement current access to care and vector control based strategies. In this study, we aim to characterise the parasite reservoir dynamics over one year in the general population of two sites in central and northern Mali. We included members of randomly selected households in four villages (2 in Kati and 2 in Dire districts). At four planned visits, infection was detected using rapid diagnostic tests (RDTs) and quantitative polymerase chain reaction (qPCR). Clinical malaria incidence was recorded passively at local health facilities, and Plasmodium-positive samples were genotyped. We analysed clinical malaria incidence, P. falciparum PCR prevalence, parasite density and multiplicity of infection (eMOI) at different seasons, as well as factors associated with P. falciparum carriage. Malaria seasonal dynamics were driven by rainfall in Kati (Central Mali) and by flooding in Dire (Northern Mali). In Kati, prevalence rose from 21.5
The recently published Sequential Organ Failure Assessment (SOFA)-2 score represents the first major revision of organ dysfunction assessment in adult critical care in nearly three decades. Developed and validated using more than three million intensive care unit (ICU) encounters across diverse healthcare systems, SOFA-2 modernises the conceptual and operational framework of organ dysfunction evaluation while preserving the simplicity and bedside applicability that contributed to the widespread adoption of the original SOFA score. Severe Plasmodium falciparum malaria shares several pathophysiological and clinical features with sepsis, including dysregulated host response, endothelial activation, microvascular dysfunction, tissue hypoxia and multi-organ dysfunction. Nevertheless, organ dysfunction assessment in severe malaria remains largely dependent on World Health Organization (WHO) severity criteria rather than integrated ICU-oriented severity models. The emergence of SOFA-2 creates an opportunity to revisit the interface between malaria and sepsis within critical care medicine. Several WHO severe malaria criteria align closely with SOFA-2 domains, particularly neurological, cardiovascular, respiratory, renal and hepatic dysfunction. However, malaria-specific biological characteristics may influence the interpretation of some SOFA-2 components, especially thrombocytopenia and neurological dysfunction. Existing African ICU data suggest that severity of organ dysfunction measured by SOFA is strongly associated with mortality in severe malaria. Context-specific adaptations and validation studies are therefore required to determine whether SOFA-2 could improve prognostic discrimination, triage standardisation and research harmonisation in malaria-endemic regions. The integration of malaria into organ dysfunction paradigms may also strengthen the conceptual convergence between severe malaria and sepsis.
Increasing insecticide resistance among malaria vectors threatens the effectiveness of conventional malaria control interventions in Burkina Faso. Following reduced susceptibility of Anopheles gambiae s.l. populations to pyrethroids and organophosphates, the National Malaria Control Programme replaced indoor residual spraying (IRS) with next-generation piperonyl butoxide insecticide-treated nets (PBO-ITNs) in several high-transmission districts. This study assessed the entomological impact of this transition in Kampti and Solenzo from 2021 to 2023. A longitudinal entomological survey was conducted during three consecutive malaria transmission seasons in two pyrethroid-resistant districts of Burkina Faso. Three intervention phases were evaluated: IRS combined with standard insecticide-treated nets (ITNs) in 2021, IRS withdrawal with PBO-ITN deployment in 2022, and PBO-ITNs alone in 2023. Adult mosquitoes were collected monthly using human landing catches and pyrethrum spray catches. Mosquitoes were morphologically identified, with molecular identification performed by PCR. Plasmodium falciparum sporozoite infection was detected using ELISA. Human biting rates (HBR), indoor resting densities (IRD), sporozoite rates (SR), and entomological inoculation rates (EIR) were compared across years and collection settings. A total of 15,533 mosquitoes were collected, of which Anopheles gambiae s.l. represented 95.5
Severe malaria remains a major cause of mortality in children under five in sub-Saharan Africa, particularly in Niger. Early identification of prognostic biomarkers is crucial to reduce deaths. This study aimed to determine the hematological and biochemical biomarkers predictor of mortality in children under five with severe malaria at the Zinder National Hospital, Niger. A matched case–control study (1:2) was conducted among children aged 0–59 months hospitalized for severe malaria during high transmission periods (July to September 2024 and July to September 2025). A total of 64 cases (children who died from severe malaria) and 128 controls (survivors), individually matched 1:2 by age, sex, and hospitalization period, were included. Hematological parameters (complete blood count) and biochemical markers (glucose, urea, and creatinine) were collected from laboratory records. Because a paired Student’s t test is not valid for a 1:2 matched design, univariate and multivariate conditional logistic regression, stratified by matched set, was used to calculate adjusted odds ratios; discriminative performance was assessed by ROC curve analysis, using R software (version 4.5.2). Median hemoglobin was 7.25 g/dL (IQR 4.80–9.65) in controls and 7.00 g/dL (IQR 4.80–9.22) in cases; median leukocyte count was 12.30 × 109/L (IQR 9.28–19.38) in controls and 14.35 × 109/L (IQR 8.82–20.20) in cases. Using conditional logistic regression to account for the 1:2 matched design, blood urea was the only parameter independently associated with mortality in the biochemical model (aOR = 1.15, 95
Quality of care and compliance with treatment guidelines supported by quality-assured parasitological diagnosis are strategic pillars of inpatient malaria case-management in Nigeria. However, scarce data, non-compliant practices, challenges in malaria microscopy, and absent linkages between clinical and laboratory quality improvement interventions are common programmatic deficiencies. We implemented and evaluated the effectiveness of a joint clinical and laboratory strategy on the quality of inpatient test-and-treat malaria case-management. The innovative strategy based on annual cycles of hospital assessments and joint quarterly clinical and laboratory quality improvement interventions was implemented in 18 hospitals in Kano State, Nigeria. The effectiveness evaluation comprised two cross-sectional assessments: baseline at the beginning of the first annual cycle and endline after its completion. Data collection comprised availability audits, health worker interviews, rechecking of malaria slides, and retrospective reviews of all August 2024 and 2025 paediatric and medical ward admissions files. At each assessment, descriptive analyses included 18 hospitals, 72 health workers, and 2743 and 3198 suspected malaria admissions and 211 and 270 rechecked malaria slides, respectively. Minimum test-and-treat readiness, comprised of availability of malaria diagnostics, injectable artesunate and ACTs, was 94.4
