Combination therapy is a cornerstone of modern malaria treatment, particularly in the context of widespread multidrug resistance. Using two or more antimalarial drugs with different mechanisms simultaneously enhances efficacy, shortens treatment duration, improves compliance and delays the developme...nt of resistance. Artemisinin-based combination therapies (ACTs), such as artemether–lumefantrine, artesunate–amodiaquine and artesunate–sulfadoxine/pyrimethamine, are highly effective in rapidly clearing parasites and reducing gametocyte carriage. They are also generally well tolerated. Non-artemisinin combinations, quinine-based regimens and novel combinations (e.g. piperaquine–dihydroartemisinin) offer alternative therapeutic options, although clinical experience with these remains limited. Although ACTs are the preferred first-line treatment, factors such as cost, local drug resistance patterns, safety during pregnancy and paediatric use must inform implementation and policy decisions.
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Antimicrobial resistance (AMR) and malaria remain significant public health challenges in the WHO Eastern Mediterranean Region (EMR). In 2021, the region reported 1.7 million sepsis-related deaths, with 373,000 associated with bacterial AMR. High antibiotic consumption, particularly in high-income c...ountries, combined with rising usage in middle-income countries, has accelerated the emergence of drug-resistant infections. Malaria management is further complicated by biological threats, including vector insecticide resistance, PFHRP2/3 gene deletions, and antimalarial drug resistance, alongside insufficient trained personnel and limited molecular surveillance capacity. Effective strategies to address these challenges include strengthening regional and cross-border surveillance networks, designating WHO collaborating centers for molecular monitoring, enforcing national treatment policies, and raising public and healthcare provider awareness about rational antimalarial and antibiotic use. These measures, coupled with sustainable funding and enhanced therapeutic efficacy studies, are essential to reduce the development and spread of drug-resistant malaria and improve overall health outcomes in the EMR.
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In 2022, a total of 6,131 confirmed malaria cases were reported across the EU/EEA. Of these, 5,375 had a known importation status and nearly all (99.8%) were travel-related. Only 13 infections were acquired within Europe, with seven occurring in France, three in Germany, two in Spain and one in Irel...and. A distinct seasonal peak was observed from July to September, reflecting travel to malaria-endemic regions. Notification rates were higher among men than women, with a male-to-female ratio of 2:1. France reported the highest number of cases, followed by Germany, Spain, Italy and Belgium. After dropping sharply in 2020 due to travel restrictions imposed during the pandemic, overall notification rates increased again in 2021 and 2022, reaching 0.8 cases per 100,000 people. These findings emphasise that malaria in Europe is predominantly an imported disease closely linked to international travel, with sporadic local transmission being rare.
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Every two minutes, a child under the age of 5 dies from malaria. Under-five children accounted for 67 per cent of all malaria deaths worldwide in 2018. Most of them occurred in sub-Saharan Africa where an estimated 24 million children were infected with its deadliest form. In addition to being the t...hird-deadliest infectious disease for children, malaria infection and the costs of treatment traps families in a cycle of illness, suffering and poverty.This year’s World Malaria Day is marred by the emergence of the COVID-19 outbreak, which further threatens people’s lives and well-being. Public health officials are taking precautionary and often aggressive measures to limit transmission of this virus, including reductions in social movement, physical distancing, hand-washing and recommending the use of personal protection equipment in high-risk settings. However, while focusing on combating this disease, the world cannot afford to ignore other diseases, such as malaria.
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