Malaria Explained: Patient Guide to Understanding Malaria
- MedReport Foundation
- Jul 2
- 10 min read
INDEX
1.0 Patient Guide to Understanding Malaria
1.1 Introduction
2.0 Causes
3.0 How Malaria Is Transmitted
4.0 Who Is Most at Risk of Malaria?
4.1 Children Under 5 (Highest Mortality Group)
4.2 Pregnant Women
4.3 People Living with HIV/AIDS
4.4 Travelers and Non-Immune Individuals
4.5 Older Adults
5.0 Geographic Risk
6.0 Genetic and Physiological Factors
7.0 Symptoms of Malaria
8.0 How Malaria Is Tested
8.1 Blood Smear Microscopy
8.2 Rapid Diagnostic Tests (RDTs)
8.3 Molecular Detection (PCR Testing)
9.0 Malaria Prevention and Treatment
9.1 Preventing Mosquito Bites
9.2 Environmental Control
9.3 Vaccination
9.4 Early Diagnosis and Awareness
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10.0 How Is Malaria Treated?
10.1 Common Antimalarial Drugs
11.0 When Should You See a Healthcare Provider?
12.0 FAQs
12.1 Why are pregnant women advised to avoid malaria-prone areas while traveling?
12.2 Can someone get malaria from a mosquito bite indoors?
12.3 Does my body odour attract mosquitoes?
13.0 References
14.0 Author's Note
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1.1 Introduction
This is a deep dive into one of the most underrated diseases prevalent in Africa, Asia, and
parts of America (1, 2).
Malaria is a life-threatening febrile illness caused by Plasmodium parasites, transmitted
to humans through the bites of infected female Anopheles mosquitoes (3, 4, 5).
Read that again- you probably skimmed past life-threatening.
It’s such a contrast that such a small insect can be so lethal. If you’re wondering why all
the fuss about these little things, it’s because malaria causes more deaths than terrorism.
According to WHO records, there were 282 million cases of malaria in 2024, an increase
of about 9 million compared with the previous year (6, 7).
We may be tempted to see these figures as mere statistics, but they represent lives at risk.
Malaria is not just a disease. It remains a persistent public health crisis that continues to
claim lives and resources despite global efforts to control it. (1 ,7, 5).
2.0 Causes
Malaria is caused by Plasmodium parasites, which infect humans through the bite of an
infected female mosquito (3, 4). There are five species known to cause disease in
humans, with varying levels of severity and prevalence (3).
The most significant is Plasmodium falciparum, which is the most prevalent and
responsible for the majority of severe malaria cases and deaths (1, 8). Plasmodium vivax
is the second most important species and is known for causing relapsing malaria, as it can
remain dormant in the liver and trigger recurrent infections. It is more commonly found
in Southeast Asia and Latin America (9, 10).
Other less prevalent species include the two Plasmodium ovale subspecies, Plasmodium
malariae, and Plasmodium knowlesi (8). While infections caused by P. vivax and P.
knowlesi can also become severe, this occurs less frequently compared to P. falciparum
(11)
Understanding these species is important, as the type of parasite involved can influence
the severity of illness, pattern of symptoms, and choice of treatment.
3.0 How Malaria Is Transmitted
Malaria is transmitted through the bite of an infected mosquito. When a female
Anopheles mosquito bites a person already infected with malaria, it ingests the parasites
along with the blood. About a week later, the mosquito becomes infective and can
transmit the parasites to another person during a subsequent bite (4)
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Once transmitted, the parasites enter the bloodstream and travel to the liver, where they
mature. They then return to the bloodstream and infect red blood cells, leading to the
symptoms of malaria. This cycle continues as more mosquitoes become infected and
spread the disease (4).
Most malaria infections occur through mosquito bites, making the mosquito the primary
vector. In regions where malaria is not common, such as the United States and the United
Kingdom, most cases are “imported malaria,” meaning they occur in people who have
traveled from endemic areas (12).
In rare cases, malaria can also be transmitted through: blood transfusion, organ
transplantation, sharing contaminated needles or syringes, from mother to child during
pregnancy or delivery (congenital malaria)
It is important to note that malaria is not contagious. It cannot be spread through
coughing, sneezing, physical contact, sexual contact, or sharing utensils (4).
IMAGE SHOWING MALARIA TRANSMISSION CYCLE (13)
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4.0 Who Is Most at Risk of Malaria?
Malaria does not affect everyone equally. Certain groups are more vulnerable due to
weaker immunity, environmental exposure, or limited access to healthcare (1). These
include young children (under 5 years), pregnant women, people living with HIV/AIDS,
travelers from non-endemic regions, immigrants, and individuals in rural areas (1, 2)
4.1 Children Under 5 (Highest Mortality Group)
Children under five are the most vulnerable. They have not yet developed partial
immunity to the Plasmodium parasite, making them more likely to develop severe,
life-threatening malaria (1, 2, 14). Malnutrition further weakens their immunity,
increasing both susceptibility and severity of infection (14).
4.2 Pregnant Women
Pregnancy reduces immunity to malaria, increasing the risk of severe disease (8). Malaria
in pregnancy is associated with complications such as miscarriage, low birth weight, and
maternal anemia (15). The risk of severe maternal anemia can increase by up to 2.4 times
(16)
4.3 People Living with HIV/AIDS
Weakened immune systems make individuals with HIV/AIDS more susceptible to severe
malaria and complications. HIV can hinder parasite clearance and damage the spleen, a
key organ in controlling malaria infection. This leads to both increased risk of infection
and worse outcomes (11).
4.4 Travelers and Non-Immune Individuals
People from non-endemic regions do not have semi-immunity to malaria, making them
more likely to develop severe symptoms when exposed. This includes travelers, migrants,
and urban residents moving into high-transmission areas (17).
4.5 Older Adults
Increasing age is associated with a higher risk of severe malaria and death. This is often
due to reduced immunity and the presence of other underlying health conditions (18).
5.0 Geographic Risk
Malaria thrives in regions with warm temperatures and high humidity. The WHO
African Region remains the global epicenter due to favorable mosquito habitats and the
high prevalence of Plasmodium falciparum, the deadliest species (1). Five countries,
Nigeria, Democratic Republic of the Congo, Ethiopia, Mozambique, and Uganda,
account for more than half of all global malaria cases (1).
Malaria is also present in South and Southeast Asia, Central and South America, and the
Caribbean, including Haiti and the Dominican Republic, as well as some islands in the
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central and south Pacific Ocean (8). Most malaria cases in the Caribbean are concentrated
on the island of Hispaniola, shared by Haiti and the Dominican Republic.
6.0 Genetic and Physiological Factors
i. HbAS (Sickle Cell Trait): Provides strong protection against severe, life-threatening
malaria, with studies showing up to 90% protection (19)
ii. HbAA (Normal): No innate genetic protection. These individuals rely on acquired
immunity and preventive measures such as insecticide-treated nets and antimalarial
drugs.
iii. HbSS (Sickle Cell Disease): Although the red blood cells are less favorable for
parasite survival, individuals are already severely anemic and immunocompromised. As a
result, malaria infection can be particularly severe and life-threatening
iv. Blood type: People with blood group O have relative resistance to severe P. falciparum
malaria because the parasite is less able to form clumps that block blood vessels
v. Obesity: A higher BMI is often associated with an increased risk of severe malaria in
Individuals with a BMI of 30 or higher have significantly greater odds of severe disease
compared to those with normal BMI (20).
7.0 Symptoms of Malaria
Malaria symptoms range from mild illness to severe, life-threatening disease. They
usually appear within a few weeks after an infected mosquito bite, although some
parasites can remain dormant in the body for months or up to a year
Early symptoms often resemble a flu-like illness and include fever, chills, headache,
fatigue, muscle or joint pain, nausea, vomiting, diarrhea, abdominal pain, rapid breathing,
and rapid heart rate. Some individuals experience cycles of malaria “attacks,” which
begin with chills and shivering, followed by high fever, and then sweating as the
temperature returns to normal (21).
If not treated promptly, malaria can progress to severe disease, presenting with kidney
failure, seizures, confusion, coma, or organ failure (22). Two serious complications are
cerebral malaria and Blackwater fever.
Because malaria is a multi-system disease, its early symptoms overlap with many other
febrile illnesses such as typhoid fever, pneumonia, urinary tract infections, Lassa fever,
dengue, meningitis, and Coronavirus infections. It is therefore important to seek proper
testing from a qualified healthcare provider rather than relying on symptoms alone (22).
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8.0 How Malaria Is Tested
Healthcare providers diagnose malaria by testing a sample of your blood (23). The test
looks for Plasmodium parasites and identifies the type of infection, which helps
determine the appropriate treatment. It is important to inform your healthcare provider if
you have traveled within the past year.
8.1 Blood Smear Microscopy:
A blood specimen is collected and prepared as a thick or thin smear. The smear is stained
using Giemsa or Wright–Giemsa stain and examined under a 100× oil immersion
objective. This method confirms the presence of malaria parasites and allows
identification of the species.
8.2 Rapid Diagnostic Tests (RDTs):
Detects specific malaria antigens in the blood, providing faster results than microscopy. It
is especially useful in clinics without access to microscopy facilities.
8.3 Molecular Detection (PCR Testing):
Detects parasite nucleic acids using polymerase chain reaction. It confirms the species
and is highly sensitive but is less practical for urgent diagnosis due to longer turnaround
times.
9.0 Malaria Prevention and Treatment
9.1 Preventing Mosquito Bites:
Sleep under insecticide-treated bed net
Use insect repellents with DEET, picaridin, IR3535, or oil of lemon eucalyptus
Wear clothing that covers as much skin as possible
Keep windows and doors closed or screened
Stay in well-screened or air-conditioned rooms (24).
9.2 Environmental Control:
Eliminate stagnant water around homes
Avoid excessive chemical fogging to reduce resistance (24).
9.3 Vaccination:
RTS,S/AS01 and R21/Matrix-M vaccines reduce malaria cases in children in high-risk
areas (1).
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9.4 Early Diagnosis and Awareness:
Seek care promptly when symptoms appear. Early treatment prevents severe illness.
Public campaigns and sensitization programmes will make people become intentional in
combating malaria.
10.0 How Is Malaria Treated?
Malaria is treated with antimalarial medications that eliminate the parasite (24). The
choice depends on location, species, severity, age, and pregnancy.
10.1 Common Antimalarial Medications:
Antimalarial Medications consists of : Artemisinin-Based Combination Therapies (ACTs)
such as Artemether–lumefantrine, Artesunate–amodiaquine,
Dihydroartemisinin–piperaquine, Artesunate–mefloquine. Other Common Antimalarials
include Atovaquone–proguanil, Chloroquine or hydroxychloroquine, Doxycycline,
tetracycline, or clindamycin, Mefloquine, Quinine, Primaquine, Tafenoquine (25).
Important Notes
Do not self-medicate. Antimalarial drugs must be properly selected and dosed. Some
drugs may cause serious side effects in certain individuals, especially: Pregnant women,
individuals with G6PD deficiency, patients with severe renal impairment, individuals
with sulfonamide (sulfur) hypersensitivity etc. Be cautious of counterfeit medications,
especially in high-risk environments (26).
Drug options and guidelines may vary by country. For more information, consult your
country's drug regulation authority or seek proper diagnosis and treatment should always
be guided by a qualified healthcare provider.
11.0 When Should You See a Healthcare Provider?
Seek medical care immediately if (22):
You notice symptoms develop during or after visiting an endemic area.
You notice symptoms weeks, months, or even up to a year after returning.
You have a fever that lasts more than 48 hours.
Always inform your healthcare provider about your travel schedule.
12.0 FAQs
12.1 Why are pregnant women advised to avoid malaria-prone areas while
traveling?
Pregnancy lowers a woman's immunity to malaria, making her more susceptible to
infection and increasing her risk of severe illness, anemia, and death. For the unborn
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child, malaria raises the risk of miscarriage, stillbirth, premature delivery, and low birth
weight, which is a leading cause of infant mortality (15).
12.2 Can someone get malaria from a mosquito bite indoors?
Yes, mosquitoes can enter homes through unscreened windows or doors (24).
12.3 Does my body odour attract mosquitoes?
Yes. Chemicals in sweat, CO2 from breath, skin bacteria, heat, and lactic acid attract
mosquitoes (27).
13.0 References
1. World Health Organization. World malaria report 2025. Geneva: WHO; 2025 [cited
2026 Apr 17]. Available from:
2. UNICEF. Child health: malaria. New York: UNICEF; 2024 [cited 2026 Apr 17].
Available from: https://data.unicef.org/topic/child-health/malaria
3. Medicines for Malaria Venture. Causes of malaria. Geneva: MMV; [cited 2026 Apr
17]. Available from: https://www.mmv.org/malaria/about-malaria/causes-malaria
4. Centers for Disease Control and Prevention. About malaria: causes. Atlanta: CDC;
2023 [cited 2026 Apr 17]. Available from:
5. World Health Organization. Malaria: fact sheet. Geneva: WHO; 2023 [cited 2026 Apr
17]. Available from: https://www.who.int/news-room/fact-sheets/detail/malaria
6. Liv Hospital. Malaria statistics: 7 key facts on deaths, cases, and prevention. Istanbul:
Liv Hospital; 2024 [cited 2026 Apr 17]. Available from:
7. Malaria No More UK. World malaria report 2024: funding shortfalls are stalling
progress. London: Malaria No More; 2024 [cited 2026 Apr 17]. Available from:
rogress
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8. Milner DA Jr. Malaria pathogenesis. Cold Spring Harb Perspect Med.
2018;8(1):a025569. [cited 2026 Apr 17]. Available from:
9. National Center for Biotechnology Information. Plasmodium falciparum Malaria.
Bethesda: NCBI; [cited 2026 Apr 17]. Available from:
10. National Center for Biotechnology Information. Malaria in selected non-Amazonian
countries of Latin America. Bethesda: NCBI; [cited 2026 Apr 17]. Available from:
11. Centers for Disease Control and Prevention. DPDx: malaria. Atlanta: CDC; [cited
2026 Apr 17]. Available from: https://www.cdc.gov/dpdx/malaria
12. UK Government. Malaria imported into the UK: 2022 report. London: UK
Government; [cited 2026 Apr 17]. Available from:
ported-into-the-uk-2022
13. Napkin AI, Inc. Napkin AI [software]. [cited 2026 Apr 17; image generated from
user-provided malaria transmission extract]. Available from: https://www.napkin.ai
14. National Center for Biotechnology Information. Effects of Malnutrition on the
Immune System and Infection and the Role of Nutritional Strategies Regarding
Improvements in Children’s Health Status: A Literature Review. Bethesda: NCBI; [cited
2026 Apr 17]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10780435
15. World Health Organization Regional Office for Africa. Lives at risk: Malaria in
pregnancy. Brazzaville: WHO AFRO; [cited 2026 Apr 17]. Available from:
16. National Center for Biotechnology Information. Malaria in pregnancy: Meta-analyses
of prevalence and associated complications. Bethesda: NCBI; [cited 2026 Apr 17].
Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10945947
17. National Center for Biotechnology Information. Imported Malaria in Countries where
Malaria Is Not Endemic: A Comparison of Semi-immune and Nonimmune Travelers.
Bethesda: NCBI; [cited 2026 Apr 17]. Available from:
18. London School of Hygiene & Tropical Medicine. Elderly 10 times more likely to die
of malaria. London: LSHTM; 2012 [cited 2026 Apr 17]. Available from:
f_malaria.html
19. PLOS Genetics. Double homozygosity for HbS and alpha-thalassemia protects
against severe malaria. San Francisco: PLOS; 2023 [cited 2026 Apr 17]. Available from:
20. Oxford Academic. Clinical Infectious Diseases. Obesity and Diabetes as Risk Factors
for Severe Plasmodium falciparum Malaria: Results From a Swedish Nationwide Study:
OUP; 2017 [cited 2026 Apr 17]. Available from:
21. Mayo Clinic. Malaria: symptoms and causes. Rochester: Mayo Clinic; [cited 2026
Apr 17]. Available from:
22.NHS Inform. Malaria: symptoms, causes, and treatment. Glasgow: NHS Scotland;
2024 [cited 2026 Apr 17]. Available from:
23. Centers for Disease Control and Prevention. Malaria: testing and diagnosis. Atlanta:
CDC; [cited 2026 Apr 17]. Available from:
24. Centers for Disease Control and Prevention. Malaria: prevention. Atlanta: CDC;
[cited 2026 Apr 17]. Available from: https://www.cdc.gov/malaria/prevention/index.html
25. Mayo Clinic. Malaria: diagnosis and treatment. Rochester: Mayo Clinic; [cited 2026
Apr 17]. Available from:
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26. Centers for Disease Control and Prevention. Malaria. In: CDC Yellow Book. Atlanta:
CDC; [cited 2026 Apr 17]. Available from:
27. News-Medical. The science behind why mosquitoes prefer to bite certain people.
Manchester: News-Medical.net; 2024 [cited 2026 Apr 17]. Available from:
te-Certain-People.aspx12
14.0 Author's Note
This guide was created to provide clear, evidence-based information about malaria for
patients, caregivers, and the general public. The intention is to raise awareness about the
causes, risks, prevention, and treatment of malaria, particularly in high-risk regions.
While every effort has been made to ensure accuracy, medical advice should always be
sought from qualified healthcare professionals. This guide is meant for educational
purposes and should not replace professional diagnosis or treatment. I hope this resource
empowers readers to take informed steps toward preventing and managing malaria.
