Misunderstanding Malaria Treatment Is Creating Problems for Its Fight

For almost five months, Idrissu Musah complained of malaria that never seemed to go away, even though he had visited the hospital several times. At one point, some people suggested he consult a traditional healer. That should not have been the case, because Musah—like many others—was not doing something right.

Musah’s situation aligns with new research showing that many malaria patients “discontinue medication once symptoms subside, stemming from misconceptions about recovery and challenges with adherence.”

In its Malaria Report released in December last year, the World Health Organisation (WHO) described malaria as a life‑threatening disease spread to humans by certain types of mosquitoes mostly found in tropical countries. Encouragingly, the condition is both preventable and curable.

The WHO noted that malaria is caused by a parasite and does not spread from person to person. Symptoms range from mild to severe. Mild symptoms include fever, chills, and headache, while severe symptoms may involve fatigue, confusion, seizures, and difficulty breathing.

According to the report, worldwide “there were 282 million cases of malaria in 2024, an increase of about 9 million cases (3%) compared with 2023. The estimated number of malaria deaths stood at 610,000 in 2024 compared to 598,000 in 2023.”

The African Region continues to carry a disproportionately high share of the global malaria burden. In 2024, the region accounted for about 95% of all malaria cases and deaths. Children under five years of age made up roughly 76% of all malaria deaths in Africa.

More than half of all deaths in the region occurred in three countries: Nigeria (31.9%), the Democratic Republic of the Congo (11.7%), and Niger (6.1%). Children under five accounted for about 75% of all malaria deaths in Africa.

A study titled “Understanding barriers to effective malaria diagnosis and treatment: A mixed methods study in Uganda, Nigeria, and Ivory Coast,” published this month in the PLOS Global Public Health journal, found that addressing behavioural barriers among malaria patients requires targeted interventions.

From a behavioural science perspective, the authors said their findings “suggest that a significant proportion of adults and caregivers delay seeking care, due in part to difficulties in recognising malaria given the non‑specificity of symptoms and overconfidence in self‑management.”

They also highlighted “inconsistent diagnostic testing practices, influenced by both healthcare providers’ clinical environment and patients’ lack of awareness or expectations regarding testing and treatment,” which further impede appropriate care.

The research was conducted in Uganda, Nigeria, and Ivory Coast following local ethical approval. First, qualitative face‑to‑face interviews were conducted with 18 adults with experience of malaria, 36 caregivers of children with malaria, and 36 healthcare professionals (HCPs) to identify behavioural drivers and barriers to access and adherence.

Cross‑sectional quantitative surveys were then conducted face‑to‑face with 311 adults, 458 caregivers, and 532 HCPs to quantify the incidence of the different drivers and barriers. The sample included respondents from both rural and urban areas, and from public and private healthcare settings.

The research identified key behaviours that delayed access and adherence. One‑third (33%) of adults and caregivers reported delaying care‑seeking when experiencing symptoms. Over a third (36%) said they were not offered a diagnostic test to confirm malaria during their last visit. Fifty‑six percent reported prematurely discontinuing antimalarial medication, with 41% believing treatment could be stopped once symptoms subsided.

Two districts were selected in each country to ensure a comprehensive understanding of different settings and to gain broader perspectives on malaria treatment access and adherence. Selection was based on two primary factors: representation of both rural and urban populations, and the practical feasibility of conducting research in those areas.

The districts included Sokoto and Taraba in Nigeria, Acholi and East‑Central Busoga in Uganda, and La Vallée du Bandaman and Bas‑Sassandra in Ivory Coast. Data collection took place in both rural and urban areas, across public and private healthcare facilities.

Purposive sampling was employed for adults aged 18 and above and for healthcare professionals, enforced through strict inclusion and exclusion criteria applied via a screening questionnaire. Adults had to be 18 years or older and either have suffered malaria in the past five years or be caregivers of children who had experienced malaria within the same period. This ensured participants could provide insight into their behaviour at key decision points.

Following findings from the rapid review, community leaders—including political, local, and religious figures—were engaged due to their influence on community health behaviour.

A mix of genders and rural/urban participants were recruited. Healthcare professionals had to be practising nurses, community health workers, or pharmacists with direct experience treating malaria patients, and must have been in their current roles for at least two years. Those who did not meet the criteria were excluded. Quotas ensured diversity across locations and facility types.

Adults and caregivers reported delaying professional medical care after experiencing symptoms indicative of malaria. Instead of promptly visiting a healthcare facility, many waited to see if symptoms would subside naturally or attempted self‑treatment using over‑the‑counter medications or traditional remedies.

“This behaviour was influenced by a lack of familiarity with malaria symptoms, difficulty in recognising early symptoms, and associated underestimation of potential severity,” the authors said, adding that “there was also evidence of misplaced self‑confidence in managing the illness independently.”

The study found that despite current interventions, behavioural barriers to effective malaria treatment and prevention persist. Key barriers identified included difficulty recognising malaria‑specific symptoms, unclear responsibility for testing, and challenges adhering to treatment.

The researchers recommended improved communication and education for patients and caregivers, emphasising the importance of early care‑seeking. They also suggested training healthcare professionals in Motivation, Ability, Processing, Physical, Social (MAPPS) to encourage consistent diagnostic testing and to utilise social strategies to shift community perceptions. MAPPS is a behavioural science framework used to explore behaviours related to timely access and adherence to antimalarials, and to guide intervention design.

“By structuring our analysis around the MAPPS behavioural framework, we were able to locate these barriers within specific dimensions, thereby distinguishing barriers that can be addressed through targeted changes in practice or communication from those likely to require broader organisational or system‑level adaptation,” the authors said.

In their view, applying the MAPPS framework enables stakeholders to develop targeted intervention strategies to improve access to care and adherence to antimalarial treatment. In this sense, MAPPS served not only as a descriptive tool but also as a practical bridge between empirical findings and intervention design. Such interventions should be tested for their potential to reduce the malaria burden and strengthen malaria control in sub‑Saharan Africa.