According to data presented in the World malaria report 2017 (WHO), an estimated 216 million cases of malaria occurred worldwide, this data shows that Malaria continues to be a major global health problem, affecting the most the developing countries in the world (1). Pregnant women are the main risk group in most endemic. In 2016, an estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally by governments of malaria-endemic countries(1). So, one has to ask, Why if there is large budget dedicated to Malaria control, this disease continues to be a problem? Well, the answer is fairly easy; it is a complex disease. The disease is transmitted from person-person through the bite of a female mosquito (1,2).
The malaria life cycle is highly complex and it can be divided into three stages; the clinical symptoms emanate from these blood stages and Malaria vaccine development efforts have employed strategies that target the three different stages of the parasite life cycle: 1)liver stage; 2)blood stage and 3)transmission-blocking vaccines (3). The most commonly used methods to prevent mosquito bites are sleeping under insecticide-treated bed nets (ITNs) and spraying the inside walls of a dwelling with an insecticide – an intervention known as IRS. Use of ITNs has been shown to reduce malaria case incidence rates by 50%, and to reduce malaria mortality rates by 55% in children aged under 5 years (4,5). These two core vector-control interventions – use of ITNs and IRS – are considered to have made a major contribution to the reduction in malaria burden since 2000 (10). In a few specific settings and circumstances, ITNs and IRS can be supplemented by larval source management (1,4) or other environmental modifications that reduce the suitability of environments as mosquito habitats, or that otherwise reduce mosquito biting of humans.There is no commercially available vaccine at the present time, however the RTS,S/AS01 is the most advanced vaccine candidate against the most deadly form of human malaria(3).
Over 20 other vaccines are currently being evaluated. The majority of patients with malaria (70%) are treated with ACTs, which are the most effective antimalarial drugs(4). This type of treatment is preferred by public health facilities rather than in the private sector, however, multidrug resistance, including artemisinin (partial) resistance and partner drug resistance remains a problem(1-4).