Effectiveness of malaria control interventions in resource-limited countries: A systematic review

Introduction: Malaria remains a key public health encounter in countries with resource limitations, where efforts to control the disease often focus on vector control strategies like insecticide-treated nets (ITNs) and indoor residual spraying (IRS), but its global burden remains high. Integrated malaria prevention, combining multiple interventions, has shown promise in reducing malaria incidence, though challenges such as high costs and insecticide resistance limit its widespread implementation in these countries. We assessed the effectiveness of malaria control interventions among individuals aged five years and above in resource-limited countries. Methods: We used a wide-range search strategy to identify studies from reputable databases, including PubMed, Google Scholar, Cochrane Library, African Journal Online, and Science Direct, using keywords related to the effectiveness of malaria control interventions. The inclusion criteria focused on peer-reviewed articles published between January 2018 and September 2024, excluding systematic reviews. The selection process was guided by PRISMA 2020 guidelines, with multiple reviewers independently extracting data on the effectiveness of malaria control interventions. The findings were synthesised quantitatively and qualitatively. The study’s quality was assessed using the GRADE framework and critically appraised using Bradford Hill’s criteria. Results: Fifteen studies met the inclusion criteria, encompassing diverse geographical regions and study designs, including cross-sectional, before-and-after and RCT. The study found that individual interventions, such as IRS and ITNs, had varying effectiveness, with IRS using non-pyrethroid insecticides being highly effective. Larviciding had a small negative effect, and Intermittent Preventive Treatment was moderately effective in pregnant women. Conclusion: The evidence is limited by high heterogeneity in studies, focusing mainly on Sub-Saharan Africa. Integrated malaria control strategies, including ITNs and IRS, are effective in resource-limited settings. Prioritizing combined interventions and non-pyrethroid IRS is crucial. However, challenges such as insecticide resistance and the need for sustained interventions remain. Future research should focus on long-term effectiveness, including the use of natural products, larviciding and other supplementary strategies for vector control. Continuous research on climate impacts, new technologies, and emerging threats is key to achieving effective and sustainable malaria control.