An image of a malaria vaccination in The Gambia. Source. The Guardian
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Malaria remains one of the world’s most significant public health challenges, yet it is both preventable and treatable.
The Gambia continues to stand out as one of sub-Saharan Africa’s leading malaria success stories.
The World Health Organization (WHO) has recognised The Gambia as one of only six countries in the WHO African Region to achieve a reduction of more than 40% in malaria cases and deaths compared with 2015 levels.
Building on this progress, the country has transitioned from a malaria control programme to an active malaria elimination phase, with the goal of eliminating the disease by 2030.
The WHO recommends a stratified, multi-layered approach to malaria prevention.
No single intervention provides complete protection. Instead, effective prevention combines personal protective measures, vector control, preventive medication, vaccination, and prompt diagnosis.
This guide outlines four essential malaria prevention strategies in line with current WHO recommendations.
1. Vector control: prevent mosquito bites
Malaria is transmitted through the bite of infected female Anopheles mosquitoes. Preventing mosquito bites is therefore the first and most important line of defence.
Insecticide-Treated Nets (ITNs)
The WHO recommends the use of Insecticide-Treated Nets (ITNs), particularly pyrethroid-PBO or dual-active ingredient nets, to combat increasing insecticide resistance.
Precautions:
Sleep under an insecticide-treated net every night.
Ensure the net is properly tucked under the mattress.
Regularly inspect the net for holes or tears and replace it when necessary.
Below is an image of a mosquito ITNs net. Source. MRC unit of The Gambia
Indoor Residual Spraying (IRS)
Indoor Residual Spraying involves applying long-lasting insecticides to the interior walls of homes to kill mosquitoes that rest indoors. WHO now recommends newer, more effective insecticides, including chlorfenapyr and isocycloseram, while reducing reliance on older chemicals such as DDT.
Precautions
If your community is included in an IRS campaign, allow trained public health teams to spray your home.
Do not wash or repaint sprayed walls until advised by health authorities.
Personal Protective Measures (PPMs)
In addition to ITNs and IRS, individuals should take the following precautions:
Use insect repellents: Apply repellents containing 20–30% DEET, picaridin (icaridin), or IR3535 to exposed skin.
Use spatial repellents: WHO conditionally recommends spatial repellents in specific settings where appropriate.
Wear protective clothing: Choose light-coloured, loose-fitting long-sleeved shirts and long trousers, particularly in the evening and night. Clothing treated with permethrin offers additional protection in high-risk areas.
Protect your home: Keep doors and windows screened or closed whenever possible.
Eliminate breeding sites: Remove standing water around homes, including water collected in flower pots, old tyres, buckets, and puddles, where mosquitoes breed.
2. Chemoprevention: Prevent malaria with medication
Preventive medication, or chemoprophylaxis, significantly reduces the risk of malaria among travellers and vulnerable populations.
For Gambian travellers
Anyone travelling to a malaria-endemic area should consult a healthcare provider or travel clinic before departure. The choice of medication depends on the destination, local drug resistance patterns, medical history, and individual health needs.
Common options include:
Atovaquone-Proguanil (Malarone): Taken daily, beginning 1–2 days before travel, throughout the trip, and for seven days after leaving the malaria-risk area. It has a few side effects but is relatively expensive.
Doxycycline: Taken daily from 1–2 days before travel until four weeks after leaving the endemic area. It is affordable and also protects against certain bacterial infections, but may increase sun sensitivity and cause stomach irritation. It is not recommended for pregnant women or young children.
Mefloquine: Taken weekly, starting 1–2 weeks before travel and continuing for four weeks after return. It is suitable for long-term travel and can be used during pregnancy, but should not be taken by individuals with certain psychiatric conditions or a history of seizures.
Primaquine or Tafenoquine: Effective against Plasmodium vivax malaria, particularly its dormant liver stage. Individuals must first be tested for G6PD deficiency because these medicines can cause severe haemolytic anaemia in people with the condition.
For vulnerable populations
WHO also recommends preventive treatment for high-risk groups living in malaria-endemic areas.
Intermittent preventive treatment in pregnancy (IPTp):
Pregnant women living in moderate-to-high Plasmodium falciparum transmission areas should receive preventive doses of sulfadoxine-pyrimethamine (SP) beginning in the second trimester.
Seasonal malaria chemoprevention (SMC):
Children should receive monthly antimalarial treatment during the rainy season, when malaria transmission is highest. Countries may extend eligibility to older children based on local epidemiological data.
Perennial malaria chemoprevention (PMC):
Infants and young children living in areas with year-round malaria transmission receive regular preventive treatment throughout the year.
Post-discharge malaria chemoprevention (PDMC):
Children recovering from severe anaemia following malaria receive preventive antimalarial treatment after leaving the hospital to reduce the risk of relapse and death.
3. Malaria vaccination
The introduction of malaria vaccines represents one of the most significant recent advances in malaria prevention.
WHO recommendation
The WHO recommends the use of the RTS, S/AS01 and R21/Matrix-M vaccines to protect children living in areas with moderate-to-high Plasmodium falciparum transmission.
Vaccination schedule
Children should receive the vaccines in a four-dose schedule beginning at approximately five months of age.
Malaria vaccines are not a replacement for bed nets, insecticides, or preventive medication. Instead, they provide an additional layer of protection. When combined with other interventions, vaccination can reduce severe, life-threatening malaria in children by up to 70%.
4. The “ABCD” rule of malaria prevention
A simple way to remember malaria prevention is the internationally recognised ABCD approach:
A – Awareness: Understand your malaria risk, local transmission patterns, and common symptoms.
B – Bite Prevention: Protect yourself using insecticide-treated nets, repellents, and appropriate clothing.
C – Chemoprophylaxis: Take preventive medication exactly as prescribed when recommended.
D – Diagnosis: Seek immediate medical attention if you develop a fever any time from one week after entering a malaria-risk area up to several months later. Malaria can surface long after exposure.
Early diagnosis saves lives
Malaria symptoms, including fever, chills, headache, muscle aches, and fatigue, often resemble influenza or other viral illnesses.
Anyone who develops a fever after visiting or living in a malaria-endemic area should seek medical care immediately. A rapid diagnostic test (RDT) can confirm malaria within minutes, enabling prompt treatment to prevent severe illness and save lives.
Key takeaway
Malaria prevention is most effective when multiple interventions are used together. Sleeping under an insecticide-treated net, reducing mosquito exposure, taking preventive medication when appropriate, vaccinating eligible children, and seeking early diagnosis all play vital roles in protecting individuals, families, and communities.
As The Gambia works towards eliminating malaria by 2030, every citizen has a role to play in preventing transmission and safeguarding public health.
