By Godwin Lasisi and Dr. Hilary Okagbue

World Malaria Day unites the global health community in reaffirming our resolve to eliminate one of humanity’s oldest and deadliest diseases. In 2025, under the compelling theme “Malaria Ends with Us: Reinvest, Reimagine, Reignite,” the call is clear: it is time to go beyond what has been done before. It is time to renew our efforts with smarter investments, reimagine what is possible with innovative strategies, and reignite the momentum to defeat malaria, especially in Nigeria, which bears the world’s heaviest malaria burden. Specifically, according to the World Health Organization, Nigeria accounted for a staggering 27% of global malaria cases and 31.3% of malaria deaths in 2022. Children under five and pregnant women remain the most vulnerable. Despite the scale-up of malaria rapid diagnostic tests (RDTs) and increased testing rates across sub-Saharan Africa from 36% in 2010 to 84% in 2020, challenges persist in data quality, provider compliance, and treatment fidelity. In Nigeria, the misuse of artemisinin-based combination therapy (ACT) due to inaccurate or presumptive diagnoses continues to undermine malaria control efforts (WHO, 2022; Nigeria NMEP, 2023).

However, the tide can turn, with the right tools, insights, and resolve. At Sydani, we imagine a malaria-free Nigeria, and we are also building solutions and optimizing the systems that bring that vision within reach.

MACRA: Driving Accuracy and Accountability in Malaria Testing

The Malaria RDT Capture and Reporting Assessment (MaCRA) project, spearheaded by Sydani in collaboration with PMI, PATH, and the Gates Foundation, is revolutionizing malaria diagnostics in Nigeria. Through an innovative cluster-randomized trial in 18 LGAs, MaCRA is validating the accuracy of RDT reporting within public primary healthcare facilities.

With over 18,000 RDTs independently reviewed via a smartphone-based AI app (HealthPulse), the study revealed a 90% agreement between health worker-reported results and objective expert readings. Yet, it also uncovered misreporting trends and regional disparities, particularly in states like Sokoto and Oyo. The second phase, MaCRA Part B, now integrates monthly data validation sessions using retained RDT cassettes and real-time analytics to correct misreporting and improve diagnostic compliance.

By transforming how malaria data is captured, verified, and used, MaCRA only reduces inappropriate ACT use and drug resistance and also enhances surveillance validity and the reliability of data collected, critical to informed decision making for targeted interventions and measuring real progress.

“Precision in Practice: How MaCRA is Transforming Malaria Diagnosis and Treatment in Nigeria”

Accurate malaria diagnosis is foundational to effective treatment and surveillance, yet in Nigeria, systemic diagnostic gaps have historically compromised control efforts. Nigeria bears a significant share of the global malaria burden, accounting for 27% of all cases and 31% of malaria-related deaths in 2021 (World Health Organization [WHO], 2022). Among children aged 6–59 months, malaria rapid diagnostic test (RDT) positivity decreased from 51.2% in 2010 to 38.5% in 2021, reflecting progress while underscoring the continued need for diagnostic accuracy (Babalola & Ayeni, 2023). However, studies reveal that compliance with RDT results when prescribing artemisinin-based combination therapy (ACT) stands at 80.9%, with significant variability across states (Oresanya, Hoshen, & Sofola, 2014). Additionally, Nigeria’s malaria surveillance system captures less than 40% of relevant data, raising questions about the validity of reported national figures (WHO, 2022). In response, Sydani implemented the MaCRA (Malaria RDT Capture and Reporting Assessment) project, which uses HealthPulse, a smartphone-based AI tool, to validate RDT outcomes across 18 LGAs. The project analyzed over 18,000 RDTs and achieved a 90% agreement between reported and expert-reviewed results, thereby improving diagnostic reliability. This strengthened data integrity, enhanced test compliance, and facilitated targeted interventions, ensuring more accurate malaria surveillance and contributing to the broader goal of reducing malaria incidence and mortality in Nigeria.

The misuse of antimalarial medications, particularly ACTs, remains a critical issue undermining malaria elimination effort in Nigeria, often resulting from misdiagnosis or overprescription. From 2010 to 2021, the proportion of children aged 6–59 months who received any antimalarial dropped from 19.6% to 10.3%, while ACT-specific use increased from 2.6% to 8.2%, reflecting improved treatment targeting (Babalola & Ayeni, 2023). Nonetheless, suboptimal compliance with test results 80.9% nationally and underreported data in the national health information system (less than 40% capture) continue to pose barriers to rational drug use and resistance monitoring (Oresanya et al., 2014; WHO, 2022). The economic cost of malaria in Nigeria, estimated at over $1.1 billion annually, further emphasizes the urgency of addressing these inefficiencies (Adebowale, 2024). Through MaCRA, Sydani has introduced monthly RDT validation exercises supported by artificial intelligence, which ensure treatment is aligned with accurate diagnoses. This intervention reduces unnecessary ACT prescriptions, preserving drug efficacy and cutting wasteful spending. By improving diagnostic precision and strengthening reporting accuracy, MaCRA contributes to enhanced patient care and also to national economic resilience, aligning with broader public health goals and optimizing the use of limited health resources.

Seasonal Malaria Chemoprevention (SMC): Scaling Protection for Children

Children under five in Nigeria face their highest malaria risk during the rainy season. That is where Seasonal Malaria Chemoprevention (SMC) comes in, an intervention proven to reduce child mortality by up to 75% when delivered effectively (Baker et al., 2025)

In 2023, Sydani partnered with Catholic Relief Services (CRS) and Malaria Consortium to conduct End-of-Round Programmatic Assessments of SMC campaigns in states including Kaduna, Jigawa, Borno, and Nasarawa. Using Lot Quality Assurance Sampling (LQAS), these assessments evaluated adherence, caregiver knowledge, and service quality across implementation cycles. Key findings revealed coverage gaps in underserved LGAs and underscored the need for intensified community engagement.

Actionable insights from Sydani’s evaluations have guided state-level strategies to surpass the 80% coverage benchmark, strengthen caregiver education, and boost adherence to treatment regimens, ensuring lifesaving drugs reach those who need them most.

From Data to Impact: Changing the Malaria Narrative

Sydani’s work is data-driven and human-focused. Whether it is improving the accuracy of malaria case data seen through successes of MaCRA phase 1 and 2 or optimizing SMC delivery in hard-to-reach communities, our malaria interventions are grounded in evidence, innovation, and impact. We are helping close the gap between reported data and lived realities. We are reducing misdiagnosis, preserving ACT efficacy, and protecting more children during peak transmission seasons. Most importantly, we are also proving that malaria control goes beyond stopping transmission; it encompasses empowering systems, service providers, and communities with tools that work.

Looking Ahead: Reinvest, Reimagine, Reignite

As we mark World Malaria Day 2025, the message is resounding: the fight to end malaria is far from over, but it aligns squarely with global commitments, particularly Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being for all at all ages. Specifically, Target 3.3 calls for an end to epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases by 2030, with Indicator 3.3.3 specifically tracking malaria incidence per 1,000 population at risk. At Sydani, we are deeply committed to accelerating progress toward these global targets by strengthening health systems, transforming malaria diagnostics, and expanding equitable access to prevention and treatment.

From Sokoto to Oyo, from the most remote communities to national health dashboards, our interventions are driven by the belief that every accurate test, every seasonal chemoprevention cycle, and every protected child advances the collective journey toward malaria elimination. By reinvesting in proven, data-driven strategies, reimagining our potential through digital innovation, and reigniting cross-sector ambition, we are building a future where malaria no longer defines lives or limits potential. Ending malaria is more than a health goal, it is a critical milestone toward achieving universal health coverage, reducing child mortality, and fostering resilient communities in line with the 2030 Agenda.

Together, let’s reinvest in proven strategies, reimagine what’s possible with the power of data and technology, and reignite our collective ambition for a malaria-free future. For every child protected. For every test that tells the truth. For every future free of malaria. The end begins with us.

References

1. World Health Organization. (2022). World malaria report 2022. Geneva: WHO. Retrieved from https://www.who.int/publications/i/item/9789240064898
2. Babalola, O., & Ayeni, O. (2023). Trends in receipt of antimalarial treatments among Nigerian children aged 6–59 months between 2010 and 2021: A cross-sectional analysis of national survey data. BMC Public Health, 23, Article 1224. https://doi.org/10.1186/s12889-023-15780-9
3. Oresanya, O., Hoshen, M., & Sofola, O. (2014). Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria. Malaria Journal, 13, 380. https://doi.org/10.1186/1475-2875-13-380
4. Adebowale, N. (2024, April 18). Nigeria loses $1.1bn annually to malaria, health minister laments. Punch Nigeria. Retrieved from https://punchng.com/nigeria-loses-1-1bn-annually-to-malaria-health-minister-laments/
5. Federal Ministry of Health, Nigeria. (2023). National Malaria Elimination Programme: Annual Malaria Programme Performance Review Report 2022. Abuja: FMOH/NMEP.

6. Sydani Group. (2024). MaCRA Nigeria Protocol (Versions 3.1 and Part B). Unpublished implementation protocol supported by PMI Insights (PATH), USAID, and the Gates Foundation.
7. World Health Organization. (2022). Malaria surveillance, monitoring & evaluation: A reference manual. Geneva: WHO. Retrieved from https://www.who.int/publications/i/item/9789240069763
8. Catholic Relief Services. (2023). Seasonal Malaria Chemoprevention (SMC) End-of-Round Assessment Report – Kaduna and Jigawa States. Internal Program Report.
9. Malaria Consortium. (2023). End-of-Cycle Assessment on SMC Coverage and Adherence in Nine Nigerian States. Abuja: Malaria Consortium Nigeria Office.

10. Baker, K., Pulido Tarquino, I. A., Aide, P., Bonnington, C. A., Rassi, C., Richardson, S., Nnaji, C., Roca-Feltrer, A., Rodrigues, M., Sitoe, M., Enosse, S., McGugan, C., de Carvalho, E. A., Saute, F., Matambisso, G., & Candrinho, B. (2025). Phase one of a hybrid effectiveness-implementation study to assess the feasibility, acceptability and effectiveness of implementing seasonal malaria chemoprevention in Nampula Province, Mozambique. Malaria Journal, 24, 56. https://doi.org/10.1186/s12936-024-05229-x