Eradicating the Enemy Within: A Narrative Review of Malaria Elimination Strategies and Future Pathways in Nigeria

Despite decades of coordinated national and international effort, the elimination targets embedded in the National Malaria Strategic Plan 2021 to 2025 remain substantially unmet, exposing a persistent and deeply rooted gap between the demonstrated efficacy of available tools and their real-world programmatic impact. This narrative review critically synthesises current evidence on both established and emerging malaria elimination strategies in Nigeria, examining the implementation landscape across six interrelated domains: vector control, case management and chemoprevention, diagnostic accuracy, malaria vaccination, mobile health surveillance, and genetic vector control. A comprehensive literature search was conducted across PubMed, Google Scholar, Web of Science, and EMBASE, supplemented by grey literature from the World Health Organization, the National Malaria Elimination Programme, and Gavi, with priority given to publications from 2015 to 2025. The review finds that existing tools, including long-lasting insecticide treated nets, artemisinin-based combination therapies, seasonal malaria chemoprevention, and indoor residual spraying, have produced measurable but insufficient reductions in burden, constrained by insecticide resistance, low utilisation rates, supply chain fragility, and weak diagnostic infrastructure. Inaccuracies in rapid diagnostic test performance substantially drive misdiagnosis and fuel antimalarial resistance in Nigeria, with deletions in the hrp2 and hrp3 genes of Plasmodium falciparum emerging as a particularly consequential threat to the reliability of frontline testing. The December 2024 rollout of the R21/Matrix-M vaccine in Bayelsa and Kebbi States represents a historic national milestone, though implementation barriers encompassing vaccine hesitancy, cold chain limitations, health workforce gaps, and the complexity of the four-dose schedule demand systematic and urgent responses. The overarching finding of this review is that no single intervention, however efficacious in trial settings, is sufficient to achieve malaria elimination in Nigeria, and that what is required is a systems-level, integrated strategy aligning biological innovation with health system strengthening, equitable financing, digital infrastructure, and genuine community partnership.