Abstract
Introduction
Despite global efforts, progress in malaria elimination has stagnated since 2010, particularly in urban areas of sub-Saharan Africa facing rapid urbanization. Urban transmission dynamics, worsened by environmental changes and emerging threats like Anopheles stephensi, remain largely understudied. Current control strategies are predominantly based on rural data, highlighting the necessity for tailored approaches suited to urban settings. This review addresses trends in malaria indicators in Bamako to refine control strategies.
Objective
This scoping review aims to describe the trends in malaria epidemiology in urban and peri-urban Bamako, focusing on prevalence, incidence, clinical forms, mortality/morbidity, and burden from 2002 to 2025 to inform control strategies.
Inclusion criteria
Epidemiological studies on malaria in Bamako’s urban and peri-urban areas from 2002 to 2025 will be included. These must cover prevalence, incidence, morbidity, mortality, transmission, manifestations, or control interventions. Studies lacking relevant data or falling outside these parameters will be excluded.
Methods
A comprehensive literature search will target databases (PubMed, Web of Science, ADHL Mali Home, and Google Scholar), National Malaria Control Program reports, and academic theses from Bamako. Data on malaria trends, clinical manifestations, and burden will be extracted and synthesized to reveal changes in transmission shifts and inform urban malaria control.
Discussion
This scoping review aims to synthesize malaria epidemiology data from urban and peri-urban Bamako between 2002 and 2025, emphasizing trends in prevalence, incidence, and transmission factors influenced by rapid urbanization. The findings will guide the adaptation of malaria control strategies to effectively address the unique challenges posed by urban environments and emerging threats like Anopheles stephensi.
Systematic review registration
osf.io/q8upv.
Keywords: Malaria, Urban area, Peri-urban areas, Prevalence, Incidence, Bamako
Introduction
Malaria elimination remains a top priority for national malaria control programs. Between 2000 and 2010, a significant reduction in malaria morbidity and mortality was observed [1]. This was due to the scaling up of malaria control strategies worldwide. However, global malaria morbidity and mortality reductions slowed or stagnated in the following decade [2]. This situation calls for reassessing control strategies to better adapt them to the disease's evolving epidemiology.
At the same time, rapid and often unregulated urbanization around major African cities has changed the landscape of malaria transmission. Once primarily considered a rural problem, malaria is increasingly recognized as a public health issue in urban and peri-urban areas [3]. Urban environments present unique transmission dynamics due to specific ecological, socioeconomic, and health system characteristics. [4]. Furthermore, the recent spread of Anopheles stephensi an urban-adapted species from Asia to Africa raises additional concerns about heightened transmission risks in urban populations.s [5].Despite these important differences, malaria prevention and control strategies are largely implemented uniformly across rural and urban contexts [6] Current WHO recommendations are mainly based on evidence from rural endemic areas, which may not fully address the challenges of urban malaria [2]. The stagnation of malaria indicators may be partly attributed to the combined impact of rapid urban growth and insufficient adaptation of control strategies for urban environments. In Mali, especially in Bamako, no thorough review has yet consolidated existing evidence on malaria epidemiology and control in urban and peri-urban settings.
This scoping review aims to map and analyse existing data on key malaria indicators: prevalence, incidence, morbidity, mortality, and transmission factors in urban and peri-urban areas of Bamako. We included studies published up to July 2025, representing the most recent evidence available at the time of protocol development. A preliminary search confirmed the absence of systematic or scoping reviews on this topic but identified several epidemiological studies and programmatic reports, supporting the feasibility and relevance of this review.
Review question
Objective
This study aims to conduct a scoping review to examine the evolution of malaria indicators in urban and peri-urban Bamako between 2002 and 2025.
Research question
What are the trends in malaria indicators in Bamako's urban and peri-urban areas as control and prevention efforts intensify?
Inclusion criteria
Participants
The population of interest comprises individuals of all age groups and sexes residing in the urban and peri-urban areas of Bamako, Mali. Studies will be included if they focus on human populations affected by malaria within this geographic scope. Urban areas will be defined according to the official administrative boundaries of the Bamako District, as specified by the Malian National Institute of Statistics. Peri-urban areas will be defined as transitional zones at the interface between the urban core and surrounding rural communes, characterized by mixed land use (residential, agricultural, and informal settlements) and recognized in national or municipal planning documents. Studies will be classified exactly as reported by the original authors regarding the study setting. However, in cases of ambiguity or mixed settings, classification will be refined using two additional criteria: (1) verification of administrative labels at the time of data collection, and (2) population density (people/km2) during the study period. For studies conducted across mixed areas (urban, peri-urban, and/or rural), results will be disaggregated whenever possible. A predominant classification will then be assigned based on the proportion of data contributed by each setting; for example, if more than 70% of the data were collected in urban areas, the study will be classified as urban.Studies will be included if they report data specifically disaggregated for populations identified as living in urban or peri-urban areas of Bamako. Exclusion criteria will include studies conducted on animal models, studies conducted outside Bamako, and studies that do not provide separate data for urban/peri-urban populations as distinct from rural populations.
Concept
The review will explore key malaria indicators relevant to the epidemiological context of urban and peri-urban Bamako. These indicators include:
Prevalence: The proportion of individuals infected with malaria at a given time to assess disease distribution.
Incidence: The rate of new malaria cases within a specified time frame to understand transmission dynamics.
Clinical forms: Manifestations of malaria, such as uncomplicated and severe cases, to evaluate disease severity.
Malaria burden: The overall impact of malaria, including morbidity, mortality, hospitalization, absenteeism, and economic costs.
Additionally, the review will assess transmission factors unique to urban environments, such as socioeconomic conditions, infrastructure, and emerging threats like Anopheles stephensi, as well as the effectiveness of control interventions tailored to urban settings. Studies lacking relevant epidemiological data, focusing solely on diagnostic or therapeutic approaches without a population-based context, or addressing non-malaria-related health issues will be excluded.
Context
The geographic focus of this review is Bamako, Mali, encompassing both urban and peri-urban areas shaped by rapid urbanization. These settings are characterized by distinct transmission dynamics influenced by environmental, socioeconomic, and infrastructural factors. The review will map the evolution of malaria epidemiology in these areas to inform the adaptation of control strategies and support global malaria elimination efforts. We will include studies published between 2002 and 2025 to capture changes in control approaches, ranging from the scale-up of insecticide-treated nets (ITNs) to the introduction of seasonal malaria chemoprevention (SMC), and to ensure alignment with data from multiple Demographic and Health Surveys (DHS) [7]. In addition, this timeframe corresponds to a period of rapid urban expansion in Bamako, which accelerated after the early 2000 s and profoundly reshaped population density, housing patterns, and environmental conditions that influence malaria transmission dynamics. This ensures that the evidence captured aligns with contemporary malaria control strategies and urbanization trends. Studies conducted outside Bamako or those lacking sufficient contextual detail to determine their relevance to urban or peri-urban areas will be excluded.
Types of sources
This scoping review will include diverse study designs to capture the breadth of available evidence. Quantitative studies such as randomized controlled trials, non-randomized controlled trials, cohort studies, case–control studies, cross-sectional studies, before-and-after studies, and interrupted time-series studies will be considered as they directly contribute to understanding epidemiological indicators such as prevalence, incidence, morbidity, mortality, and related trends. Qualitative studies employing methodologies like phenomenology, grounded theory, ethnography, and action research provide insights into community perceptions, environmental determinants, and implementation challenges that may influence malaria epidemiology in urban settings.. Their role will be to complement, rather than replace, quantitative findings. Descriptive studies, including case series, case reports, and descriptive cross-sectional studies, will be reviewed to identify trends and gaps in knowledge.Systematic reviews addressing malaria in urban contexts that align with the inclusion criteria will also be considered. Alongside text and opinion papers will be used only to provide relevant contextual background..
Given the expected diversity of study designs and reporting formats, heterogeneity will be managed using a descriptive and structured approach consistent with JBI methodology for scoping reviews. Malaria indicators will be organized into common categories (e.g., prevalence, incidence, morbidity, mortality, transmission factors), and where feasible, values will be presented using standardized units (such as incidence per 1,000 population). Differences in diagnostic methods (e.g., RDT, microscopy, PCR) will be documented and grouped to support meaningful comparison without formal statistical synthesis. When indicators are reported inconsistently, incompletely, or in incompatible formats, results will be summarized narratively with explicit notation of these gaps. All missing or partially reported indicators will be captured in the extraction matrix to ensure transparency, and patterns of methodological or reporting variation will be highlighted in the synthesis to contextualize findings.The review will adhere to PRISMA Extension for Scoping Reviews (PRISMA-ScR) [8],
to ensure methodological rigor and transparency. The checklist was adapted to the context of this review by focusing on items most relevant to epidemiological and programmatic evidence. Specifically, we will:
use PRISMA-ScR items to guide the reporting of eligibility criteria, information sources, search strategy, study selection, data charting, and synthesis of results.
adapt the data-charting process to capture malaria-specific indicators (prevalence, incidence, morbidity, mortality, and transmission factors) and contextual information on urban and peri-urban settings in Bamako.
include only studies published in English and French between 2002 and July 2025..
This tailored approach ensures consistency with PRISMA-ScR standards while making the checklist operational for the scope and objectives of this review.
Methods
The following scoping review protocol was created using the JBI methodology template for scoping review protocols [9] and an adapted version of the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist (see Appendix 1) [8]. The protocol for this review was also registered in the Open Science Framework (osf.io/q8upv). The final scoping review will be conducted following the JBI methodology for scoping reviews [10] and the PRISMA-ScR Checklist [8].
Consistent with JBI guidance for scoping reviews, this study does not include formal critical appraisal, as the purpose is to map the breadth and nature of existing evidence rather than evaluate study quality or risk of bias. Given the inclusion of diverse designs, including exploratory and contextual studies, a uniform appraisal tool is not methodologically appropriate. However, limitations related to variability in diagnostic methods, reporting quality, and study design will be explicitly described in the discussion.
Search strategy
The search strategy for this scoping review will aim to locate both published and unpublished studies. A three-step search approach will be utilized to ensure a comprehensive search. A preliminary search of PubMed was first conducted to identify relevant articles. The keywords appearing in the titles and abstracts of these articles, along with the associated index terms, were then analysed to inform the development of an initial PubMed search strategy (see Appendix 2). The comprehensive search will be executed across multiple electronic databases, including PubMed, Web of Science, ADHL Mali Home, and Google Scholar. Additional sources, such as annual reports from the National Malaria Control Program (PNLP) and academic theses from institutions in Mali, will also be consulted. To ensure completeness, the reference lists of all included studies will also be screened to identify additional sources. Studies published in English and French between 2002 and 2025 will be included to reflect recent trends and data availability. This timeframe is justified by the focus on understanding recent developments in malaria indicators in urban and peri-urban settings of Bamako.
Study/source of evidence selection
EndNote X7, 2016 will be used for reference management and deduplication; Rayyan [11] will be used for title/abstract and full-text screening; and Excel will be used to manage data extraction and synthesis matrices. Two reviewers BK and AZA will independently screen titles and abstracts to assess relevance against the inclusion criteria. Reasons for exclusion at the full-text stage will be systematically recorded and included in the final scoping review. Any disagreements arising during the selection process will be resolved through discussion or consultation with a third reviewer SK. The study selection process will be documented and reported using a PRISMA flow diagram [12], to ensure transparency and reproducibility.
Data extraction
Data will be extracted from the included studies by two independent reviewers using a standardized data extraction tool (see Appendix 3). The extracted data will capture key study characteristics, including authorship, year of publication, study design, population features, and study setting. Malaria-related indicators will encompass prevalence, incidence, and clinical forms, as well as the overall burden of malaria in terms of morbidity, mortality, and socioeconomic impact. The draft extraction tool will be piloted and revised as necessary during the data extraction process, with modifications documented. Any discrepancies between reviewers will be resolved through discussion or via a third reviewer. In cases where data are incomplete or unclear, authors of the studies will be contacted to obtain additional information.
Data analysis and presentation
The extracted data will be synthesized narratively and presented in both tabular and graphical formats. The analysis will focus on identifying trends in malaria prevalence, incidence, clinical forms, and burden in urban and peri-urban Bamako from 2002 to 2025. Study characteristics, including publication year, population, and study design, will also be summarized. Results will be mapped to the review’s objectives, providing insights into how urbanization has influenced malaria epidemiology in the region. These findings will inform the adaptation of malaria control strategies to better address the unique challenges in urban and peri-urban settings.
Discussion
This scoping review protocol is crucial for addressing the gap in knowledge regarding malaria epidemiology in urban and peri-urban settings, particularly in Bamako, where transmission dynamics differ significantly from rural areas. Focusing on the recent period (2002–2025) is highly relevant. Furthermore, by exploring transmission factors specific to urban environments, this review could guide the adaptation of interventions to better address the challenges posed by population growth and emerging threats like Anopheles stephensi.
Acknowledgements
We would like to thank Dr. Sory Diawara, Dr. Drissa Konate, Dr. Amadou S. Traore, and Dr. Philippe Mutwa the permanent resident of USAID – PMI in Mali for their helpful comments of the protocol, Mali National Malaria Control Program, Fogarty International Center of the National Institutes of Health of the United States (Grant D43TW008652 and D43TW011818) for the research training support.
Appendix 1
Adapted PRISMA-ScR checklist
| Section | Item | PRISMA-ScR checklist item | Reported on page # |
|---|---|---|---|
| Title | |||
| Title | 1 | Identify the report as a scoping review | Page 1 |
| Abstract | |||
| Structured summary | 2 | Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, and methods that relate to the review questions and objectives. | Page 1-2 |
| 1 | |||
| Rationale | 3 | Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach. | Page 2,3 |
| Objectives | 4 | Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives. | Page 3 |
| Methods | |||
| Protocol and registration | 5 | Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number. | Page 1,4 |
| Eligibility criteria | 6 | Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale. | Page 3 |
| Information sources* | 7 | Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed. | Page 6 |
| Search | 8 | Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated. | Page 13-14 |
| Selection of sources of evidence† | 9 | State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review. | Page 4-6 |
| Data charting process‡ | 10 | Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators. | Page 7 |
| Data items | 11 | List and define all variables for which data were sought and any assumptions and simplifications made. | Page 7,14-15 |
| Critical appraisal of individual sources of evidence§ | 12 | If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate). | N/A |
| Synthesis of results | 13 | Describe the methods of handling and summarizing the data that were charted. | Page 7 |
| Funding | |||
| Funding | 14 | Describe the role of the funders of the scoping review. | Page 9 |
*Information sources include electronic databases, web-based searches, and other sources
†Selection of sources of evidence refers to the screening and eligibility process
‡Data charting process refers to the methods used to extract data from included sources of evidence
Appendix 2
Search strategy—PUBMED search strategy
#1 Malaria
"Malaria"[Mesh] OR “Malaria, Falciparum"[Mesh] OR "plamodi*" [tw] OR "anopheles*" [tw] OR "paludism*" [tw] OR "malaria*" [tw]
#2 Indicators
((("Prevalence"[Mesh] OR “Epidemiology"[Mesh]) OR "Morbidity"[Mesh]) OR "Incidence"[Mesh]) OR "Mortality"[Mesh] OR "prevalence*" [tw] OR "incidence*" [tw] OR "indicator*" [tw] OR "mortalit*" [tw] OR "morbidit*" [tw] OR "epidemiology" [tw]
#3 Urban and Peri-Urban Settings
"Urban Population"[Mesh] OR "Urban Health"[Mesh] OR "Peri-Urban"[tiab] OR "Urban"[tiab] OR "Urbanization"[tiab] OR "City"[tiab] OR "Cities"[tiab] OR "Urban Areas"[tiab] OR " District "[tiab] OR "Periurban"[tiab] OR "Suburban"[tiab] OR "Town"[tiab]
#5 Study Period: 2002–2025
("2002/01/01"[Date - Publication]: "2025/12/31"[Date - Publication])
#6 Combined Search
#6: #1 AND #2 AND #3 AND #4
("Malaria"[MeSH Terms] OR "malaria, falciparum"[MeSH Terms] OR "plamodi*"[Text Word] OR "anopheles*"[Text Word] OR "paludism*"[Text Word] OR "malaria*"[Text Word]) AND ("Prevalence"[MeSH Terms] OR "Epidemiology"[MeSH Terms] OR "Morbidity"[MeSH Terms] OR "Incidence"[MeSH Terms] OR "Mortality"[MeSH Terms] OR "prevalence*"[Text Word] OR "incidence*"[Text Word] OR "indicator*"[Text Word] OR "mortalit*"[Text Word] OR "morbidit*"[Text Word] OR "Epidemiology"[Text Word]) AND ("Urban Population"[MeSH Terms] OR "Urban Health"[MeSH Terms] OR "Peri-Urban"[Title/Abstract] OR "Urban"[Title/Abstract] OR "Urbanization"[Title/Abstract] OR "City"[Title/Abstract] OR "Cities"[Title/Abstract] OR "Urban Areas"[Title/Abstract] OR "District"[Title/Abstract] OR "Periurban"[Title/Abstract] OR "Suburban"[Title/Abstract] OR "Town"[Title/Abstract])
Appendix 3
Data extraction instrument
| Study Characteristics |
| 1. Author(s): |
| 2. Year of publication: |
| 3. Title: |
| 4. Study design (e.g., cross-sectional, cohort, case-control): |
| Population Characteristics |
| 1. Population description (age, gender, other demographics): |
| 2. Sample size: |
| 3. Urban or peri-urban classification: |
| Malaria Indicators |
| 1. Prevalence (% or N of population infected): |
| 2. Incidence (number of new cases per year): |
| 3. Clinical forms of malaria (e.g., uncomplicated, severe, cerebral): |
| 4. Morbidity (e.g., number of hospitalizations): |
| 5. Mortality (e.g., number of deaths attributed to malaria): |
| 6. Burden (e.g., days lost from work or school, economic costs): |
| Context and Interventions |
| 1. Environmental or socioeconomic factors described: |
| 2. Malaria control interventions (e.g., bed nets, insecticides, treatment): |
| 3. Transmission factors (e.g., vector species, breeding sites): |
| Methodological Quality and Relevance |
| 1. Data collection methods (e.g., surveys, clinical records): |
| 2. Limitations noted by authors: |
| 3. Overall relevance to scoping review objectives: |
Authors’ contributions
The contributions of each author to this manuscript are as follows: MT, SK, BK, NS, MD, and SD conceptualized and designed the protocol. ID, SK, developed a search strategy. BK, SK, AZA, MK, FK, M, and DS drafted the protocol and revised it critically for intellectual content. ID, COT, MT, AK, MHM and SD provided expert input on methodology and search strategy. MT, ID, and SK contributed to critical review of the final version of the protocol. All authors affirm that they have read and approved the final manuscript.
Funding
This study is part of the research activities of the West African Center of Excellence for Malaria Research program (Mali ICEMR) supported by National Institutes of Health Cooperative Agreements U19AI129387. Author Mahamoudou Toure’s PhD was supported by the Fogarty International Center and the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH) under Award Number D43 TW010543. Author Idiatou Diallo was supported by the Fogarty International Center and the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH) under Award Number D43 TW010543. Author Soumba Keita was supported by Science for Africa Foundation to [Grant Del -22–001] with support from Welcome Trust and the UK Foreign Commonwealth & Development Office to the Malaria Research Capacity Development in West and Central Africa (MARCAD-Plus) in part of the PhD fellowship.
Declarations
Ethics and approval and consent to participate
This review synthesizes publicly available published literature and does not involve human subjects; therefore, ethical approval is not required. All data will be managed in accordance with responsible research and data protection principles.
Competing of interests
There are no conflicts of interest to declare for this protocol.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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