Climate blind spots in malaria control: frontline perspectives on climate adaptation and malaria control in Zambia

Abstract

Background Climate change is increasingly recognised as a significant barrier to malaria elimination, particularly in low- and middle-income countries. This study explored frontline perspectives of healthcare workers and community-based volunteers on climate change and how malaria control programmes are responding to these changes in Zambia. Methods A cross-sectional qualitative study was conducted in 20 districts representing higher- and lower-malaria burden settings in Zambia. Nine key informant interviews and fourteen focus group discussions were conducted with 64 healthcare workers and community-based volunteers. Data were analysed thematically using ATLAS.ti. Results Participants reported that flooding, drought, deforestation, and shifting rainfall patterns were altering malaria transmission and increasing mosquito breeding sites. Climate-related disruptions, poor road access during floods and competing health priorities, including cholera outbreaks and COVID-19, were perceived to hinder malaria prevention and case management. Although participants recognised climate-related malaria risks, proposed responses remained largely focused on strengthening existing interventions such as indoor residual spraying and insecticide-treated nets, with limited reference to broader climate adaptation measures or national climate policies. Participants also identified barriers, including vector resistance, diagnostic challenges and supply chain disruptions. Conclusions Frontline perspectives highlight substantial climate-related challenges to sustaining malaria control in Zambia. While healthcare workers and community-based volunteers recognised that climate variability influences malaria transmission, this awareness was not consistently accompanied by consideration of how malaria programmes may need to adapt. Strengthening climate-health competencies, improving policy dissemination, and integrating climate considerations into routine malaria planning and decision-making may help support climate-adaptive malaria control and sustain progress towards elimination.