Understanding the syndemic interaction of malaria and malnutrition in the Mano River Union

Abstract

The Mano River Union (MRU) countries, Liberia, Sierra Leone, Guinea, and Côte d’Ivoire, continue to experience overlapping epidemics of malaria and child malnutrition. Malaria prevalence among children under five is estimated at 22% in Sierra Leone, 10–12% in Liberia, and 17% in Guinea, while stunting affects 32% of children in Liberia, 29.1% in Sierra Leone, 24–30% in Guinea, and 28.7% in Côte d’Ivoire. Anaemia, a biological condition linking infection and undernutrition, affects more than 75% of children in several MRU countries. This editorial critically examines whether malaria and malnutrition in the MRU constitute a syndemic by evaluating three dimensions: biological interaction, shared environmental and social determinants, and policy responses that fail to address these interconnected risks. Although vertical programmes targeting malaria and nutrition have improved service coverage, their impact is constrained by fragmented interventions, weak primary health systems, and limited integration of environmental and multisectoral governance within health policy. Emerging evidence from climate modelling, insecticide resistance surveillance, and malaria programme tailoring in West Africa suggests that malaria transmission patterns are heterogeneous and increasingly influenced by environmental change. Activities such as deforestation and artisanal mining may alter vector ecology and transmission risk, although causal evidence specific to the MRU remains limited. Studies from neighbouring Sahelian contexts further demonstrate that integrated service delivery platforms combining malaria prevention and treatment with nutritional assessment and supplementation are operationally feasible and can improve child health outcomes. Addressing these intersecting challenges requires integrated policy reforms, including routine nutritional screening within malaria service delivery points, strengthened community health worker systems, cross-sectoral coordination between health and environmental sectors, integrated supply chains for malaria and nutrition commodities, and coordinated public health messaging. Without a stronger institutional commitment to integrated and environmentally informed health policy, MRU countries are unlikely to achieve key global targets related to child nutrition, malaria control, and universal health coverage.