Climate, Interventions, and Malaria Outcomes in a Warming World: Towards Climate-Smart Malaria Control in Kenya.

Malaria control in sub-Saharan Africa lies at the intersection of changing climate suitability and the scale-up of vector control and case management. Drawing on recent evidence from Kenya, we argue that climate variability already exerts effects on malaria outcomes comparable to, and sometimes stronger than, those of commonly measured interventions at local scales. Transmission dynamics display non-linear, lagged relationships with temperature and rainfall. As a result, climate change is expected to alter prevailing conditions and extremes, reshaping the geography and seasonality of malaria risk. At the same time, socio-economic development and vector control intervention such as insecticide-treated bed nets (ITNs) and timely case management continue to reduce malaria incidence and deaths, especially among young children. However, their population-level impact depends on when and where interventions are deployed relative to climate-favoured windows of transmission. We propose a practical agenda for "climate-smart" malaria control in Kenya advocating for dynamic targeting of interventions according to observed climate lags and thresholds, sustaining protection for the youngest, and innovating approaches for school-age reservoirs of infection. Access to effective care should be re-conceptualized as a climate-adaptation strategy, and short-term, locally tailored forecasts should be embedded into routine planning to support anticipatory and equitable malaria control.