Abstract

Malaria remained one of the most pressing public health challenges in sub-Saharan Africa, where over 90% of global 
cases and deaths occur annually. Timely diagnosis and effective treatment were essential for reducing mortality and 
curbing transmission, yet health system limitations often restrict access to formal healthcare in rural communities. 
Community health workers (CHWs) had been deployed widely to bridge this gap, offering diagnostic and treatment 
services for uncomplicated malaria in resource-constrained settings. This review evaluated the role of CHWs in 
malaria case management across rural sub-Saharan Africa, focusing on their effectiveness, challenges, and future 
opportunities. A structured literature review was conducted using PubMed, Scopus, and Web of Science databases 
to identify peer-reviewed publications from 2012 to 2025, with inclusion criteria emphasizing studies of CHW 
malaria diagnosis, treatment, supervision, and outcomes in African rural contexts. Evidence showed that CHW 
programs significantly increased access to prompt diagnosis through rapid diagnostic tests (RDTs) and ensure 
timely treatment with artemisinin-based combination therapies (ACTs), contributing to reductions in morbidity and 
mortality. However, challenges such as stockouts, inadequate training, supervision deficits, and limited integration 
with formal health systems constrained their impact. Innovative models integrating digital health tools, sustained 
supervision, and supply chain strengthening showed promise in addressing these barriers. CHWs represent a critical 
frontline strategy for malaria case management in rural Africa. Ensuring sustained investment, supportive 
supervision, and integration within national health systems is essential for optimizing their contribution to malaria 
elimination efforts. 
Keywords: Community health workers, Malaria, Sub-Saharan Africa, Case management, Rural health