Laksmyn Kadir, Sri M. Pateda
Malaria remains a major cause of morbidity and anaemia in endemic regions, disproportionately affecting young children and pregnant women. Zinc, an essential micronutrient that supports immune regulation and erythropoiesis, has been investigated as a potential adjunctive intervention to mitigate malaria and its haematological consequences. This systematic review synthesized evidence from randomized controlled trials, observational studies, and mechanistic investigations published between 2013 and 2025 to clarify zinc’s effects on malaria incidence, parasitemia, and anaemia-related outcomes. Comprehensive searches were conducted across Medline, Embase, Web of Science, Scopus, Cochrane Central, and Global Health, supplemented with grey literature from ClinicalTrials.gov and WHO ICTRP. Eligible studies included zinc supplementation trials, epidemiological analyses of zinc status, and mechanistic studies of zinc-dependent pathways, with methodological quality assessed using RoB 2, ROBINS-I, and GRADE frameworks. The findings indicated that zinc-only supplementation did not significantly reduce malaria incidence or parasitemia; however, multi-micronutrient interventions containing zinc showed modest improvements in malaria outcomes and greater effects on anaemia recovery. Zinc consistently enhanced hemoglobin levels and reduced anaemia severity among high-risk groups, even when parasitological outcomes remained unchanged. Mechanistic evidence attributed these effects to zinc’s regulatory roles in immune modulation, hepcidin control, and erythropoiesis, while also identifying parasite zinc-binding proteins as potential therapeutic targets. Study heterogeneity was influenced by baseline zinc deficiency, malaria transmission intensity, pregnancy status, and socioeconomic factors. Overall, zinc supplementation should not be regarded as a standalone antimalarial intervention but rather as an essential adjunct within integrated nutrition and malaria-control strategies. © 2026 Kadir and Pateda.
Department of Public Health, Universitas Negeri Gorontalo, Jalan Jendral Sudirman, No. 6, Kota Gorontalo, 96128, Indonesia; Department of Medical, Universitas Negeri Gorontalo, Jalan Jendral Sudirman, No. 6, Kota Gorontalo, 96128, Indonesia
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