Children and malaria
Malaria accounts for one in five of all childhood deaths in Africa. Anaemia, low birth-weight, epilepsy, and neurological problems, all frequent consequences of malaria, compromise the health and development of millions of childr en throughout the tropical world. Yet much of the impact of malaria on the world's children could be prevented with currently available interventions.
The unacceptable mortality from malaria
Over 40% of the world's children live in malaria-endemic countries. Each year, approximately 300 to 500 million malaria infections lead to over one million deaths, of which over 75% occur in African children < 5 years infected with Plasmodium falciparum1. The rapid spread of resistance to antimalarial drugs, coupled with widespread poverty, weak health infrastructure, and, in some countries, civil unrest, means that mortality from malaria in Africa continues to rise. The tragedy is that the vast majority of these deaths are preventable.
Under-recognized consequences of malaria
The profound consequences that one or more episodes of malaria may have on a child's subsequent health and development are often unrecognized or inadequately managed.
Low birth weight
Malaria in pregnancy leads to low birth weight and premature delivery, both of which are associated with an increased risk of neonatal death and impaired cognitive development. In many parts of the developing world, specialist care for low birth weight babies is very limited, and untreated hypoglycaemia (low blood glucose, a common problem in low birth weight babies) may cause brain damage.
Consequences of cerebral malaria
Approximately 7% of children who survive cerebral malaria (a severe form of the disease, characterized by coma and convulsions) are left with permanent neurological problems. These include weakness, spasticity, blindness, speech problems and epilepsy. The limited availability of specialized educational provision and equipment for such children means that opportunities for subsequent learning, and for attainment of independence, are compromised even further. Epilepsy may be inadequately treated, or untreated, due to lack of appropriate drugs and expertise, and further injury or death may result from uncontrolled convulsions. Recent evidence suggests that some children who appear to have made a complete neurological recovery from cerebral malaria may develop significant cognitive problems (attention deficits, difficulty with planning and initiating tasks, speech and language problems), which can adversely affect school performance2.
Anaemia
Although nutritional deficiencies, hookworm infection, and HIV all predispose to anaemia in children, evidence suggests that, in endemic countries, malaria is one of the most important factors. Antimalarial drug resistance exacerbates the situation, by increasing the proportion of children who fail to adequately clear parasitaemia after treatment, and who consequently remain anaemic. It has been estimated that severe malarial anaemia causes between 190 000 and 974 000 deaths each year among children < 5 years3. Although blood transfusion may be life-saving in this situation, it also exposes children to the risk of HIV and other blood-borne diseases.
Recurrent fever
It is estimated that African children have between 1.6 and 5.4 episodes of malarial fever each year, a figure that varies according to geographical and epidemiological circumstances3. Children are vulnerable to malaria from about 4 months of age, and, in highly endemic areas during the peak transmission season, approximately 70% of one-year-olds have malaria parasites in their blood. Fever reduces appetite, and exacerbates malnutrition. Recurrent episodes of malaria in the child, or in a family member (which may mean that the child is required to stay at home to help with domestic chores), are likely to result in the loss of a substantial amount of time from school.
Preliminary data from Sri Lanka also suggest that multiple attacks of uncomplicated malaria per se have a deleterious effect on school performance, and that this is independent of both school absenteeism and socioeconomic circumstances.
