Malaria in school‐age children in Africa: an increasingly important challenge

Abstract

School-age children have attracted relatively little attention as a group in need of special measures to protect them against malaria. However, increasing success in lowering the level of malaria transmission in many previously highly endemic areas will result in children acquiring immunity to malaria later in life than has been the case in the past. Thus, it can be anticipated that in the coming years there will be an increase in the incidence of both uncomplicated and severe malaria in school-age children in many previously highly endemic areas. In this review, which focuses primarily on Africa, recent data on the prevalence of malaria parasitaemia and on the incidence of clinical malaria in African school-age children are presented and evidence that malaria adversely effects school performance is reviewed. Long-lasting insecticide treated bednets (LLIN) are an effective method of malaria control but several studies have shown that school-age children use LLINs less frequently than other population groups. Antimalarial drugs are being used in different ways to control malaria in school-age children including screening and treatment and intermittent preventive treatment. Some studies of chemoprevention in school-age children have shown reductions in anaemia and improved school performance but this has not been the case in all trials and more research is needed to identify the situations in which chemoprevention is likely to be most effective and, in these situations, which type of intervention should be used. In the longer term, malaria vaccines may have an important role in protecting this important section of the community from malaria. Regardless of the control approach selected, it is important this is incorporated into the overall programme of measures being undertaken to enhance the health of African school-age children.

Impact of a malaria intervention package in schools onPlasmodiuminfection, anaemia and cognitive function in schoolchildren in Mali: a pragmatic cluster-randomised trial

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19] Nonetheless, there remains a paucity of evidence on the optimal control strategies in schoolchildren, and how these might vary between different malaria transmission settings. 20 21 Intermittent preventive treatment in schools has previously been shown to reduce malaria infections and anaemia and to improve sustained attention in an area of intense perennial transmission in western Kenya 12 but has not been evaluated in areas of seasonal transmission. Seasonal malaria chemoprevention in the Sahel region, when expanded to target children up to 10 years of age, is associated with significant improvement in malaria and anaemia in all ages 13 22 but impacts on cognition or learning have not been examined.…”

Asymptomatic only at first sight: malaria infection among schoolchildren in highland Rwanda

“…Owing to the enormous morbidity and mortality of clinical malaria in young children, the epidemiology and consequences of asymptomatic infection in different settings and age-groups has received comparatively little attention. Increasingly, however, the underrated impact of asymptomatic and/or submicroscopic infections is now being recognized [2, 3, 5–10]. …”

“…Increasing age has consequently been associated with low and submicroscopic parasite density as well as with asymptomatic infection, particularly among school-age children [5, 11–14]. Most of these infections remain undiagnosed and untreated [14, 15], and—in the case of schoolchildren—are not subject of targeted interventions.…”

Enhancing Malaria Prevention in Cameroon Through Community Participation: An in-Depth Review

“…Malaria affects mostly children of school-going age, particularly under-fives, causing persistent cognitive defects. [66] Despite being recognized as key players in malaria control, little evidence exists on the involvement of school children in prevention activities. [67] Teaching malaria lessons in primary schools effectively increased knowledge and made children in a Kenyan rural community change agents, [67] with significantly improved hygiene in school and home environments, hence, decreased malaria prevalence.…”

“…Despite its long term benefit of improvement in school attendance and performance, it is not financially feasible because it demands additional expenditures on teachers and pupils. [66] However, it is highly sustainable because it cultivates behaviour change, with long term positive impacts. [67] d) Training of mothers and caregivers Mothers and caregivers spend most of their time with the under-fives who are most affected by malaria, hence, the need for them to gain skills in managing the disease, whose benefit will also reduce morbidity and mortality among women, especially those who are pregnant.…”