Malaria in children under five

Children under five years of age are one of most vulnerable groups affected by malaria. There were an estimated 660 000 malaria deaths around the world in 2010, of which approximately 86% were in children under five years of age.

In high transmission areas, partial immunity to the disease is acquired during childhood. In such settings, the majority of malarial disease, and particularly severe disease with rapid progression to death, occurs in young children without acquired immunity. Severe anaemia, hypoglycemia and cerebral malaria are features of severe malaria more commonly seen in children than in adults.

WHO recommends the following package of interventions for the prevention and treatment of malaria in children:

  • use of long-lasting insecticidal nets (LLINs);
  • in areas with highly seasonal transmission of the Sahel sub-region of Africa, seasonal malaria chemoprevention (SMC) for children aged between 3 and 59 months;
  • in areas of moderate-to-high transmission in sub-Saharan Africa, intermittent preventive therapy for infants (IPTi), except in areas where WHO recommends administration of SMC;
  • prompt diagnosis and effective treatment of malaria infections.

As with any patient, children with suspected malaria should have parasitological confirmation of diagnosis before treatment begins, provided that diagnosis does not significantly delay treatment. Artemisinin derivatives are safe and well tolerated by young children, so the choice of ACT will be determined largely by the safety and tolerability of the partner drug. Many antimalarials lack paediatric formulations, necessitating the division of adult tablets, which can lead to inaccurate dosing.

Because the clinical condition of children with malaria can deteriorate rapidly, there should be a low threshold for the use of parenteral treatment. Recent data support the use of intravenous artesunate in preference to quinine for the treatment of severe malaria in children. When injectable treatment cannot be given, artesunate should be administered rectally and the child transferred to a facility for full parenteral treatment. A single dose of rectal artesunate as pre-referral treatment reduces the risk of death in children when the time for referral exceeds 6 hours.

Last update: 6 March 2013

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