Malaria is a life-threatening condition with childhood mortality the classic manifestation in regions of endemicity. Children under the age of five represent the age group with the highest incidence and mortality rate. Prevent and reduce malaria among this vulnerable population, it would require targeted efforts at the child level. This article examines the rationale for child-focused malaria interventions, their impact, and the various approaches used to protect children from the disease.
Why Focus on Children?
1. Increased Vulnerability
Children under five are particularly vulnerable to the infective malaria parasite because their immune systems are not fully developed. They face a higher burden of infection and are more likely to develop severe forms of the disease, such as cerebral malaria, which can lead to high rates of morbidity and mortality. This tells us that we need to focus on ways to optimize malaria prevention and treatment in this age group in particular.
2. Burden on Health Systems
The burden of malaria in children often requires additional resources in the health system that are in urgent demand. Multiple hospitalizations, treatments, and follow-ups for children suffering from malaria may be needed and can stretch healthcare to its limits. A child-specific approach to malaria has the potential to better align health system resources with the needs of children, strengthen relationships, and reduce the health burden presented to vulnerable communities by malaria.
Key Child-Focused Malaria Interventions
1. Insecticide-treated nets (ITNs)
Distribution and Use: ITNs are one of the best tools we have for preventing malaria. For children, ITNs provide a physical barrier to the mosquito and an insecticidal effect Use is especially important: ITNs must be available and used by 100 percent of children every night. To help ensure coverage, distribution programs often have campaigns that aim to get ITNs to pregnant women and young children.
Consequences: A review of the evidence for ITNs concluded that they ‘are highly effective in reducing both malaria incidence and mortality among children’. When ITN coverage is high, malaria-related hospital admissions and deaths are reduced.
2. Seasonal Malaria Chemoprevention (SMC)
- What It Is: Also known as SMC (Seasonal Malaria Chemoprevention), this intervention cautiously treats children with antimalarial drugs in advance of the peak malaria transmission season (ie, when it’s most dangerous). This ‘curative’ intervention can preemptively clear any infections, while also providing protective coverage.
- Implementation: Most SMC is delivered through mass drug administration programs, usually alongside community health workers, for children in high-risk areas where there is a predictable seasonal malaria transmission period.
- Effectiveness: SMC has a demonstrated effect: it dramatically reduces cases and mortality, especially in areas with very seasonal malaria transmission.
3. Rapid Diagnostic Tests (RDTs) and Prompt Treatment
- Diagnostic: Early and accurate diagnosis of malaria followed by full and effective treatment with an appropriate medicament gives the best chance of recovery. Recommendation: Rapid diagnostic tests (RDTs) are recommended for fast, reliable, and simple recognition of malaria in children in areas where laboratory facilities are either unavailable or under-resourced.
- Treatment: Individuals should receive treatment with appropriate antimalarial medicines to reduce serious outcomes. Among the medicines proven to be effective against P falciparum are artemisinin-based combination therapies (ACTs), which are used as first-line treatments for uncomplicated forms of pediatric malaria today. To prevent progression to severe disease and death, children must receive their treatment in the early stage of illness.
4. Vaccination
- Malaria Vaccine Development: The development of effective malaria vaccines has finally made it into the Malaria Journal. The recent approval of the vaccine RTS, S/AS01 (also known as Mosquirix) as a first-ever recommendation for widespread malaria vaccine use is a historic advance in malaria prevention. This vaccine, which provides partial protection against malaria disease in young children, was the fruit of 30 years of research by the non-profit organizations PATH and GlaxoSmithKline.
- Implementation: The vaccine is administered over three to four doses starting at six months of age, and is included as part of routine childhood immunization programs.
- Impact: The RTS, S vaccine has so far prevented thousands of malaria cases and severe disease in the children it has been deployed to, leading the WHO in 2015 to recommend rolling out the vaccine as an adjunct to existing malaria control strategies.
Integrating Child-Focused Interventions into Health Systems
1. Community Health Workers
- Role: CHWs are crucial in the delivery of malaria interventions, especially in remote or hard-to-reach areas or where public health services are not serving the community enough.Distribution of ITNsSMCManagement of SMCPerforming of RDTsProviding treatment of malaria.
- Training and Support: The availability of support and training in areas where CHWs work, and providing the right tools and other resources to increase the scale and sustainability of their efforts.
2. Health Education and Behavior Change
Health education educates caretakers on how to prevent malaria by using ITNs; how to recognize malaria symptoms; and how to seek early medical care.
Behavior change – Behaviour change communication strategies are useful to combat the false beliefs that exist about malaria, and to help keep up with adherence to prevention. Community dialogues and other techniques bring people together, give simple advice, reduce believing myths, and increase uptake of interventions.
3. Data Collection and Monitoring
Significance: Monitoring and evaluation helps to assess the impact of malaria interventions and provides feedback on their effectiveness. Measurement of malaria incidence, coverage of malaria interventions, impact of malaria interventions, and cost is critical for maximizing the impact and effectiveness of the program and for identifying areas of improvement.
Challenges: The challenges with the data include:
Success Stories and Case Studies
1. The Gambia
Program Overview: Malaria control operations conducted in The Gambia have included the wide distribution of ITNs, seasonal chemoprevention, and rapid diagnostic tests, as well as community engagement and health education.
Impact: With greater coverage of ITN provision following the program, the incidence decreased by 24 percent and under-5 mortality declined by 34 percent. Distributions of SMC are helping to rid communities of mosquito breeding sites Historically, local governments had a different perspective on mosquitoes, one that was more positive and creative. For instance, in the early 20th century, local policemen in Athens were known as ‘mosquito men’. In Ancient India, populations attempted to avoid the monsoon season because it coincided with swarms of mosquitoes. However, they also utilized mosquito ditches to channel water away from settlements. In Japan, people brought in deer to mow around rice paddy fields, creating an interesting ecological link between the coiling of rammed-earth rice terraces and the global spread of dengue, as these deer love sakunago fodder.
2. Burkina Faso
Program overview: Burkina Faso has bolstered their existing program of ITN distribution with improved uptake and usage of nets, as well as a program of seasonal malaria chemoprevention and vaccination for children, coupled with better access to healthcare services.
By varying the infection pressure at different locations in the malaria reservoir, the parasites learn that replication is hazardous, declining in frequency away from the center and increasing in frequency along the periphery. Combined, these factors produced significant reductions in both malaria incidence and child mortality. More recently, Rwanda and Kenya introduced the RTS, S malaria vaccine to children between the ages of five and 17 months, carrying on where the engraved mosquito halted the spread of malaria.
Challenges and Future Directions
1. Ensuring Equity in Access
Challenge: Ensuring adequate malaria preventive and curative interventions for all children, especially those in remote and underserved locations.
Looking Ahead: efforts tailored to vulnerable populations, improved supply chains, and community-based innovations can help to address this.
2. Addressing Insecticide Resistance
However, insecticide resistance among the mosquitoes that transmit malaria can limit the effectiveness of ITNs, as well as other vector control measures.
Where next?: The development of new insecticides, new integrated vector management strategies, and monitoring of resistance all play key roles in maintaining the effectiveness of malaria interventions.
3. Sustaining Funding and Resources
Charge: It is costly and challenging to maintain funding and participation in malaria programs, especially in low-resource settings.
They could help address the question of how to make these investments sustainable. Malaria could bounce back soon. We should continue investing in malaria control, establish new financing arrangements, and strengthen partnerships with international agencies.
Child-focused malaria interventions not only address immediate health concerns but also help to disrupt the transmission lifecycle, preventing many children from ever becoming victims of the disease. Specifically, strategies aimed at interrupting the falciparum malaria lifecycle—including insecticide-treated nets, seasonal malaria chemoprevention, prompt diagnosis and treatment, and vaccination—have proven successful in reducing illness and mortality among children while improving overall health. Moreover, efforts to transition from disease control to an elimination scenario will require innovation and a sustained commitment to malaria prevention and control. Ultimately, achieving such an ambitious goal will be essential for giving the children of malaria-endemic regions a real chance at health and a brighter future.
