Abstract
Malaria among school children has received increased attention recently, yet there remain few detailed data on the health and educational burden of malaria, especially in southern Africa. This paper reports a survey among school children in 50 schools in Zomba District, Malawi. Children were assessed for Plasmodium infection, anemia, and nutritional status and took a battery of age-appropriate tests of attention, literacy, and numeracy. Overall, 60.0% of children were infected with Plasmodium falciparum, 32.4% were anemic and 32.4% reported sleeping under a mosquito net the previous night. Patterns of P. falciparum infection and anemia varied markedly by school. In multivariable analysis, higher odds of P. falciparum infection were associated with younger age and being stunted, whereas lower odds were associated with reported net use, higher parental education, and socioeconomic status. The odds of anemia were significantly associated with P. falciparum infection, with a dose–response relationship between density of infection and odds of anemia. No clear relationship was observed between health status and cognitive and educational outcomes. The high burden of malaria highlights the need to tackle malaria among school children.
Highlights
Higher odds of P. falciparum infection were associated with younger age and being stunted, whereas lower odds were associated with reported net use, higher parental education, and socioeconomic status
A total of 2,667 children were included in the health analysis and 2,623 children were included in the education and health analysis (Figure 2)
The overall prevalence of P. falciparum infection was 60.0%
Summary
Since the launch of Roll Back Malaria in 1998 there has been increased funding for malaria control and subsequent expansion in the coverage of malaria interventions.[1,2] As a consequence, some areas of Africa have witnessed a marked decline in malaria transmission and disease burden.[3,4,5,6,7] Notwithstanding this progress, an estimated 57% of the continent’s population continues to live in areas of high malaria transmission where there has been little or no change in the burden of malaria between 2000 and 2010.8 One such country is Malawi where, despite the scale-up of malaria interventions, there has been limited decline in malaria transmission or hospital admissions over the last decade.[9,10] The reasons for the lack of change are multifactorial, ranging from health system factors to the underlying high intensity of malaria transmission.[11] In areas of high malaria transmission, modeling analysis shows that the breadth of coverage of malaria interventions across age groups needs to be broad to achieve substantive impact.[12,13] Studies show that Plasmodium infection prevalence is typically highest among school-aged children[14,15] yet this age group are often the least likely to be covered by malaria interventions[16,17] and represent an untreated reservoir of parasite transmission.[18,19,20] The high rates of infection among school-aged children may have a number of health and educational consequences for chronically infected children.[21,22,23] To better understand the patterns of Plasmodium infection among school children in Malawi, we present analysis of health and education data from a cross-sectional survey conducted in 50 schools in Zomba District in southern Malawi
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