Malaria in children aged <6 months: a narrative review of current evidence, recommendations and practice gaps
Jéssica Dalsuco1, Quique Bassat2,3,4,5,6, Hazem Ahmed7
1Centro de Investigação Em Saúde de Manhiça (CISM), CISM, Rua 12, Vila da Manhiça, CP1929, Maputo, Mozambique. jessica.dalsuco@manhica.net.
Insights
Malaria diagnosis and treatment in infants under six months is challenging due to overlapping symptoms and limited drug data. Harmonizing global guidelines is crucial for this vulnerable population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Malaria is less common in infants under six months but poses significant public health challenges.
- Diagnosis is difficult due to overlapping symptoms with other infant illnesses, risking misdiagnosis and treatment delays.
- This age group is often perceived as protected, but this can lead to underestimation of risks.
Purpose of the Study:
- To review current evidence on malaria management in infants under six months.
- To explore existing treatment recommendations and identify practice gaps.
- To highlight the need for improved understanding and harmonized treatment approaches.
Main Methods:
- A comprehensive literature search was conducted using major databases (PubMed, EMBASE, Google Scholar).
- The search was supplemented with guidelines from the World Health Organization and regional malaria treatment protocols.
- A narrative review approach was employed to synthesize the findings.
Main Results:
- Data on malaria prevalence in young infants are highly variable and inconsistent.
- Limited evidence exists on the safety and efficacy of antimalarial drugs for this age group.
- Few antimalarial agents were previously licensed for neonates or infants weighing under 4.5 kg, indicating inadequate current recommendations.
Conclusions:
- Current malaria treatment guidelines may not sufficiently address the needs of infants under six months.
- Variability in country-specific guidelines necessitates policy and practice amendments.
- There is an urgent need to bridge knowledge gaps and harmonize treatment strategies for at-risk infant populations globally.
Background:
Although clinical malaria occurs far less frequently in newborns and young infants aged <6 months than in older children, its importance and public health relevance should not be ignored. This population is often perceived to have protection against malaria, and making a diagnosis of malaria in this age group can be challenging, as the symptoms generally overlap with those of many other common conditions in infancy, possibly leading to misdiagnosis or treatment delay. This narrative review synthesises current evidence, explores existing treatment recommendations, and highlights practice gaps in malaria management in children aged <6 months (or weighing <5 kg).
Methods:
A literature search was conducted using PubMed, EMBASE, and Google Scholar and supplemented with World Health Organization and region-specific malaria treatment guidelines.
Findings:
Data on malaria prevalence in young infants are highly variable and heterogeneous, reflecting differences in the methodology used, diagnostic criteria and treatment approaches. Evidence regarding the safety and efficacy of available antimalarial therapies in this population is limited, and until recently, no antimalarial agents were licensed for neonates or infants weighing <4.5 kg. Consequently, current recommendations may not adequately address the needs of this vulnerable group.
Conclusion:
Given the variability in the guidelines across different countries, there is an urgent need to make specific policy and practice amendments that can enhance understanding, bridge existing knowledge gaps and harmonise treatment approaches for at-risk populations worldwide.
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