Treatment and prevention of malaria in children

Malaria disproportionately affects children younger than 5 years. Falciparum malaria is responsible for more than
200 000 child deaths per year in Africa and vivax malaria is well documented as a cause of severe anaemia and excess
mortality in children in Asia and Oceania. For the treatment of malaria in children, paediatric dosing recommendations
for several agents, including parenteral artesunate and dihydroartemisinin–piperaquine, have belatedly been shown to be
suboptimal. Worsening antimalarial resistance in Plasmodium falciparum in the Greater Mekong Subregion threatens to
undermine global efforts to control malaria. Triple antimalarial combination therapies are being evaluated to try to impede
this threat. The RTS,S/AS01 vaccine gives partial protection against falciparum malaria and is being evaluated in large,
pilot studies in Ghana, Malawi, and Kenya as a complementary tool to other preventive measures. Seasonal malaria
chemoprevention in west Africa has resulted in declines in malaria incidence and deaths and there is interest in scaling
up efforts by expanding the age range of eligible recipients. Preventing relapse in Plasmodium vivax infection with
primaquine is challenging because treating children who have G6PD deficiency with primaquine can cause acute
haemolytic anaemia. The safety of escalating dose regimens for primaquine is being studied to mitigate this risk