Malaria in infants

Last update: 27 January 2018

Newborns and infants less than 12 months of age are one of most the vulnerable groups affected by malaria. During pregnancy, malaria infection in the mother can cause low birth weight and result in infant death.

In malaria-endemic areas, infants once again become vulnerable to Plasmodium falciparum malaria at approximately 3 months of age, when immunity acquired from the mother starts to wane. Infants are at increased risk of rapid disease progression, severe malaria and death. Severe anaemia is particularly common in this age group in areas of high transmission.

P. vivax malaria, traditionally viewed as a relatively benign form of the disease, can also be a major cause of morbidity and mortality, particularly in infants and young children. Some studies report that a high proportion of severe malaria episodes may be caused by P. vivax in this age group.

WHO recommends the following package of interventions for the prevention and control of malaria in infants:

  • use of long-lasting insecticidal nets (LLINs);
  • intermittent preventive therapy with sulphadoxine-pyrimethamine for infants (IPTi) in areas of moderate to high transmission in sub-Saharan Africa;
  • prompt diagnosis and effective treatment of malaria infections.

Diagnosis and treatment

As with any patient, infants with suspected malaria should have prompt parasitological confirmation of the diagnosis before treatment begins.

Artemisinin-based combination therapy (ACT) is the recommended treatment for uncomplicated malaria in infants. 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. For infants weighing less than 5 kg with uncomplicated P. falciparum, WHO recommends treatment with an ACT at the same mg/kg body weight dose as for children weighing 5 kg.

Use of parenteral treatment

Most antimalarials lack infant formulations, which can lead to inaccurate dosing. Because the health of infants can deteriorate rapidly, there should be a low threshold for the use of parenteral treatment.

In cases of suspected severe malaria where parenteral treatment cannot be given, rectal artesunate should be administered as pre-referral treatment and the infant should then immediately be transferred to a facility where comprehensive care for severe malaria can be provided. A single dose of rectal artesunate as pre-referral treatment reduces the risk of death in children under 6 years of age.

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