The analysis found that children younger than age five who were very underweight for their height had nearly double the risk of malaria treatment failing, even when given the World Health Organisation recommended doses of an artemisinin-based combination therapy. This is currently the best treatment for falciparum malaria.
47 million children across the world are estimated to suffer from acute malnutrition, with a 30% increase in the last three years (an additional 13.6 million children). Areas with malnutrition overlap with those affected by malaria across many tropical and sub-tropical parts of the world, and children under five account for 80% of all malaria deaths.
The results from the study by the researchers at IDDO suggest that acute malnutrition in children may play a role not only in treatment failure but also puts this vulnerable group at higher risk of severe malaria and death. The study was published in Lancet Global Health.
Professor Philippe Guerin, Director of the Infectious Diseases Data Observatory, and the study lead said: ‘Malaria and malnutrition both affect poorer communities with limited research resources, so there just aren’t enough studies on the efficacy of antimalarial drugs in malnourished children, and past studies have contradictory results. So we used a different strategy to answer this question.’
The research team pooled individual patient data from 36 different antimalarial efficacy studies from 24 countries, that included both height and weight information for the study participants.
Dr Kasia Stepniewska, the Head of Statistics at IDDO, said: ‘No one individual study included a large enough sample of malnourished children to uncover a clear relationship, but by combining information across many different studies, which each included few malnourished children, we were able to spot a clear pattern.’
Professor Karen Barnes, Head of the WorldWide Antimalarial Resistance Network’s Africa Hub, and the author of this study said: ‘These results highlight the power of pooling and reusing data from clinical studies of poverty-related diseases across Asia, Africa and the Americas.’ IDDO has one of the biggest data repositories of this kind for tropical and infectious diseases, which is free to use for researchers across the world.
The study’s conclusions also urge scientists and doctors to record young children’s height and weight in future malaria studies, to identify children who need more careful medical follow-up because malaria treatment is more likely to fail. Future work is also now needed to optimise the dose of current anti-malarial drugs for this group of children.
Read the full paper here: www.sciencedirect.com/science/article/pii/S2214109X24000032