These are described in detail in the Methods section on page 780.
ReviewMalaria in adolescence: burden of disease, consequences, and opportunities for intervention
Introduction
Malaria is one of the most important infections in the tropics with an estimated 1 to 2·7 million deaths annually.1 The age-groups at highest risk are primarily determined by the intensity of malarial transmission. Where transmission is intense, clinical disease is most common in young children: immunity develops with increasing age and adults are far less affected. In areas of lower transmission, clinical disease occurs throughout life.2 Although much has been learnt about the epidemiology and clinical effects of malaria in children, malaria in adolescence has been relatively neglected. Approximately 914 million adolescents (aged 10–19 years) live in low-income countries, and many of them will be exposed to malaria, but this group has rarely been targeted for malaria control.3 This review was undertaken to collate evidence and observations from different sources to better understand the burden and consequences of malaria in adolescents, and to identify relevant interventions or opportunities for improved control.
Section snippets
Methods
To obtain data for this review, we searched the 26 Cochrane systematic reviews on malaria for data relevant to adolescents (up to December, 2005). The Cochrane clinical trial register was searched for trials by use of the keywords “malaria” and “adolescence” in any field. Abstracts of these trials were examined to identify interventions relevant to adolescents. We also searched the English and French literature by use of PubMed (1966 to December, 2005) for articles containing the words
Clinical illness
Few studies have examined directly rates of clinical illness in adolescents. Observations in younger children indicate that, even within stable transmission areas, the intensity of transmission has a strong influence on the peak age of clinical illness (panel 1).5 This is shown by a comparison of two villages in Senegal with different transmission rates (200 vs 20 infective bites per year): clinical disease was rare in adolescence in the high-transmission area, but did occur in the area of
Clinical presentation of malaria
The clinical presentation of uncomplicated malaria in adolescents seems to be similar to other age-groups, although adolescents may have a stronger correlation of fever to parasite density than do younger children.15 A Senegalese study found no differences in symptoms, duration, or severity of symptoms between age-groups (including 41 adolescents).10
The pattern of severe malaria differs between adults and children; although cerebral malaria occurs in both, severe anaemia and respiratory
Prevention of malaria in non-pregnant adolescents
There are very limited data on the prevention of malaria in male and non-pregnant female adolescents. Although adolescents have been included in studies of bednets,101 detailed data are limited. One study examined the effect of insecticide-treated nets in non-pregnant adolescent girls and showed a reduction in anaemia in 12 and 13-year-olds (OR 0·38 [95% CI 0·21–0·69]) but not in older adolescents; no effect on malaria episodes or morbidity was shown in any age-group.102 Studies in Africa,
Discussion
Most attention in malaria has focused on the young African child because of the huge burden of disease and mortality in this age group. Finding good quality data on the incidence of disease in adolescents is not easy: few published studies specifically investigate malaria in adolescents, and younger adolescents are often not separated from children. However, although the burden of disease and mortality is clearly far less than that in younger children, we have presented evidence that from the
Conclusions
This review has examined all aspects of malaria in adolescence. Although the burden of malaria is far lower than in younger children in areas of stable transmission, malaria should be one of the highest priorities in adolescent health care; in particular, young pregnant women are at high risk and require special attention in all malaria endemic areas. This review has also shown the relative paucity of good data on many aspects of malaria in adolescents. Researchers should be encouraged to
Search strategy and selection criteria
References (148)
- et al.
Combating malaria morbidity and mortality by reducing transmission
Parasitol Today
(1996) - et al.
Malaria attacks in children exposed to high transmission: who is protected?
Trans R Soc Trop Med Hyg
(1993) The effect of malaria suppression in a group of Accra school children
Trans R Soc Trop Med Hyg
(1955)- et al.
Premunition in Plasmodium falciparum infection: insights from the epidemiology of multiple infections
Trans R Soc Trop Med Hyg
(1999) - et al.
Situation analysis of malaria in school-aged children in Kenya—what can be done?
Parasitol Today
(2000) - et al.
The epidemiology of malaria in a Karen population on the western border of Thailand
Trans R Soc Trop Med Hyg
(1996) - et al.
Field epidemiological studies on malaria in a low endemic area in the Philippines
Acta Trop
(1997) - et al.
The epidemiology of malaria in Rondonia (Western Amazon region, Brazil): study of a riverine population
Acta Trop
(1999) - et al.
The epidemiology of severe malaria in an area of low transmission in Thailand
Trans R Soc Trop Med Hyg
(1997) - et al.
Risk factors for malaria in pregnancy in an urban and peri-urban population in western Kenya
Trans R Soc Trop Med Hyg
(2002)
Malaria during pregnancy in an area of unstable endemicity
Trans R Soc Trop Med Hyg
Risk factors for infection with malaria in a low endemic community in Bataan, the Philippines
Acta Trop
Comparison of artemesinin suppositories, intramuscular artesunate and intravenous quinine for the treatment of severe childhood malaria
Trans R Soc Trop Med Hyg
Severe malaria among children in a low seasonal transmission area, Dakar, Senegal: influence of age on clinical presentation
Trans R Soc Trop Med Hyg
Low dietary iron availability is a major cause of anemia: a nutrition survey in the Lindi District of Tanzania
Am J Clin Nutr
Neurological sequelae of cerebral malaria in children
Lancet
Absence of neuropsychological sequelae following cerebral malaria in Gambian children
Trans R Soc Trop Med Hyg
An analysis of anaemia and pregnancy related maternal mortality
J Nutr
Adolescent maternal mortality in Mozambique
J Adolesc Heath
Malaria: ethnomedical perceptions and practice in an Adangbe farming community and implications for control
Soc Sci Med
Treatment seeking behaviour for malaria: a review of recent research
Soc Sci Med
Treatment seeking for malaria in Morong, Bataan, the Philippines
Soc Sci Med
Expert Committee on Malaria: 20th Report. Technical Report Series 892
The epidemiology and control of malaria
HIV, malaria and beyond: reducing the disease burden of female adolescents
Malar J
Global programme on evidence
New insights into the epidemiology of malaria relevant for disease control
Br Med Bull
Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission II. Descriptive epidemiology of malaria infection and disease among children
Am J Trop Med Hyg
Assessment of the incidence and prevalence of clinical malaria in semi-immune children exposed to intense and perennial transmission
Am J Epidemiol
Plasmodium falciparum clinical malaria in Dielmo, a holoendemic area in Senegal: no influence of acquired immunity on initial symptomatology and severity of malaria attacks
Am J Trop Med Hyg
Relationships between Plasmodium falciparum infection and morbidity in a highly endemic area
Parasitology
Premunition against Plasmodium falciparum in a malaria hyperendemic village in Myanmar
Trans R Soc Trop Med Hyg
The epidemiology of malaria in the Wosera area, East Sepik Province, Papua New Guinea, in preparation for vaccine trials. II. Mortality and morbidity
Ann Trop Med Parasitol
Is fever a good sign for clinical malaria in surveys of endemic communities?
Am J Trop Med Hyg
Estimating mortality, morbidity and disability due to malaria among Africa's non-pregnant population
Bull World Health Organ
Hospital-based surveillance of malaria-related paediatric morbidity and mortality in Kinshasa, Zaire
Bull World Health Organ
Malaria and urbanization in central Africa: the example of Brazzaville. Part V: pernicious attacks and mortality
Trans R Soc Trop Med Hyg
Child morbidity and mortality due to cerebral malaria in Brazzaville, Congo. A retrospective and prospective hospital-based study 1983–1989
Trop Med Parasitol
Clinical pattern and outcome in children with acute severe falciparum malaria at Jos University Teaching Hospital, Nigeria
East Afr Med J
African children with malaria in an area of intense Plasmodium falciparum transmission: features on admission to the hospital and risk factors for death
Am J Trop Med Hyg
Malaria in African infants and children in southern Nigeria
Ann Trop Med Parasitol
Changes in the pattern of mortality following the eradication of hyperendemic malaria from a highly susceptible community
Bull World Health Organ
Hypoendemic malaria in Rondonia (Brazil, western Amazon region): seasonal variation and risk groups in an urban locality
Am J Trop Med Hyg
Unstable hypoendemic malaria in Rondonia (western Amazon region, Brazil): epidemic outbreaks and work-associated incidence in an agro-industrial rural settlement
Am J Trop Med Hyg
Measuring the economic cost of malaria to households in Sri Lanka
Am J Trop Med Hyg
Some points in the epidemiology of malaria arising out of the study of the malaria epidemic in Ceylon in 1934–35
Trans R Soc Trop Med Hyg
Longitudinal malaria studies in rural north-east Thailand: demographic and temporal variables of infection
Bull World Health Organ
Newly transmitted Plasmodium falciparum malaria in the central highland plateaux of Madagascar: assessment of clinical impact in a rural community
Bull World Health Organ
Severe and complicated malaria in KwaZulu-Natal
S Afr Med J
Management of admitted malaria cases in four major hospitals of Delhi: a case study
Indian J Malariol
Cited by (54)
Changes in the associations between malaria incidence and climatic factors across malaria endemic countries in Africa and Asia-Pacific region
2023, Journal of Environmental ManagementA history of juvenile mild malaria exacerbates chronic stress-evoked anxiety-like behavior, neuroinflammation, and decline of adult hippocampal neurogenesis in mice
2020, Journal of NeuroimmunologyCitation Excerpt :Malarial infection causes 300–400 million clinical cases annually and poses a risk to about 40% of the global population (White et al., 2014). Children under 5 years of age bear an overwhelming burden of the infection and have been identified as a high-risk group by the WHO (Lalloo et al., 2006; Walker et al., 2007; White et al., 2014). Early-life malarial infection is identified as one of the major risk-factors in childhood development (Walker et al., 2007), highlighting the detrimental effects of the disease.
Mosquito-borne diseases
2019, Dengue Virus Disease: From Origin to OutbreakDrug targets for resistant malaria: Historic to future perspectives
2018, Biomedicine and PharmacotherapyIron supplementation in children with malaria: Timing the treatment
2016, Journal of NutritionDesign, synthesis and evaluation of antimalarial potential of polyphosphazene linked combination therapy of primaquine and dihydroartemisinin
2015, European Journal of Pharmaceutical SciencesCitation Excerpt :There were estimated 0.881 million deaths globally in 2006, of which 90% were in the African province and 4% in each of the South-East Asia and the Eastern Mediterranean regions (World Malaria Report, 2008). The individual most at risk of significant morbidity and transience on account of malaria are the children under the age of 5 years and the pregnant women (Ashley et al., 2006; Lalloo et al., 2006). The preface of chloroquine (1) in the 1940s had a marvellous impact on health worldwide; however, today resistance to the drug has been observed in every region where P. falciparum occurs (Wongsrichanalai et al., 2002).