“Utilising schools as a platform to deliver preventive treatment improves the feasibility of this intervention,” said Dr Lauren Cohee, faculty member in the Malaria Research Program at the University of Maryland School of Medicine and first author of the report.
“Preventive treatment of malaria could be added to existing school-based health programs, including nutrition and deworming, to further promote the overall health of the learner.”
Prof Chico added that focusing on reducing transmission among school age children was significant because “epidemiological shift” means an increasing proportion of infections are among this group.
“Historically the burden of disease has predominantly been in children aged zero to five, so that’s where efforts focused first, as well as in pregnant women,” he said. “But we are seeing the burden transition to older, school aged children as interventions have not targeted them previously.”
He added that a lack of semi-acquired immunity may also be contributing to this trend, as children have less exposure to malaria during their early years. “So when they are infected, it is more likely that the infection will require medical treatment,” he said.
Currently, the World Health Organization recommends providing intermittent preventive treatment to pregnant women, infants and young children in some malaria-endemic areas, but has not issued recommendations for school-age children. Prof Chico and is confident this could soon change.
“There’s evidence to suggest that school age children are a primary driver of continued transmission, that they represent at this point really a key barrier to achieving malaria elimination,” he said. “I am optimistic that the WHO will take our findings into consideration.
“We have come a great distance and over the last fifteen years have cut malaria mortality by half,” he added. “But in the face of stalling progress to cut mortality in half again means you have to do more – the low lying fruit, as such, has already been picked.”
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