Malaria in childhood: school-based diagnosis and treatment as a public health approach offering equitable access to care

Despite the newly available malaria vaccines, the World Health Organization (WHO) continues to call for innovative programs able to improve malaria care for children, because malaria-related child mortality and morbidity remain so high. Social determinants of health compound the challenge of managing malaria; the influence of geography (rural versus urban living) and multiple adverse consequences of poverty particularly impact children. The WHO advocates the accurate diagnosis of malaria and effective treatment within 24 h of symptom onset. Rapid diagnostic testing (RDT) and artemisinin combination therapy (ACT) are validated measures to achieve this, but the burden of disease remains particularly high in rural areas and other low-resource settings where access to these interventions is limited. The literature documents that several school-based approaches can effectively reduce malaria morbidity among school-aged children. In particular, teacher-driven screening using RDT and treatment with ACT have been shown to positively impact malaria-related absence from school, an established surrogate measure for morbidity. This approach conforms with WHO-endorsed criteria for diagnosis and treatment, and also follows recommendations made by the Lancet Commission on the future of health in sub-Saharan Africa for ‘non-traditional outlets’ and ‘people-centered approaches’ to be used to meet current health challenges and address inequities in care. In addition to this school-based, teacher-driven model being a logical and relevant way to improve morbidity among school children in rural African communities, its scale-up would meet the moral imperative to address the long recognized inequities in malaria care that continue to disproportionately affect the health and academic potential of school-aged children.