Malaria in children aged <6 months: a narrative review of current evidence, recommendations and practice gaps.

backgroundAlthough clinical malaria occurs far less frequently in newborns and young infants aged  <6 months than in older children, its importance and public health relevance should not be ignored. This population is often perceived to have protection against malaria, and making a diagnosis of malaria in this age group can be challenging, as the symptoms generally overlap with those of many other common conditions in infancy, possibly leading to misdiagnosis or treatment delay. This narrative review synthesises current evidence, explores existing treatment recommendations, and highlights practice gaps in malaria management in children aged <6 months (or weighing <5 kg).

methodsA literature search was conducted using PubMed, EMBASE, and Google Scholar and supplemented with World Health Organization and region-specific malaria treatment guidelines.

findingsData on malaria prevalence in young infants are highly variable and heterogeneous, reflecting differences in the methodology used, diagnostic criteria and treatment approaches. Evidence regarding the safety and efficacy of available antimalarial therapies in this population is limited, and until recently, no antimalarial agents were licensed for neonates or infants weighing  <4.5 kg. Consequently, current recommendations may not adequately address the needs of this vulnerable group.

conclusionGiven the variability in the guidelines across different countries, there is an urgent need to make specific policy and practice amendments that can enhance understanding, bridge existing knowledge gaps and harmonise treatment approaches for at-risk populations worldwide.