Antimalarial treatments more likely to fail in children with acute malnutrition

13 March 2024

Children with acute malnutrition across Africa and Asia have a higher risk of treatment failure and malaria reinfection, even after being given the best currently available and recommended malaria treatment. Researchers from the Infectious Diseases Data Observatory (IDDO) at Oxford University analysed data from over 11,000 young children for this study, published in Lancet Global Health.

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 research study suggest that acute malnutrition in children may play a role not only in treatment failure, but it also puts this vulnerable group at higher risk of severe malaria and death.

“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,” said Professor Philippe Guerin, study lead and Director of the Infectious Diseases Data Observatory. “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.

“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,” said Dr Kasia Stepniewska, the IDDO Head of Statistics.

“These results highlight the power of pooling and reusing data from clinical studies of poverty-related diseases across Asia, Africa and the Americas,” said study author Professor Karen Barnes, Head of WWARN’s Africa Hub and the Pharmacology Scientific Group at the University of Cape Town, South Africa. The Infectious Diseases Data Observatory 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.

Notes for editors

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About the Infectious Diseases Data Observatory
The Infectious Diseases Data Observatory (IDDO) exists to promote the reuse of individual participant data across the global infectious disease community. IDDO curates submitted data from many different sources in-house, to produce freely available harmonised datasets, enabling scientists to answer new research questions from existing data.
It also provides the methods, governance and infrastructure to translate clinical data into evidence to improve health outcomes worldwide. IDDO incorporates the pioneering WorldWide Antimalarial Resistance Network (WWARN), a collaborative data-sharing framework that proved it is possible to produce policy-changing scientific evidence from pooling existing data. Find out more on

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