When Rose Akinyi’s baby, Jayla Joy, would not eat or stop crying one night, she thought her newborn had a stomach upset. She gave her some mild pain medication, but her condition grew worse.
“She was burning hot, so I removed her clothes and gave her [more pain medication],” said 30-year-old Akinyi, from Kisumu, a port city in western Kenya on Lake Victoria.
It was late at night so she could not get to the nearest hospital, which was several miles away, and calls to doctors went unanswered. By the time she reached hospital the next morning on a motorcycle taxi, the baby’s temperature was 39.8C (103.6F). “At that point, I was thinking I could lose my child,” said Akinyi.
The diagnosis of malaria shocked Akinyi. Like many people, she assumed her baby would be protected from the disease by maternal immunity.
“I was very worried because I didn’t know my little one could get malaria too,” she said. Nurses administered antimalarials, and Jayla Joy’s fever broke. Health workers say the little girl, now nine months old, could have died.
There is no malaria treatment for babies weighing under 5kg (11lbs) – so from newborn to about three months old. But a new drug by the Switzerland-based pharmaceutical company Novartis being trialled in Africa could offer some hope.
“Malaria in newborns presents differently so it’s not easy to catch it in good time,” said Agnes Akoth, who worked as a nurse in Kisumu, where malaria is endemic. Infants sometimes have no symptoms or those they do have can easily be mistaken for common childhood illnesses.
“By the time they reach the diagnosis, the parasite may have multiplied and caused complications,” said Akoth. “Some of them may even die.”
Malaria is one of the leading causes of child deaths across Africa, and make up nearly 80% of all malaria-related deaths on the continent, according to a 2023 malaria report. In 2022, 94% of all malaria cases occurred in Africa.
Although the World Health Organization requires testing where malaria is suspected, hospitals do not always perform routine tests on babies due to shortages of diagnostic kits or lab staff.
Scientists and medical practitioners say the assumption that mothers confer immunity to babies has meant they have been left out of clinical trials for treatments. The RTS,S and R21 vaccines approved for malaria prevention have only been tested in children aged five months and above.
However, the Novartis drug undergoing stage 3 trials in Burkina Faso, Kenya, the Democratic Republic of the Congo, Nigeria, Mali and Zambia is looking promising. Results are expected in early 2024.
“I can see how health workers are struggling to treat babies,” said Dr Bérenger Kaboré, a research associate with the Nanoro Health and Demographic Surveillance System in Burkina Faso and principal investigator on the trials, which are being supported by the PAMAfrica Consortium and co-funded by the European & Developing Countries Clinical Trials Partnership and Medicines for Malaria Venture.
At present, babies diagnosed with malaria are treated with antimalarial tablets for bigger infants which are cut in half or quarters, an inaccurate process which risks overdoses and potential organ damage.
There is no accurate data on the prevalence of newborn malaria but it is thought to be not as common as in older children, while still being under-diagnosed.
“The challenge is that … no one thinks these babies could have malaria,” said Nekoye Otsyula, the global medical affairs director at Novartis. “In some cases, they rule out mothball poisoning before they think about malaria, so [it’s] really the last thing that the doctor or healthcare worker will think about when they are handling this infant.”
Findings on the extent of maternal immunity protections vary, but the risk of malaria to a newborn rises when a mother contracts the disease during pregnancy, or where the newborn is exposed to mosquitoes because the family doesn’t have insecticide-treated bed nets.
In 2022, about 35.4 million pregnant women in 33 moderate and high-transmission African countries were exposed to malaria. Medical experts say that treatments for newborns need to be prioritised.
“When these little babies have malaria, we can and should diagnose and treat them,” said Otsyula. “They are a neglected population and we need to do something about it.”
