Volume 74, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


A double-blind, placebo-controlled trial of nine months duration was carried out to investigate the impact of malaria and its prevention on the educational attainment of school children in a malaria-endemic area in southern Sri Lanka where both and infections are prevalent. A total of 587 children attending grades 1–5 in four schools and resident in the area were randomly allocated to chloroquine (n = 295) and placebo (n = 292) arms. Language and mathematics scores of end-of-term school examinations for 1998 and 1999 and number of days absent and reasons for absenteeism during seven months pre-intervention and nine months of the intervention were recorded. The results indicate that there were no differences in language (95% confidence interval [CI] = 48.44–53.78 in chloroquine group and 50.43–55.81 in placebo group) and mathematics (95% CI = 49.24–54.38 in chloroquine group and 51.12–56.38 in placebo group) scores between the two groups prior to the intervention. During the intervention, the malaria incidence rate decreased by 55% (95% CI = 49–61%) and school absenteeism due to malaria was reduced by 62.5% (95% CI = 57–68%) in children who received chloroquine compared with the placebo group. Post-intervention, children who received chloroquine scored approximately 26% higher in both language (95% CI = 21–31%) and mathematics (95% CI = 23–33%) than children who received placebo. In a multivariate model, educational attainment was significantly associated with taking chloroquine prophylaxis and absenteeism due to malaria ( < 0.001 for both) but not due to health causes other than malaria or non-health causes. Language scores were associated with number of malaria attacks ( < 0.022). Educational attainment was significantly better among children whose compliance to chloroquine prophylaxis was higher ( < 0.001). The data suggest that malarial attacks have an adverse impact on the educational attainment of the school child and prevention of these attacks significantly improves educational attainment of children living in malaria-endemic areas.


Article metrics loading...

Loading full text...

Full text loading...



  1. Clark SE, Brooker S, Njagi JK, Njau E, Estambale B, Muchiri E, Magnussein P, 2004. Malaria morbidity amongst school children living in two areas of contrasting transmission in western Kenya. Am J Trop Med Hyg 71 : 732–738.
  2. Luxemburger C, Perera WA, Delmas G, Pruja C, Pecoul B, Moren A, 1994. Permethrin-impregnated bed nets for prevention of malaria in schoolchildren on the Thai-Burmese Border. Trans R Soc Trop Med Hyg 88 : 155–159.
  3. Snow RW, 1997. Relationship between severe malaria in children and level of Plasmodium falciparum in Africa. Lancet 349 : 1650–1654.
  4. Brooker S, Guyatt H, Omumbo J, Shretta R, Drake L, Ouma J, 2000. Situation analysis of malaria in school-aged children in Kenya-what can be done? Parasitol Today 16 : 183–186.
  5. Bundy DAP, Lwin S, Osika JS, McLaughlin J, Pannenborg CO, 2000. What should schools do about malaria? Parasitol Today 16 : 181–182.
  6. Holding PA, Snow RW, 2001. Impact of Plasmodium falciparum malaria on performance and learning: review of evidence. Am J Trop Med Hyg 64 : 68–75.
  7. Trape JF, Zoulani A, Quinet MC, 1987. Assessment of incidence and prevalence of clinical malaria in semi-immune children exposed to intense and perennial transmission. Am J Epidemiol 126 : 193–201.
  8. Trape JE, Lefebvre-Zante E, Legros F, Druilhe P, Rogier C, Bourganali H, Salem G, 1993. Malaria morbidity among children exposed to low seasonal transmission in Dakar, Senegal and its implications for malaria control in tropical Africa. Am J Trop Med Hyg 48 : 748–756.
  9. United Nations Educational, Scientific and Cultural Organization, 2002. Focusing Resources on Effective School Health. Available from http://portal.unesco.org/education/en/ev.php-url_id=24006&url_do=do_topic&url_section=201.html
  10. Colbourne M, 1955. The effect of malaria suppression in a group of Accra schoolchildren. Trans R Soc Trop Med Hyg 49 : 356–369.
  11. Boivin M, Giordani B, Ndanga K, Maky M, Menzeki M, Ngunu N, Muamba K, 1993. Effects of treatment for intestinal parasites and malaria on cognitive abilities of schoolchildren in Zaire, Africa. Health Psychol 12 : 220–226.
  12. Al Serouri AW, Grantham-McGregor SM, Greenwood B, Costello A, 2000. Impact of asymptomatic malaria parasitaemia on cognitive function and school achievement of school children in the Yemen Republic. Parasitology 121 : 3337–3345.
  13. Fernando D, Wickremasinghe R, Mendis KN, Wickremasinghe AR, 2003. Cognitive performance at school entry of children living in malaria endemic areas of Sri Lanka. Trans R Soc Trop Med Hyg 97 : 161–165.
  14. Fernando SD, Gunawardena DM, Bandara MR, de Silva D, Mendis KN, 2003. The impact of repeated malaria attacks on school performance of children. Am J Trop Med Hyg 69 : 582–588.
  15. Fernando D, de Silva D, Wickremasinghe R, 2003. Short-term impact of an acute attack of malaria on the cognitive performance of schoolchildren living in a malaria-endemic area of Sri Lanka. Trans R Soc Trop Med Hyg 97 : 633–639.
  16. Boivin M, 2002. Effects of early cerebral malaria on cognitive ability in Senegalese children. J Dev Behav Pediatr 23 : 1–12.
  17. Muntendam AH, Jaffar S, Bleichrodt N, van Hensbroek MB, 1996. Absence of neuropsychological sequelae following cerebral malaria in Gambian children. Trans R Soc Trop Med Hyg 90 : 391–394.
  18. Holding PA, Stevenson J, Peshu N, Marsh K, 1999. Cognitive sequelae of severe malaria with impaired consciousness. Trans R Soc Trop Med Hyg 93 : 529–534.
  19. Mendis KN, Carter R, 1995. Clinical disease and pathogenesis in malaria. Parasit Today 11 (Suppl): 1–6.
  20. Handunnetti SM, Gunawardena DM, Pathirana PPSL, Ekanayake K, Weerasinghe CS, Mendis KN, 1996. Features of recrudescent chloroquine resistant Plasmodium falciparum infections confer a survival advantage on parasites, and have implications for disease control. Trans R Soc Trop Med Hyg 90 : 563–567.
  21. Fleck SL, Moody AH, 1993. Diagnostic Techniques in Medical Parasitology. 11th Edition. London: Butterworth-Heinemann.
  22. Gamage-Mendis AC, Carter R, Mendis C, De Zoysa APK, Herath PRJ, Mendis KN, 1991. Malaria infections are clustered within an endemic population: risk of malaria associated with house construction type. Am J Trop Med Hyg 45 : 77–85.
  23. Gunawardena DM, Wickremasinghe AR, Muthuwatta L, Weerasingha S, Rajakaruna J, Senanayaka T, Kotta PK, Attanayake N, Carter R, Mendis KN, 1998. Malaria risk factors in an endemic region, and the impact and cost implications of risk factor-based interventions. Am J Trop Med Hyg 58 : 533–542.
  24. Fernando SD, Paranavitane SR, Rajakaruna J, Weerasinghe S, de Silva D, Wickremasinghe AR, 2000. The health and nutritional status of school children in two rural communities in Sri Lanka. Trop Med Int Health 5 : 450–452.
  25. Snow RW, Craig M, Deichmann U, Marsh K, 1999. Estimating mortality, morbidity and disability due to malaria among Africa’s non-pregnant population. Bull World Health Organ 77 : 624–640.

Data & Media loading...

  • Received : 13 Apr 2005
  • Accepted : 22 Oct 2005

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error