Intersecting burdens of malaria and malnutrition in displaced children under five in the democratic Republic of Congo

Malaria and malnutrition represent a dual burden that severely affects children under 5 in refugee camps across the Democratic Republic of Congo (DRC). The DRC, with its limited infrastructure and persistent poverty, continues to experience high rates of these preventable health threats, both of which are further compounded in emergency settings. Malaria, caused by parasites of the Plasmodium genus and transmitted by female Anopheles mosquitoes, remains one of the leading public health challenges in sub-Saharan Africa[1-3]. In 2021, the DRC accounted for 12.3% of all global malaria cases, second only to Nigeria[4]. The country’s Human Development Index (HDI) of 0.481 ranks it 180th out of 193 countries, making children under 5 and pregnant women particularly vulnerable to severe illness and death from malaria[4,5]. While vector control strategies, including insecticide-treated nets and indoor residual spraying, alongside prompt diagnosis and treatment using artemisinin-based combination therapies (ACTs), have shown efficacy[6,7], the persistence of the disease underscores the challenges posed by drug and insecticide resistance and limited healthcare access[8,9]. Simultaneously, malnutrition persists as a silent but equally deadly crisis. Chronic undernutrition, micronutrient deficiencies, and acute malnutrition continue to claim lives and impair development, especially among young children[10–12]. Malnutrition weakens immune responses, increasing susceptibility to infections like malaria[13,14]. The intersection of malaria and malnutrition forms a vicious cycle – malnourished individuals are more likely to contract and suffer severe consequences from malaria, while malaria exacerbates nutritional deficits by impairing appetite and nutrient absorption. Children under 5 bear the brunt of this burden, which can result in lifelong cognitive and physical impairments[13,15]. Data from 2005 to 2014 show only modest reductions in stunting and wasting across the DRC and Republic of Congo, while malaria prevalence among children remains high, with testing revealing rates of 30.8% (RDT) and 22.6% (microscopy)[4]. This suggests that while interventions are underway, they are insufficient in addressing the full scope of the problem. To mitigate malaria, widespread distribution and proper use of insecticide-treated nets must be prioritized. Complementary indoor residual spraying programs are essential, particularly in areas with low net usage or insecticide resistance. Ensuring access to affordable ACTs through public health systems and community health workers is equally important[6,7]. Combating malnutrition requires a multi-faceted approach: promoting exclusive breastfeeding, integrating nutrition education into maternal and child healthcare, supporting sustainable agriculture, and implementing water, sanitation, and hygiene (WASH) programs. Expanding community-based management of acute malnutrition (CMAM) will be critical to reduce child mortality[10–12]. The DRC faces systemic challenges including healthcare infrastructure deficits, political instability, and inefficient intersectoral coordination. Health policies must prioritize investment in infrastructure and workforce capacity while ensuring equitable access to services for marginalized populations, including those in rural and conflict-affected areas. A call to action is warranted. Governments, civil society, donors, and international organizations must unite to implement integrated, data-driven strategies. Malaria and malnutrition are not isolated crises – they are manifestations of deeper structural inequalities that require holistic, sustained solutions.

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