Over 40% of the world's children live in malaria-endemic countries. Of the one million malaria deaths each year, 75% occur among African children under five years of age. The rapid spread of resistance to antimalarial drugs, coupled with widespread poverty, weak health infrastructure and, in some countries, civil unrest, means that morbidity and mortality from malaria in Africa continues to rise.

Approximately 7% of children who survive cerebral malaria (a severe form of the disease characterized by coma and convulsions) are left with permanent neurological problems. These include weakness, spasticity, blindness, speech problems and epilepsy. The limited availability of specialized educational provision and equipment for such children means that opportunities for subsequent learning, and for attainment of independence, are compromised even further. Recent evidence suggests that some children who appear to have made a complete neurological recovery from cerebral malaria may later develop significant cognitive problems (attention deficits, difficulty with planning and initiating tasks, speech and language problems), which can adversely affect school performance.

Although nutritional deficiencies, hookworm infection, and HIV all predispose children to anemia, evidence suggests that malaria is one of the most important factors in endemic countries. It has been estimated that severe malarial anemia causes between 190, 000 and 974, 000 deaths each year among children < 5 years. And although blood transfusion may be life-saving in this situation, such action also exposes children to the risk of HIV and other blood-borne diseases.

It is estimated that African children have between 1.6 and 5.4 episodes of malarial fever each year, a figure that varies according to geographical and epidemiological circumstances. Children are vulnerable to malaria from about 4 months of age and, in highly endemic areas during the peak transmission season, approximately 70% of one-year-olds have malaria parasites in their blood. Fever reduces appetite, thereby exacerbating malnutrition. Recurrent episodes of malaria in the child, or in a family member—which may mean that the child is required to stay at home to help with domestic chores—are likely to result in the loss of a substantial amount of time from school.