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A systematic literature review demonstrated a very complex relationship between malaria and malnutrition, but chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitaemia and anaemia (BMC Med. 2018;16(1):186). The particular impact of malnutrition on the pharmacokinetic properties of lumefantrine was evaluated in children with severe acute malnutrition in Niger.

Modelling and simulations demonstrated that anthropometric indicators of malnutrition were significantly associated with decreased absorption of lumefantrine, and that malnourished children were at risk of under-exposure to lumefantrine and an increased risk of malaria reinfection compared to well-nourished children (Clin Pharmacol Ther. 2019 Dec; 106(6): 1299–1309). An optimised dosing regimen was suggested for this group of patients. This work has been submitted and is under review for publication.