Malaria among school children has received increased attention recently, yet there remain few detailed data on the
health and educational burden of malaria, especially in southern Africa. This paper reports a survey among school
children in 50 schools in Zomba District, Malawi. Children were assessed for Plasmodium infection, anemia, and
nutritional status and took a battery of age appropriate tests of attention, literacy, and numeracy. Overall, 60.0% of
children were infected with Plasmodium falciparum, 32.4% were anemic and 32.4% reported sleeping under a
mosquito net the previous night. Patterns of P. falciparum infection and anemia markedly varied by school. In
multivariable analysis, higher odds of P. falciparum infection were associated with younger age and being stunted,
whereas lower odds were associated with reported net use, higher parental education, and socioeconomic status. The
odds of anemia were significantly associated with P. falciparum infection, with a dose–response relationship
between density of infection and odds of anemia. No clear relationship was observed between health status and
cognitive and educational outcomes. The high burden of malaria highlights the need to tackle malaria among school
children.