BACKGROUND:
In the wake of the Millennium and Sustainable Development Goals, numerous health indicators have focused on children under 5 years of age. The health of children aged 5-9 has been the subject of far fewer studies, interventions, and monitoring. Regarding the campaign against malaria, this prioritization has led to documented progress. However, new transmission dynamics and the possible resurgence of morbidity among older children justify broadening the focus. We conducted a systematic review and meta-analysis of data extracted from nationally representative surveys that included children aged 5-9 years in sub-Saharan Africa (SSA).

METHODS:
All detailed reports from Demographic and Health Surveys (DHS), Malaria Indicator Surveys (MIS), and Multiple Cluster Indicator Surveys (MICS) conducted in SSA since 2000 were reviewed. To be included, a survey had to have been administered to children 5 who had: (i) undergone a biological test for malaria, (ii) had their hemoglobin measured, or (iii) documented the presence of fever during the two preceding weeks. Data were extracted and a mixed-effects meta-analysis was replicated for each of the three outcomes under study.

RESULTS:
The systematic review identified 121 DHS, 74 MIS, and 92 MICS surveys conducted in SSA since 2000. Only 15 MIS conducted in 7 SSA countries met the inclusion criteria. The prevalence of malaria and moderate-to-severe anemia ranged 6%-60% and 3%-29%, respectively, depending on the year, country, and age. Self-reported fever in the 2 weeks prior to the survey among children 5-9 ranged 18%-47%, depending on the year and country.

CONCLUSIONS:
There is a worrying lack of data on morbidity among children aged 5-9 years. The few national surveys suggest a high prevalence of malaria, anemia, and recent experience of fever. There is a need to better document the burden in order to improve child health in SSA through effective and equitable interventions.