According to "Hard work, little pay and long hours", the report released by Plan on 24 August, child tobacco pickers in Malawi were being exposed to "high levels of nicotine poisoning - the equivalent of 50 cigarettes per day".
"You reach a point where you cannot breathe because of the pain in your chest; then the blood comes when you vomit," one child told researchers.
Over 78,000 children work on tobacco estates across Malawi, with some as young as five working up to 12 hours a day for less than one US cent per hour, the report noted.
Child labour is often viewed as the norm, and an important source of income in Malawi. Many tobacco farmers struggle to break even, leading them to cut costs, and to "more children being exposed to hazardous and exploitative working conditions".
Plan urged Malawi's government to better enforce existing child labour and protection laws, and tobacco companies and estates to improve working conditions. Malawi is the world's fifth biggest tobacco producer and the crop accounts for 70 percent of export income.