Abstract
Anti-malarial drugs can make a significant contribution to the control of malaria in endemic areas when used for prevention as well as for treatment. Chemoprophylaxis is effective in preventing deaths and morbidity from malaria, but it is difficult to sustain for prolonged periods, may interfere with the development of naturally acquired immunity and will facilitate the emergence and spread of drug resistant strains if applied to a whole community. However, chemoprophylaxis targeted to groups at high risk, such as pregnant women, or to periods of the year when the risk from malaria is greatest, can be an effective and cost effective malaria control tool and has fewer drawbacks. Intermittent preventive treatment, which involves administration of anti-malarials at fixed time points, usually when a subject is already in contact with the health services, for example attendance at an antenatal or vaccination clinic, is less demanding of resources than chemoprophylaxis and is now recommended for the prevention of malaria in pregnant women and infants resident in areas with medium or high levels of malaria transmission. Intermittent preventive treatment in older children, probably equivalent to targeted chemoprophylaxis, is also highly effective but requires the establishment of a specific delivery system. Recent studies have shown that community volunteers can effectively fill this role. Mass drug administration probably has little role to play in control of mortality and morbidity from malaria but may have an important role in the final stages of an elimination campaign.
Highlights
This review on the use of anti-malarial drugs to prevent malaria in the population of malaria endemic areas focuses on Africa where the potential for this approach to malaria control is greatest
Mode of action of Intermittent Preventive Treatment (IPT) in infants (IPTi) and in children (IPTc) is prophylaxis, so that this intervention overlaps with approaches previously termed seasonal or targeted chemoprophylaxis
An initial trial of IPTi in Tanzania, in which three doses of SP were given during the first year of life at the time of routine immunization, showed highly encouraging results with an approximately 50% reduction in clinical attacks of malaria and in anaemia [14,15]
Summary
This review on the use of anti-malarial drugs to prevent malaria in the population of malaria endemic areas focuses on Africa where the potential for this approach to malaria control is greatest. School children Mass treatment programmes to control intestinal helminths and schistosomiasis are in progress in a number of malaria endemic countries and provide a vehicle through which anti-malarial drugs could be given. It is generally accepted that in medium or high transmission areas, the currently deployed malaria control tools – treatment with an artemisinin combination (ACT) and vector control with ITNs and/or IRS - will alone be insufficient to interrupt transmission and that an additional tool will be needed to do this This might be a vaccine with transmission-blocking properties or it might be a drug given as MDA. A more effective drug than primaquine, one which can ideally be given as single dose, will be needed if drugs are to play an important role in the elimination of P. vivax and P.ovale infections
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