Abstract
BackgroundIntermittent preventive treatment of malaria in infants (IPTi) consists of the administration of a treatment dose of sulphadoxine-pyrimethamine (SP) at the time of routine vaccinations. The use of routine Health Management and Information Services (HMIS) data to investigate the effect of IPTi on malaria, anaemia, and all-cause attendance in children aged 2-11 months presenting to 11 health centres in southern Tanzania is described.MethodsClinical diagnosis of malaria was confirmed with a positive blood slide reading from a quality assurance laboratory. Anaemia was defined using two thresholds (mild [Hb < 11 g/dL], severe [Hb < 8 g/dL]). Incidence rates between IPTi and non-implementing health centres were calculated using Poisson regression, and all statistical testing was based on the t test due to the clustered nature of the data.ResultsSeventy two per cent of infants presenting in intervention areas received at least one dose of IPTi- 22% received all three. During March 2006 - April 2007, the incidence of all cause attendance was two attendances per person, per year (pppy), including 0.2 episodes pppy of malaria, 0.7 episodes of mild and 0.13 episodes of severe anaemia. Point estimates for the effect of IPTi on malaria varied between 18% and 52%, depending on the scope of the analysis, although adjustment for clustering rendered these not statistically significant.ConclusionsThe point estimate of the effect of IPTi on malaria is consistent with that from a large pooled analysis of randomized control trials. As such, it is plausible that the difference seen in health centre data is due to IPTi, even thought the effect did not reach statistical significance. Findings draw attention to the challenges of robust inference of effects of interventions based on routine health centre data. Analysis of routine health information can reassure that interventions are being made available and having desired effects, but unanticipated effects should trigger data collection from representative samples of the target population.
Highlights
Intermittent preventive treatment of malaria in infants (IPTi) consists of the administration of a treatment dose of sulphadoxine-pyrimethamine (SP) at the time of routine vaccinations
IPTi using SP, the incidence of clinical malaria in the first year of life was reduced by 30% [5], and IPTi was a considered a safe and effective anti-malarial strategy, likely to form a useful component of malaria control programmes in relevant settings [6]
Overall incidence rates of 0.2 episodes of lab-confirmed malaria; 0.7 episodes of mild and 0.13 of severe anaemia; and 2 episodes of all-cause health centre attendance per child per year were seen. These analyses of routine health information data suggest that IPTi was associated with an increased risk of anaemia, a reduced risk of malaria, an increase in coverage of routine vaccinations, and no effect on all cause out-patient attendance
Summary
Intermittent preventive treatment of malaria in infants (IPTi) consists of the administration of a treatment dose of sulphadoxine-pyrimethamine (SP) at the time of routine vaccinations. The use of routine Health Management and Information Services (HMIS) data to investigate the effect of IPTi on malaria, anaemia, and allcause attendance in children aged 2-11 months presenting to 11 health centres in southern Tanzania is described. RBM’s Monitoring and Evaluation Reference Group (MERG) recommends a number of data collection methods to monitor and evaluate malaria control strategies, and highlights as currently under-exploited, the use of routine health management and information system, from randomlyselected malaria sentinel sites [2,3]. Intermittent preventive treatment of malaria in infants (IPTi) consists of the administration of a treatment dose of sulphadoxine-pyrimethamine (SP) at the time of routine vaccinations in the first year of life [4]. In addition to RCTs [5,7,8,9,10,11,12], studies addressing questions of cost [13,14], safety, drug resistance [15], acceptability [16,17], and the implementation of IPTi through the Expanded
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