Abstract
BackgroundRecent studies have shown that intermittent preventive malaria treatment (IPT) in infants in areas of stable malaria transmission reduces malaria and severe anaemia incidence. However in most areas malaria morbidity and mortality remain high in older children.MethodsTo evaluate the effect of seasonal IPT with sulphadoxine pyrimethamine (SP) on incidence of malaria disease in area of seasonal transmission, 262 children 6 months-10 years in Kambila, Mali were randomized to receive either IPT with SP twice at eight weeks interval or no IPT during the transmission season of 2002 and were followed up for 12 months. Subjects were also followed during the subsequent transmission season in 2003 to assess possible rebound effect. Clinical malaria cases were treated with SP and followed to assess the in vivo response during both periods.ResultsThe incidence rate of malaria disease per 1,000 person-months during the first 12 months was 3.2 episodes in the treatment group vs. 5.8 episodes in the control group with age-adjusted Protective Efficacy (PE) of 42.5%; [95% CI 28.6%–53.8%]. When the first 16 weeks of follow up is considered age-adjusted PE was 67.5% [95% CI 55.3% – 76.6%]. During the subsequent transmission season, the incidence of clinical malaria per 1000 persons-days was similar between the two groups (23.0 vs 21.5 episodes, age-adjusted IRR = 1.07 [95% CI, 0.90–1.27]). No significant difference was detected in in vivo response between the groups during both periods.ConclusionTwo malaria intermittent treatments targeting the peak transmission season reduced the annual incidence rate of clinical malaria by 42.5% in an area with intense seasonal transmission. This simple strategy is likely to be one of the most effectives in reducing malaria burden in such areas.Trial RegistrationClinicaltrials.gov NCT00623155
Highlights
Recent studies have shown that intermittent preventive malaria treatment (IPT) in infants in areas of stable malaria transmission reduces malaria and severe anaemia incidence
This study assessed the impact of two doses of intermittent preventive treatment with sulphadoxine pyrimethamine (SP) at 8-week intervals in children of six months to 10 years of age targeting the transmission season in Kambila, Mali and found a reduction of 42.5% in annual incidence of clinical malaria
When SP plus single dose of artesunate was given at monthly intervals in an area with seasonal malaria transmission, Cisse et al [12] in Senegal found a reduction of 86% in incidence of clinical malaria children less than five years of age over 13 weeks period
Summary
Recent studies have shown that intermittent preventive malaria treatment (IPT) in infants in areas of stable malaria transmission reduces malaria and severe anaemia incidence. In most areas malaria morbidity and mortality remain high in older children. It is estimated that malaria causes between 300 and 500 million clinical cases and 700,000 to 1.6 million deaths each year with 94% of deaths occurring in subSaharan Africa [1,2]. In Mali, malaria is the leading cause of mortality and morbidity in the general population [3]. It has been shown that more than 80% of malaria cases occurred during five months of the transmission season in the north savanna area of Mali. In such conditions, a suitable control strategy implemented during this period may have the most impact on the reduction of disease burden
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