Abstract
Previous studies have shown that a single season of intermittent preventive treatment in schoolchildren (IPTsc) targeting the transmission season has reduced the rates of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Efficacy over the course of multiple years of IPTsc has been scantly investigated. Methods: An open, randomized-controlled trial among schoolchildren aged 6–13 years was conducted from September 2007 to January 2010 in Kolle, Mali. Students were included in three arms: sulphadoxine-pyrimethamine+artesunate (SP+AS), amodiaquine+artesunate (AQ+AS), and control (C). All students received two full doses, given 2 months apart, and were compared with respect to the incidence of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Results: A total of 296 students were randomized. All-cause clinic visits were in the SP+AS versus control (29 (20.1%) vs. 68 (47.2%); 20 (21.7%) vs. 41 (44.6%); and 14 (21.2%) vs. 30 (44.6%); p < 0.02) in 2007, 2008, and 2009, respectively. The prevalence of asymptomatic parasitemia was lower in the SP+AS compared to control (38 (7.5%) vs. 143 (28.7%); and 47 (12.7%) vs. 75 (21.2%); p < 0.002) in 2007 and 2008, respectively. Hemoglobin concentration was significantly higher in children receiving SP+AS (11.96, 12.06, and 12.62 g/dL) than in control children (11.60, 11.64, and 12.15 g/dL; p < 0.001) in 2007, 2008, and 2009, respectively. No impact on clinical malaria was observed. Conclusion: IPTsc with SP+AS reduced the rates of all-cause clinic visits and anemia during a three-year implementation.
Highlights
Intermittent preventive treatment (IPT) for malaria in children has recently been identified as an important tool in the fight against malaria, in areas where malaria transmission follows a distinct seasonal pattern [1,2,3]
The majority of these studies have focused on children, who are most vulnerable to the disease, and a 2013 Cochrane review supported the implementation of IPT for infants and under-5 children living in areas with predominantly seasonal transmission [10]
In 2009, we reported the results of a randomized controlled trial of artemisinin-based combination therapies (ACTs) used for intermittent preventive treatment in school-aged children (IPTsc) [4]
Summary
Intermittent preventive treatment (IPT) for malaria in children has recently been identified as an important tool in the fight against malaria, in areas where malaria transmission follows a distinct seasonal pattern [1,2,3]. Several clinical trials have demonstrated IPT efficacy in reducing morbidity and mortality associated with malaria infection [1,2,4,5,6,7,8,9]. The majority of these studies have focused on children, who are most vulnerable to the disease, and a 2013 Cochrane review supported the implementation of IPT for infants and under-5 children living in areas with predominantly seasonal transmission [10]. We hypothesized that IPTsc would continue to positively impact malaria morbidity reduction among school-aged children in an area with primarily seasonal transmission
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