Abstract
BackgroundEven though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with Sulfadoxine-Pyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met. However IPTi may also increase the adherence of the community to EPI services and improve EPI coverage, once the benefice of strategy is perceived.MethodsTo assess the impact of IPTi implementation on the coverage of EPI vaccines, 22 health areas of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The EPI vaccines coverage was assessed using cross-sectional surveys at baseline in November 2006 and after one year of IPTi pilot-implementation in December 2007.ResultsAt baseline, the proportion of children of 9-23 months who were completely vaccinated (defined as children who received BGG, 3 doses of DTP/Polio, measles and yellow fever vaccines) was 36.7% (95% CI 25.3% -48.0%). After one year of implementation of IPTi-SP using routine health services, the proportion of children completely vaccinated rose to 53.8% in the non intervention zone and 69.5% in the IPTi intervention zone (P <0.001).The proportion of children in the target age groups who received IPTi with each of the 3 vaccinations DTP2, DTP3 and Measles, were 89.2% (95% CI 85.9%-92.0%), 91.0% (95% CI 87.6% -93.7%) and 77.4% (95% CI 70.7%-83.2%) respectively. The corresponding figures in non intervention zone were 2.3% (95% CI 0.9% -4.7%), 2.6% (95% CI 1.0% -5.6%) and 1.7% (95% CI 0.4% - 4.9%).ConclusionThis study shows that high coverage of the IPTi can be obtained when the strategy is implemented using routine health services and implementation results in a significant increase in coverage of EPI vaccines in the district of Kolokani, Mali.Trial RegistrationClinicalTrials.gov NCT00766662
Highlights
Even though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with SulfadoxinePyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met
Several randomized control studies of IPTi with Sulfadoxine-pyrimethamine (SP) in different parts of Africa have shown that the strategy is efficacious in preventing clinical episodes of malaria by 30% and incidence of anemia by 20% [2] no efficacy was found in an area where the resistance to SP was 82% [3]
Coverage of IPTi after one year of implementation The proportion of children in the target age groups who received IPTi with each of the 3 vaccinations Second dose of Diphtheria-Tetanus-Pertussis vaccine (DTP2), Third dose of Diphtheria-Tetanus-Pertussis vaccine (DTP3) and Measles, were 89.2%, 91.0% and 77.4% respectively
Summary
Even though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with SulfadoxinePyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met. The absence of interaction with EPI vaccines and safety of IPTi are well established, there are still concerns that addition of IPTi will result in an increase in the work burden and will disrupt the routines EPI services especially in Africa where the target EPI vaccines coverage remains to be met. IPTi may increase the adherence of the community to EPI services and improve EPI coverage, once the benefit of the strategy is perceived [14,15]
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