Abstract
BackgroundIntermittent preventive treatment of malaria in children (IPTc) is a promising strategy for malaria control. A study conducted in Mali in 2008 showed that administration of three courses of IPTc with sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) at monthly intervals reduced clinical malaria, severe malaria and malaria infection by >80% in children under 5 years of age. Here we report the results of a follow-on study undertaken to establish whether children who had received IPTc would be at increased risk of malaria during the subsequent malaria transmission season.MethodsMorbidity from malaria and the prevalence of malaria parasitaemia and anaemia were measured in children who had previously received IPTc with SP and AQ using similar surveillance methods to those employed during the previous intervention period.Results1396 of 1508 children (93%) who had previously received IPTc and 1406 of 1508 children (93%) who had previously received placebos were followed up during the high malaria transmission season of the year following the intervention. Incidence rates of clinical malaria during the post-intervention transmission season (July –November 2009) were 1.87 (95% CI 1.76 –1.99) and 1.73 (95% CI; 1.62–1.85) episodes per child year in the previous intervention and placebo groups respectively; incidence rate ratio (IRR) 1.09 (95% CI 0.99 –1.21) (P = 0.08). The prevalence of malaria infection was similar in the two groups, 7.4% versus 7.5%, prevalence ratio (PR) of 0.99 (95% CI 0.73–1.33) (P = 0.95). At the end of post-intervention malaria transmission season, the prevalence of anaemia, defined as a haemoglobin concentration<11g/dL, was similar in the two groups (56.2% versus 55.6%; PR = 1.01 [95% CI 0.91 – 1.12]) (P = 0.84).ConclusionIPTc with SP+AQ was not associated with an increase in incidence of malaria episodes, prevalence of malaria infection or anaemia in the subsequent malaria transmission season.Trial RegistrationClinicalTrials.gov NCT00738946
Highlights
Malaria is one of the most important infectious diseases in the world and 40% of the world’s population is at risk
Despite increasing use of current control strategies such as rapid diagnosis and treatment of clinical cases, use of insecticide impregnated materials and indoor residual spraying with insecticides, malaria remains an important cause of morbidity and mortality, in sub-Saharan Africa
Given to infants through the Expanded Programme of Immunization (EPI), Intermittent preventive treatment of malaria (IPT) reduced the incidence of clinical malaria by 30% [3]
Summary
Malaria is one of the most important infectious diseases in the world and 40% of the world’s population is at risk. Intermittent preventive treatment of malaria (IPT), defined as the administration of a curative dose of an anti-malarial drug or drug combination at predefined time intervals to an at risk population regardless of whether or not they are known to be infected, is a promising new strategy for malaria control in areas where the infection still causes substantial morbidity and mortality [2]. More marked reductions in the incidence of uncomplicated and severe malaria, in the range of 67% to 86%, have been obtained when children aged 0–5 years or 0–10 years were given IPT during the peak malaria transmission season [4,5,6]. A study conducted in Mali in 2008 showed that administration of three courses of IPTc with sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) at monthly intervals reduced clinical malaria, severe malaria and malaria infection by .80% in children under 5 years of age. We report the results of a follow-on study undertaken to establish whether children who had received IPTc would be at increased risk of malaria during the subsequent malaria transmission season
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