Abstract
BackgroundMalaria and anaemia are the leading causes of morbidity and mortality in children in sub-Saharan Africa. We have investigated the effect of intermittent preventive treatment with sulphadoxine-pyrimethamine or artesunate plus amodiaquine on anaemia and malaria in children in an area of intense, prolonged, seasonal malaria transmission in Ghana.Methods2451 children aged 3–59 months from 30 villages were individually randomised to receive placebo or artesunate plus amodiaquine (AS+AQ) monthly or bimonthly, or sulphadoxine-pyrimethamine (SP) bimonthly over a period of six months. The primary outcome measures were episodes of anaemia (Hb<8.0 g/dl) or malaria detected through passive surveillance.FindingsMonthly artesunate plus amodiaquine reduced the incidence of malaria by 69% (95% CI: 63%, 74%) and anaemia by 45% (95% CI: 25%,60%), bimonthly sulphadoxine-pyrimethamine reduced the incidence of malaria by 24% (95% CI: 14%,33%) and anaemia by 30% (95% CI: 6%, 49%) and bimonthly artesunate plus amodiaquine reduced the incidence of malaria by 17% (95% CI: 6%, 27%) and anaemia by 32% (95% CI: 7%, 50%) compared to placebo. There were no statistically significant reductions in the episodes of all cause or malaria specific hospital admissions in any of the intervention groups compared to the placebo group. There was no significant increase in the incidence of clinical malaria in the post intervention period in children who were >1 year old when they received IPTc compared to the placebo group. However the incidence of malaria in the post intervention period was higher in children who were <1 year old when they received AS+AQ monthly compared to the placebo group.InterpretationIPTc is safe and efficacious in reducing the burden of malaria in an area of Ghana with a prolonged, intense malaria transmission season.Trial RegistrationClinicalTrials.gov NCT00119132
Highlights
In Africa, malaria causes over a million deaths and many millions of episodes of illness in children less than five years of age each year [1,2]
The protective effect of IPTc against malaria and anaemia observed in our study is consistent with findings from Senegal and Mali
SP+AS IPTc had a protective efficacy against clinical attacks of malaria of 86% in Senegal [4] and bimonthly SP IPTc had a protective efficacy against clinical attacks of malaria of 40% among 6 months to 10 year old children in Mali [3]
Summary
In Africa, malaria causes over a million deaths and many millions of episodes of illness in children less than five years of age each year [1,2]. IPTc using sulphadoxine-pyrimethamine (SP) alone or in combination with a single dose of artesunate (AS) has been shown to be efficacious in reducing the incidence of malaria in areas of Mali [3] and Senegal [4] with a short malaria transmission season. The ability of IPTc to reduce the burden of malaria in areas with a more prolonged transmission season is not known. Malaria and anaemia are the leading causes of morbidity and mortality in children in sub-Saharan Africa. We have investigated the effect of intermittent preventive treatment with sulphadoxine-pyrimethamine or artesunate plus amodiaquine on anaemia and malaria in children in an area of intense, prolonged, seasonal malaria transmission in Ghana
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