Abstract
Intermittent preventive treatment (IPT) administers a full therapeutic course of an anti-malarial drug at predetermined intervals, regardless of infection or disease status. It is recommended by the World Health Organization (WHO) for protecting pregnant women from the adverse effects of malaria (IPTp) and shows great potential as a strategy for reducing illness from malaria during infancy (IPTi). Administered concurrently with standard immunizations, IPTi is expected to reduce the frequency of clinical disease, but to allow blood-stage infections to occur between treatments, thus allowing parasite-specific immunity to develop. While wide deployment of IPTi is being considered, it is important to assess other potential effects. Transmission conditions, drug choice and administration schedule will likely affect the possibility of post-treatment rebound in child morbidity and mortality and the increased spread of parasite drug resistance and should be considered when implementing IPTi.
Highlights
Intermittent preventive treatment (IPT) protects pregnant women from malaria and placental parasitaemia and their newborns from malaria-associated low birth weight [1,2,3,4,5,6]
A study of IPT in children under five in an area of highly seasonal transmission administered doses of SP at monthly intervals exclusively during the high transmission season. This approach reduced the incidence of clinical malaria by more than 80% in the treated group compared to the control group, indicating that adapting the IPT schedule can be accomplished with good results [30]
It is certain that for some age interval, over some time interval, IPTi would reduce the clinical malaria case rate, whether the drug is acting as prophylaxis, or to clear sub-clinical infections, or both
Summary
Intermittent preventive treatment (IPT) protects pregnant women from malaria and placental parasitaemia and their newborns from malaria-associated low birth weight [1,2,3,4,5,6]. A study of IPT in children under five in an area of highly seasonal transmission administered doses of SP at monthly intervals exclusively during the high transmission season This approach reduced the incidence of clinical malaria by more than 80% in the treated group compared to the control group, indicating that adapting the IPT schedule can be accomplished with good results [30]. Preliminary results from two studies with SP in children under five years of age show increased frequencies of infections with SP-resistant parasites among children receiving IPT [30,35] It is not known how much this increase will increase the community-wide transmission and prevalence of drug resistance, but several studies indicate that infants and young children are the most important infectious reservoir in a population, despite their minority [79]. EPI seroconversion and drug resistance data can be integrated in a meta analysis across these diverse trials, this would provide considerable evidence for evaluating the safety of this scheme of IPTi
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