Prevention Of Malaria In Children Research Articles

A comparative immunological assessment of multiple clinical-stage adjuvants for the R21 malaria vaccine in nonhuman primates.

Authorization of the Matrix-M (MM)-adjuvanted R21 vaccine by three countries and its subsequent endorsement by the World Health Organization for malaria prevention in children are a milestone in the fight against malaria. Yet, our understanding of the innate and adaptive immune responses elicited by this vaccine remains limited. Here, we compared three clinically relevant adjuvants [3M-052 + aluminum hydroxide (Alum) (3M), a TLR7/8 agonist formulated in Alum; GLA-LSQ, a TLR4 agonist formulated in liposomes with QS-21; and MM, the now-approved adjuvant for R21] for their capacity to induce durable immune responses to R21 in macaques. R21 adjuvanted with 3M on a 0, 8, and 23-week schedule elicited anti-circumsporozoite antibody responses comparable in magnitude to the R21/MM vaccine administered using a 0-4-8-week regimen and persisted up to 72 weeks with a half-life of 337 days. A booster dose at 72 weeks induced a recall response similar to the R21/MM vaccination. In contrast, R21/GLA-LSQ immunization induced a lower, short-lived response at the dose used. Consistent with the durable serum antibody responses, MM and 3M induced long-lived plasma cells in the bone marrow and other tissues, including the spleen. Furthermore, whereas 3M stimulated potent and persistent antiviral transcriptional and cytokine signatures after primary and booster immunizations, MM induced enhanced expression of interferon- and TH2-related signatures more highly after the booster vaccination. Collectively, these findings provide a resource on the immune responses of three clinically relevant adjuvants with R21 and highlight the promise of 3M as another adjuvant for malarial vaccines.

Home-based care practices on prevention of malaria in children under 5 years: A narrative review.

Malaria is a major threat to lives in developing countries, especially in Africa. A lot of measures have been tried to curb the increased mortality and morbidity associated with malaria. A lot of resources have been channeled to control the devastating effects of malaria in these parts of the world. The aim of this paper is to discuss home-based care practices on prevention of malaria in children under 5 years. By cutting back on bushes and upholding good hygiene and sanitation, malaria in young children can be prevented in homes. This lessens disease and transmission while also assisting in death prevention and disease reduction. In Africa, Uganda is the third most affected country by malaria, which is a major cause of high morbidity and mortality in young children and pregnant women. This has forced the Government of Uganda and implementing partners, including the Global Fund and the Roll Back Malaria initiative, to redouble efforts to increase the use of insecticide-treated mosquito nets. Effective use of insecticide-treated bed nets is necessary to eliminate the above serious sequelae in children under 5 years old. Households and especially caregivers apply the use of impregnated mosquito nets and cleaning of surrounding bushes. According to research results, the use of indoor residual spray nets and insecticide-impregnated nets has significantly contributed to the prevention of malaria in children.

Increasing the uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) through seasonal malaria chemoprevention channel delivery: protocol of a multicenter cluster randomized implementation trial in Mali and Burkina Faso

BackgroundThe uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) remains unacceptably low, with more than two-thirds of pregnant women in sub-Saharan Africa still not accessing the three or more doses recommended by the World Health Organisation (WHO). In contrast, the coverage of Seasonal Malaria Chemoprevention (SMC), a more recent strategy recommended by the WHO for malaria prevention in children under five years living in Sahelian countries with seasonal transmission, including Mali and Burkina-Faso, is high (up to 90%). We hypothesized that IPTp-SP delivery to pregnant women through SMC alongside antenatal care (ANC) will increase IPTp-SP coverage, boost ANC attendance, and increase public health impact. This protocol describes the approach to assess acceptability, feasibility, effectiveness, and cost-effectiveness of the integrated strategy.Methods and analysisThis is a multicentre, cluster-randomized, implementation trial of IPTp-SP delivery through ANC + SMC vs ANC alone in 40 health facilities and their catchment populations (20 clusters per arm). The intervention will consist of monthly administration of IPTp-SP through four monthly rounds of SMC during the malaria transmission season (July to October), for two consecutive years. Effectiveness of the strategy to increase coverage of three or more doses of IPTp-SP (IPTp3 +) will be assessed using household surveys and ANC exit interviews. Statistical analysis of IPT3 + and four or more ANC uptake will use a generalized linear mixed model. Feasibility and acceptability will be assessed through in-depth interviews and focus group discussions with health workers, pregnant women, and women with a child < 12 months.DiscussionThis multicentre cluster randomized implementation trial powered to detect a 45% and 22% increase in IPTp-SP3 + uptake in Mali and Burkina-Faso, respectively, will generate evidence on the feasibility, acceptability, effectiveness, and cost-effectiveness of IPTp-SP delivered through the ANC + SMC channel. The intervention is designed to facilitate scalability and translation into policy by leveraging existing resources, while strengthening local capacities in research, health, and community institutions. Findings will inform the local national malaria control policies.Trial registrationRetrospectively registered on August 11th, 2022; registration # PACTR202208844472053.Protocol v4.0 dated September 04, 2023.Trail sponsor: University of Sciences Techniques and Technologies of Bamako (USTTB), Mali.

Prevalence and risk factors associated with malaria infection in children under two years of age in southern Togo prior to perennial malaria chemoprevention implementation

BackgroundMalaria remains the leading cause of mortality and morbidity in young children in sub-Saharan Africa. To prevent malaria in children living in moderate-to-high malaria transmission areas, the World Health Organization has recommended perennial malaria chemoprevention (PMC). Prior to piloting PMC implementation in southern Togo, a household survey was conducted to estimate malaria infection prevalence in children under 2 years of age (U2).MethodsA cross-sectional community-based household survey was conducted in the Haho district in the Togo Plateaux region. A three-stage random sampling method was used to select study participants aged 10–23 months whose caretakers gave informed consent. The prevalence of Plasmodium infection, defined as a positive rapid diagnostic test (RDT), was estimated with 95% confidence interval (CI). Clinical malaria was defined as having a positive RDT plus fever (≥ 37.5 °C) or history of fever in the last 24 h. Mixed-effects logistic regression models were used to assess the child’s, caretaker’s, and household’s factors associated with malaria infection.ResultsA total of 685 children were included in the survey conducted January–February in 2022 (dry season). Median age was 17 months (interquartile range: 13–21). About 80% of the children slept under a bed net the night before the interview. Malaria infection prevalence was 32.1% (95% CI 27.7–37.0) with significant area variation (cluster range: 0.0–73.3). Prevalence of clinical malaria was 15.4% (95% CI 12.2–19.2). Children whose caretakers were animist (aOR: 1.71, 95% CI 1.19–2.46) and those living in mother-headed households (aOR: 2.39, 95% CI 1.43–3.99) were more likely to have a positive RDT. Living more than 5 km away from the nearest health facility (aOR: 1.60, 95% CI 1.04–2.44) and presence of two or more under-5-years children in the household (aOR: 1.44, 95% CI 1.01–2.07) were also associated with increased risk of infection.ConclusionOne-third of the children U2 who participated in this survey had malaria infection, thus PMC could be a promising strategy to reduce malaria burden in young children in Plateaux region. Reinforcement of outreach services and targeting the poorest households should be prioritized to reduce the inequity in malaria prevention in children exposed to the infection.

Permethrin-treated baby wraps for the prevention of malaria in children: Protocol for a double-blind, randomized placebo-controlled controlled trial in western Uganda.

This article details the study protocol for a double-blind, randomized placebo-controlled trial to determine the effectiveness of permethrin-treated baby wraps to prevent Plasmodium falciparum malaria infection in children 6-24 months of age. Participating mother-infant dyads will be randomized to receive either a permethrin-treated or a sham-treated wrap, known locally as a "lesu." After a baseline home visit, during which time all participants will receive new long-lasting insecticidal nets, participants will attend scheduled clinic visits every two weeks for a period of 24 weeks. In the event of an acute febrile illness or other symptoms that may be consistent with malaria (e.g., poor feeding, headache, malaise), participants will be instructed to present to their respective study clinic for evaluation. The primary outcome of interest is the incidence of laboratory-confirmed, symptomatic malaria in participating children. Secondary outcomes of interest include: (1) change in children's hemoglobin levels; (2) change in children's growth parameters; (3) prevalence of asymptomatic parasitemia in children; (4) hospitalization for malaria in children; (5) change in the mother's hemoglobin level; and (6) clinical malaria in the mother. Analyses will be conducted using a modified intent-to-treat approach, with woman-infant dyads who attend one or more clinic visits analyzed according to the arm to which they were randomly assigned. This is the first use of an insecticide-treated baby wrap for prevention of malaria in children. The study began recruitment in June 2022 and is ongoing. ClinicalTrials.gov Identifier: NCT05391230, Registered 25 May 2022.

Permethrin-treated baby wraps for the prevention of malaria in children: Protocol for a double-blind, randomized placebo-controlled controlled trial in western Uganda

Permethrin-treated baby wraps for the prevention of malaria in children: Protocol for a double-blind, randomized placebo-controlled controlled trial in western Uganda

Seasonal malaria chemoprevention: closing the know–do gap

Malaria continues to impact on young lives, causing sickness, impaired school performance, disability, and preventable death, with little progress made to reduce the overall burden since 2014. 1 Ashley EA Poespoprodjo JR Treatment and prevention of malaria in children. Lancet Child Adolesc Health. 2020; 4: 775-789 Summary Full Text Full Text PDF Scopus (6) Google Scholar , 2 WHOWorld malaria report 2020: 20 years of global progress and challenges. World Health Organization, Geneva2020https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2020Date accessed: November 30, 2020 Google Scholar In 2019, 274 000, or 67%, of all malaria deaths were in children younger than 5 years in sub-Saharan Africa. 2 WHOWorld malaria report 2020: 20 years of global progress and challenges. World Health Organization, Geneva2020https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2020Date accessed: November 30, 2020 Google Scholar WHO has recommended seasonal malaria chemoprevention (SMC) for malaria control in areas across the Sahel sub-region since 2012. 3 WHOWHO policy recommendation: seasonal malaria chemoprevention (SMC) for Plasmodium falciparum malaria control in highly seasonal transmission areas of the Sahel sub-region in Africa. World Health Organization, Geneva2012 Google Scholar These areas are characterised by a unimodal rainfall pattern, with the majority (at least 60%) of confirmed malaria cases in children younger than 5 years occurring in a short period of not more than 4 consecutive months. In these areas, sulfadoxine–pyrimethamine plus amodiaquine retains an antimalarial effectiveness of more than 90%. A complete treatment course of sulfadoxine–pyrimethamine plus amodiaquine is given to children aged between 3 and 59 months at monthly intervals, beginning at the start of the transmission season, to a maximum of four doses. 3 WHOWHO policy recommendation: seasonal malaria chemoprevention (SMC) for Plasmodium falciparum malaria control in highly seasonal transmission areas of the Sahel sub-region in Africa. World Health Organization, Geneva2012 Google Scholar Effectiveness of seasonal malaria chemoprevention at scale in west and central Africa: an observational studySMC at scale was effective in preventing morbidity and mortality from malaria. Serious adverse reactions were rarely reported. Coverage varied, with some areas consistently achieving high levels via door-to-door campaigns. Markers of resistance to sulfadoxine–pyrimethamine and amodiaquine remained uncommon, but with some selection for resistance to sulfadoxine–pyrimethamine, and the situation needs to be carefully monitored. These findings should support efforts to ensure high levels of SMC coverage in west and central Africa. Full-Text PDF Open Access

Effect of Seasonal Malaria Chemoprevention (SMC) with SulfadoxinePyrimethamine (SP) and Amodiaquine (AQ) on the Acquisition of antiAMA1 and anti-MSP1_42 Antibodies among Children under 10 Years Living in the Southern part of Senegal (Velingara)

Background: In developing countries, malaria is still a leading cause of morbidity and mortality and children are the most affected individuals. In order to strengthen malaria control, new intervention such as Seasonal Malaria Chemoprevention (SMC) has been developed. This strategy is very effective in preventing malaria clinical episodes but its effect on children’s immunity is not well documented. This study aimed to evaluate the effects of SMC on the acquisition of anti-AMA1 and anti-MSP1_42 antibodies among children fewer than 10 years living in the southern part of Senegal (Velingara). Patients and methods: The study was nested in a cluster randomized trial assessing the impact of SMC with a single dose of Sulfadoxine-Pyrimethamine (SP) and 3 doses of Amodiaquine (AQ). Two cross-sectional surveys were carried out (October 2010) and (September 2011) to assess the effect of SMC on children’s immunity. Thick and thin blood smears were performed to assess malaria parasiteamia prevalence. Blood was collected on filter paper for serological measurement by ELISA to measure IgG anti-MSP1_42 and anti-AMA1. Logistic regression analysis was performed to assess factors associated with the production of antibodies. Results: A total number of 1611 children under 10 years old were included in two surveys (866 children in 2010 and 745 children in 2011). Malaria prevalence was 10.39% at baseline (2010) and 5.03% one year after intervention (2011). The seroprevalence of anti-MSP1_42 anti-AMA1 antibodies was higher in 2010 compared to 2011 providing a significant reduction of IgG production at 11.4 AU (95%CI ⦋8.3-14.4⦌) for MSP1_42 and 7.2 AU (95%CI ⦋4.5-9.9⦌) for AMA1. Seroprevalence increased with age and Plasmodium falciparum carriage while it decreased according to the area and study period. Conclusion: SMC is an effective strategy for malaria prevention in children under 10 years. The strategy can as well induce a decrease of IgG anti-AMA1 and anti-MSP1_42 which are protective against malaria. Consequently, this strategy needs to be renewed each year in areas where malaria is highly seasonal to avoid a resurgence of malaria, while promoting the use of other antimalarial interventions.

Knowledge, Attitudes and Practices of Mothers of Under-Five Regarding Prevention of Malaria in Children: Evidence from ogun State, Nigeria

Knowledge, Attitudes and Practices of Mothers of Under-Five Regarding Prevention of Malaria in Children: Evidence from ogun State, Nigeria

Prevalence and Severity of Malaria Parasitemia among Children Requiring Emergency Blood Transfusion in a Tertiary Hospital in Imo State, Nigeria.

Background:Malaria is one of the most serious and complex health problems in Sub Saharan Africa. Anemia in Children with malaria may require blood transfusion and has been be associated with high mortality rates.Aim:The aim of this study is to evaluate the prevalence, pattern, and severity of malaria parasitemia among children 6 months to 14 years old, requiring blood transfusion.Subjects and Methods:This is a cross-sectional study carried out at the children emergency unit of the Imo state University Teaching Hospital South East Nigeria. Data were analyzed using SPSS version 21, Chicago Il, USAResults:A total of 409 children were recruited into the study. The overall rate of malaria parasitemia was 83.1% (340/409) lower in males 81.6% (228/276) than in females 86.3% (112/133). The peak of parasitemia is similar in both sexes (5-9 years). Most of the children had medium levels of parasitemia, which decreased with increasing age. The proportion of children transfused also decreased with increasing age. At medium and high levels of parasitemia; in children below 5 years, 92.8% (132/142) were transfused while in 5 years and above only 79.6% (39/49) of the children were transfused. At medium level parasitemia the proportion of children transfused was significantly higher than those not transfused (P < 0.001).Conclusion:Most children 6 months to 14 years with medium level of parasitemia may require blood transfusion. Targeted measures toward primary prevention of malaria in children should be intensified as this will not only reduce morbidity and mortality of malaria, but will reduce the economic burden of the disease in Semi-rural and rural dwellers in Sub Saharan Africa.

Feasibility, safety and effectiveness of combining home based malaria management and seasonal malaria chemoprevention in children less than 10 years in Senegal: a cluster-randomised trial

Home-based management of malaria (HMM) may improve access to diagnostic testing and treatment with artemisinin combination therapy (ACT). In the Sahel region, seasonal malaria chemoprevention (SMC) is now recommended for the prevention of malaria in children. It is likely that combinations of antimalarial interventions can reduce the malaria burden. This study assessed the feasibility, effectiveness and safety of combining SMC and HMM delivered by community health workers (CHWs). A cluster-randomised trial was carried out during two transmission seasons in eight villages located in the south-eastern part of Senegal. Intervention communities received HMM+SMC while control communities received HMM. Primary end point was the incidence of malaria attacks during the follow up period. Secondary end points included: malaria diagnostic accuracy; access to ACT treatment; SMC coverage; safety and drug tolerability. The adjusted rate ratio for incidence of malaria attacks in intervention and control communities was 0.15, indicating a protective effect of HMM+SMC of 85% (95% CI: 39.9-96.3%, p=0.01). Access to ACT treatment was 96.4% while SMC coverage represented 97.3% (95% CI: 91.3-100%) in 2010, and 88.8% (95% CI: 84.2-93.6%) in 2011. No serious adverse events were recorded. It seems feasible and safe to combine SMC with HMM intervention, while achieving high coverage and effectiveness of both SMC and HMM. (www.pactr.org) PACTR201305000551876.

Педиатрические аспекты малярии

В лекции акцентируется внимание на возрастающей опасности распространения малярии в Украине. Обобщены современные данные об эпидемиологии, диагностике, лечении и профилактике малярии у детей.

Malaria und Kinder, die reisen – Prophylaxe und Therapie

Children account for between 15 - 20 % of all imported malaria cases worldwide. Immigrant children visiting their families in the country of origin in sub-Saharan Africa are at highest risk. Prevention of malaria in children who travel to endemic areas is guided by the ABCD principles - Awareness of risk, Bite prevention, Chemoprophylaxis for high risk areas and rapid Diagnosis and treatment when malaria is suspected. The use of anti-malarial medication in small children is hampered by a paucity of dosage, pharmcokinetic and tolerability data. In the pre-travel consultation parents should be provided with practical advice on anti-mosquito measures, exact, (weight-based) dosages of chemoprophylaxis medication and/or stand-by treatment as indicated. A paediatric formulation is available for daily atovaquone-proguanil chemoprophylaxis (children > 11 kg) and mefloquine is a cost-effective, once weekly prophylaxis that is useful for children > 5 kg who travel for longer periods. The bitter taste of mefloquine should be disguised to increase adherence. When a Stand-by Emergency Treatment (SBET) is indicated, artemether-lumefantrine cherry flavoured dispersible tablets are a good choice for small children. Post-travel to endemic areas, malaria should always be suspected if a child becomes ill. Paediatric malaria is an emergency requiring prompt diagnosis and appropriate treatment.

Factors Associated with Utilization of Insecticide-Treated Nets in Children Seeking Health Care at a Ugandan Hospital: Perspective of Child Caregivers

In Uganda malaria causes more morbidity and mortality than any other disease and children below 5 years contribute the biggest percentage of malaria related mortality. Insecticide treated nets (ITNs) are currently one of the most cost effective option for reducing malaria-related morbidity and mortality, however the factors affecting their utilization in Uganda are still not well understood. This study examined the prevalence and factors associated with ITN utilization among children of age 0-12 years seeking health care from a Ugandan hospital using caregiver's reports. A cross sectional design was used to collect data using a semi-structured questionnaire from 418 participants. Binary logistic regression was employed to determine predictors of ITN utilization. Results show that the prevalence of ITN utilization among children seeking health care was 34.2%. ITN utilization was higher among children of age <5 years [37.0, 95% CI 31.81-42.21] as compared to children aged ≥5 years [22.9, 95% CI 13.77-32.01]. Source of mosquito net (OR = 13.53, 95% CI = 6.47-28.27), formal employment by head of household (OR = 6.00, 95% CI = 1.95-18.48), sharing a bed with parent (s) (OR = 2.61, 95% CI = 1.21-5.63) and number of children below 12 years in a household (OR = 0.80, 95% CI = 0.65-0.99), were significant predictors of utilization. ITN utilization among children was below the set national target. The predictors identified by this study reveal opportunities that can be taken advantage of by malaria control programs to achieve the desired rates of utilization and subsequently malaria prevention in children.

Awareness, possession and use of insecticide‐treated nets for prevention of malaria in children under five in Abeokuta, Nigeria

A survey was carried out to assess awareness, possession and use of insecticide-treated nets (ITN) by mothers in preventing malaria among children under 5 years old. Pretested questionnaires were administered by trained research assistants to women that have had a child in the last 59 months, irrespective of place of child delivery. Malaria was considered dangerous by almost all respondents (98.5%); the level of awareness of ITN as a malaria preventive tool was 75.1% while possession was 45%. Awareness and possession of ITN were positively and significantly influenced by high educational qualification of mothers and attendance of a public hospital for antenatal care. Hospitals were identified as the major source of awareness among respondents; women that delivered their babies in traditional birth home displayed least awareness (38.6%) and recorded low possession (10%). There was no significant relationship between ITN usage, birth order and age of child. Heat experienced while sleeping under ITN and problem of how to hang the net were major limitations identified in the use of ITN. The need to involve women receiving antenatal care outside the hospital in malaria control intervention is hereby recommended. Methods of bridging ITN possession and use needs to de developed.

Prise en charge à domicile du paludisme chez l'enfant : propositions d'actions à partir des résultats d'une enquête CAP menée auprès des mères d'enfants de moins de 5 ans à Notsé (Togo)

Malaria is a common and frequently fatal disease in sub-Saharan Africa and children suffer the consequences of their family's erroneous therapeutic decisions. To assess knowledge, attitudes and practices related to malaria treatment and prevention among mothers of children younger than 5 years old. Cross-sectional survey conducted from July to September 2000, in Notsé (Togo) among a sample of 385 mothers of children aged younger than 5 years. Investigators completed environmental evaluation cards and used a questionnaire to interview mothers. Mothers' level of knowledge was qualified as high among 53% of the subjects, intermediate among 30%, and poor among 17%. It was associated with the mothers' level of education. All mothers considered malaria to be a serious disease; 79% said that they were favourable to drug use for malaria prevention in children; 81% preferred mosquito nets as the means of prevention; 94% of them preferred that their child receive modern medical treatment for malaria. Mothers' global practices for malaria prevention and treatment were qualified as good among 5%, intermediate among 23%, and poor among 73%. Practices were associated with educational and level of knowledge and inversely associated with the number of children she had. These results suggest that improved communication with the population and promotion of intra- and inter-sector collaborations and literacy in mothers, together with active participation by the population, might be useful measures for reaching the objectives of antimalaria program in Togo.

Review of intermittent preventive treatment for malaria in infants and children

Malaria is one of the greatest killers of children in the world. Treatment is available, but there are problems with affordability, availability, accessibility and increasing drug resistance. A new regime, intermittent preventive treatment in infants (IPTi) shows promise. It involves giving a treatment course of antimalarial drugs, regardless of parasitaemia, at intervals over the first year of life. The aim is to decrease the frequency of malarial illness while allowing the development of natural immunity. Its strength is that it can be linked with the childhood immunisation schedule. Early studies are encouraging, but much remains to be learned before its potential place in the prevention of malaria in children can be determined and it can safely be introduced as public policy. A review of the literature was performed in July 2006 for references relating to IPTi and other forms of personal prevention of malaria in infants and children.

Prevention of Malaria in Children

Malaria is caused by infection with 1 or more of 4 Plasmodium species Plasmodium falciparum Plasmodium malariae Plasmodium ovale and Plasmodium vivax which are transmitted to humans via the bites of female Anopheles mosquitoes. An estimated 200-500 million cases of malaria occur annually globally resulting in 1.5-2.7 million deaths 75% of which occur in children younger than 5 years of age in sub-Saharan Africa. In the U.S. most malaria cases are imported often by persons who travel to malaria-endemic countries without taking chemoprophylaxis (CP). This review focuses on malaria prevention for children who travel to or reside in malaria-endemic areas. (excerpt)

Review: Intermittent preventive treatment – a new approach to the prevention of malaria in children in areas with seasonal malaria transmission

Intermittent preventive treatment, the administration of a full course of an anti-malarial treatment to a population at risk at specified time points regardless of whether or not they are known to be infected, is now a recommended approach to the prevention of malaria in pregnancy and is being explored as a potential way of preventing malaria in infants. However, in many malaria endemic areas, the main burden of malaria is in older children and increasing use of insecticide treated bednets is likely to increase further the proportion of episodes of malaria that occur in older children. Recently, it has been shown in Senegal and in Mali that intermittent preventive treatment given to older children during the malaria transmission season can be remarkably effective in preventing malaria. This approach to malaria control is likely to be most effective in areas with a high level of malaria transmission concentrated in a short period of the year. However, several issues need to be addressed before intermittent preventive treatment in children can be advocated for use in malaria control programmes. These include: (1) determination of whether intermittent preventive treatment adds to the protection afforded by other control measures such as insecticide-treated bednets; (2) whether an effective and sustainable delivery system can be found; (3) choice of drug to be used; (4) optimum timing of drug administration; (5) the requisite interval between treatments. The potential benefits of intermittent preventive treatment in children are substantial; more research is needed to determine if this is a practical approach to malaria control.

Seasonal intermittent preventive treatment with artesunate and sulfadoxine-pyrimethamine for prevention of malaria in Senegalese children: a randomised, placebo-controlled, double-blind trial

In the Sahel and sub-Sahelian regions of Africa, malaria transmission is highly seasonal. During a short period of high malaria transmission, mortality and morbidity are high in children under age 5 years. We assessed the efficacy of seasonal intermittent preventive treatment-a full dose of antimalarial treatment given at defined times without previous testing for malaria infection. We did a randomised, placebo-controlled, double-blind trial of the effect of intermittent preventive treatment on morbidity from malaria in three health-care centres in Niakhar, a rural area of Senegal. 1136 children aged 2-59 months received either one dose of artesunate plus one dose of sulfadoxine-pyrimethamine or two placebos on three occasions during the malaria transmission season. The primary outcome was a first or single episode of clinical malaria detected through active or passive case detection. Primary analysis was by intention-to-treat. This study is registered with , number NCT00132561. During 13 weeks of follow-up, the intervention led to an 86% (95% CI 80-90) reduction in the occurrence of clinical episodes of malaria. With passive case detection, protective efficacy against malaria was 86% (77-92), and when detected actively was 86% (78-91). The incidence of malaria in children on active drugs was 308 episodes per 1000 person-years at risk, whereas in those on placebo it was 2250 episodes per 1000 person-years at risk. 13 children were not included in the intention-to-treat analysis, which was restricted to children who received a first dose of antimalarial or placebo. There was an increase in vomiting in children who received the active drugs, but generally the intervention was well tolerated. Intermittent preventive treatment could be highly effective for prevention of malaria in children under 5 years of age living in areas of seasonal malaria infection.