Malaria morbidity in children in the year after they had received intermittent preventive treatment of malaria in Mali: a randomized control trial.

Abstract

BACKGROUND:

Intermittent 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.

METHODS:

Morbidity 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.

RESULTS:

1396 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).

CONCLUSION:

IPTc 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 REGISTRATION:

ClinicalTrials.gov NCT00738946.

• Authors: Alassane Dicko, Amadou Barry, Mohamed Dicko, Abdoulbaki I Diallo, Intimbeye Tembine, Yahia Dicko, Niawanlou Dara, Youssoufa Sidibe, Gaoussou Santara, Toumani Conaré, Daniel Chandramohan, Simon Cousens, Paul J Milligan, Diadier A Diallo, Ogobara K Doumbo, Brian Greenwood
• Journal: PloS one (PLoS One) Vol. 6 Issue 8 Pg. e23390 ( 2011) ISSN: 1932-6203 [Electronic] United States
• PMID: 21858096 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Drug Combinations
• Amodiaquine
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Pyrimethamine

Topics

• Amodiaquine (therapeutic use)
• Anemia (epidemiology)
• Antimalarials (therapeutic use)
• Body Weight
• Child, Preschool
• Drug Administration Schedule
• Drug Combinations
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Humans
• Incidence
• Infant
• Kaplan-Meier Estimate
• Malaria, Falciparum (epidemiology, prevention & control, transmission)
• Male
• Mali (epidemiology)
• Morbidity
• Mosquito Nets
• Parasitemia (epidemiology)
• Plasmodium falciparum (drug effects)
• Prevalence
• Pyrimethamine (therapeutic use)
• Seasons
• Sulfadoxine (therapeutic use)
• Treatment Outcome