Varying efficacy of intermittent preventive treatment for malaria in infants in two similar trials: public health implications


Menendez, C; Schellenberg, D; MacEte, E; Aide, P; Kahigwa, E; Sanz, S; Aponte, J; Sacarlal, J; Mshinda, H; Tanner, M; Alonso, P; (2007) Varying efficacy of intermittent preventive treatment for malaria in infants in two similar trials: public health implications. Malar J, 6 (1). p. 132. ISSN 1475-2875 DOI: 10.1186/1475-2875-6-132

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Abstract

ABSTRACT: BACKGROUND: Intermittent preventive treatment (IPTi) with sulphadoxine-pyrimethamine (SP) in infants resulted in different estimates of clinical malaria protection in two trials that used the same protocol in Ifakara, Tanzania, and Manhica, Mozambique. Understanding the reasons for the discrepant results will help to elucidate the action mechanism of this intervention, which is essential for rational policy formulation. METHODS: A comparative analysis of two IPTi trials that used the same study design, follow-up, intervention, procedures and assessment of outcomes, in Tanzania and Mozambique was undertaken. Children were randomized to receive either SP or placebo administered three times alongside routine vaccinations delivered through the Expanded Programme on Immunization (EPI). Characteristics of the two areas and efficacy on clinical malaria after each dose were compared. RESULTS: The most relevant difference was in the use of insecticide-treated nets (ITNs); 68% in Ifakara and zero in Manhica. In Ifakara, IPTi was associated with a 53% (95% CI 14.0; 74.1) reduction in the risk of clinical malaria between the second and the third dose; during the same period, there was no significant effect in Manhica. Similarly, protection against malaria episodes was maintained in Ifakara during six months after dose 3, but no effect of IPTi was observed in Manhica. CONCLUSIONS: The high ITN coverage in Ifakara is the most likely explanation for the difference in IPTi efficacy on clinical malaria. Combination of IPTi and ITNs may be the most cost-effective tool for malaria control currently available, and needs to be explored in current and future studies.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Malaria Centre
Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 17897454
Web of Science ID: 251452800001
URI: http://researchonline.lshtm.ac.uk/id/eprint/8871

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