Research Article: Intermittent Preventive Treatment of Malaria Provides Substantial Protection against Malaria in Children Already Protected by an Insecticide-Treated Bednet in Mali: A Randomised, Double-Blind, Placebo-Controlled Trial

Date Published: February 1, 2011

Publisher: Public Library of Science

Author(s): Alassane Dicko, Abdoulbaki I. Diallo, Intimbeye Tembine, Yahia Dicko, Niawanlou Dara, Youssoufa Sidibe, Gaoussou Santara, Halimatou Diawara, Toumani Conaré, Abdoulaye Djimde, Daniel Chandramohan, Simon Cousens, Paul J. Milligan, Diadier A. Diallo, Ogobara K. Doumbo, Brian Greenwood, Stephen John Rogerson

Abstract: A randomized trial reported by Alassane Dicko and colleagues shows that intermittent preventive treatment for malaria in children who are protected from mosquitoes by insecticide-treated bednets provides substantial protection from malaria.

Partial Text: An estimated 863 million people live in sub-Saharan Africa of whom 16.2% are under 5 y of age [1]. About 300 million people live in areas where malaria transmission is highly seasonal. Malaria remains a major cause of morbidity and mortality and is estimated to cause 881,000 deaths globally per year and sub-Saharan Africa is disproportionately affected, suffering 91% of global malaria deaths with 88% occurring in children under 5 y of age [2]. Thus, in the absence of a vaccine, simple and effective control strategies are urgently needed to reduce the malaria burden in sub-Saharan Africa. Vector control, using insecticide-treated bednets (ITNs), insecticide-treated curtains, or indoor residual spraying (IRS), can reduce mortality and morbidity from malaria substantially [3], but in high transmission settings, these interventions provide only partial protection and additional control measures are needed.

The protocol of the trial (Text S1), protocol amendment (Text S5), and CONSORT checklist (Text S2) are available as supporting information.

This study has shown that three doses of IPTc with SP+Q given at monthly intervals during the peak transmission season reduced the incidence of uncomplicated and severe malaria by 80% in children 3–59 mo of age who slept under an ITN in three localities in Mali despite the difference in ITN use at baseline. This level of protective efficacy is similar to that reported in a previous trial conducted in an area of Senegal with a coverage of ITNs of less than 1% [7], suggesting that the relative efficacy of IPTc is not reduced by the use of an ITN at the time of the intervention. Two studies have shown that in pregnant women, IPT adds little benefit to the protection afforded by an ITN, at least in multigravidae [18],[19]. This finding is not the case for IPTc in children, as the strategy remained highly efficacious even when deployed in a community with a high usage of ITNs.



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