Research Article: Two Strategies for the Delivery of IPTc in an Area of Seasonal Malaria Transmission in The Gambia: A Randomised Controlled Trial

Date Published: February 1, 2011

Publisher: Public Library of Science

Author(s): Kalifa A. Bojang, Francis Akor, Lesong Conteh, Emily Webb, Ousman Bittaye, David J. Conway, Momodou Jasseh, Virginia Wiseman, Paul J. Milligan, Brian Greenwood, James Beeson

Abstract: Bojang and colleagues report a randomized trial showing that delivery of intermittent preventive treatment for malaria in children by village health workers is more effective than delivery by reproductive and child health trekking clinics.

Partial Text: Trials conducted in a number of sub-Saharan African countries have shown that antimalarial chemoprophylaxis reduces malaria morbidity and mortality in children and school absenteeism [1]–[5]. However, this approach to malaria control has rarely been implemented widely owing to concerns over its possible effect on the propagation of resistance to antimalarials, the development of natural immunity to malaria, and logistic constraints [6],[7]. To take advantage of the protective effect of chemoprophylaxis whilst reducing the possible adverse effect of chemoprevention on the development of natural immunity to malaria, the concept of intermittent preventive treatment (IPT) with an effective antimalarial has been developed. IPT involves administration of a full treatment dose of an antimalarial drug at specific times, regardless of the presence or absence of malaria parasites. Since treatment is only given intermittently, this intervention is less likely to interfere with the development of natural immunity than sustained chemoprophylaxis.

The efficacy results of this trial are consistent with findings from previous studies of IPTc carried out in other West African countries, which have shown significant levels of protection against clinical attacks of malaria during the malaria transmission season [16]–[20]. It was not considered appropriate to include a placebo group in this study because of the clear evidence from previous studies that IPTc is beneficial. However, using a case-control approach, the intervention appeared to be highly efficacious in preventing clinical episodes of malaria with a protective efficacy for an IPT course given within the previous month of over 80%, a figure comparable to that observed in a randomised controlled trial undertaken in neighbouring Senegal [17]. The prevalence of parasitaemia at the end of the malaria transmission season, when this is normally at its highest, was very low in both sets of villages (<3%) and much lower than the rate recorded in the study area in previous years [30], suggesting that in both study arms IPTc had been highly efficacious. However, these low incidence and prevalence figures must be set in the context of an overall, recent decline in the incidence of malaria in The Gambia associated with a high use of ITNs and introduction of more effective treatment [15]. Source: http://doi.org/10.1371/journal.pmed.1000409

 

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