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Open Access Research

The implementation of malaria intermittent preventive trialtreatment with sulphadoxine-pyrimethamine in infants reduced all-cause mortality in the district of Kolokani, Mali: results from a cluster randomized control

Alassane Dicko12*, Moussa Konare1, Djibril Traore1, Jean Testa2, Roger Salamon3, Ogobara Doumbo1 and Christophe Rogier45

Author Affiliations

1 Malaria Research and Training Center, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805, Bamako, Mali

2 Department of Public Health, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805, Bamako, Mali

3 Institut de Santé Publique, d'Épidémiologie et de Développement, Université Victor Segalen Bordeaux 2, Case 11 146 Rue Léo Saignat, Bordeaux Cedex 33076, France

4 Institut de Recherche Biomédicale des Armées IRBA-ex-IMTSSA & UMR6236-URMITE, Allée du Médecin colonel Jamot, Parc du Pharo, BP60109, 13262 Marseille cedex 07, France

5 Institut Pasteur de Madagascar, B.P. 1274, 101, Antananarivo, Madagascar

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Malaria Journal 2012, 11:73  doi:10.1186/1475-2875-11-73

Published: 16 March 2012

Abstract

Background

Malaria intermittent preventive treatment of malaria in infant with sulphadoxine-pyrimethamine (IPTi-SP) reduced the incidence of malaria and anaemia by 30% and 20% respectively. The strategy is now a recommended policy for malaria control. However, there was no published study on the impact of the strategy on mortality. The present study assessed the impact of the implementation of IPTi-SP in health services in Mali on all-cause mortality.

Methods

The 22 health sub-districts of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The IPTi-SP was implemented for two years starting December 2006. Information on births and deaths through 31 March, 2009 was collected on all children who reached four months of age on 1 December, 2006, likely to be exposed to the intervention in 75 localities randomly selected in each zone.

Results

A total of 5,882 children (2,869 from the intervention zone and 3,013 from the nonintervention zone) who reached four months of age between 1 December, 2006 and 1 December, 2008 were surveyed between the age of four months to the age of 18 months from 1 December, 2006 to 31 March, 2009. In the cohort of four to 18 months of age, the mortality rate per 1,000 children was 2.53 in the intervention zone compared to 3.46 in the nonintervention zone, gender and season adjusted mortality rate ratio (MRR) = 0.73 (95% CI 0.55-0.97, p = 0.029). In the cohort of the four to 12 months of age, mortality rates per 1,000 children were 2.22 in the intervention zone and 3.13 in the non-intervention zone, MRR = 0.71 (95% CI 0.49-1.02, p = 0.064) adjusted for gender and season.

Conclusion

The implementation of the IPTi-SP resulted in a substantial reduction in all-cause mortality in children. The results of this study support the adoption and the implementation of IPTi-SP as malaria control strategy.

Trial Registration

ClinicalTrials.govNCT00766662

Keywords:
Mortality; Malaria; Intermittent preventive treatment; Sulphadoxine-pyrimethamine; Expanded programme of immunization