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

doi:10.1186/1475-2875-6-132

Malaria Journal

Volume 6

Viewing options:

Abstract
Full text
PDF (283KB)

Associated material:

Related literature:

Articles citing this article
on BioMed Central
on Google Scholar
on ISI Web of Science
on PubMed Central
Other articles by authors
on Google Scholar

Menendez C
Schellenberg D
Macete E
Aide P
Kahigwa E
Sanz S
Aponte JJ
Sacarlal J
Mshinda H
Tanner M
Alonso PL

on PubMed

Menendez C
Schellenberg D
Macete E
Aide P
Kahigwa E
Sanz S
Aponte JJ
Sacarlal J
Mshinda H
Tanner M
Alonso PL
Related articles/pages
on Google

on Google Scholar

on PubMed

Tools:

Post to:

Research

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

Clara Menendez¹^,2 , David Schellenberg¹^,5^,8 , Eusebio Macete²^,3 , Pedro Aide²^,4 , Elizeus Kahigwa⁵^,7 , Sergi Sanz¹ , John J Aponte¹^,2 , Jahit Sacarlal² , Hassan Mshinda⁵ , Marcel Tanner⁶ and Pedro L Alonso¹^,2

¹Barcelona Center for International Health Research (CRESIB), Hospital Clinic, Institut d'Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain

²Manhiça Health Research Center, Manhiça (CISM), Mozambique

³National Directorate of Health, Maputo, Mozambique

⁴National Institute of Health, Mozambique

⁵Ifakara Health Research and Development Centre, Ifakara, Tanzania

⁶Swiss Tropical Institute, Basel, Switzerland

⁷World Health Organisation- Country Office, Dar es Salaam, Tanzania

⁸London School of Hygiene and Tropical Medicine, (LSHTM), UK

author email corresponding author email

Malaria Journal 2007, 6:132doi:10.1186/1475-2875-6-132


Published:	26 September 2007

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 Manhiça, 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 randomised to receive either SP or placebo administered 3 times alongside routine vaccinations delivered through the Expanded Program on Immunisation (EPI). Characteristics of the two areas and efficacy on clinical malaria after each dose were compared.

Results

The most relevant difference was in ITN's use ; 68% in Ifakara and zero in Manhiça. 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 Manhiça. Similarly, protection against malaria episodes was maintained in Ifakara during 6 months after dose 3, but no effect of IPTi was observed in Manhiça.

Conclusion

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.

Trial Registration

Manhiça study registration number: NCT00209795

Ifakara study registration number: NCT88523834