Malaria incidence and efficacy of intermittent preventive treatment in infants (IPTi)

doi:10.1186/1475-2875-6-163

Malaria Journal

Volume 6

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Kobbe R
Adjei S
Kreuzberg C
Kreuels B
Thompson B
Thompson PA
Marks F
Busch W
Tosun M
Schreiber N
Opoku E
Adjei O
Meyer CG
May J

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Kobbe R
Adjei S
Kreuzberg C
Kreuels B
Thompson B
Thompson PA
Marks F
Busch W
Tosun M
Schreiber N
Opoku E
Adjei O
Meyer CG
May J
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Research

Malaria incidence and efficacy of intermittent preventive treatment in infants (IPTi)

Robin Kobbe¹ , Samuel Adjei¹^,2 , Christina Kreuzberg¹ , Benno Kreuels¹ , Benedicta Thompson³ , Peter A Thompson³ , Florian Marks¹^,4 , Wibke Busch¹ , Meral Tosun¹ , Nadine Schreiber¹ , Ernest Opoku³ , Ohene Adjei³ , Christian G Meyer⁵ and Juergen May¹

¹Infectious Disease Epidemiology Group, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Straße 74, D-20359 Hamburg, Germany

²Ministry of Health/Ghana Health Service District Health Directorate, Agona, Ashanti Region, Ghana

³Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana

⁴International Vaccine Institute, Seoul, South Korea

⁵Dept. Molecular Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

author email corresponding author email

Malaria Journal 2007, 6:163doi:10.1186/1475-2875-6-163


Published:	9 December 2007

Abstract

Background

Intermittent preventive antimalarial treatment in infants (IPTi) is currently evaluated as a malaria control strategy. Among the factors influencing the extent of protection that is provided by IPTi are the transmission intensity, seasonality, drug resistance patterns, and the schedule of IPTi administrations. The aim of this study was to determine how far the protective efficacy of IPTi depends on spatio-temporal variations of the prevailing incidence of malaria.

Methods

One thousand seventy infants were enrolled in a registered controlled trial on the efficacy of IPTi with sulphadoxine-pyrimethamine (SP) in the Ashanti Region, Ghana, West Africa (ClinicalTrial.gov: NCT00206739). Stratification for the village of residence and the month of birth of study participants demonstrated that the malaria incidence was dependent on spatial (range of incidence rates in different villages 0.6–2.0 episodes/year) and temporal (range of incidence rates in children of different birth months 0.8–1.2 episodes/year) factors. The range of spatio-temporal variation allowed ecological analyses of the correlation between malaria incidence rates, anti-Plasmodium falciparum lysate IgG antibody levels and protective efficacies provided by IPTi.

Results

Protective efficacy of the first SP administration was positively correlated with malaria incidences in children living in a distinct village or born in a distinct month (R²0.48, p < 0.04 and R²0.63, p < 0.003, respectively). Corresponding trends were seen after the second and third study drug administration. Accordingly, IgG levels against parasite lysate increased with malaria incidence. This correlation was stronger in children who received IPTi, indicating an effect modification of the intervention.

Conclusion

The spatial and temporal variations of malaria incidences in a geographically and meteorologically homogeneous study area exemplify the need for close monitoring of local incidence rates in all types of intervention studies. The increase of the protective efficacy of IPTi with malaria incidences may be relevant for IPTi implementation strategies and, possibly, for other malaria control measures.