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Effects of intermittent preventive anti-malarial treatment of infants in a holoendemic area

Abstract number: 1733_273

Kobbe R., Adjei S., Adjei O., May on behalf of the Agona IPTi Trial Team J.

Background: Intermittent preventive antimalarial treatment of infants (IPTi) with sulfadoxine-pyrimethamine reduces falciparum malaria and anaemia in areas of moderate and seasonal transmission. To date, IPTi has not been assessed in areas of intense perennial malaria transmission. We investigated the protective efficacy of IPTi in a holoendemic area of perennial high transmission and analysed the time-dependency as well as the therapeutic and prophylactic fraction of the effects.

Methods: A randomised, double-blinded, placebo-controlled trial on IPTi with sulfadoxine-pyrimethamine at three, nine and fifteen months of age was conducted with 1070 children in an area holoendemic for malaria inthe Ashanti Region, Ghana. Participants were monitored for 21 months after recruitment by active follow-ups and passive case detection. Primary endpoint was the reduction of malaria incidence. Additional outcome measures were incidence of anaemia, number of outpatient visits, frequency of hospital admissions, and mortality.

Results: Overall protective efficacy against malaria episodes was 20% (95% CI: 11%–29%; p < 0.001). The frequency of malaria episodes was reduced after the first two sulfadoxine-pyrimethamine applications (protective efficacy 23%; 95% CI: 6%–36%; p = 0.01 and 17%; 95% CI: 1%–30%; p = 0.04, respectively). After the third sulfadoxine-pyrimethamine administration at month 15, however, no further protection was achieved. Stratified analyses for six-months periods after each treatment were performed. Protection against the first or single episode of anaemia was only significant after the first IPTi dose (30%; 95% CI: 5%–49%; p = 0.02) and the frequency of anaemia episodes increased during the rebound period (-24%; 95% CI: -50%–-2%; p = 0.03). For all IPTi applications the prophylactic effects clearly exceeded the therapeutic effects.

Conclusion: In an area of intense perennial malaria transmission, the protective efficacy of sulfadoxine-pyrimethamine based IPTi is age-dependent and based on the prophylactic effects of the antimalarial drug.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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