Intermittent preventive treatment using artemisinin-based combination therapy reduces malaria morbidity among school-aged children in Mali

Abstract

Objective: To assess the efficacy of intermittent preventive treatment (IPT) against malaria in school-aged children.

Methods: This was an open randomized controlled trial of seasonal IPT among school children (IPTsc) aged 6-13 years in Kollé, Mali. The study began in September 2007 and completed follow-up in May 2008. Students were randomized to one of three study arms: Sulfadoxine-pyrimethamine plus artesunate (SP/AS), amodiaquine plus artesunate (AQ/AS) or vitamin C. All students received two full treatment doses, given 2 months apart during the season of high transmission from September to December. Groups were compared with respect to incidence of clinical malaria, asymptomatic parasitemia and haemoglobin concentration.

Results: A total of 296 students were randomized, and retention in the study was 99.3%. Clinical malaria incidence in the SP/AS and AQ/AS arms was reduced by 66.6% and 46.5%, respectively, vs. vitamin C (P < 0.001). There were fewer clinic visits for any cause among the children receiving SP/AS or AQ/AS (P = 0.024). The prevalence of asymptomatic parasitemia was fivefold higher in the vitamin C arm than either SP/AS or AQ/AS at each post-treatment evaluation (P < 0.001). At the end of the transmission period, children treated with IPT had lower rates of anaemia (SP/AS, 17.7%; AQ/AS, 16.0%; vitamin C, 29.6%; P = 0.039).

Conclusion: IPT among school children reduced the rates of clinical malaria, all-cause acute clinic visits, asymptomatic parasitemia and anaemia among school-aged children.

Figure 1

Trial profile. SP/AS, sulfadoxine–pyrimethamine + artesunate 3-day; AQ/AS, amodiaquine 3-day + artesunate 3-day.

Figure 2

Intermittent preventive treatment of school-age children with artemisinin-based combination therapy reduces Plasmodium parasitemia at routine follow-up testing. Shown is the percentage of children in each treatment group with parasitemia detected on blood smears collected monthly during the malaria transmission season (September–January), and 4 months later (May). Treatments were given in September and again in November (arrows). Treatment groups: SP/AS, sulfadoxine–pyrimethamine + artesunate 3-day; AQ/AS, amodiaquine 3-day + artesunate 3-day; vit C, vitamin C control.

Figure 3

Kaplan–Meier survival plot: percent of population without malaria during 140-day follow-up. SP/AS, sulfadoxine–pyrimethamine + artesunate 3-day; AQ/AS, amodiaquine 3-day + artesunate 3-day; vit C, vitamin C.