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Randomized Controlled Trial
. 2022 Aug 22;107(4):796-803.
doi: 10.4269/ajtmh.21-1218. Print 2022 Oct 12.

Overall and Gender-Specific Effects of Intermittent Preventive Treatment of Malaria with Artemisinin-Based Combination Therapies among Schoolchildren in Mali: A Three-Group Open Label Randomized Controlled Trial

Hamma Maiga  1   2 , Charles Opondo  3 , R Matthew Chico  4 , Lauren M Cohee  5 , Issaka Sagara  2 , Oumar B Traore  2 , Mamadou Tekete  2 , Antoine Dara  2 , Zoumana I Traore  2 , Modibo Diarra  2 , Samba Coumare  2 , Aly Kodio  2 , Amadou Bamadio  2 , Bouran Sidibe  2 , Ogobara K Doumbo  2 , Abdoulaye A Djimde  2
Affiliations
Randomized Controlled Trial

Overall and Gender-Specific Effects of Intermittent Preventive Treatment of Malaria with Artemisinin-Based Combination Therapies among Schoolchildren in Mali: A Three-Group Open Label Randomized Controlled Trial

Hamma Maiga et al. Am J Trop Med Hyg. .

Abstract

Intermittent preventive treatment of malaria among schoolchildren (IPTsc) reduces clinical malaria, asymptomatic parasitemia, and anemia. The effects of IPTsc by gender have not been studied longitudinally. We investigated overall IPTsc efficacy and conducted a secondary analysis to explore gender-specific differences. We enrolled schoolchildren aged 6-13 years in an open-label, rolling-cohort randomized controlled trial between September 2007 and February 2013 in Kolle, Mali. Annually, schoolchildren received two full-treatment courses of sulfadoxine-pyrimethamine (SP) plus artesunate, or amodiaquine (AQ) plus artesunate, or no malaria treatment as control. We used mixed-effects generalized linear models to estimate differences in treatment outcomes across groups with interaction terms to explore gender-specific differences associated with Plasmodium falciparum infection, hemoglobin, and grade point averages (GPA) based on standardized testing. Overall, 305 students contributed 4,564 observations. Compared with the control, SP plus artesunate and AQ plus artesunate reduced the odds of P. falciparum infection (odds ratio [OR]: 0.33, 95% CI: 0.26-0.43; OR: 0.46, 95% CI: 0.36-0.59). We found strong evidence of increased mean hemoglobin concentrations (g/dL) in the SP plus artesunate group versus control (difference +0.37, 95% CI: 0.13-0.58). Collectively, schoolchildren given AQ plus artesunate had higher mean GPA (difference +0.36, 95% CI: 0.02-0.69) relative to control. Schoolgirls, compared with schoolboys, given SP plus artesunate had greater improvement in GPA (+0.50, 95% CI: -0.02 to 1.02 versus -0.27, 95% CI: -0.71 to 0.16); interaction P = 0.048, respectively. The IPTsc decreases P. falciparum infections in schoolchildren. Treatment regimens that include longer-acting drugs may be more effective at decreasing malaria-related anemia and improving educational outcomes as observed among girls in this setting.

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Figures

Figure 1.
Figure 1.
CONSORT diagram with group allocation, follow-up, and analysis of trial participants.
Figure 2.
Figure 2.
Linear trends in hemoglobin in three allocation groups by grade over the course of the study. This figure appears in color at www.ajtmh.org.
See this image and copyright information in PMC

References

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