OBJECTIVE: To evaluate the effects of intermittent preventive treatment for malaria in infants (IPTi) withsulfadoxine-pyrimethamine in an area of intense, seasonal transmission. DESIGN: Cluster randomised placebo controlled trial, with 96 clusters allocated randomly to sulfadoxine-pyrimethamine or placebo in blocks of eight. INTERVENTIONS: Children received sulfadoxine-pyrimethamine or placebo and one month of iron supplementation when they received DPT-2, DPT-3, or measles vaccinations and at 12 months of age. MAIN OUTCOME MEASURES: Incidence of malaria and of anaemia determined through passive case detection. RESULTS: 89% (1103/1242) of children in the placebo group and 88% (1088/1243) in the IPTi group completed follow-up to 24 months of age. The protective efficacy of IPTi against all episodes of malaria was 24.8% (95% confidence interval 14.3% to 34.0%) up to 15 months of age. IPTi had no protective effect against malaria between 16 and 24 months of age (protective efficacy -4.9%, -21.3% to 9.3%). The incidence of high parasite density malaria (> or = 5000 parasites/mul) was higher in the IPTi group than in the placebo group between 16 and 24 months of age (protective efficacy -19.5%, -39.8% to -2.2%). IPTi reduced hospital admissions with anaemia by 35.1% (10.5% to 52.9%) up to 15 months of age. IPTi had no significant effect on anaemia between 16 and 24 months of age (protective efficacy -6.4%, -76.8% to 35.9%). The relative risk of death up to 15 months of age in the IPTi group was 1.26 (95% confidence interval 0.81 to 1.96; P = 0.31), and from 16 to 24 months it was 1.28 (0.77 to 2.14; P = 0.35). CONCLUSIONS:Intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine can reduce malaria and anaemia in infants even in seasonal, high transmission areas, but concern exists about possible rebound in the incidence of malaria in the second year of life.
RCT Entities:
OBJECTIVE: To evaluate the effects of intermittent preventive treatment for malaria in infants (IPTi) with sulfadoxine-pyrimethamine in an area of intense, seasonal transmission. DESIGN: Cluster randomised placebo controlled trial, with 96 clusters allocated randomly to sulfadoxine-pyrimethamine or placebo in blocks of eight. INTERVENTIONS:Children received sulfadoxine-pyrimethamine or placebo and one month of iron supplementation when they received DPT-2, DPT-3, or measles vaccinations and at 12 months of age. MAIN OUTCOME MEASURES: Incidence of malaria and of anaemia determined through passive case detection. RESULTS: 89% (1103/1242) of children in the placebo group and 88% (1088/1243) in the IPTi group completed follow-up to 24 months of age. The protective efficacy of IPTi against all episodes of malaria was 24.8% (95% confidence interval 14.3% to 34.0%) up to 15 months of age. IPTi had no protective effect against malaria between 16 and 24 months of age (protective efficacy -4.9%, -21.3% to 9.3%). The incidence of high parasite density malaria (> or = 5000 parasites/mul) was higher in the IPTi group than in the placebo group between 16 and 24 months of age (protective efficacy -19.5%, -39.8% to -2.2%). IPTi reduced hospital admissions with anaemia by 35.1% (10.5% to 52.9%) up to 15 months of age. IPTi had no significant effect on anaemia between 16 and 24 months of age (protective efficacy -6.4%, -76.8% to 35.9%). The relative risk of death up to 15 months of age in the IPTi group was 1.26 (95% confidence interval 0.81 to 1.96; P = 0.31), and from 16 to 24 months it was 1.28 (0.77 to 2.14; P = 0.35). CONCLUSIONS: Intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine can reduce malaria and anaemia in infants even in seasonal, high transmission areas, but concern exists about possible rebound in the incidence of malaria in the second year of life.
Authors: D Schellenberg; C Menendez; E Kahigwa; J Aponte; J Vidal; M Tanner; H Mshinda; P Alonso Journal: Lancet Date: 2001-05-12 Impact factor: 79.321
Authors: David Schellenberg; Clara Menendez; John J Aponte; Elizeus Kahigwa; Marcel Tanner; Hassan Mshinda; Pedro Alonso Journal: Lancet Date: 2005 Apr 23-29 Impact factor: 79.321
Authors: Maxwell Appawu; Seth Owusu-Agyei; Samuel Dadzie; Victor Asoala; Francis Anto; Kwadwo Koram; William Rogers; Francis Nkrumah; Stephen L Hoffman; David J Fryauff Journal: Trop Med Int Health Date: 2004-01 Impact factor: 2.622
Authors: Julius J Massaga; Andrew Y Kitua; Martha M Lemnge; Jumaa A Akida; Lincoln N Malle; Anita M Rønn; Thor G Theander; Ib C Bygbjerg Journal: Lancet Date: 2003-05-31 Impact factor: 79.321
Authors: D Schellenberg; J R M Armstrong Schellenberg; A Mushi; D de Savigny; L Mgalula; C Mbuya; C G Victora Journal: Bull World Health Organ Date: 2003-10-14 Impact factor: 9.408
Authors: C Drakeley; D Schellenberg; J Kihonda; C A Sousa; A P Arez; D Lopes; J Lines; H Mshinda; C Lengeler; J Armstrong Schellenberg; M Tanner; P Alonso Journal: Trop Med Int Health Date: 2003-09 Impact factor: 2.622
Authors: Ilona Carneiro; Lucy Smith; Amanda Ross; Arantxa Roca-Feltrer; Brian Greenwood; Joanna Armstrong Schellenberg; Thomas Smith; David Schellenberg Journal: Bull World Health Organ Date: 2010-05-10 Impact factor: 9.408
Authors: Matthew Cairns; Roly Gosling; Ilona Carneiro; Samwel Gesase; Jacklin F Mosha; Ramadhan Hashim; Harparkash Kaur; Martha Lemnge; Frank W Mosha; Brian Greenwood; Daniel Chandramohan Journal: PLoS One Date: 2010-03-01 Impact factor: 3.240
Authors: Lesong Conteh; Elisa Sicuri; Fatuma Manzi; Guy Hutton; Benson Obonyo; Fabrizio Tediosi; Prosper Biao; Paul Masika; Fred Matovu; Peter Otieno; Roly D Gosling; Mary Hamel; Frank O Odhiambo; Martin P Grobusch; Peter G Kremsner; Daniel Chandramohan; John J Aponte; Andrea Egan; David Schellenberg; Eusebio Macete; Laurence Slutsker; Robert D Newman; Pedro Alonso; Clara Menéndez; Marcel Tanner Journal: PLoS One Date: 2010-06-15 Impact factor: 3.240
Authors: Marjolein Gysels; Christopher Pell; Don P Mathanga; Philip Adongo; Frank Odhiambo; Roly Gosling; Patricia Akweongo; Rose Mwangi; George Okello; Peter Mangesho; Lawrence Slutsker; Peter G Kremsner; Martin P Grobusch; Mary J Hamel; Robert D Newman; Robert Pool Journal: Malar J Date: 2009-08-10 Impact factor: 2.979