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Antimicrobial Agents and Chemotherapy, May 2009, p. 1753-1759, Vol. 53, No. 5
0066-4804/09/$08.00+0 doi:10.1128/AAC.01723-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Reduced Efficacy of Intermittent Preventive Treatment of Malaria in Malnourished Children
Ina Danquah,1
Ekkehart Dietz,2
Philipp Zanger,3
Klaus Reither,4
Peter Ziniel,5
Ulrich Bienzle,1,
and
Frank P. Mockenhaupt1*
Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin, Germany,1 Institute of Biometry and Clinical Epidemiology, Charité University Medicine, Berlin, Germany,2 Institute of Tropical Medicine, University of Tuebingen, Tuebingen, Germany,3 Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany,4 Northern Region Malaria Project, Tamale, Ghana5
Received 30 December 2008/ Returned for modification 25 January 2009/ Accepted 7 February 2009
Intermittent preventive treatment in infants with sulfadoxine-pyrimethamine (IPTi-SP) reduces malaria episodes by 20 to 59% across Africa. This protective efficacy, however, may be affected by the high frequency of malnutrition in African infants. We analyzed the impact of malnutrition as defined by anthropometry on the incidence of malaria and on the protective efficacy of IPTi in a cohort of 1,200 children in northern Ghana, where malaria is hyperendemic. These children received IPTi-SP or placebo at 3, 9, and 15 months of age and were monitored until 24 months of age. Malnutrition was present in 32, 40, and 50% of children at ages 3, 9, and 15 months, respectively. It was associated with increased risks of severe anemia and death but not an increased risk of malaria. Although malaria slightly contributed to chronic malnutrition, IPTi did not substantially improve child growth. Importantly, the protective efficacies of IPTi in malnourished children were roughly half or even less of those observed in nonmalnourished children. In the first year of life, IPTi reduced the incidence of malaria to a significantly lesser extent in infants who received both doses in a malnourished condition (25%; 95% confidence interval [CI], –7 to 48%) compared to that of nonmalnourished children (46%; 95% CI, 30 to 58%; P = 0.049). Moreover, in contrast to nutritionally advantaged children, the rate of severe malaria appeared to be increased in malnourished children who took IPTi. IPTi might exhibit reduced efficacy in regions of abundant malnutrition. Concomitant nutrition programs may be needed in these places to achieve the desired impact.
* Corresponding author. Mailing address: Institute of Tropical Medicine and International Health, Spandauer Damm 130, 14050 Berlin, Germany. Phone: 49 30 30116 815. Fax: 49 30 30116 888. E-mail: frank.mockenhaupt{at}charite.de
Published ahead of print on 17 February 2009.
Deceased.
Antimicrobial Agents and Chemotherapy, May 2009, p. 1753-1759, Vol. 53, No. 5
0066-4804/09/$08.00+0 doi:10.1128/AAC.01723-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
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