Previous Article | Next Article 
Antimicrobial Agents and Chemotherapy, September 2007, p. 3273-3281, Vol. 51, No. 9
0066-4804/07/$08.00+0 doi:10.1128/AAC.00513-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
Intermittent Preventive Treatment in Infants as a Means of Malaria Control: a Randomized, Double-Blind, Placebo-Controlled Trial in Northern Ghana
Frank P. Mockenhaupt,1*
Klaus Reither,1
Philipp Zanger,1
Felix Roepcke,1
Ina Danquah,1
Eiman Saad,1
Peter Ziniel,2
Stephen Y. Dzisi,2
Marc Frempong,2
Patrick Agana-Nsiire,3
Felicia Amoo-Sakyi,2
Rowland Otchwemah,4
Jakob P. Cramer,1
Sylvester D. Anemana,5
Ekkehart Dietz,6 and
Ulrich Bienzle1
Institute of Tropical Medicine and International Health, Charité—University Medicine Berlin, Berlin, Germany,1 Northern Region Malaria Project (NORMAP), Tamale, Ghana,2 Regional Health Administration, Bolgatanga, Ghana,3 School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana,4 Regional Health Administration, Takoradi, Ghana,5 Institute of Biostatistics and Clinical Epidemiology, Charité—University Medicine Berlin, Berlin, Germany6
Received 17 April 2007/ Returned for modification 11 June 2007/ Accepted 2 July 2007
Morbidity and mortality from malaria remain unacceptably high among young children in sub-Saharan Africa. Intermittent preventive treatment in infancy (IPTi) involves the administration of antimalarials alongside routine vaccinations and might be an option in malaria control. In an area of intense, perennial malaria transmission in northern Ghana, 1,200 children received IPTi with sulfadoxine-pyrimethamine or placebo at approximately 3, 9, and 15 months of age. Children were followed up until 24 months of age to assess morbidity and adverse events. During the intervention period (3 to 18 months of age), IPTi reduced the incidences of malaria and severe anemia by 22.5% (95% confidence interval, 12 to 32%) and 23.6% (95% confidence interval, 4 to 39%), respectively, and reduced hospitalizations and episodes of asymptomatic parasitemia by one-third. Protection was pronounced in the first year of life and not discernible in the second. The malaria-protective effect was largely confined to a period of 1 month after sulfadoxine-pyrimethamine treatments. Following the intervention, protection against asymptomatic parasitemia persisted. In contrast, a significant rebound of severe malaria, predominantly severe malarial anemia, occurred among children having received IPTi. Although the treatment was generally well tolerated, one case of moderately severe skin reaction followed sulfadoxine-pyrimethamine treatment. IPTi reduces malaria and anemia in infants in northern Ghana. Extension of IPTi into the second year of life by administering a dose at 15 months of age provided no substantial benefit beyond a 1-month prophylactic effect. Although this simple intervention offers one of the few available malaria-preventive measures for regions where malaria is endemic, the observed rebound of severe malaria advises caution and requires further investigation.
* 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 16 July 2007.
Antimicrobial Agents and Chemotherapy, September 2007, p. 3273-3281, Vol. 51, No. 9
0066-4804/07/$08.00+0 doi:10.1128/AAC.00513-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
This article has been cited by other articles:
-
Danquah, I., Dietz, E., Zanger, P., Reither, K., Ziniel, P., Bienzle, U., Mockenhaupt, F. P.
(2009). Reduced Efficacy of Intermittent Preventive Treatment of Malaria in Malnourished Children. Antimicrob. Agents Chemother.
53: 1753-1759
[Abstract] [Full Text]
Copyright © 2009 by the American Society for Microbiology. For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»