NEW APPROACH TO INFANT MALARIA AND ANAEMIA CONTROL (p 1471)May 09, 2001A new approach to malaria and anaemia control involving drug treatment delivered at the time of an existing WHO immunisation schedule could substantially reduce illness and death from malaria among infants, conclude authors of a study in this week's issue of THE LANCET. An estimated 1 000 000 malaria deaths per year underline the need for improved malaria control. Clinical malaria and severe anaemia are major causes of paediatric hospital admission and death in many malaria-endemic settings. In the absence of an effective and affordable vaccine, control programmes continue to rely on case management while attempting the large-scale deployment of insecticide-treated nets. David Schellenberg and colleagues from Hospital Clinic Barcelona, and the Ifakara Health Research and Development centre, Tanzania, did a randomised, placebo-controlled trial to assess the efficacy and safety of intermittent sulphadoxine-pyrimethamine treatment on the rate of malaria and severe anaemia in infants in a rural area of Tanzania. 701 children living in Ifakara, southern Tanzania, were randomly assigned sulphadoxine-pyrimethamine or placebo at 2, 3, and 9 months of age. All children received iron supplementation between 2 and 6 months of age. The intervention was given alongside routine vaccinations delivered through WHO's Expanded Program on Immunisation (EPI; diphtheria-tetanus-pertussis and oral polio vaccine, with 80% of infants receiving measles vaccine). The primary outcome measures were first or only episode of clinical malaria, and severe anaemia in the period from recruitment to the study to 1 year of age. Intermittent sulphadoxine-pyrimethamine treatment was well tolerated and no drug-attributable adverse events were recorded. The treatment reduced the rate of clinical malaria by 59%, the rate of severe anaemia by 50%, the number of hospital admissions by 30%, and the rate of all febrile episodes by 13%. Pedro Alonso comments: "Data are urgently needed to assess the potential role of intermittent treatment in areas where the age pattern of malaria disease and death is different to that in Ifakara. Nevertheless, the effects we found suggest that this intervention could be a promising tool for malaria control. Sulphadoxine-pyrimethamine is readily available, affordable, and can be delivered through routine EPI contacts to the target population, therefore serious consideration should be given to the implementation and further assessment of intermittent treatment delivered through the EPI". Ccontact: Professor Pedro L Alonso, Unidad de Epidemiologia y Biostadistica, Hospital Clinic Villarroel 170, E-08036 Barcelona, Spain; T) +34 93 2275706; F) +34 93 4515272; E) Palonso@clinic.ub.es Lancet |
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