Preventive malaria treatment lowers anemia prevalence and improves attention span of children

July 10, 2008

Intermittent preventive treatment (IPT) for malaria lowers anaemia prevalence in and improves the attention span of schoolchildren in Africa. Such interventions could be a valuable addition to school health programmes in these low-income settings. These are the conclusions of authors of an Article in this week's edition of The Lancet.

Malaria is a major cause of death and disease in early childhood, yet its consequences for health and education during the school-age years remain poorly understood. Dr Siân Clarke, London School of Hygiene and Tropical Medicine (LSHTM), UK, and colleagues from LSHTM, Harvard University, USA, and Kenya did a randomised controlled trial of children aged 5-18 years from 30 primary schools in Western Kenya. They aimed to assess IPT in reducing anaemia (a common consequence of malaria infection) and improving classroom attention and education achievement in schoolchildren in an area of high malaria transmission.

A total of 2604 children received IPT, which consisted of three treatments of sulfadoxine-pyrimethamine in combination with amodiaquine at four month intervals, while 2302 received placebo. Children were diagnosed anaemic if a haemoglobin concentration below 110g/L was recorded in their blood. IPT reduced the occurrence of malaria infection after 12 months of the intervention, with prevalence of parasitaemia* in schools averaging <5% in the IPT group compared with 39.7% in the placebo group. Prevalence of anaemia was also lowered, averaging 6.3% in the IPT group and 12.6% in the placebo group, ie, children in the IPT group were around half as likely to become anaemic. Significant improvements were also seen in the IPT group in two classroom-based tests of sustained attention compared with placebo. No effect was shown on inattentive or hyperactive-compulsive behaviours or on educational achievement.

The authors conclude: "The pronounced effects of the IPT intervention on anaemia and malaria parasitaemia, and the effect on sustained attention, highlight the issue of the continued, and often unrecognised, malaria burden among school-aged children in Africa and the potential of school-based programmes for tackling the problem. Our findings also illustrate the possible gains of integrating malaria control into broader school health programmes."
Dr Siân Clarke, London School of Hygiene and Tropical Medicine (LSHTM), UK T) +44 (0) 207 299 4642 / +44 (0) 776 665 4045 E)

*Notes to editors: parasitaemia is the presence of malaria parasites in the blood. However this is not a diagnosis of clinical malaria which also requires the presence of symptoms such as fever. Parasitaemia thus indicates malaria infection, but not disease. Malaria infections in this age group are usually asymptomatic.


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