Chemoprophylaxis and intermittent treatment for preventing malaria in children

  • Review
  • Intervention


  • MM Meremikwu,

  • AAA Omari,

  • P Garner

Dr Martin Meremikwu, Reader, Department of Paediatrics, University of Calabar, Calabar, Cross River State, PMB 1115, NIGERIA.



Malaria causes repeated illness in children living in endemic areas. Policies of giving antimalarial drugs at regular intervals (prophylaxis or intermittent treatment) are being considered for preschool children.


To evaluate chemoprophylaxis and intermittent treatment with antimalarial drugs to prevent malaria in young children living in malaria endemic areas.

Search strategy

We searched the Cochrane Infectious Diseases Group Specialized Register (April 2005), CENTRAL (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to April 2005), EMBASE (1974 to April 2005), LILACS (1982 to April 2005), and reference lists of identified trials. We also contacted researchers.

Selection criteria

Randomized and quasi-randomized controlled trials comparing antimalarial drugs given at regular intervals (prophylaxis or intermittent treatment) with placebo or no drug in children aged one month to six years or less living in an area where malaria is endemic.

Data collection and analysis

We independently extracted data and assessed methodological quality. We used relative risk (RR) or weighted mean difference with 95% confidence intervals (CI) for meta-analyses. Where we detected heterogeneity and considered it appropriate to combine the trials, we used the random-effects model (REM).

Main results

Nineteen trials (14,393 participants) met the inclusion criteria. Children receiving antimalarial drugs as prophylaxis or intermittent treatment had fewer clinical malaria episodes (RR 0.52, 95% CI 0.35 to 0.77, REM; 4051 participants, 8 trials), and severe anaemia was less common (RR 0.54, 95% CI 0.42 to 0.68; 2727 participants, 8 trials). We did not detect a difference in the number of deaths from any cause (RR 0.82, 95% CI 0.65 to 1.04; 7929 participants, 9 trials), but the confidence intervals do not exclude a potentially important difference. None of the trials reported serious adverse events. Three trials measured morbidity and mortality six months to two years after stopping regular antimalarial drugs; overall, there was no statistically significant difference, but participant numbers were small.

Authors' conclusions

Prophylaxis and intermittent treatment with antimalarial drugs reduce clinical malaria and severe anaemia in preschool children. There is insufficient evidence to detect an effect on mortality.

Plain language summary

Plain language summary

Preschool children taking antimalarial drugs regularly are less likely to get malaria or severe anaemia, but more trials are needed show whether survival is improved

Most children in areas where malaria is endemic are semi-immune against serious malaria by the age of seven, but for children under five the disease can be serious, and a million worldwide die each year from malaria. The review of trials found that children taking regular antimalarial prophylaxis or intermittent treatment were less likely to get malaria, severe anaemia, or be admitted to hospital, but there was no change in the overall death rate. The benefits are similar in intermittent treatment of infants and prolonged prophylaxis, but long-term deleterious effects, including the possibility that it may interfere with the development of children's immunity to malaria, are unknown for either regimen. Further trials with long-term follow up are needed.