Intermittent preventive treatment using artemisinin-based combination therapy reduces malaria morbidity among school-aged children in Mali

Authors

  • Breanna Barger,

    1.  School of Medicine, University of Washington, Seattle, WA, USA
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  • Hamma Maiga,

    1.  Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali
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  • Oumar Bila Traore,

    1.  Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali
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  • Mamadou Tekete,

    1.  Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali
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  • Intimbeye Tembine,

    1.  Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali
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  • Antoine Dara,

    1.  Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali
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  • Zoumana Isaac Traore,

    1.  Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali
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  • Soren Gantt,

    1.  Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
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  • Ogobara K. Doumbo,

    1.  Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali
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  • Abdoulaye A. Djimde

    1.  Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali
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Corresponding Author Abdoulaye A. Djimde, Malaria Research Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto–Stomatology, University of Bamako, Mali. E-mail: adjimde@mrtcbko.org

Summary

Objective  To assess the efficacy of intermittent preventive treatment (IPT) against malaria in school-aged children.

Methods  This was an open randomized controlled trial of seasonal IPT among school children (IPTsc) aged 6–13 years in Kollé, Mali. The study began in September 2007 and completed follow-up in May 2008. Students were randomized to one of three study arms: Sulfadoxine–pyrimethamine plus artesunate (SP/AS), amodiaquine plus artesunate (AQ/AS) or vitamin C. All students received two full treatment doses, given 2 months apart during the season of high transmission from September to December. Groups were compared with respect to incidence of clinical malaria, asymptomatic parasitemia and haemoglobin concentration.

Results  A total of 296 students were randomized, and retention in the study was 99.3%. Clinical malaria incidence in the SP/AS and AQ/AS arms was reduced by 66.6% and 46.5%, respectively, vs. vitamin C (P < 0.001). There were fewer clinic visits for any cause among the children receiving SP/AS or AQ/AS (= 0.024). The prevalence of asymptomatic parasitemia was fivefold higher in the vitamin C arm than either SP/AS or AQ/AS at each post-treatment evaluation (P < 0.001). At the end of the transmission period, children treated with IPT had lower rates of anaemia (SP/AS, 17.7%; AQ/AS, 16.0%; vitamin C, 29.6%; = 0.039).

Conclusion  IPT among school children reduced the rates of clinical malaria, all-cause acute clinic visits, asymptomatic parasitemia and anaemia among school-aged children.

Le traitement préventif intermittent utilisant la thérapie combinée à base d’artémisinine réduit la morbidité de la malaria chez les écoliers au Mali

Objectif:  Evaluer l’efficacité du traitement préventif intermittent (TPI) contre la malaria chez les écoliers.

Méthodes:  Essai randomisé contrôlé ouvert du TPI saisonnier chez les écoliers âgés de 6 à 13 ans à Kollé au Mali. L’étude a débuté en septembre 2007 et le suivi terminé en mai 2008. Les élèves ont été randomisés à l’un des trois bras d’étude: sulfadoxine-pyriméthamine plus artésunate (SP/AS), amodiaquine plus artésunate (AQ/AS) ou vitamine C. Tous les élèves ont reçu deux doses complètes de traitement, administrées avec un intervalle de deux mois pendant la saison de haute transmission allant de septembre à décembre. Les groupes ont été comparés selon l’incidence de malaria clinique, la parasitémie asymptomatique et la concentration d’hémoglobine.

Résultats:  296 élèves ont été randomisés et la rétention dans l’étude était de 99,3%. L’incidence de malaria clinique dans les bras SP/AS et AQ/AS a été réduite de 66,6% et 46,5% respectivement, par rapport au bras vitamine C (p < 0,001). Il y avait moins de visites cliniques pour une quelconque raison chez les enfants recevant SP/AS ou AQ/AS (p = 0,024). La prévalence de la parasitémie asymptomatique était 5 fois plus élevée dans le bras vitamine C que dans le bras SP/AS ou AQ/AS à chaque évaluation post-traitement (p < 0,001). À la fin de la période de transmission, les enfants traités selon le TPI avaient des taux plus faibles d’anémie (SP/AS 17,7%, AQ/AS 16,0%, vitamine C 29,6%, p = 0,039).

Conclusion:  Le TPI chez les écoliers réduit le taux de malaria clinique, toutes les causes de visite clinique aiguë, la parasitémie asymptomatique et l’anémie chez les enfants d’âge scolaire.

El tratamiento preventivo intermitente utilizando terapia de combinación basada en la artemisina, reduce la morbilidad por malaria entre niños en edad escolar en Mali

Objetivo:  Evaluar la eficacia del tratamiento preventivo intermitente (TPI) frente a la malaria en niños escolares.

Métodos.  Ensayo abierto, aleatorizado y controlado de TPI estacional entre niños escolares (TPIesc) con edades entre los 6 y 13 años en Kollé, Mali. El estudio comenzó en Septiembre 2007 y se completó el seguimiento en Mayo 2008. Los estudiantes fueron aleatorizados a uno de los tres brazos del estudio: Sulfadoxina-pirimetamina más artesunato (SP/AS), amodiaquina más artesunato (AQ/AS), o vitamina C. Todos los estudiantes recibieron dos dosis completas de tratamiento, dadas con dos meses de separación durante la época de trasmisión alta entre Septiembre y Diciembre. Los grupos fueron comparados con respecto a incidencia de malaria clínica, parasitemia asintomática y concentración de hemoglobina.

Resultados.  296 estudiantes fueron aleatorizados, y la retención en el estudio fue del 99.3%. La incidencia de malaria clínica en los brazos de SP/AS y AQ/AS fue reducida en un 66.6% y 46.5%, respectivamente, versus vitamina C (< 0.001). Hubo menos visitas clínicas por cualquier razón entre los niños que recibieron SP/AS o AQ/AS (= 0.024). La prevalencia de parasitemia asintomática fue >5-veces más alta en el brazo de vitamina C que en el de SP/AS o AQ/AS en cada evaluación post-tratamiento (p < 0.001). Al final del periodo de transmisión, los niños tratados con PTI tenían una menor tasa de anemia (SP/AS 17.7%, AQ/AS 16.0%, vitamina C 29.6%; = 0.039).

Conclusiones.  El TPIesc redujo las tasas de malaria clínica, visitas clínicas agudas por cualquier causa, la parasitemia asintomática, y la anemia entre niños escolares.

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