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Title: Impact of intermittent preventive treatment in children (IPTc) with amodiaquine (AQ) plus artesunate (AS) versus sulphadoxine-pyrimethamine (SP) alone on Haemoglobin levels and malaria morbidity in the Hohoe District of Ghana
Author: Kweku, Margaret Abena
ISNI:       0000 0004 2745 4846
Awarding Body: University of London
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2007
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Malaria and anaemia are the leading cause of morbidity and mortality in children worldwide (WHO, 1986) and are the main disease burdens in sub-Saharan Africa. Severe malaria and anaemia are often fatal, while moderate anaemia in childhood is associated with impaired physical and mental development. One promising approach to the prevention of malaria is the administration of intermittent preventive treatment (IPT) to infants (IPTi) or to children under five years old (IPTc). This involves administration of a predefined number of treatment courses of antimalarial drugs at specified time intervals. Although IPTi has been shown to be efficacious in reducing the incidence of malaria in infants, this strategy may not be adequate to reduce the burden of malaria in children because in many parts of Africa the burden of malaria is high in children under five years of age not just in infants. Furthermore, in highly seasonal transmission areas of West Africa targeting IPT during the high transmission season is more appropriate than administering IPT throughout the year. There is now some evidence from Mali and Senegal that seasonal IPTc can reduce the burden of malaria substantially in Sahelian West Africa. The IPTc studies done so far have been carried out in areas with an intense but short transmission season. Furthermore resistance to SP, the drug commonly used for IPT is increasing. Thus, there is a need to assess the efficacy of IPTc in an area of intense transmission with a prolonged seasonal peak of malaria transmission and to find alternative drugs or drug combinations for IPTc. Hence, a randomised, controlled trial of amodiaquine plus artesunate (AQ+AS), given at two different intervals (monthly or bimonthly), SP alone bimonthly or placebo to children aged 3- 59 months during the high malaria transmission season was conducted in Ghana in 2005-2006. The protective efficacy of IPTc against malaria and anaemia was assessed during the intervention period and one year post intervention period to determine if there was any rebound in the incidence of malaria or anaemia after stopping IPTc. A total of 2451 children were enrolled from 30 villages and randomly assigned to four arms. The number of children assigned to each arm and followed up to six months was 650 to placebo, 613 to SP bimonthly, 562 to AQ+AS bimonthly and 626 to AQ+AS monthly. The follow up rate was high (range 92%-95%) and was comparable between groups. IPTc provided protection against clinical malaria and anaemia in children less than five years of age. Monthly AQ+AS IPTc reduced the incidence of malaria by 75% (95% Cl: 65%-83%) and anaemia 58% (95% Cl: 33%-74%), bimonthly SP reduced the incidence of malaria 35% (95% Cl: 17%-49%) and anaemia 45% (95% Cl: 15%-65%) and bimonthly AQ+AS reduced the incidence of malaria 30% (95% Cl: 11%-46%) and anaemia 24% (95% Cl: 14%-50%) compared to placebo. Episodes of hospital admissions with severe malaria were reduced by 62% (95% Cl: 5%-86%) in the AQ+AS monthly, 39% in SP bimonthly (95% Cl: -36%-74%) and 58% in the AQ+AS bimonthly group (95% Cl: 5%-85). There was no significant increase in the incidence of clinical malaria with any parasitaemia or high density parasitaemia in the dry and rainy seasons following IPTc intervention in older children (12-59 months). However, there was a slight increase in the incidence of clinical malaria with any parasitaemia or high density parasitaemia in infants (3-11months) in the rainy season following IPTc intervention. IPTc using any of the three treatment regimens was cost effective and scaling up to cover more children reduced cost drastically. The intervention was found to be acceptable to the community. We conclude that IPTc is safe and efficacious even in areas with a prolonged intense transmission season. IPTc, when combined with other interventions such as the use of insecticide treated bednets and home management of malaria, will reduce the burden of malaria in West Africa.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available