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Evidence summaries

Intermittent Preventive Treatment for Malaria in Children

PIn areas with seasonal malaria transmission, giving intermittent antimalarial drugs to preschool children markedly reduces episodes of clinical malaria, including severe malaria. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 7 trials with 12589 participants. All were conducted in West Africa, and six of seven trials were restricted to children aged less than 5 years.

Intermittent Preventive Treatment in children (IPTc) prevents approximately three quarters of all clinical malaria episodes (rate ratio 0.26; 95% CI 0.17 to 0.38; 9321 participants, six trials), and a similar proportion of severe malaria episodes (rate ratio 0.27, 95% CI 0.10 to 0.76; 5964 participants, two trials). These effects remain present even where insecticide treated net (ITN) usage is high (two trials, 5964 participants).IPTc probably produces a small statistically non-significant reduction in all-cause mortality consistent with the effect on severe malaria (risk ratio 0.66, 95% CI 0.31 to 1.39).The risk of moderately severe anaemia is probably lower with IPTc (risk ratio 0.71, 95% CI 0.52 to 0.98; 8805 participants, five trials).Serious drug-related adverse events, if they occur, are probably rare, with none reported in the six trials (9533 participants, six trials). Amodiaquine plus sulphadoxine-pyrimethamine is the most studied drug combination for seasonal chemoprevention. Although effective, it causes increased vomiting in this age-group (risk ratio 2.78, 95% CI 2.31 to 3.35; two trials, 3544 participants).When antimalarial IPTc was stopped, no rebound increase in malaria was observed in the three trials which continued follow-up for one season after IPTc.

    References

    • Meremikwu MM, Donegan S, Sinclair D et al. Intermittent preventive treatment for malaria in children living in areas with seasonal transmission. Cochrane Database Syst Rev 2012;2():CD003756. [PubMed]

Primary/Secondary Keywords