The clinical impact of combining intermittent preventive treatment with home management of malaria in children aged below 5 years: cluster randomised trial.
Trop Med Int Health
; 16(3): 280-9, 2011 Mar.
Article
em En
| MEDLINE
| ID: mdl-21159081
ABSTRACT
OBJECTIVE:
To investigate the impact of seasonal intermittent preventive treatment (IPTc) on malaria-related morbidity in children <5 years of age who already had access to home-based management of malaria (HMM) for presumptive treatment of fevers.METHOD:
Thirty community-based drug distributors (CDDs) from all 13 communities of a rural subdistrict in Ghana were trained to provide prompt treatment for presumptive malaria using artesunate-amodiaquine (AS+AQ) to all children under 5 years of age. Six communities were randomised to also receive bimonthly courses of seasonal IPTc with AS+AQ in May, July and September of 2007. The primary outcome was the incidence rate of febrile episodes diagnosed presumptively as malaria by the CDDs in the communities in each intervention group. Cross-sectional surveys were conducted to determine the prevalence of parasitaemia and anaemia among the study children.RESULTS:
During the 6 months in which IPTc was delivered, incidence of fevers in communities given HMM+IPTc was lower than in communities given HMM alone, but this difference was not statistically significant (protective efficacy 37.0%(95% CI -9.7 to 63.8; P = 0.14). However, incidence of presumptive malaria was significantly lower in IPTc communities when only children who received all three courses of IPTc were included in theanalysis:
protective efficacy 61.5% (95% CI31.2-78.5; P = 0.018). Protection with IPTc was not followed by rebound morbidity in the following year. At the end of the intervention period, prevalence of asymptomatic parasitaemia was lower in communities that had received IPTc, but there were no differences in anaemia or haemoglobin concentration.CONCLUSION:
In this study area, incidence of fevers was lower in communities given three courses of IPTc during the time of peak transmission than in communities that received only HMM. However, high levels of coverage for IPTc will be necessary for maximum impact.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Serviços de Assistência Domiciliar
/
Malária
/
Antimaláricos
Tipo de estudo:
Clinical_trials
/
Risk_factors_studies
Limite:
Child, preschool
/
Female
/
Humans
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Infant
/
Male
País/Região como assunto:
Africa
Idioma:
En
Revista:
Trop Med Int Health
Assunto da revista:
MEDICINA TROPICAL
/
SAUDE PUBLICA
Ano de publicação:
2011
Tipo de documento:
Article
País de afiliação:
Gana