Seasonal intermittent preventive treatment for the prevention of anaemia and malaria in Ghanaian children: a randomized, placebo controlled trial

Margaret Kweku, Dongmei Liu, Martin Adjuik, Fred Binka, Mahmood Seidu, Brian Greenwood, Daniel Chandramohan, Margaret Kweku, Dongmei Liu, Martin Adjuik, Fred Binka, Mahmood Seidu, Brian Greenwood, Daniel Chandramohan

Abstract

Background: Malaria and anaemia are the leading causes of morbidity and mortality in children in sub-Saharan Africa. We have investigated the effect of intermittent preventive treatment with sulphadoxine-pyrimethamine or artesunate plus amodiaquine on anaemia and malaria in children in an area of intense, prolonged, seasonal malaria transmission in Ghana.

Methods: 2451 children aged 3-59 months from 30 villages were individually randomised to receive placebo or artesunate plus amodiaquine (AS+AQ) monthly or bimonthly, or sulphadoxine-pyrimethamine (SP) bimonthly over a period of six months. The primary outcome measures were episodes of anaemia (Hb<8.0 g/dl) or malaria detected through passive surveillance.

Findings: Monthly artesunate plus amodiaquine reduced the incidence of malaria by 69% (95% CI: 63%, 74%) and anaemia by 45% (95% CI: 25%,60%), bimonthly sulphadoxine-pyrimethamine reduced the incidence of malaria by 24% (95% CI: 14%,33%) and anaemia by 30% (95% CI: 6%, 49%) and bimonthly artesunate plus amodiaquine reduced the incidence of malaria by 17% (95% CI: 6%, 27%) and anaemia by 32% (95% CI: 7%, 50%) compared to placebo. There were no statistically significant reductions in the episodes of all cause or malaria specific hospital admissions in any of the intervention groups compared to the placebo group. There was no significant increase in the incidence of clinical malaria in the post intervention period in children who were >1 year old when they received IPTc compared to the placebo group. However the incidence of malaria in the post intervention period was higher in children who were <1 year old when they received AS+AQ monthly compared to the placebo group.

Interpretation: IPTc is safe and efficacious in reducing the burden of malaria in an area of Ghana with a prolonged, intense malaria transmission season.

Trial registration: ClinicalTrials.gov NCT00119132.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Trial Profile
Figure 1. Trial Profile
Figure 2
Figure 2
Figure 2a: Kaplan-Meier survival estimates for time to first or only episode of anaemia during the intervention period between placebo and SP groups. Figure 2b: Kaplan-Meier survival estimates for time to first or only episode of anaemia during the intervention period between placebo and AS+AQ bimonthly groups Figure 2c: Kaplan-Meier survival estimates for time to first or only episode of anaemia during the intervention period between placebo and AS+AQ monthly groups
Figure 3. Figure 3a:
Figure 3. Figure 3a:
Kaplan-Meier survival estimates for time to first or only episode of malaria during the intervention period between placebo and SP groups. Figure 3b: Kaplan-Meier survival estimates for time to first or only episode of malaria during the intervention period between placebo and AS+AQ bimonthly groups. Figure 3c: Kaplan-Meier survival estimates for time to first or only episode of malaria during the intervention period between placebo and AS+AQ monthly groups
Figure 4. Trend of rainfall and the…
Figure 4. Trend of rainfall and the incidence of anaemia and malaria during the intervention and follow-up period of the study

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