IPT

Several studies have shown the efficacy of the intermittent preventive treatment (IPT) using sulfadoxine–pyrimethamine (SP) coupled with the expanded program of immunization (EPI) in infants.

Each year, infections with the protozoan parasite Plasmodium falciparum kill 1 million people, mostly children in Africa.

The data showed that the implementation IPT using SP in children needs to be reviewed.

The risk of LBW and severe anaemia tended to be lower in the SP3 group, though this was not statistically significant, probably due to the low uptake of the intervention which reduced the power of the study.

These data indicate important differences in the spectrum of anti-bacterial activity for the evaluated anti-malarial drugs.

IPTp-SP was highly cost-effective for both prevention of maternal malaria and reduction of neonatal mortality in Mozambique. These findings are likely to hold for other settings where IPTp-SP is implemented through ANC visits.

IPTi delivered alongside the EPI is a highly cost effective intervention against clinical malaria with a range of drugs in a range of malaria transmission settings. Where IPTi did not have a statistically significant impact on malaria, generally in low transmission sites, it was not cost effective.

Commentary on:
Gosling RD, Gesase S, Mosha JF, et al . Protective efficacy and safety of three antimalarial regimens for intermittent preventive treatment for malaria in infants: a randomised, double-blind, placebo-controlled trial. Lancet 2009;374:1521–32.

Levels of IgG antibody to pregnancy‐specific VSAs decrease during receipt of IPTp. Antibody levels in early pregnancy did not predict clinical outcome. IPTp and decreasing malaria prevalence pose challenges for the evaluation of novel interventions for malaria during pregnancy.

IPTi with long-acting regimens provide protection against clinical malaria for up to 8 weeks even in the presence of high ITN coverage, and that the prophylactic rather than the treatment effect of IPTi appears central to its protective efficacy.