Two randomized controlled trials (with over 3000 children in each study) carried out by a team of researchers led by Diadier Diallo from the London School of Hygiene & Tropical Medicine, London, UK, Amadou Konate from the Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou and Alassane Dicko from the Malaria Research and Training Centre (University of Bamako), Bamako, Mali found that in the peak malarial transmission season in Burkina Faso and Mali, intermittent preventive treatment for malaria (using the antimalarial drugs sulphadoxine pyrimethamine and amodiaquine) provided substantial additional protection against episodes of clinical malaria, severe malaria, and all-cause hospital admissions in children sleeping under long-lasting insecticide treated bednets.
Intermittent preventive treatment (administration of anti-malarial drugs at defined time intervals to individuals, regardless of whether they are known to be infected with malaria) was initially recommended for pregnant women and has recently been extended to include infants and children. However, previous studies in children were carried out in countries where the use of insecticide treated bednets — an intervention that provides at least 50% protection against morbidity from malaria and is the main tool used for malaria control in most of sub-Saharan Africa — was relatively low. Therefore, the findings of these two trials are important as they demonstrate the additional benefit that intermittent preventive treatment can confer on standard malaria control practice.
The authors of the Burkino Faso study conclude: "There is now strong evidence to support the integration of [Intermittent preventive treatment for children] into malaria control strategies in areas of seasonal malaria transmission."
The authors of the study conducted in Mali arrive at a similar conclusion: "These findings indicate that [Intermittent preventive treatment for children] could make a valuable contribution to malaria control in areas of seasonal malaria transmission alongside other interventions."
However, for the scale up of intermittent preventive treatment for children to be successful, there needs to be an appropriate delivery system that can be generalized to most settings in Sub-Saharan Africa. A randomized controlled trial carried out by Kalifa Bojang from the Medical Research Council Laboratories, Banjul, The Gambia, and colleagues finds that in 26 rural areas of the Gambia (each with 400-500 children), delivery of intermittent preventive treatment to children by community-based, volunteer village health workers was more effective and less costly than delivery by reproductive and child health trekking teams (run by the Ministry of Health).
The authors found that delivery through the trained village volunteers was more effective because as these workers are resident in the community, drug administration was easier and more flexible since children were able to receive their medication on any day of the month. Therefore, delivery of the intervention is more convenient for parents and guardians.
The authors conclude: "Longer term experience will show whether the high level of coverage obtained in this study can be sustained but the results of this trial suggest that community volunteers can achieve high level coverage with this very effective malaria control intervention if they are supported to do so."
INFORMATION:
From the PLoS Medicine magazine section
New mechanisms can improve Africa drug development
Based upon their report for the Drugs for Neglected Disease initiative (DNDi), Mary Moran from PolicyCures and colleagues discuss in this week's PLoS Medicine the best strategies for African regulators to be supported in their efforts to reliably evaluate the safety, efficacy, and quality of drugs for African use.
Funding: MM, JG, and LW have support from the Drugs for Neglected Disease initiative (DNDi) for this work. MM, JG, and LW have received funding from the World Bank (via Global Forum for Health Research), the Bill & Melinda Gates Foundation, the Council on Health Research for Development (COHRED), the Wellcome Trust, the UK Department of Health, the World Health Organization, and the International AIDS Vaccine Initiative. The funders helped in the organization of the report on which this article is based, in the preparation and writing of the manuscript and decision to publish, and had input into the study design; however, they played no role in data collection or analysis.
Competing Interests: MM, JG, and LW have relationships with the World Bank (via Global Forum for Health Research), the Bill & Melinda Gates Foundation, the Council on Health Research for Development (COHRED), the Wellcome Trust, the UK Department of Health, the World Health Organization, and the International AIDS Vaccine Initiative, all of which may have an interest in the submitted work. No authors' spouse, partner, or children has financial relationships that may be relevant to the submitted work. DNDi develops new drugs or new formulations of existing drugs for patients suffering from HAT (sleeping sickness), visceral leishmaniasis (VL), and Chagas disease.
Citation: Moran M, Strub-Wourgaft N, Guzman J, Boulet P, Wu L, et al. (2011) Registering New Drugs for Low-Income Countries: The African Challenge. PLoS Med 8(2): e1000411. doi:10.1371/journal.pmed.1000411
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For further information, or to interview the authors, please contact Lindsay Wright, Communications Manager at the London School of Hygiene & Tropical Medicine on +44 (0) 207 927 2073 or email lindsay.wright@lshtm.ac.uk
The related articles are published alongside a Perspective by James Beeson (Walter and Eliza Hall Institute of Medical Research, Victoria, AU) and colleagues. Beeson and colleagues (not involved in the research) discuss the three studies and conclude that "based on the present evidence, we support the call for the implementation of IPTc as a population-level intervention in specific settings to reduce the burden of malaria in children." The authors also emphasize there is still much to know about when, how, and under what circumstances IPTc should be implemented, and how to mitigate the potential impact of increasing drug resistance and impairing immune acquisition, stressing "these questions need to be a high priority for ongoing research."
Citation information and press previews for the four related papers:
Burkina Faso randomized, double-blind, placebo-controlled trial by Diallo and colleagues
Funding: This work was supported by a grant to the London School of Hygiene & Tropical Medicine from the Bill & Melinda Gates Foundation (grant number: 41783). The funder had no role in the study design, data collection, analysis, decision to publish or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Konate AT, Yaro JB, Ouedraogo AZ, Diarra A, Gansane A, et al. (2011) Intermittent Preventive Treatment of Malaria Provides Substantial Protection against Malaria in Children Already Protected by an Insecticide-Treated Bednet in Burkina Faso: A Randomised, Double-Blind, Placebo-Controlled Trial. PLoS Med 8(2): e1000408. doi:10.1371/journal.pmed.1000408
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000408
PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plos-08-02-diallo.pdf
Mali randomized, double-blind, placebo-controlled trial by Dicko and colleagues
Funding: This work was supported by a grant to the London School of Hygiene & Tropical Medicine from the Bill & Melinda Gates Foundation (grant number 41783). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Dicko A, Diallo AI, Tembine I, Dicko Y, Dara N, et al. (2011) Intermittent Preventive Treatment of Malaria Provides Substantial Protection against Malaria in Children Already Protected by an Insecticide-Treated Bednet in Mali: A Randomised, Double-Blind, Placebo-Controlled Trial. PLoS Med 8(2): e1000407. doi:10.1371/journal.pmed.1000407
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000407
PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-08-02-dicko.pdf
Two strategies for the delivery of IPTc in The Gambia: A randomized controlled trial by Bojang and colleagues
Funding: This study was funded by the Gates Malaria Partnership, which receives financial support from the Bill & Melinda Gates Foundation and by the Medical Research Council, UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Bojang KA, Akor F, Conteh L, Webb E, Bittaye O, et al. (2011) Two Strategies for the Delivery of IPTc in an Area of Seasonal Malaria Transmission in The Gambia: A Randomised Controlled Trial. PLoS Med 8(2): e1000409. doi:10.1371/journal.pmed.1000409
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000409
PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-08-02-bojang.pdf
Perspective by James Beeson and colleagues
Funding: The authors received no specific funding for this article.
Competing Interests: Stephen J. Rogerson is on the Editorial Board of PLoS Medicine.
Citation: Beeson JG, Rogerson SJ, Mueller I, Richards JS, Fowkes FJI (2011) Intermittent Preventive Treatment to Reduce the Burden of Malaria in Children: New Evidence on Integration and Delivery. PLoS Med 8(2): e1000410. doi:10.1371/journal.pmed.1000410
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000410
PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-08-02-beeson.pdf
CONTACT:
press@plos.org
beeson@burnet.edu.au
