Researchers in Senegal studied the effect of intermittent preventive treatment (IPT) of malaria for children during the malaria transmission season in that country and found that, “The prevention of malaria would improve child nutritional status in areas with seasonal transmission.” In particular mean weight gain was significantly better for those receiving IPT.
These researchers also note that similar positive results have been observed in other malaria prevention research efforts in the Gambia and Tanzania. The Tanzania work included ITNs in addition to IPT.
A basic child health monitoring tool, the Road to Health Chart, comes to mind. The guidance with the charts was usually to suspect illness, such as diarrhoeal diseases and TB should a child’s weight remain static or decrease between clinic visits. It is encouraging to know that we can also improve overall child nutritional status through malaria prevention. More work is needed to document these effects of preventive interventions in areas with year-round malaria transmission. Such results also add to the economic benefits arguments for malaria control as children with better nutritional status will hopefully grow into more productive adults.
For the past several years a consortium has been investigating whether intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) for infants (IPTi) could be as effective a malaria control tool as its counterpart for pregnant women (IPTp). According to Ghanaweb.com on Friday, “Professor John Gyapong, Director of the Health Research Unit of the GHS (Ghana Health Service, noted that IPTi with SP had been found to be very efficacious, safe and cost effective.” Reductions in malaria and related factors found in the Ghana research are seen in the attached graph.
Although Prof. Gyapong appeared to advocate for quick adoption of IPTi in Ghana, he also did note that WHO has yet to endorse the practice. In fact some would say that a verdict on IPTi is overdue considering the volume of research generated so far and available for review on the IPTi Consortium website. This delay may not be surprising based on the reluctance of WHO’s Global Malaria Program to embrace IPTp even though evidence of its effectiveness persists.
Of course, there are some legitimate concerns about expanding IPT, which need to be addressed, even based on the data generated in Ghana. Among these issues are the following:
- resistance of parasites to SP
- appropriateness of EPI as a delivery mechanism for IPTi
- equity of access to IPTi
- timing of IPTi dosages
- concerns about seasonality of transmission
These issues are explored in detail in the various journal articles available for free download at the IPTi website. Fortunately, Dr. Andrea Egan from IPTi Consortium has assured that, “a comprehensive research and implementation agenda had been developed to resolve any outstanding scientific questions on whether IPTi was safe and effective to use as a malaria control intervention and move the intervention into policy and practice.”
Clearly IPTi would not be implemented as a stand alone intervention, but would and should be integrated with other control measures including ITNs and prompt case management with ACTs. There is always benefit to having another strategy to add to a comprehensive malaria program in order to outwit mosquitoes and parasites.