Preventive Treatment for School Children

Providing malaria treatment once a term to Kenyan pupils offers important benefits according to this headline: “Malaria prevention in schools reduces anaemia and improves educational potential in Kenyan school children.” In fact lower rates of anemia and improved classroom attention were achieved. Children do not have to be observably sick from malaria to be affected by the disease – the prevalence of P. falciparum was around 40% in these children at baseline.

The study which is fully described in The Lancet, was “A stratified, cluster-randomised, double-blind, placebo-controlled trial of IPT in 30 primary schools in western Kenya. Schools were randomly assigned to treatment (sulfadoxine-pyrimethamine [SP] in combination with amodiaquine or dual placebo) by use of a computer-generated list. Children aged 5–18 years received three treatments at 4-month intervals (IPT n=3535, placebo n=3223). The primary endpoint was the prevalence of anaemia, defined as a haemoglobin concentration below 110 g/L. This outcome was assessed through cross-sectional surveys 12 months post-intervention.”

school-under-the-mangoes-sm.jpgHere is an example where Millennium Development Goals for health and education goals can be achieved through a common intervention.

Of course the benefits of a school-based health program are based on the levels of school attendance, and as reported, “School-age children represent 26% of Africa’s population where 94% of children go to school.”  It should be stressed that this figure is for primary school students.

Interestingly the average age of the study pupils was almost 14 years, likely reflecting late start for education possibly due to family financial problems. The implication for community level malaria control is that there may be a large number of 5-8 year old children who are not yet in school, but are hopefully protected by ITNs at home.

While WHO’s Global Malaria Program (GMP) acknowledges the existence of a now quite extensive body of research on intermittent preventive treatment for infants, it has yet to endorse the practice. The fact that the current study on school children was “funded by the Gates Malaria Partnership which is supported by a grant from the Bill & Melinda Gates Foundation (with) additional funding … provided by the Norwegian Education Trust Fund and multi-donor Education Development Programme Fund of the World Bank; DBL Centre for Health Research and Development; and the Wellcome Trust,” is unlikely to sway opinion at GMP, which has been critical of Gates’ involvement in malaria control and research.

While some may question the use of SP as part of the IPT regimen for these children, the overall concept of IPT for primary school pupils is valuable. One cannot assume that because they don’t look sick that these children are in fact healthy and are not part of the malaria transmission process – it would be a mistake to neglect school children. Partners need to work together to increase available interventions that can reach this group so that endemic countries will ultimately benefit not only from their improved educational attainments, but also from their enhanced economic potential as adults.

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