Time to Give IPTi a Chance

logo_ipti.jpgEight years ago researchers in Tanzania discovered that giving a full dose of sulphadoxine-pyrimethamine (SP) to infants as intermittent preventive treatment (IPT) has similar positive effects of reduced malaria and anemia as the same process had already shown in pregnant women.  This led to the formation of the IPTi Consortium whose aim was to amass the evidence needed so that international bodies could accept and develop guidelines for this life saving intervention.

Although a variety of studies across Africa with support from UNICEF, the Gates Foundation and others have confirmed the benefits of IPTi, there has been reluctance by WHO to endorse this intervention.  This may have been based on fears of rising parasite resistance to SP.

Today the Lancet has published a meta or pooled analysis of these IPTi Confortium sponsored studies from trials that were conducted in Mozambique, Gabon, Tanzania and Ghana. IPTi Consortium reports that, “SP has a protective efficacy of 30·3% (95% Confidence Intervals 19·8–39·4, p<0·0001) against clinical malaria, in areas of low to moderate resistance to SP during the first year of life.”

Researchers from the Consortium are realistic: “IPTi is not a ‘not a magic bullet‘ and noted that SP resistance has spread to several parts of Africa, which could limit the effectiveness of the IPTi using this drug. But the intervention could prevent 6 million cases of malaria each year among those most vulnerable to the disease.”

IPTi with SP has been proven not only efficacious, but relatively easy to deliver through infant immunization campaigns and routine immunization services. IPTi has also been shown to be acceptable to the community and parents of these infants. Also IPTi is cheap – about US $0.13-0.23 per dose.

While research will continue to find replacements for SP, there is no reason not to act now using this proven intervention to save lives.  It is time for malaria partners and endemic country control programs to come together and operationalize these findings and begin saving lives until such time as a replacement medicine can be found of good efficacy and reasonable cost.

Countries must also remove SP from the shelves of shops and pharmacies where it is sold for treatment so that what remains of its efficacy can be protected until a replacement is found.

The IPTi Consortium is right that there is no magic bullet – this includes nets and treatment drugs, too. All possible and affordable strategies need to be employed to meet the 2015 Millennium Development Goals – saving children’s lives.

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