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Intermittent preventive treatment for malaria in infants
Ekpereonne B Esu1, Chioma Oringanje2, Martin M Meremikwu3
1Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
The Cochrane Database of Systematic Reviews
|July 17, 2021
Summary
Intermittent preventive treatment in infants (IPTi) with antimalarial drugs likely reduces malaria, anemia, and hospital admissions in sub-Saharan Africa. Sulfadoxine-pyrimethamine (SP) efficacy declined over time, but artemisinin-based combination therapies (ACTs) show promise for IPTi.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Malaria remains a significant threat to infants in sub-Saharan Africa.
- Intermittent preventive treatment in infants (IPTi) is recommended by the WHO but adoption is limited.
- Evaluating the efficacy of IPTi is crucial for malaria control strategies.
Purpose of the Study:
- To assess the effects of intermittent preventive treatment (IPT) with antimalarial drugs on malaria prevention in infants.
- To synthesize evidence from randomized controlled trials (RCTs) on IPTi outcomes.
Main Methods:
- Systematic review and meta-analysis of 12 RCTs involving 19,098 infants in sub-Saharan Africa.
- Searched multiple databases up to December 2018 for relevant trials.
- Assessed risk of bias and certainty of evidence using the GRADE approach.
Main Results:
- IPTi reduced clinical malaria by 30% (rate ratio 0.70).
- IPTi with sulfadoxine-pyrimethamine (SP) reduced clinical malaria, anemia, and hospital admissions, but efficacy declined over time.
- Artemisinin-based combination therapies (ACTs) showed promising effects on clinical malaria and parasitemia in recent trials.
Conclusions:
- IPTi with effective antimalarials likely reduces clinical malaria, anemia, and hospitalizations in infants.
- Declining efficacy of SP suggests increasing drug resistance, necessitating alternative strategies.
- ACTs represent a promising alternative for IPTi, particularly in light of SP resistance.
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