Cluster-randomized study of intermittent preventive treatment for malaria in infants (IPTi) in southern Tanzania: evaluation of impact on survival

Malaria Journal

Research

Pedro Alonso¹  Werner Maokola²  Kizito Shirima²  Mwifadhi Mrisho²  Hassan Mshinda²  Fatuma Manzi²  Adiel Mushi³  David M Schellenberg⁴  Joanna RM Armstrong Schellenberg⁵  Marcel Tanner⁶ 

[1] Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain;Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique;Ifakara Health Institute, Ifakara, Tanzania;Ifakara Health Institute, Ifakara, Tanzania;National Institute for Medical Research, Muheza, Tanzania;London School of Hygiene and Tropical Medicine, London, UK;London School of Hygiene and Tropical Medicine, London, UK;Ifakara Health Institute, Ifakara, Tanzania;Swiss Tropical and Public Health Institute, Basel, Switzerland;University of Basel, Basel, Switzerland;

关键词: Malaria;    Measle Vaccine;    Comparison Area;    Intermittent Preventive Treatment;    Infant Survival;   

DOI  :  10.1186/1475-2875-10-387

 received in 2011-07-26, accepted in 2011-12-30,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundIntermittent Preventive Treatment for malaria control in infants (IPTi) consists of the administration of a treatment dose of an anti-malarial drug, usually sulphadoxine-pyrimethamine, at scheduled intervals, regardless of the presence of Plasmodium falciparum infection. A pooled analysis of individually randomized trials reported that IPTi reduced clinical episodes by 30%. This study evaluated the effect of IPTi on child survival in the context of a five-district implementation project in southern Tanzania. [Trial registration: clinical trials.gov NCT00152204].MethodsAfter baseline household and health facility surveys in 2004, five districts comprising 24 divisions were randomly assigned either to receive IPTi (n = 12) or not (n = 12). Implementation started in March 2005, led by routine health services with support from the research team. In 2007, a large household survey was undertaken to assess the impact of IPTi on survival in infants aged two-11 months through birth history interviews with all women aged 13-49 years. The analysis is based on an "intention-to-treat" ecological design, with survival outcomes analysed according to the cluster in which the mothers lived.ResultsSurvival in infants aged two-11 months was comparable in IPTi and comparison areas at baseline. In intervention areas in 2007, 48% of children aged 12-23 months had documented evidence of receiving three doses of IPTi, compared to 2% in comparison areas (P < 0.0001). Over the three years of the study there was a marked improvement in survival in both groups. Between 2001-4 and 2005-7, mortality rates in two-11 month olds fell from 34.1 to 23.6 per 1,000 person-years in intervention areas and from 32.3 to 20.7 in comparison areas. In 2007, divisions implementing IPTi had a 14% (95% CI -12%, 49%) higher mortality rate in two-11 month olds in comparison with non-implementing divisions (P = 0.31).ConclusionThe lack of evidence of an effect of IPTi on survival could be a false negative result due to a lack of power or imbalance of unmeasured confounders. Alternatively, there could be no mortality impact of IPTi due to low coverage, late administration, drug resistance, decreased malaria transmission or improvements in vector control and case management. This study raises important questions for programme evaluation design.

【 授权许可】

Unknown   
© Schellenberg et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Acess article distributed under the terms of the Creative Common Attribution License (http://creativecommons.org/license/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.