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Preventive therapy significantly reduced malaria incidence in Senegal
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Seasonal administration of sulfadoxine-pyrimethamine plus amodiaquine to children younger than 10 years reduced malaria incidence by 60% in this age group, according to data published in PLOS Medicine.
Additionally, malaria incidence among age groups too old to receive preventive treatment was reduced by 26%.
WHO has previously recommended that children aged younger than 5 years living in the Sahel and sub-Sahel regions of Africa – areas with highly seasonal malarial transmission – should receive preventive sulfadoxine-pyrimethamine plus amodiaquine for up to four months of the year. Per recent estimates, approximately 25 million children reside in the areas that would qualify for preventive treatment.
“In areas of intense transmission, the main burden of severe malaria disease is in young children, but, as the intensity of transmission decreases, an increasing proportion of cases occur at older ages, reflecting slower acquisition of natural immunity,” Paul Milligan, PhD, of the London School of Hygiene & Tropical Medicine, and colleagues wrote. “In these areas, wider age groups could be included in the seasonal malaria chemoprevention programs.”
To determine the costs, practicality and safety of delivering preventive malaria treatment on a large scale to children aged younger than 5 years, Milligan and colleagues randomized 54 health posts in central Senegal to either provide treatment to children younger than 10 years or act as controls. Between 2008 and 2011, the researchers monitored malaria cases and associated mortality in outpatient clinics and hospitals.
During the study period, 780,000 preventive treatments were administered to children in the designated age group. While the incidence of mortality was similar within the prevention and non-prevention areas (rate ratio: 0.9; 95% CI, 0.68-1.2), researchers determined that preventive treatment reduced the incidence of malaria in children younger than 10 years by 60% (95% CI, 54-64) and reduced severe malaria transmission by 45%.
Additionally, Milligan and colleagues observed that in areas where preventive treatment was administered, incidence of confirmed malaria among older age groups was reduced by 26% (95% CI, 18-33) while total number of malaria treatments for these groups was reduced by 29% (95% CI, 21-35).
“Apart from in Senegal, seasonal malaria chemoprevention is currently being provided only for children up to 5 years of age, but in many areas the burden in older children may justify extending this range,” Milligan and colleagues wrote. “Our study shows that in some areas expanding the age range for seasonal malaria chemoprevention could have a substantial impact on the malaria burden and could contribute to reducing malaria transmission.”– by Kate Sherrer
Disclosure: Milligan reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures. The study was funded by the Bill & Melinda Gates Foundation.
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