The effects of a pre-season treatment with effective antimalarials on subsequent malaria morbidity in under five-year-old children living in high and seasonal malaria transmission area of Burkina Faso.
OBJECTIVE
To evaluate the effects of pre-season treatment with single dose of sulfadoxine-pyrimethamine (SP) or artemether-lumefantrine (AL) on subsequent malaria morbidity in under-fives.


METHODS
A cohort of 156 children was enrolled for longitudinal follow-up. Children received curative therapy with SP or AL, and a third group received no treatment. Participants were home-visited twice a week with blood smears taken from children with fever (axillary T° ≥ 37.5 °C) or history of fever. To assess the time to re-infection, a blood film was also systematically obtained from pre-treated children every 2 weeks.


RESULTS
The mean time to the first malaria infection was 36 days in the SP arm and 26 days in the AL arm (P=0.006). The incidence density of malaria infection was similar in both groups (86.5%vs. 92.3%, P=0.52). The mean time to the first malaria episode was 47 days in the SP arm and 32 days in the AL arm (P<0.001). The incidence of malaria episodes was significantly higher in the group pre-treated with AL (45.7 per 1000 child days-at-risk CI 95% [35-56]) than in the control group (10.7 per 1000 child days-at-risk CI 95% [7-15]); P<0.001).


CONCLUSIONS
Our findings suggest that the radical clearance of parasitemia with AL may increase susceptibility to malaria infection and clinical malaria episodes.
Ouédraogo
Alphonse
A
Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso  Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
Tiono
Alfred B
AB
Diarra
Amidou
A
Nébié
Issa O
IO
Konaté
Amadou T
AT
Sirima
Sodiomon B
SB
D017677:Age Distribution; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002050:Burkina Faso; D002675:Child, Preschool; D004198:Disease Susceptibility; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004812:Epidemiologic Methods; D004983:Ethanolamines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000517:prevention & control*; D008297:Male; D018512:Parasitemia / Q000188:drug therapy; D011739:Pyrimethamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012621:Seasons; D017678:Sex Distribution; D013413:Sulfadoxine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine