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.
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.
Alphonse
A
Ouédraogo
Alfred B
AB
Tiono
Amidou
A
Diarra
Issa O
IO
Nébié
Amadou T
AT
Konaté
Sodiomon B
SB
Sirima
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