title: Increase in EPI vaccines coverage after implementation of intermittent preventive treatment of malaria in infant with Sulfadoxine -pyrimethamine in the district of Kolokani, Mali: results from a cluster randomized control trial.
abstract: BACKGROUND
  Even though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with Sulfadoxine-Pyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met. However IPTi may also increase the adherence of the community to EPI services and improve EPI coverage, once the benefice of strategy is perceived.
  
  
  METHODS
  To assess the impact of IPTi implementation on the coverage of EPI vaccines, 22 health areas of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The EPI vaccines coverage was assessed using cross-sectional surveys at baseline in November 2006 and after one year of IPTi pilot-implementation in December 2007.
  
  
  RESULTS
  At baseline, the proportion of children of 9-23 months who were completely vaccinated (defined as children who received BGG, 3 doses of DTP/Polio, measles and yellow fever vaccines) was 36.7% (95% CI 25.3% -48.0%). After one year of implementation of IPTi-SP using routine health services, the proportion of children completely vaccinated rose to 53.8% in the non intervention zone and 69.5% in the IPTi intervention zone (P <0.001).The proportion of children in the target age groups who received IPTi with each of the 3 vaccinations DTP2, DTP3 and Measles, were 89.2% (95% CI 85.9%-92.0%), 91.0% (95% CI 87.6% -93.7%) and 77.4% (95% CI 70.7%-83.2%) respectively. The corresponding figures in non intervention zone were 2.3% (95% CI 0.9% -4.7%), 2.6% (95% CI 1.0% -5.6%) and 1.7% (95% CI 0.4% - 4.9%).
  
  
  CONCLUSIONS
  This study shows that high coverage of the IPTi can be obtained when the strategy is implemented using routine health services and implementation results in a significant increase in coverage of EPI vaccines in the district of Kolokani, Mali.
authors.affiliation: Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, Mali. adicko@mrtcbko.org
authors.forename: Alassane
authors.initials: A
authors.lastname: Dicko
authors.forename: Sidy O
authors.initials: SO
authors.lastname: Toure
authors.forename: Mariam
authors.initials: M
authors.lastname: Traore
authors.forename: Issaka
authors.initials: I
authors.lastname: Sagara
authors.forename: Ousmane B
authors.initials: OB
authors.lastname: Toure
authors.forename: Mahamadou S
authors.initials: MS
authors.lastname: Sissoko
authors.forename: Alpha T
authors.initials: AT
authors.lastname: Diallo
authors.forename: Christophe
authors.initials: C
authors.lastname: Rogier
authors.forename: Roger
authors.initials: R
authors.lastname: Salomon
authors.forename: Alexandra
authors.initials: A
authors.lastname: de Sousa
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007223:Infant; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008302:Mali; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use*; D014612:Vaccines / Q000008:administration & dosage
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D014612:Vaccines; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine