title: Malaria morbidity in children in the year after they had received intermittent preventive treatment of malaria in Mali: a randomized control trial.
abstract: BACKGROUND
  Intermittent preventive treatment of malaria in children (IPTc) is a promising strategy for malaria control. A study conducted in Mali in 2008 showed that administration of three courses of IPTc with sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) at monthly intervals reduced clinical malaria, severe malaria and malaria infection by >80% in children under 5 years of age. Here we report the results of a follow-on study undertaken to establish whether children who had received IPTc would be at increased risk of malaria during the subsequent malaria transmission season.
  
  
  METHODS
  Morbidity from malaria and the prevalence of malaria parasitaemia and anaemia were measured in children who had previously received IPTc with SP and AQ using similar surveillance methods to those employed during the previous intervention period.
  
  
  RESULTS
  1396 of 1508 children (93%) who had previously received IPTc and 1406 of 1508 children (93%) who had previously received placebos were followed up during the high malaria transmission season of the year following the intervention. Incidence rates of clinical malaria during the post-intervention transmission season (July-November 2009) were 1.87 (95% CI 1.76-1.99) and 1.73 (95% CI; 1.62-1.85) episodes per child year in the previous intervention and placebo groups respectively; incidence rate ratio (IRR) 1.09 (95% CI 0.99-1.21) (P = 0.08). The prevalence of malaria infection was similar in the two groups, 7.4% versus 7.5%, prevalence ratio (PR) of 0.99 (95% CI 0.73-1.33) (P = 0.95). At the end of post-intervention malaria transmission season, the prevalence of anaemia, defined as a haemoglobin concentration<11g/dL, was similar in the two groups (56.2% versus 55.6%; PR = 1.01 [95% CI 0.91-1.12]) (P = 0.84).
  
  
  CONCLUSIONS
  IPTc with SP+AQ was not associated with an increase in incidence of malaria episodes, prevalence of malaria infection or anaemia in the subsequent malaria transmission season.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00738946.
authors.affiliation: Malaria Research and Training Centre, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, Bamako, Mali. adicko@icermali.org
authors.forename: Alassane
authors.initials: A
authors.lastname: Dicko
authors.forename: Amadou
authors.initials: A
authors.lastname: Barry
authors.forename: Mohamed
authors.initials: M
authors.lastname: Dicko
authors.forename: Abdoulbaki I
authors.initials: AI
authors.lastname: Diallo
authors.forename: Intimbeye
authors.initials: I
authors.lastname: Tembine
authors.forename: Yahia
authors.initials: Y
authors.lastname: Dicko
authors.forename: Niawanlou
authors.initials: N
authors.lastname: Dara
authors.forename: Youssoufa
authors.initials: Y
authors.lastname: Sidibe
authors.forename: Gaoussou
authors.initials: G
authors.lastname: Santara
authors.forename: Toumani
authors.initials: T
authors.lastname: Conaré
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Milligan
authors.forename: Diadier A
authors.initials: DA
authors.lastname: Diallo
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use*; D000740:Anemia / Q000453:epidemiology; D000962:Antimalarials / Q000627:therapeutic use; D001835:Body Weight; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D008302:Mali / Q000453:epidemiology; D009017:Morbidity; D057147:Mosquito Nets; D018512:Parasitemia / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000187:drug effects; D015995:Prevalence; D011739:Pyrimethamine / Q000627:therapeutic use*; D012621:Seasons; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine