title: Effect of iron/folic Acid supplementation on the outcome of malaria episodes treated with sulfadoxine-pyrimethamine.
abstract: Folic acid supplementation may potentially alter the efficacy of sulfadoxine-pyrimethamine (SP) treatment in children with malaria. However, there is lack of evidence from randomized controlled trials and effects of folic acid supplementation on clinical efficacy of SP therapy remain moderately understood among children. In a double masked, placebo-controlled trial among preschool children in Pemba Island (Tanzania), iron and folic acid supplementation (Fe/FA) showed an increased risk of hospitalizations and death. In the present paper, we evaluated if folic acid supplementation reduced the efficacy of malaria treatment and thereby contributed to observed adverse effects. During the study, 1648 children had confirmed malarial episodes and received either sulphadoxine-pyrimethamine (SP) treatment and iron folic acid or SP treatment and placebo. These children were evaluated for recovery and incidence of hospitalization during the next 15, 30, and 140 days. Two groups did not differ in malarial episode or hospitalization rate on subsequent 15, 30, and 140 days. Altered efficacy of SP by folic acid was not observed and did not contribute to adverse events in the previous trial. This trial is registered with Controlled-trials.com ISRCTN59549825.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E8527, Baltimore, MD 21205, USA ; Center for Public Health Kinetics, New Delhi, India.
authors.forename: Sunil
authors.identifier: 0000-0002-8035-9085
authors.initials: S
authors.lastname: Sazawal
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E8527, Baltimore, MD 21205, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: Public Health Laboratory-Ivo de Carneri, Wawi, Chake-Chake, Pemba, Zanzibar, Tanzania.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Kabole
authors.affiliation: Center for Public Health Kinetics, New Delhi, India ; Public Health Laboratory-Ivo de Carneri, Wawi, Chake-Chake, Pemba, Zanzibar, Tanzania.
authors.forename: Arup
authors.identifier: 0000-0003-0602-0363
authors.initials: A
authors.lastname: Dutta
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E8527, Baltimore, MD 21205, USA ; Center for Public Health Kinetics, New Delhi, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Dhingra
authors.affiliation: Public Health Laboratory-Ivo de Carneri, Wawi, Chake-Chake, Pemba, Zanzibar, Tanzania.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Ramsan