title: Impact of intermittent preventive treatment with dihydroartemisinin-piperaquine on malaria in Ugandan schoolchildren: a randomized, placebo-controlled trial.
abstract: BACKGROUND
  Intermittent preventive treatment (IPT) in schoolchildren offers a promising option for malaria control. However, the optimal drug and dosing regimens for IPT remain to be determined.
  
  
  METHODS
  We conducted a randomized, double-blind, placebo-controlled trial in 740 schoolchildren aged 6-14 years living in a setting of high malaria transmission in Uganda. Enrolled children were randomized to dihydroartemisinin-piperaquine (DP) given once a month (IPTm), DP given once a school term (4 treatments over 12 months, IPTst), or placebo and followed for 12 months. The primary outcome was the incidence of malaria over 12 months. Secondary outcomes included parasite prevalence and anemia over 12 months. Analyses were conducted on an intention-to-treat basis.
  
  
  RESULTS
  In the placebo arm, the incidence of malaria was 0.34 episodes per person-year and the prevalence of parasitemia and anemia was 38% and 20%, respectively. IPTm reduced the incidence of malaria by 96% (95% confidence interval [CI], 88%-99%, P < .0001), the prevalence of asymptomatic parasitemia by 94% (95% CI, 92%-96%, P < .0001), and the prevalence of anemia by 40% (95% CI, 19%-56%, P < .0001). IPTst had no significant effect on the incidence of symptomatic malaria or the prevalence of anemia, but reduced the prevalence of asymptomatic parasitemia by 54% (95% CI, 47%-60%, P < .0001).
  
  
  CONCLUSIONS
  Monthly IPT with DP offered remarkable protection against clinical malaria, parasitemia, and anemia in schoolchildren living in a high-malaria-transmission setting.
  
  
  BACKGROUND
  NCT01231880.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences.
authors.forename: Joaniter I
authors.initials: JI
authors.lastname: Nankabirwa
authors.forename: Bonnie
authors.initials: B
authors.lastname: Wandera
authors.forename: Pauline
authors.initials: P
authors.lastname: Amuge
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenthal
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Brooker
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Staedke
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
mesh_terms: D000740:Anemia / Q000453:epidemiology / Q000517:prevention & control; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D002648:Child; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D016778:Malaria, Falciparum / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D018512:Parasitemia / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D011804:Quinolines / Q000008:administration & dosage*; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D010879:Piperazines
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
keywords: intermittent preventive treatment; malaria; schoolchildren