PMID- 18493597
OWN - NLM
STAT- MEDLINE
DCOM- 20080819
LR  - 20211020
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 3
IP  - 5
DP  - 2008 May 21
TI  - Duration of protection against malaria and anaemia provided by intermittent 
      preventive treatment in infants in Navrongo, Ghana.
PG  - e2227
LID - 10.1371/journal.pone.0002227 [doi]
LID - e2227
AB  - BACKGROUND: Intermittent preventive treatment for malaria in Infants (IPTi) has 
      been shown to give effective and safe protection against malaria. It has been 
      suggested that IPTi might have long-lasting beneficial effects but, in most 
      settings, the protection provided by IPTi appears to be short-lived. Knowledge of 
      the duration of protection given by IPTi would help interpret the results of 
      existing trials and suggest optimal delivery schedules for IPTi. This study 
      investigated how the protective efficacy of IPTi against malaria and anaemia 
      changes over time. METHODS AND FINDINGS: A secondary analysis of data from a 
      cluster-randomised, placebo-controlled trial of IPTi using 
      sulfadoxine-pyrimethamine (SP) in Ghana was conducted. In this trial IPTi was 
      given to 2485 infants at 3, 4, 9 and 12 months of age; children remained in 
      follow-up until two years of age. Poisson regression with a random effect to 
      adjust for the cluster-randomised design was used to determine protective 
      efficacy of IPTi against clinical malaria and anaemia in defined time strata 
      following administration of IPTi. Analysis of first-or-only clinical malaria 
      episode following the individual IPTi doses showed that some protection against 
      malaria lasted between 4 to 6 weeks. A similar pattern was seen when the 
      incidence of all malaria episodes up to 2 years of age was analysed in relation 
      to the most recent IPT, by pooling the incidence of malaria after the individual 
      IPTi doses. Protective efficacy within four weeks of IPTi was 75.2% (95% CI: 
      66-82) against malaria, 78.9% (95% CI: 69-86) against high parasite density 
      malaria, and 93.8% (95% CI: 73-99) against anaemia. Protection against these 
      outcomes was short-lived, with evidence of any effect lasting for only 6, 6 and 4 
      weeks respectively. Protection in children who were parasitaemic when receiving 
      IPTi appeared to be of shorter duration than in uninfected children. There was no 
      evidence of any benefit of IPTi after the immediate period following the IPTi 
      doses. CONCLUSIONS: Intermittent preventive treatment provides considerable 
      protection against malaria and anaemia for short periods, even in an area of 
      intense seasonal transmission. Due to the relatively short duration of protection 
      provided by each dose of IPTi, this treatment will be of most benefit when 
      delivered at the time of peak malaria incidence.
FAU - Cairns, Matthew
AU  - Cairns M
AD  - Department of Epidemiology and Population Health, London School of Hygiene & 
      Tropical Medicine, London, United Kingdom. matthew.cairns@lshtm.ac.uk
FAU - Carneiro, Ilona
AU  - Carneiro I
FAU - Milligan, Paul
AU  - Milligan P
FAU - Owusu-Agyei, Seth
AU  - Owusu-Agyei S
FAU - Awine, Timothy
AU  - Awine T
FAU - Gosling, Roly
AU  - Gosling R
FAU - Greenwood, Brian
AU  - Greenwood B
FAU - Chandramohan, Daniel
AU  - Chandramohan D
LA  - eng
GR  - G0700837/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20080521
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Drug Combinations)
RN  - 0 (Placebos)
RN  - 37338-39-9 (fanasil, pyrimethamine drug combination)
RN  - 88463U4SM5 (Sulfadoxine)
RN  - Z3614QOX8W (Pyrimethamine)
SB  - IM
MH  - Anemia/*prevention & control
MH  - Drug Administration Schedule
MH  - Drug Combinations
MH  - Ghana
MH  - Humans
MH  - Infant
MH  - Malaria/*prevention & control
MH  - Placebos
MH  - Pyrimethamine/*administration & dosage
MH  - Sulfadoxine/*administration & dosage
PMC - PMC2375060
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2008/05/22 09:00
MHDA- 2008/08/20 09:00
PMCR- 2008/05/21
CRDT- 2008/05/22 09:00
PHST- 2008/02/22 00:00 [received]
PHST- 2008/03/25 00:00 [accepted]
PHST- 2008/05/22 09:00 [pubmed]
PHST- 2008/08/20 09:00 [medline]
PHST- 2008/05/22 09:00 [entrez]
PHST- 2008/05/21 00:00 [pmc-release]
AID - 08-PONE-RA-03719 [pii]
AID - 10.1371/journal.pone.0002227 [doi]
PST - epublish
SO  - PLoS One. 2008 May 21;3(5):e2227. doi: 10.1371/journal.pone.0002227.