Evaluation of the Public Health Impact of Seasonal Intermittent Preventive Treatment (IPT) in Children in Senegal
Status:
Unknown status
Trial end date:
2012-07-01
Target enrollment:
Participant gender:
Summary
In areas of seasonal malaria transmission the burden of severe disease and mortality due to
malaria is mainly among children under 5 years of age. Intermittent preventive treatment
(IPT) with antimalarial drugs given to all children once a month during the transmission
season is a promising new strategy for malaria prevention. Studies in Senegal, Ghana, Mali
and The Gambia have shown this approach can be highly effective. In Senegal, seasonal IPT
with sulfadoxine-pyrimethamine (SP) and one dose of artesunate resulted in a 90% reduction in
incidence of clinical malaria in a recent trial in Senegal (Cisse et al., Lancet 2006). The
purpose of the present project is to determine the public health impact and cost
effectiveness of this intervention when it is delivered through the routine health service to
communities in rural areas in Senegal. Demographic surveillance will be set up in the rural
population of three districts (Mbour, Bambey and Fatick) which comprises approximately
540,000 people, including 100,000 children under 5 yrs, and is served by 54 health posts, as
an expansion of the area covered by the existing DSS of Niakhar. Information about births,
deaths and migrations, household characteristics such as socioeconomic status, and
vaccination status of children and their use of bednets, will be recorded in 6-monthly rounds
of all households. In selected areas, deaths among children under 10 years will be
investigated using verbal autopsies. Over four years from September 2008 - November 2011,
seasonal IPT (three monthly administrations of SP (sulfalene-pyrimethamine) plus amodiaquine
during the transmission season each year to children 3-59 months of age) will be introduced
gradually, in a step-wedge design, by 9 health posts in 2008, by an additional 18 posts in
2009, and another 18 in 2010 and 9 in 2011. At the end of each transmission season, a
cross-sectional survey of 2400 children under 5 yrs of age, in which finger prick blood
samples will be taken, will be used to estimate the prevalence of molecular markers of drug
resistance to Plasmodium falciparum, the prevalence of anaemia and the nutritional status of
children. Malaria incidence will be monitored by passive surveillance through health posts,
health centres, and hospitals. Cost effectiveness will be assessed. Due to changes in the
epidemiology of malaria in the study area, the upper age limit for inclusion was increased
from 5 to 10 years old from September 2009.
Phase:
Phase 4
Details
Lead Sponsor:
London School of Hygiene and Tropical Medicine
Collaborators:
Cheikh Anta Diop University, Senegal Institut de Recherche pour le Developpement Senegal: Ministere de la Sante
Treatments:
Amodiaquine Fanasil, pyrimethamine drug combination Pyrimethamine Sulfadoxine