A team of researchers from the London School of Hygiene & Tropical Medicine, working in partnership with colleagues from Senegal, has found that intermittent preventive malaria treatment of children under five has a dramatic impact on malaria frequency.

In a randomised, placebo-controlled trial, 1,136 children aged between two months and five years received either intermittent preventive treatment, consisting of one dose of artesunate plus one dose of sulfadoxine-pyrimethamine, or two placebos. The preventative treatments were carried out on three occasions during the malaria transmission season, in a health-care centre in Niakhar, a rural area of Senegal.

During thirteen weeks of follow up, the intervention led to an 86% reduction in the frequency of clinical episodes of malaria. The incidence of malaria in children with active drugs was 308 episodes per 1,000 person-years at risk, whereas in controls it was 2,250 episodes per 1,000 person-years at risk. The preventative treatment was safe and did not result in children who had received it experiencing more malaria episodes the following year.

According to the World Health Organisation, 90% of deaths from malaria occur in Africa, mostly in children under 5 years of age. In Senegal, the yearly mortality rate from malaria in children has increased substantially since the beginning of the 1990s, due in large part to growing resistance to standard malaria treatments. In addition to developing new malaria drugs there is a need to develop new ways of preventing the disease.

Dr Badara Cisse, a PhD student of the London School of Hygiene & Tropical Medicine (LSHTM) who is now based at the University of Dakar, Senegal, was principal investigator of the trial, and first author of the study, which appears in the February 25 issue of The Lancet. He is a one of 33 research degree students, mostly from malaria-endemic countries, to have been trained under the Capacity Development component of the Gates Malaria Partnership, which aims to strengthen research capability in the field of malaria.

Dr Cisse comments: 'Seasonal intermittent preventive treatment is simple, cheap and dramatic in its impact on malaria in children under five in areas of seasonal malarial transmission. The results of this trial are very encouraging, but we do need to carry out further studies into whether the treatment can be delivered on a bigger scale. If we are to ensure higher rates of coverage, then we need to bring the whole community on board. There is also the question of what the effect might be on drug resistance, which needs to be further explored'.

Seasonal intermittent treatment with artesunate and sulfadoxine-pyrimethamine for prevention of malaria in Senegalese children: a randomised, placebo-controlled, double-blind trial. Badara Cisse, Cheikh Sokhna, Denis Boulanger, Jacqueline Milet, El Hadj Ba, Keshena Richardson, Rachel Hallett, Colin Sutherland, Kirsten Simondon, Francois Simondon, Neal Alexander, Oumar Gaye, Geoffrey Targett, Jo Lines, Brian Greenwood, Jean-Francois Trape. Lancet 2006; 367: xx-xx

The Gates Malaria Partnership is a collaboration between:

-- Centre for Medical Parasitology, University of Copenhagen, Denmark
-- College of Medicine, University of Malawi
-- Danish Bilharziasis Laboratory, Copenhagen, Denmark
-- Kilimanjaro Christian Medical College, Tanzania
-- Liverpool School of Tropical Medicine, UK
-- London School of Hygiene & Tropical Medicine, UK
-- Medical Research Council Laboratories, The Gambia
-- National Institute for Medical Research, Tanzania
-- School of Public Health, College of Health Sciences, University of Ghana
-- World Health Organisation

The goal of the Gates Malaria Partnership is to develop a programme of innovative approaches to the control of malaria in endemic countries, particularly those in sub-Saharan Africa, by:

-- Research - promoting research in malaria endemic countries into new interventions;

-- Knowledge into practice - developing mechanisms/systems for transferring malaria-related knowledge into use and control strategies into action;

-- Capacity development - developing needs-based sustainable capacity strengthening programmes that improve the skills, knowledge and attitudes of those who should be involved in research on and advocacy, control, prevention and management of malaria.

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