Community Effectiveness of Intermittent Preventive Treatment for Infants (IPTi) in Rural Southern Tanzania

Abstract

Intermittent preventive treatment of malaria in infants (IPTi) with sulphadoxine-pyrimethamine shows evidence of efficacy in individually randomized, controlled trials. In a large-scale effectiveness study, IPTi was introduced in April 2005 by existing health staff through routine contacts in 12 randomly selected divisions out of 24 in 6 districts of rural southern Tanzania. Coverage and effects on malaria and anemia were estimated through a representative survey in 2006 with 600 children aged 2–11 months. Coverage of IPTi was 47–76% depending on the definition. Using an intention to treat analysis, parasitemia prevalence was 31% in intervention and 38% in comparison areas (P = 0.06). In a “per protocol” analysis of children who had recently received IPTi, parasite prevalence was 22%, 19 percentage points lower than comparison children (P = 0.01). IPTi can be implemented on a large scale by existing health service staff, with a measurable population effect on malaria, within 1 year of launch.

Evaluating the effectiveness of IPTi on malaria using routine health information from sentinel health centres in southern Tanzania

“…Median age at IPTi dose was older than recommended by EPI guidelines, but similar to median ages at routine vaccinations, and similar to those seen during the 2006 IPTi representative household survey [22]. Results suggest that more children from intervention areas received DPT2 and measles vaccine, however, results from the representative 2006 IPTi household survey, carried out during a time period that overlapped this study, show no indication of increased levels of EPI coverage in IPTi intervention areas-coverage of DPT vaccination was identical in both areas at 74% of children aged 6-11 months [22]. …”

Enhancing the routine health information system in rural southern Tanzania: successes, challenges and lessons learned

“…The enhanced HMIS data collection and morbidity monitoring described took place in the context of a cluster‐randomized control trial of Intermittent Preventive Treatment for malaria in infants (IPTi), assessed using household surveys and a community census, and health centre surveys (Armstrong Schellenberg et al. 2010).…”

“…The enhanced HMIS data collection and morbidity monitoring described took place in the context of a cluster-randomized control trial of Intermittent Preventive Treatment for malaria in infants (IPTi), assessed using household surveys and a community census, and health centre surveys (Armstrong Schellenberg et al 2010). Additionally, in a morbidity monitoring substudy, HMIS data from 11 sentinel health centres were used to document feasibility of the delivery of IPTi through routine contacts with the health service and evaluate effectiveness of IPTi.…”

Safety of sulfadoxine/pyrimethamine for intermittent preventive treatment of malaria in infants: evidence from large-scale operational research in southern Tanzania

“…Following evidence of the safety and benefits of IPTi generated by this project in 2006, 24 and after further discussion with national stakeholders, implementation was extended to the comparison areas in March 2008. Coverage surveys were conducted in 2006 24 and 2007.…”

“…Coverage surveys were conducted in 2006 24 and 2007. The total number of doses of IPTi-SP delivered between April 2005 and December 2008 was estimated by applying the 2007 coverage estimates to the number infants in the study area.…”