Impact of Intermittent Preventive Anti-Malarial Treatment on the Growth and Nutritional Status of Preschool Children in Rural Senegal (West Africa)

Ntab, Balthazar; Cissé, Badara; Boulanger, Denis; Sokhna, Cheikh; Targett, G. A. T.; Lines, Jo; Nast, Alexander; Trape, Jean‐François; Simondon, François; Greenwood, Brian; Simondon, Kirsten

doi:10.4269/ajtmh.2007.77.411

Cited by 30 publications

(19 citation statements)

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“…We did not detect any difference between the intervention and control arms in wasting, stunting, or under weight. This finding is consistent with a previous study in Senegal [25], which did not find evidence of an impact of IPTc on wasting, stunting, or being under weight at the end of the transmission season but only on triceps and subscapular skinfold, indicators that were not assessed in our study. However, in line with the Senegalese study, we found an increase in weight gain in the IPTc arm compared to the control arm during the course of the intervention period.…”

Section: Discussionsupporting

confidence: 94%

Intermittent Preventive Treatment of Malaria Provides Substantial Protection against Malaria in Children Already Protected by an Insecticide-Treated Bednet in Mali: A Randomised, Double-Blind, Placebo-Controlled Trial

et al. 2011

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Section: Discussionsupporting

confidence: 94%

Intermittent Preventive Treatment of Malaria Provides Substantial Protection against Malaria in Children Already Protected by an Insecticide-Treated Bednet in Mali: A Randomised, Double-Blind, Placebo-Controlled Trial

et al. 2011

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“…Administration of a total of 1700 doses of SP to 546 children (on an average of 3.1 occasions per child) prevented 101 episodes of malaria during an average period of follow up of 2.7 months, a saving of 1 clinical episode of malaria for every 17 doses of SP given, a figure comparable to that seen in studies of IPTi. The reduction in the number of clinical episodes of malaria was associated with a 27% reduction in the overall number of clinic visits during the follow-up period and children who received SP were better nourished than those who received placebo, consistent with findings in other studies of IPT in children [29]. Deaths and hospital admissions were fewer in children who received SP than in those who received placebo but numbers of events are too small for conclusions to be drawn.…”

Section: Discussionsupporting

confidence: 84%

Prevention of the Recurrence of Anaemia in Gambian Children Following Discharge from Hospital

et al. 2010

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BackgroundIn malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective.MethodsDuring the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration <7 g/dL) were randomised to receive either monthly sulfadoxine-pyrimethamine (SP) or placebo until the end of the malaria transmission season in which they were enrolled, in a double-blind trial. All study subjects were treated with oral iron for 28 days and morbidity was monitored through surveillance at health centres. The primary endpoint was the proportion of children with moderate or severe anaemia at the end of the transmission season. Secondary endpoints included the incidence of clinical episodes of malaria during the surveillance period, outpatient attendances, the prevalence of parasitaemia and splenomegaly, nutritional status at the end of the malaria transmission season and compliance with the treatment regimen.ResultsThe proportions of children with a Hb concentration of <7 g/dL at the end of the malaria transmission season were similar in the two study groups, 14/464 (3.0%) in children who received at least one dose of SP and 16/471 (3.4%) in those who received placebo, prevalence ratio 0.89 (0.44,1.8) P = 0.742. The protective efficacy of SP against episodes of clinical malaria was 53% (95% CI 37%, 65%). Treatment with SP was safe and well tolerated; no serious adverse events related to SP administration were observed. Mortality following discharge from hospital was low among children who received SP or placebo (6 in the SP group and 9 in the placebo group respectively).ConclusionsIntermittent treatment with SP did not reduce the proportion of previously anaemic children with moderate or severe anaemia at the end of the malaria season, although it prevented malaria. The combination of appropriate antimalarial treatment plus one month of iron supplementation and good access to healthcare during follow-up proved effective in restoring haemoglobin to an acceptable level in the Gambian setting.Trial RegistrationClinicalTrials.gov NCT00131716

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“…In this study, we sought to determine whether malaria morbidity management might be an explanation for the impressive 42% decrease in prevalence of stunting (from 28.3 to 16.3%) observed in both placebo and malaria-preventively treated children at the end of the 2002-2003 IPT study (11). Indeed, all children included in this study benefited from weekly active malaria case detection by home visits and prompt treatment.…”

Section: Discussionmentioning

confidence: 94%

“…The intervention was highly successful; the risk of a clinical attack was reduced by 86% (10). The prevalence of wasting increased significantly in the control group during the transmission season but remained constant in intervention children (11). In addition, an unexpected 42% decrease in stunting was observed in both groups during follow-up: from 28.3% (95% CI: 25.6-31.0) at inclusion to 16.3% (95% CI: 13.9-18.7) 15 mo later at the end of the intervention (P , 0.0001).…”

Section: Introductionmentioning

confidence: 89%

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Active Malaria Morbidity Management Has Limited Impact on Height Status of Preschool Senegalese Children ,

Fillol

Cournil

Cames

et al. 2010

The Journal of Nutrition

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Although infections contribute to growth faltering in preschool children, malaria prevention seems to have limited impact on height status. In 2002-2003, a malaria intermittent preventive treatment (IPT) trial was conducted in Senegal, including randomly selected preschool children from 11 villages. A rapid decrease in stunting prevalence (from 28.3 to 16.3%; P < 0.0001) was reported in both intervention and placebo groups. During this 15-mo period, both groups of children benefited from active detection and prompt treatment of malaria attacks. In this study, we investigated whether management of malaria morbidity could explain the improvement of height status. An anthropometric survey, conducted in September 2004 in the area, included 929 2- to 5-y-old children. Some 539 children, previously included in the 2002-2003 IPT trial, benefited from active malaria morbidity management and formed the malaria trial group. The remaining 390 children constituted the control group. Mean height-for-age and stunting prevalence in September 2004 were compared between groups adjusting for age and mother's activity. Mean height-for-age Z-scores did not differ between trial (-1.17 +/- 0.93) and control children (-1.24 +/- 1.00; P = 0.25). Only 36- to 47-mo-old malaria trial children had a lower prevalence of stunting than controls of similar age (19.4 vs. 28.7%; P = 0.044). Compared with the usually slow progression of height status related to better living conditions, it seems very likely that the rapid improvement observed among IPT study children resulted from the trial. These findings suggest that improved health services provided by the trial may also have benefited children not included living in study villages.

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Impact of Intermittent Preventive Anti-Malarial Treatment on the Growth and Nutritional Status of Preschool Children in Rural Senegal (West Africa)

Cited by 30 publications

References 27 publications

Intermittent Preventive Treatment of Malaria Provides Substantial Protection against Malaria in Children Already Protected by an Insecticide-Treated Bednet in Mali: A Randomised, Double-Blind, Placebo-Controlled Trial

Intermittent Preventive Treatment of Malaria Provides Substantial Protection against Malaria in Children Already Protected by an Insecticide-Treated Bednet in Mali: A Randomised, Double-Blind, Placebo-Controlled Trial

Prevention of the Recurrence of Anaemia in Gambian Children Following Discharge from Hospital

Active Malaria Morbidity Management Has Limited Impact on Height Status of Preschool Senegalese Children ,

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