EFFECTIVENESS OF EFFECTIVENESS OF INTERMITTENT PREVENTIVE INTERMITTENT PREVENTIVE TREATMENT OF MALARIA IN TREATMENT OF MALARIA IN

SUB-SAHARAN AFRICAN SUB-SAHARAN AFRICAN INFANTS.INFANTS.

BYMUKHTAR .A. IJAIYA

The Burden of MalariaThe Burden of Malaria

In 2010, approximately 216,000,000 episodes of malaria was recorded worldwide with 655,000 deaths.

Africa accounts for an estimated 81% of the incidence rate and 91% of the mortality rate.

An African child under five dies of malaria approximately EVERY MINUTE.

(WHO 2011a)

MALARIAMALARIA Preventable and Curable. Caused by Plasmodium Species. Transmitted by the Vector; Anopheles

Mosquito. High Risk persons: Young Children,

Pregnant Women, Persons living with HIV/AIDS, Travellers from non endemic areas to endemic areas.

Diagnosed by parasitological examination in the laboratory or with rapid test kits.

(WHO 2012)

MALARIAMALARIA Symptoms: Fever, Headache, Chills,

Nausea, Vomiting (Dale et al, 2007). Severe Malaria further presents : Severe

anaemia, Respiratory distress, Shock, Multiple Organ Failure (Goldsmith 2006).

Prevention: Mainly directed at Vector Control and Chemoprevention (WHO 2012).

Treatment: WHO (2005) recommends Artemisinin based Combination Therapy (ACT).

REASONS FOR THE HEAVY REASONS FOR THE HEAVY MALARIA BURDEN IN SUB-MALARIA BURDEN IN SUB-SAHARAN AFRICAN INFANTS.SAHARAN AFRICAN INFANTS.

Predominance of the deadly Plasmodium falciparum strain (WHO 2008).

Long lifespan and strong human biting habit of the African vector species (WHO 2012).

Favourable climatic conditions (WHO 2012).

Poor Socioeconomic factors/indices (WHO 2008, UNDP 2012)

Lack of acquired protective immunity in infants (WHO 2008).

CURRENT MALARIA CONTROL CURRENT MALARIA CONTROL PROGRAMME.PROGRAMME. Africa Roll Back Malaria partnership which

involves: Proper organization and management of health

systems. Improved disease management. Provision of antimalarial drugs with malaria

control related materials. Increased disease prevention and disease

surveillance. Epidemic preparedness and response. Human resources development. Legislative action and sustainable control

(WHO 2003).

INTERMITTENT PREVENTIVE INTERMITTENT PREVENTIVE TREATMENTTREATMENT IN INFANTS (IPTi). IN INFANTS (IPTi). Intermittent preventive therapy in infants involves

administering to infants at specific time points, a complete course of an effective antimalarial medication with the objective of reducing the infant malaria burden regardless of whether they are parasitaemic or not (WHO 2009).

The infants should receive the anti malaria drug administration with routine vaccinations in their first year of life with exact timing dictated by the country’s immunization schedule (WHO 2011b).

The WHO (2009) recommends Sulfadoxine-Pyrimethamine (SP) as the Drug of Choice.

TRIALSTRIALS Amponsa-Achiano et al (2005), used

SP with iron supplementation for IPTi in Ghana.

Incidence rates of mild to moderate malaria and anaemia declined.

No effect on severe malaria and mortality rates.

High density of Parasitaemia some months after IPTi, suggesting rebound morbidity.

Verhoeff and West (2003), severe anaemia controlled by malaria control and iron intake.

TRIALSTRIALS Adjei et al (2009) pooled analysis of six

trials in African infants using SP. Reduction in clinical malaria, hospital

admissions and anaemia incidence rates.

No effect on mortality rates, no adverse effects, no interaction with vaccines and no rebound morbidity seen.

Mildly effective in areas of high parasite resistance and greater efficacy when combined with the use of bednets.

TRIALSTRIALS Carneiro et al (2009), safety and

efficacy of three regimens for IPTi in an area of high SP parasite resistance.

SP, well tolerated but not significantly effective.

Mefloquine, highly efficacious but badly tolerated.

Chlorproguanil-Dapsone, not effective and caused an increased risk of anaemia.

TRIALSTRIALS Alexander et al (2006),

combined use of artesunate and SP for IPTi in African Children.

Impressive amount of protection conferred.

Infants showed a stronger persistent protective effect.

No rebound morbidity observed.

TRIALSTRIALS Akida et al (2003), used

Amodiaquine for IPTi in Tanzanian infants.

Decrease in incidence of clinical malaria.

No rebound morbidity observed.Well tolerated but previously

documented adverse reactions remained an issue.

TRIALSTRIALS Breman and Rosen (2004) and

Crawley et al (2012) have noted that IPTi has no impact whatsoever on immune responses to vaccines.

Widespread efficacy of IPTi depends on the coverage rates of the Expanded programme on immunization (Kruger 2004).

Alonso et al (2009), calculated and found IPTi to be a highly cost effective intervention in African infants.

CONCLUSION.CONCLUSION.

Sulfadoxine-Pyrimethamine (SP) for IPTi should be included in existing malaria prevention strategies in areas of low parasite resistance and a greater emphasis placed on improving socioeconomic conditions.

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