advanced search

<< Back To Home

WHAT'S NEW THIS FRIDAY: THREE ON MALARIA: IRS IMPACT, PRENATAL S-P, IPTc IN GHANA

Thursday, 12th of July 2012

 

THREE ON MALARIA

• REDUCTION OF MALARIA PREVALENCE BY INDOOR RESIDUAL SPRAYING: A META-REGRESSION ANALYSIS

 

Dohyeong Kim*, Kristen Fedak and Randall Kramer

Am J Trop Med Hyg 2012 vol. 87 no. 1 117-124

 

Abstract below; full text is at

http://www.ajtmh.org/content/87/1/117.full.pdf+html

Indoor residual spraying (IRS) has become an increasingly popular method of insecticide use for malaria control, and many recent studies have reported on its effectiveness in reducing malaria burden in a single community or region. There is a need for systematic review and integration of the published literature on IRS and the contextual determining factors of its success in controlling malaria. This study reports the findings of a meta-regression analysis based on 13 published studies, which were chosen from more than 400 articles through a systematic search and selection process. The summary relative risk for reducing malaria prevalence was 0.38 (95% confidence interval = 0.31–0.46), which indicated a risk reduction of 62%. However, an excessive degree of heterogeneity was found between the studies. The meta-regression analysis indicates that IRS is more effective with high initial prevalence, multiple rounds of spraying, use of DDT, and in regions with a combination of Plasmodium falciparum and P. vivax malaria.

       Expand+

Clinical Infectious Diseasescid.oxfordjournals.org

First published online: March 22, 2012

ANTENATAL RECEIPT OF SULFADOXINE-PYRIMETHAMINE DOES NOT EXACERBATE PREGNANCY-ASSOCIATED MALARIA DESPITE THE EXPANSION OF DRUG-RESISTANT PLASMODIUM FALCIPARUM

Clin Infect Dis. (2012) 55 (1): 42-50.

1. 1.   Steve M. Taylor, Alejandro L. Antonia, Ebbie Chaluluka, Victor Mwapasa,  Gaoqian Feng,

  Malcolm E. Molyneux, Feiko O. ter Kuile, Steven R. Meshnick, and Stephen J. Rogerson

1. Correspondence: Steve M. Taylor, MD, MPH, Department of Epidemiology, Gillings School of Global Public Health, Campus Box 7435, Chapel Hill, NC 27599 (taylo115@email.unc.edu).

Abstract below and at http://cid.oxfordjournals.org/content/55/1/42.abstract

 Full text available to journal subscribers

Background. Antenatal intermittent preventive therapy with 2 doses of sulfadoxine-pyrimethamine (IPTp-SP) is the mainstay of efforts in sub-Saharan Africa to prevent pregnancy-associated malaria (PAM). Recent studies report that drug resistance may cause IPTp-SP to exacerbate PAM morbidity, raising fears that current policies will cause harm as resistance spreads.

Methods. We conducted a serial, cross-sectional analysis of the relationships between IPTp-SP receipt, SP-resistant Plasmodium falciparum, and PAM morbidity in delivering women during a period of 9 years at a single site in Malawi. PAM morbidity was assessed by parasite densities, placental histology, and birth outcomes.

Results. The prevalence of parasites with highly SP-resistant haplotypes increased from 17% to 100% (P < .001), and the proportion of women receiving full IPTp (≥2 doses) increased from 25% to 82% (P < .001). Women who received full IPTp with SP had lower peripheral (P = .018) and placental (P < .001) parasite densities than women who received suboptimal IPTp (<2 doses). This effect was not significantly modified by the presence of highly SP-resistant haplotypes. After adjustment for covariates, the receipt of SP in the presence of SP-resistant P. falciparum did not exacerbate any parasitologic, histologic, or clinical measures of PAM morbidity.

Conclusions. In this longitudinal study of malaria at delivery, the receipt of SP as IPTp did not potentiate PAM morbidity despite the increasing prevalence and fixation of SP-resistant P. falciparum haplotypes. Even when there is substantial resistance, SP may be used in modified IPTp regimens as a component of comprehensive antenatal care.

 

• VILLAGE HEALTH WORKERS PROVIDING IPTc IN GHANA

 

PLoS One. 2011;6(11):e24871. Epub 2011 Nov 3.

 

Full text is at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0024871

 

Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana

Patouillard E, Conteh L, Webster J, Kweku M, Chandramohan D, Greenwood B.

Source

Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England. Edith.Patouillard@lshtm.ac.uk

Abstract

BACKGROUND:

Intermittent preventive treatment of malaria in children (IPTc) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxine-pyrimethamine plus amodiaquine (SP&AQ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy.

METHODS:

A community randomized trial was undertaken in Jasikan district, Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways. Twelve villages were randomly selected to receive IPTc from village health workers (VHWs) or facility-based nurses working at health centres' outpatient departments (OPD) or EPI outreach clinics. Children aged 3 to 59 months-old received one IPT course (three doses) in May, June, September and October. Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective.

RESULTS:

The economic cost per child receiving at least the first dose of all 4 courses was US$4.58 when IPTc was delivered by VHWs, US$4.93 by OPD nurses and US$ 5.65 by EPI nurses. The unit economic cost of receiving all 3 doses of all 4 courses was US$7.56 and US$8.51 when IPTc was delivered by VHWs or facility-based nurses respectively. The main cost driver for the VHW delivery was supervision, reflecting resources used for travelling to more remote communities rather than more intense supervision, and for OPD and EPI delivery, it was the opportunity cost of the time spent by nurses in dispensing IPTc.

CONCLUSIONS:

VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district, Ghana.