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Am. J. Trop. Med. Hyg., 74(3), 2006, pp. 386-393
Copyright © 2006 by The American Society of Tropical Medicine and Hygiene

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A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, CLINICAL TRIAL OF THE IMPACT OF MALARIA PREVENTION ON THE EDUCATIONAL ATTAINMENT OF SCHOOL CHILDREN

DEEPIKA FERNANDO*, DAMANI DE SILVA, RICHARD CARTER, KAMINI N. MENDIS, AND RAJITHA WICKREMASINGHE
Department of Parasitology and Department of Psychological Medicine, Faculty of Medicine, Colombo, Sri Lanka; Division of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Roll Back Malaria Project, World Health Organization, Geneva, Switzerland; Department of Community and Family Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka

A double-blind, placebo-controlled trial of nine months duration was carried out to investigate the impact of malaria and its prevention on the educational attainment of school children in a malaria-endemic area in southern Sri Lanka where both Plasmodium falciparum and P. vivax infections are prevalent. A total of 587 children attending grades 1–5 in four schools and resident in the area were randomly allocated to chloroquine (n = 295) and placebo (n = 292) arms. Language and mathematics scores of end-of-term school examinations for 1998 and 1999 and number of days absent and reasons for absenteeism during seven months pre-intervention and nine months of the intervention were recorded. The results indicate that there were no differences in language (95% confidence interval [CI] = 48.44–53.78 in chloroquine group and 50.43–55.81 in placebo group) and mathematics (95% CI = 49.24–54.38 in chloroquine group and 51.12–56.38 in placebo group) scores between the two groups prior to the intervention. During the intervention, the malaria incidence rate decreased by 55% (95% CI = 49–61%) and school absenteeism due to malaria was reduced by 62.5% (95% CI = 57–68%) in children who received chloroquine compared with the placebo group. Post-intervention, children who received chloroquine scored approximately 26% higher in both language (95% CI = 21–31%) and mathematics (95% CI = 23–33%) than children who received placebo. In a multivariate model, educational attainment was significantly associated with taking chloroquine prophylaxis and absenteeism due to malaria (P < 0.001 for both) but not due to health causes other than malaria or non-health causes. Language scores were associated with number of malaria attacks (P < 0.022). Educational attainment was significantly better among children whose compliance to chloroquine prophylaxis was higher (P < 0.001). The data suggest that malarial attacks have an adverse impact on the educational attainment of the school child and prevention of these attacks significantly improves educational attainment of children living in malaria-endemic areas.

Received April 13, 2005. Accepted for publication October 22, 2005.

Acknowledgments: We thank Anusha Gallewate, Jagath Rajakaruna, and Sudath Weerasinghe for technical assistance, and Dr. Shiroma Handunetti, the staff of the Malaria Research Unit, and the staff of the Department of Parasitology, University of Colombo for their cooperation.

Financial support: This study was supported by the United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases (grant no. 970315).

* Address correspondence to Deepika Fernando, Department of Parasitology, Faculty of Medicine, P.O. Box 271, Kynsey Road, Colombo 8, Sri Lanka. E-mail: deepfern{at}slt.lk

Authors’ addresses: Deepika Fernando, Department of Parasitology, Faculty of Medicine, P.O. Box 271, Kynsey Road, Colombo 8, Sri Lanka, Telephone: 94-11-269-9284, Fax: 94-11-259-8014, E-mail: deepfern{at}slt.lk. Damani de Silva, Department of Psychiatry, Faculty of Medicine, P.O. Box 271, Kynsey Road, Colombo 8, Sri Lanka, Telephone: 94-11-269-5300. Richard Carter, Institute of Cell, Animal, and Population Biology, Division of Biological Sciences, University of Edinburgh, Kings Building, West Mains Road, Edinburgh EH9 3JT, United Kingdom, Telephone: 44-122-740-0764, Fax: 44-131-668-3861. Kamini N. Mendis, Roll Back Malaria Project, World Health Organization, CH-1211, Geneva 27, Switzerland, Telephone: 41-22-740-0764, Fax: 41-22-791-4854. Rajitha Wickremasinghe, Department of Community and Family Medicine, Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, Sri Lanka, Telephone: 94-11-259-8014, Fax: 94-11-259-8014.

Reprint requests: Deepika Fernando, Department of Parasitology, Faculty of Medicine, P.O. Box 271, Kynsey Road, Colombo 8, Sri Lanka, E-mail: deepfern{at}slt.lk.




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Copyright © 2006 by the American Society of Tropical Medicine and Hygiene.