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

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  • London School of Hygiene and Tropical Medicine, London, United Kingdom; Ifakara Health Insititute, Ifakara, Tanzania; National Institute for Medical Research, Muheza, Tanzania; Hospital Clinic I Provincial, Barcelona, Spain; Swiss Tropical Institute, Basel, Switzerland

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.

Author Notes

*Address correspondence to Joanna R. M. Armstrong Schellenberg, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT. E-mail: Joanna.schellenberg@lshtm.ac.uk

Financial support: This study received funding from the Bill and Melinda Gates Foundation through the Intermittent Preventive Treatment in infants (IPTi) consortium (www.ipti-malaria.org). JAS received funding from the Bill and Melinda Gates Foundation through the Gates Malaria Partnership.

Authors' addresses: Joanna R. M. Armstrong Schellenberg and David M. Schellenberg, Department of Infectious and Tropical Disease, LSHTM, London, UK, E-mails: joanna.schellenberg@lshtm.ac.uk and david.schellenberg@lshtm.ac.uk. Kizito Shirima, Werner Maokola, Fatuma Manzi, Mwifadhi Mrisho, and Hassan Mshinda, Ifakara Health Institute, Dar es Salaam, Tanzania, E-mails: kshirima@ihi.or.tz, drwernerm@yahoo.com, fmanzi@ihi.or.tz, mmrisho@ihi.or.tz, and hmshinda@ihi.or.tz. Adiel Mushi, National Institute for Medical Research, Muheza, Tanzania, E-mail: adiel.mushi@gmail.com. Pedro Alonso, CRESIB, Hospital Clinic i Provincial, Barcelona, Spain, E-mail: palonso@clinic.ub.es. Marcel Tanner, Swiss Tropical and Public Health Institute, Basel, Switzerland, E-mail: marcel.tanner@unibas.ch.

Reprint requests: Joanna R. M. Armstrong Schellenberg, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, E-mail: Joanna.schellenberg@lshtm.ac.uk.

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