Intermittent Preventive Treatment For Malaria In Schoolchildren Also Improves Attention Span

In treating malaria in schoolchildren in Africa, the use of intermittent preventive treatment (IPT) not only lowers the prevalence of anemia but also improves attention span in the children. These conclusions, published in an Article released on July 11, 2008 in The Lancet, could help guide future interventions in this and similar settings.

Malaria, a major cause of death and disease around the world often affects children, but its consequences on health and education during the school age years is poorly understood. Historically, standard treatments and chemical prevention methods have been effective, and are associated with lower rates of malarial parasite infection, severe anemia (a major symptom of malaria) and malaria related deaths. This results in reduced school absenteeism.

Though these therapies and methods might largely be effective, they may be too expensive to effectively implement in sub-Saharan Africa. Additionally, subclinical infections are common in the population, making directed therapies difficult. An alternative therapy, intermittent preventive treatment involves mass distribution of a full course of anti-malarial treatment, regardless of the infection status of each individual.

To investigate the effects of IPT on the biological and educational effects of malaria, Dr. Sian Clarke, London School of Hygiene and Tropical Medicine (LSHTM), UK, and colleagues performed a randomized controlled trial on children between the ages of 5 and 18 years from 30 primary schools in an area of Western Kenya with high malaria transmission rates.

IPT was administered to 2,604 children, composed of three treatments of sulfadoxine-pyrimethamine in combination with amodiaquine at four month intervals. Meanwhile, a group of 2,302 students received a placebo. The children were evaluated for anemia, defined as a hemoglobin concentration below 110g/L. A reduction in malaria occurrence was associated with IPT after 12 months. That is, prevalence of parasite presence was <5% in the IPT group in comparison with 39.7% in the placebo group. Additionally, anemia levels decreased, and the prevalence of anemia was 6.3% in the IPT group in comparison with 12.6% in the placebo group. Finally, in classroom-based tests of sustained attention, IPT group participants showed significant improvement in comparison with students in the placebo group. This effect, however, showed no effect on educational achievement or hyperactive-compulsive behaviors.

The authors conclude with a statement about the potential benefits of this new treatment if used in new policy in these areas. "The pronounced effects of the IPT intervention on anemia and malaria parasitemia, and the effect on sustained attention, highlight the issue of the continued, and often unrecognized, malaria burden among school-aged children in Africa and the potential of school-based programs for tackling the problem. Our findings also illustrate the possible gains of integrating malaria control into broader school health programs."

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Females With High Birth Weight More Likely To Develop Rheumatoid Arthritis

A new study published in the Annals of the Rheumatic Diseases finds that compared to females born with average birth weight, those born with heavy birth weight are two times as likely to develop rheumatoid arthritis when they become adults. Rheumatoid arthritis is a condition that occurs when the immune system attacks the joints, lungs or skin and results in inflammation, pain, and loss of functioning mobility.

Researcher L. A. Mandl (Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College) and colleagues argue that these findings support the fetal origin of disease theory. That is, factors that occur during pregnancy program an individual to be more prone to certain diseases and conditions in adult life. For example, previous research has linked low birth weight to conditions such as diabetes, coronary heart disease, and high blood pressure, and high birth weight has been associated with an increased risk of breast cancer and leukemia.

These new findings on rheumatoid arthritis development come from a survey of more than 87,000 women, age 30 to 55, who took part in the US Nurses' Health Study from 1976 and 2002. In two year intervals, the women responded to questions about their health, lifestyle, and family illness. In 1992, researchers asked them questions about birth weight.

Between 1976 and 2002, 619 women received their first diagnosis of rheumatoid arthritis. The average birth weight was between 3.2 to 3.85 kg, and women who weighed over 4.45 kg at birth were found to be twice as likely to develop the autoimmune disease known as rheumatoid arthritis. These findings held after the researchers statistically controlled for factors that may influence birth weight such as socioeconomic status, parental smoking, maternal diabetes, age at first period, use of oral contraceptives or hormone replacement therapy, breastfeeding and weight.

Though the authors do not have a clear biological explanation for their results, they do note that abnormal hormone regulation - a process thought to affect a baby while in the womb - is prevalent in adults with rheumatoid arthritis.

The authors conclude that: "The biology underlying this association is speculative, and the relative importance of fetal nutrition versus genotype is unknown. However, if fetal nutrition has an impact on future risk of RA [rheumatoid arthritis], this could be a potentially modifiable risk factor. Further study of our observation that high birth weight is associated with an increased risk of RA could provide insight into the pathogenesis of RA. These data also provide further evidence for the importance of fetal environment as a crucible for future adult diseases."

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