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Monday, July 14, 2008

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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