The effectiveness of an intermittent preventative treatment against malaria in infants across Africa may be inhibited by high incidences of malnutrition say researchers from Charite University Medicine, Berlin, Germany; the University of Tuebingen, Germany; the University of Munich, Germany; and the Northern Region Malaria Project, Tamale, Ghana.
An initial trial in Tanzania of intermittent preventative treatment in infants (IPTi) with sulfadoxine-pyrimethamine (SP), a promising tool for controlling malaria in young children, showed an effective rate of 59% against uncomplicated malaria in infancy. Malnutrition is rampant in some regions of Africa, such as Ghana where approximately 50% of preschool children suffer from poor nutritional status. Previous studies associate greater malaria morbidity and mortality with protein-energy malnutrition suggesting that treatment strategies may fail when not coinciding with proper nutritional programs.
In the study researchers analyzed the impact of malnutrition on the protective efficacy of IPTi in 1,200 children in Northern Ghana where malaria is hyperendemic. The children were administered IPTi-SP or a placebo at 3, 9, and 15 months of age (of which malnutrition was present in 32, 40, and 50% respectively) and monitored until 24 months old. Significant findings showed the protective efficacies of IPTi in malnourished children were about half or even less of those in nonmalnourished children. IPTi was much less effective at reducing the incidence of malaria in malnourished children receiving two doses in the first year of life than in nonmalnourished children. Finally, the rate of severe malaria appeared to increase in malnourished children who took IPTi.
"In conclusion, in northern Ghana, IPTi in malnourished children achieved only roughly half the protective efficacy attainable under normal nutritional conditions," say the researchers. "Moreover, malnourished children did not benefit from IPTi in terms of weight gain or growth and, possibly bear the risk of rare but severe adverse events."
- Danquah et al. Reduced Efficacy of Intermittent Preventive Treatment of Malaria in Malnourished Children. Antimicrobial Agents and Chemotherapy, 2009; 53 (5): 1753 DOI: 10.1128/AAC.01723-08
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