Department of Medicine, Makerere University, College of Health Sciences, PO Box 7475, Kampala, Uganda; Infectious Disease Research Collaboration, School of Public Health, Makerere University, Kampala, Uganda; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, United States; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom; Malaria Public Health and Epidemiology Group, Kenya Medical Research Institute, Wellcome Trust Collaborative Programme, Nairobi, Kenya
Nankabirwa, J.I., Department of Medicine, Makerere University, College of Health Sciences, PO Box 7475, Kampala, Uganda, Infectious Disease Research Collaboration, School of Public Health, Makerere University, Kampala, Uganda; Wandera, B., Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda; Amuge, P., Department of Medicine, Makerere University, College of Health Sciences, PO Box 7475, Kampala, Uganda; Kiwanuka, N., Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda; Dorsey, G., Department of Medicine, San Francisco General Hospital, University of California, San Francisco, United States; Rosenthal, P.J., Department of Medicine, San Francisco General Hospital, University of California, San Francisco, United States; Brooker, S.J., Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom, Malaria Public Health and Epidemiology Group, Kenya Medical Research Institute, Wellcome Trust Collaborative Programme, Nairobi, Kenya; Staedke, S.G., Infectious Disease Research Collaboration, School of Public Health, Makerere University, Kampala, Uganda, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom; Kamya, M.R., Department of Medicine, Makerere University, College of Health Sciences, PO Box 7475, Kampala, Uganda, Infectious Disease Research Collaboration, School of Public Health, Makerere University, Kampala, Uganda
Intermittent preventive treatment (IPT) in schoolchildren offers a promising option for malaria control. However, the optimal drug and dosing regimens for IPT remain to be determined. Methods. We conducted a randomized, double-blind, placebo-controlled trial in 740 schoolchildren aged 6-14 years living in a setting of high malaria transmission in Uganda. Enrolled children were randomized to dihydroartemisinin-piperaquine (DP) given once a month (IPTm), DP given once a school term (4 treatments over 12 months, IPTst), or placebo and followed for 12 months. The primary outcome was the incidence of malaria over 12 months. Secondary outcomes included parasite prevalence and anemia over 12 months. Analyses were conducted on an intention-to-treat basis. Results. In the placebo arm, the incidence of malaria was 0.34 episodes per person-year and the prevalence of parasitemia and anemia was 38% and 20%, respectively. IPTm reduced the incidence of malaria by 96% (95% con-fidence interval [CI], 88%-99%, P.0001), the prevalence of asymptomatic parasitemia by 94% (95% CI, 92%-96%, P.0001), and the prevalence of anemia by 40% (95% CI, 19%-56%, P .0001). IPTst had no significant effect on the incidence of symptomatic malaria or the prevalence of anemia, but reduced the prevalence of asymptomatic parasitemia by 54% (95% CI, 47%-60%, P.0001). Conclusions. Monthly IPT with DP offered remarkable protection against clinical malaria, parasitemia, and anemia in schoolchildren living in a high-malaria-transmission setting. Clinical Trials Registration. NCT01231880. © 2014 The Author.
Wellcome Trust; 51941, Wellcome Trust; Wellcome Trust; 087540, Wellcome Trust; FIC, Wellcome Trust; NIH, Wellcome Trust; TW007375, NIH, Wellcome Trust; TW008077, NIH, Wellcome Trust