Community Effectiveness of Intermittent Preventive Treatment delivered through the Expanded Programme of Immunisation for Malaria and Anaemia Control in Tanzanian Infants.

Sponsor: Bill & Melinda Gates Foundation
IHRDC investigators: F Manzi, M Mrisho, A Mushi, S Charles, K Shirima, S Abdulla, J Armstrong Schellenberg, H Mshinda, D Schellenberg,

Partners: Pedro Alonso, Clara Menendez; IDIBAPS, Hospital Clinic, Barcelona, Spain & Robert Pool, Cally Roper; London School of Tropical Medicine and Hygiene, UK & Guy Hutton, Marcel Tanner; Swiss Tropical Institute, Basle, Switzerland

In 2001 the results of an Ifakara-based controlled trial of intermittent preventive malaria treatment in infants (IPTi) showed that treatment doses of antimalarial given to children at the time of routine vaccinations in the first year of life reduced the incidence of clinical malaria by 59% and halved the amount of severe anaemia. There were also useful reductions in presentations to hospital with fever (13%) and admission to hospital (30%). IPTi was safe, did not interfere with the serological response to EPI vaccines, cost approximately US$ 0.23 per child and the drug used (sulphadoxine-pyrimethamine) is readily available in Tanzania. Hence it is possible to reduce the rate of clinical malaria and severe anaemia by delivering an available and affordable drug through the existing EPI system in southern Tanzania.

Under the umbrella of the IPTi Consortium, a number of similar studies are now planned or underway to assess the safety and efficacy of IPTi in different settings and to confirm the non-interaction between various antimalarials that may be used for IPTi and EPI vaccines. The IPTi Consortium is generating information to inform a policy recommendation on IPTi. If it is decided to recommend implementation of IPTi, a major challenge would be to transform a positive policy recommendation into public health action in a reasonable timeframe. Because safety and efficacy data already exist for IPTi from Southern Tanzania, this area is in a good position to address the issues surrounding the development and implementation of IPTi as part of a district-based strategy to control malaria.

The new Ifakara IPTi project is a five-year programme that will develop, implement and evaluate a strategy for the delivery of IPTi in five rural districts in southern Tanzania. Comparison of process and outcome indicators in areas with and without the IPTi strategy will provide an opportunity to consolidate the safety profile of IPTi and to evaluate its impact on (i) the rate of development of antimalarial drug resistance, (ii) perceptions and compliance with the EPI programme and (iii) infant health and survival patterns. This effectiveness evaluation will be linked to costing data to produce realistic estimates of cost and cost effectiveness of the IPTi strategy.