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Stop-start drug regimen helps infants against malaria

PARIS: Giving babies a cheap, standard malaria treatment at key points in their first months of life can reduce their risk of falling sick with the disease, trials reported in The Lancet on Thursday, 17 September 2009, say.
Investigators give the green light to this novel pre-emptive approach, although they also sound a warning about its effectiveness in areas where the malaria parasite is resistant to the drug.

The technique has already been tried successfully among pregnant women in areas where malaria is a major problem, raising hopes that it could be adapted for the very young who bear the brunt of this disease.

Intermittent Preventative Treatment in Infants (IPTi) entails giving tiny doses of an antimalarial at several points in the first months of a child's life.

Usually, the drug is used after infection to kill the Plasmodium falciparum parasite, transmitted in a mosquito bite, which causes malaria.

Used in IPTi, though, the drug would be used preventatively, as a defensive measure against the intruder.

A review of six published trials of IPTi, three of them in the West African state of Ghana and the others in Mozambique and Tanzania, found that IPTi, using sulphadoxine-pyrimethadine, was both safe and effective.

Nearly 4,000 infants were given IPTi while 4,000 others were given a harmless, lookalike placebo.

There was no difference in the number of the deaths in the two groups. But there was a significant protective effect among the IPTi infants when it came to the risk of sickness in their first year of life.

IPTi shielded 30% of children in this group against malaria and 21% against malaria-related anaemia. Hospital admissions in this group, caused by both malaria or other diseases, also fell sharply, by up to 38%, compared with the non-IPTi children.

Sulphadoxine-pyrimethadine used to be the frontline drug against malaria, supplanting chloroquine.

It is cheap and well tolerated, but its use has been blunted by the rise of resistance to it in many areas.

A second study, also published in The Lancet, showed that IPTi was useless in high-resistance areas. Mefloquine was effective, but provoked vomiting and other side effects.

There were an estimated 247 million cases of malaria in 2006, leading to nearly 881,000 deaths, according to the website of the World Health Organisation's Global Malaria Programme.

Ninety-one percent of the fatalities were in Africa and 85 percent occurred among children aged under five.

Source: AFP

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