The Community Effectiveness of IPTi in Southern Tanzania

• Mortality rate in children aged 2-11 months (estimated by birth history questioning) [ Time Frame: Up to 12 months of age ] [ Designated as safety issue: Yes ]
  
• Incidence of severe adverse drug reactions following IPTi (as detected by spontaneous, passive reporting system) [ Time Frame: All age groups, particular attention in under 2 year olds ] [ Designated as safety issue: Yes ]
  

• Prevalence of P falciparum parasitemia in children aged 2-11 months. [ Time Frame: First year of life ] [ Designated as safety issue: No ]
  
• Prevalence of anaemia (Hb<11 g/dL) in children aged 2-11 months. [ Time Frame: First year of life ] [ Designated as safety issue: No ]
  
• Period prevalence of fever without cough or diarrhoea (in preceding 2 weeks) in children aged 2-11 months. [ Time Frame: First year of life ] [ Designated as safety issue: No ]
  

A controlled trial of intermittent preventive malaria treatment in infants (IPTi) in southern Tanzania 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 used for IPTi and EPI vaccines. The aim is to generate robust information to inform a policy recommendation on the use of IPTi. The challenge will be to transform a positive policy recommendation into public health action in a short timeframe. Southern Tanzania is now in the unique position of being able to address the issues surrounding the development and implementation of IPTi as part of a district-based strategy to control malaria.

This project will develop, implement and evaluate a strategy for the delivery of IPTi to communities in five rural districts in southern Tanzania. IPTi will be delivered by routine health services in half of the facilities in the project area. 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. The effectiveness evaluation will be linked to costing data to produce realistic estimates of cost effectiveness of the IPTi strategy.