In high endemic areas, malaria infection and its adverse effects in schoolchildren may be prevented by intermittent preventive treatment (IPTsc). However, little evidence is available and the most appropriate drug regimen for IPTsc still needs to be identified.
To determine the most promising drug regimen for IPT in schoolchildren (IPTsc), we conducted a systematic review of previous available data. Only five studies were identified as IPTsc. Dihydroartemisinin-piperaquine (DP) given monthly provided the highest protection against asymptomatic and clinical malaria and anaemia. Contrarily, Sulfadoxine-pyrimethamine (SP) was the poorest drug regimen, and should not be considered for IPTsc in settings of SP resistance. However, combination of two long hall-life (SP+AQ) showed acceptable protection against asymptomatic and clinical malaria and anaemia, while allowing a four-monthly dosing interval, suggesting that other combinations of two half-life drugs should be prioritized for further investigational trials.
A randomized controlled trial (RCT) was conducted to evaluate the efficacy and safety of SP and SP plus piperaquine (PQ) as IPT in Congolese schoolchildren. Baseline data showed that malaria parasitaemia was highly prevalent and strongly associated to anaemia. This RCT portrayed that SP+PQ should be considered as an effective drug regimen to prevent malaria in schoolchildren. In contrast, SP alone appeared to be not effective for IPTsc.
We conducted a qualitative research, following the RCT, to understand the school community perception and experience with IPTsc. The results reveal that some parents/legal tutors were reluctant to IPTsc because the drugs used were believed to be unsafe. Most adherent parents/ legal tutors preferred to confirm a malaria infection before treatment. The possibility of allowing teachers to give IPTsc drugs was not accepted by of parents. Willing parents required a short training in order to enable them to safely administer drugs to children.
Intermittent preventive treatment using SP+PQ may be a good option for malaria prevention in schoolchildren living in endemic area for malaria. However, more studies evaluating this combination in other endemic areas must be conducted to bring more evidence of its effectiveness and efforts to increase awareness must be invested to facilitate a successful implementation of IPTsc.