Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, Mali.
BMC Public Health. 2011 Jul 18;11:573. doi: 10.1186/1471-2458-11-573.
Even though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with Sulfadoxine-Pyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met. However IPTi may also increase the adherence of the community to EPI services and improve EPI coverage, once the benefice of strategy is perceived.
To assess the impact of IPTi implementation on the coverage of EPI vaccines, 22 health areas of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The EPI vaccines coverage was assessed using cross-sectional surveys at baseline in November 2006 and after one year of IPTi pilot-implementation in December 2007.
At baseline, the proportion of children of 9-23 months who were completely vaccinated (defined as children who received BGG, 3 doses of DTP/Polio, measles and yellow fever vaccines) was 36.7% (95% CI 25.3% -48.0%). After one year of implementation of IPTi-SP using routine health services, the proportion of children completely vaccinated rose to 53.8% in the non intervention zone and 69.5% in the IPTi intervention zone (P <0.001).The proportion of children in the target age groups who received IPTi with each of the 3 vaccinations DTP2, DTP3 and Measles, were 89.2% (95% CI 85.9%-92.0%), 91.0% (95% CI 87.6% -93.7%) and 77.4% (95% CI 70.7%-83.2%) respectively. The corresponding figures in non intervention zone were 2.3% (95% CI 0.9% -4.7%), 2.6% (95% CI 1.0% -5.6%) and 1.7% (95% CI 0.4% - 4.9%).
This study shows that high coverage of the IPTi can be obtained when the strategy is implemented using routine health services and implementation results in a significant increase in coverage of EPI vaccines in the district of Kolokani, Mali.
虽然磺胺多辛-乙胺嘧啶间歇性预防疗法（IPTi）对婴儿的临床疾病疗效以及与扩大免疫规划（EPI）常规疫苗无相互作用已经得到证实，但在非洲，添加 IPTi 仍存在一些担忧，因为这可能会增加工作负担并扰乱常规 EPI 服务，特别是在目标免疫覆盖率仍有待达到的地区。然而，一旦认识到该策略的益处，IPTi 还可能提高社区对 EPI 服务的依从性并提高 EPI 覆盖率。
为了评估 IPTi 实施对 EPI 疫苗覆盖率的影响，将科洛卡尼区的 22 个卫生区按 1:1 的比例随机分配，分别接受 IPTi-SP 或作为对照。使用横断面调查在 2006 年 11 月基线时和 2007 年 12 月 IPTi 试点实施一年后评估 EPI 疫苗覆盖率。
在基线时，9-23 个月龄儿童完全接种疫苗的比例（定义为接受 BGG、3 剂 DTP/脊髓灰质炎、麻疹和黄热病疫苗的儿童）为 36.7%（95%CI 25.3%-48.0%）。在使用常规卫生服务实施 IPTi-SP 一年后，非干预区儿童完全接种疫苗的比例上升至 53.8%，干预区上升至 69.5%（P<0.001）。在目标年龄组中，接受每剂 DTP2、DTP3 和麻疹疫苗的儿童中，接受 IPTi 的比例分别为 89.2%（95%CI 85.9%-92.0%）、91.0%（95%CI 87.6%-93.7%）和 77.4%（95%CI 70.7%-83.2%）。非干预区的相应数字分别为 2.3%（95%CI 0.9%-4.7%）、2.6%（95%CI 1.0%-5.6%）和 1.7%（95%CI 0.4%-4.9%）。
本研究表明，当使用常规卫生服务实施该策略时，可获得较高的 IPTi 覆盖率，并且该策略在科洛卡尼区实施后，EPI 疫苗覆盖率显著提高。
