疟疾在儿童接受间歇性预防治疗疟疾后的次年的发病情况：一项随机试验。

Morbidity from malaria in children in the year after they had received intermittent preventive treatment of malaria: a randomised trial.

机构信息

Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.

出版信息

PLoS One. 2011;6(8):e23391. doi: 10.1371/journal.pone.0023391. Epub 2011 Aug 12.

DOI:10.1371/journal.pone.0023391

PMID:21858097

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3155539/

Abstract

BACKGROUND

Interventions that reduce exposure to malaria infection may lead to delayed malaria morbidity and mortality. We investigated whether intermittent preventive treatment of malaria in children (IPTc) was associated with an increase in the incidence of malaria after cessation of the intervention.

METHODS

An individually randomised, trial of IPTc, comparing three courses of sulphadoxine pyrimethamine (SP) plus amodiaquine (AQ) with placebos was implemented in children aged 3-59 months during the 2008 malaria transmission season in Burkina Faso. All children in the trial were given a long lasting insecticide treated net; 1509 children received SP+AQ and 1505 received placebos. Passive surveillance for malaria was maintained until the end of the subsequent malaria transmission season in 2009, and active surveillance for malaria infection, anaemia and malnutrition was conducted.

RESULTS

On thousand, four hundred and sixteen children (93.8%) and 1399 children (93.0%) initially enrolled in the intervention and control arms of the trial respectively were followed during the 2009 malaria transmission season. During the period July 2009 to November 2009, incidence rates of clinical malaria were 3.84 (95%CI; 3.67-4.02) and 3.45 (95%CI; 3.29-3.62) episodes per child during the follow up period in children who had previously received IPT or placebos, indicating a small increase in risk for children in the former intervention arm (IRR = 1.12; 95%CI 1.04-1.20) (P = 0.003). Children who had received SP+AQ had a lower prevalence of malaria infection (adjusted PR: 0.88 95%CI: 0.79-0.98) (P = 0.04) but they had a higher parasite density (P = 0.001) if they were infected. There was no evidence that the risks of moderately severe anaemia (Hb<8 g/dL), wasting, stunting, or of being underweight in children differed between treatment arms.

CONCLUSION

IPT with SP+AQ was associated with a small increase in the incidence of clinical malaria in the subsequent malaria transmission season.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00738946.

摘要

背景

减少疟疾感染暴露的干预措施可能会导致疟疾发病率和死亡率的延迟。我们研究了儿童间歇性预防治疗疟疾（IPTc）是否会导致干预停止后疟疾发病率的增加。

方法

在布基纳法索 2008 年疟疾传播季节期间，对 3-59 个月大的儿童进行了一项个体随机、IPTc 试验，比较了三种磺胺多辛-乙胺嘧啶（SP）+阿莫地喹（AQ）与安慰剂的疗效。所有参加试验的儿童均使用长效驱虫蚊帐；1509 名儿童接受 SP+AQ，1505 名儿童接受安慰剂。在 2009 年随后的疟疾传播季节结束前，持续进行被动疟疾监测，并进行疟疾感染、贫血和营养不良的主动监测。

结果

1416 名（93.8%）和 1399 名（93.0%）最初参加试验干预组和对照组的儿童在 2009 年疟疾传播季节期间接受了随访。2009 年 7 月至 11 月期间，在接受 IPT 或安慰剂治疗的儿童中，临床疟疾的发病率分别为 3.84（95%CI；3.67-4.02）和 3.45（95%CI；3.29-3.62）/儿童。这表明在以前接受 IPT 治疗的儿童中，风险略有增加（IRR=1.12；95%CI 1.04-1.20）（P=0.003）。接受 SP+AQ 的儿童疟疾感染率较低（调整后的 PR：0.88 95%CI：0.79-0.98）（P=0.04），但如果感染，其寄生虫密度较高（P=0.001）。没有证据表明治疗组中度严重贫血（Hb<8 g/dL）、消瘦、发育迟缓或体重不足的风险有差异。