Institut National de Santé Publique, Bamako, Mali.
Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
Am J Trop Med Hyg. 2022 Aug 22;107(4):796-803. doi: 10.4269/ajtmh.21-1218. Print 2022 Oct 12.
Intermittent preventive treatment of malaria among schoolchildren (IPTsc) reduces clinical malaria, asymptomatic parasitemia, and anemia. The effects of IPTsc by gender have not been studied longitudinally. We investigated overall IPTsc efficacy and conducted a secondary analysis to explore gender-specific differences. We enrolled schoolchildren aged 6-13 years in an open-label, rolling-cohort randomized controlled trial between September 2007 and February 2013 in Kolle, Mali. Annually, schoolchildren received two full-treatment courses of sulfadoxine-pyrimethamine (SP) plus artesunate, or amodiaquine (AQ) plus artesunate, or no malaria treatment as control. We used mixed-effects generalized linear models to estimate differences in treatment outcomes across groups with interaction terms to explore gender-specific differences associated with Plasmodium falciparum infection, hemoglobin, and grade point averages (GPA) based on standardized testing. Overall, 305 students contributed 4,564 observations. Compared with the control, SP plus artesunate and AQ plus artesunate reduced the odds of P. falciparum infection (odds ratio [OR]: 0.33, 95% CI: 0.26-0.43; OR: 0.46, 95% CI: 0.36-0.59). We found strong evidence of increased mean hemoglobin concentrations (g/dL) in the SP plus artesunate group versus control (difference +0.37, 95% CI: 0.13-0.58). Collectively, schoolchildren given AQ plus artesunate had higher mean GPA (difference +0.36, 95% CI: 0.02-0.69) relative to control. Schoolgirls, compared with schoolboys, given SP plus artesunate had greater improvement in GPA (+0.50, 95% CI: -0.02 to 1.02 versus -0.27, 95% CI: -0.71 to 0.16); interaction P = 0.048, respectively. The IPTsc decreases P. falciparum infections in schoolchildren. Treatment regimens that include longer-acting drugs may be more effective at decreasing malaria-related anemia and improving educational outcomes as observed among girls in this setting.
间歇性预防治疗疟疾在学童中的应用（IPTsc）可降低临床疟疾、无症状寄生虫血症和贫血的发生率。IPTsc 对不同性别的影响尚未进行纵向研究。我们调查了 IPTsc 的总体疗效，并进行了二次分析以探索性别特异性差异。我们于 2007 年 9 月至 2013 年 2 月在马里的科勒招募了年龄在 6-13 岁的在校儿童，进行了一项开放标签、滚动队列随机对照试验。每年，在校儿童接受两剂完整的磺胺多辛-乙胺嘧啶（SP）加青蒿琥酯、阿莫地喹（AQ）加青蒿琥酯或不接受疟疾治疗作为对照。我们使用混合效应广义线性模型来估计各组之间治疗结果的差异，并使用交互项来探索基于标准化测试的与间日疟原虫感染、血红蛋白和平均绩点（GPA）相关的性别特异性差异。总体而言，305 名学生共提供了 4564 次观察。与对照组相比，SP 加青蒿琥酯和 AQ 加青蒿琥酯降低了间日疟原虫感染的可能性（优势比 [OR]：0.33，95%CI：0.26-0.43；OR：0.46，95%CI：0.36-0.59）。我们发现 SP 加青蒿琥酯组与对照组相比，血红蛋白浓度（g/dL）平均升高（差异+0.37，95%CI：0.13-0.58），证据确凿。与对照组相比，接受 AQ 加青蒿琥酯治疗的在校儿童的平均 GPA 更高（差异+0.36，95%CI：0.02-0.69）。与男校相比，接受 SP 加青蒿琥酯治疗的女校女生 GPA 提高幅度更大（差异+0.50，95%CI：-0.02 至 1.02 与-0.27，95%CI：-0.71 至 0.16）；交互 P=0.048。IPTsc 降低了在校儿童的间日疟原虫感染。在该环境中，包括作用时间更长的药物的治疗方案可能更有效地降低疟疾相关贫血和改善教育成果。
