Leading scientists from an ambitious international consortium charged with evaluating the potential of Intermittent Preventive Treatment in Infants (IPTi) will explore the results of a recent clinical trial in Ghana and preliminary evidence from other IPTi research underway in Africa. IPTi has the potential to become a major tool for malaria control in Africa as it may be delivered at the time of routine childhood vaccination--through the Expanded Program on Immunization (EPI)--which increases the chance of long-term sustainability.
Researchers will discuss these topics at a special IPTi symposium to be held at this week's Fourth Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference. (Thursday, 9:00 a.m., Mongosi Hall, Symposium 14) The symposium comes on the heels of last month's publication of results from the Ghana trial, which showed for the first time that IPTi can be effective at preventing malaria in areas of intense and highly seasonal transmission.
"What we have at the moment is a new prevention strategy that has shown clear potential," said Andrea Egan, coordinator of the IPTi Consortium. "The IPTi Consortium was formed to enable researchers to investigate the questions that need to be resolved if IPTi is to become a widely used tool for fighting malaria. The MIM symposium is a timely opportunity to discuss the results from the Ghana trial and other IPTi studies with the international malaria research and control communities. We aim to balance what we know is an urgent demand for new malaria prevention strategies with the need for clear evidence of safety and effectiveness in multiple settings."
As for determining the effectiveness of IPTi, consortium members recently launched a broad "implementation study" in Tanzania to assess the safety and effectiveness of IPTi by making it available through routine health services in five rural districts in Southern Tanzania. This study will provide more in depth analysis of the treatment's ability to prevent malaria in children, generate experience with implementing the IPTi strategy, and help determine whether widespread use of IPTi would risk accelerating parasite resistance to malaria drugs. Similar large-scale implementation studies coordinated through UNICEF are soon to begin in six African countries.
"The IPTi consortium offers an instructive model for how quickly scientists can achieve results if they have the funding and the networks to aggressively pursue malaria research in Africa," said Andreas Heddini, the MIM Secretariat coordinator. "There are many other areas of malaria research that could benefit from a similar level of support and coordination."
Background to the Ghana Trial
Last month, researchers from the London School of Hygiene & Tropical Medicine and Ghana's Kintampo and Navrongo Health Research Centers reported in the British Medical Journal (BMJ) on a study involving 2400 infants that found that, for children up to 15 months old, preventive treatment reduced malaria by 25 percent and anemia by 20 percent.
After the end of the intervention there was evidence of an increased rate of malaria episodes with a higher density of malaria parasites in children who had received the drug compared to those who had been given a placebo. However, this effect was not associated with a significant increase in clinical symptoms of malaria, anemia or hospital admissions.
While the trial showed that IPTi can protect children from malaria, the 25 percent reduction observed was substantially lower than the 59 percent reduction in clinical malaria achieved by IPTi in an earlier study of infants in Tanzania. The scientists involved in the Ghana study believe the differences may be in part explained by the more intense and highly seasonal malaria transmission in the area where they were working compared to the setting of the Tanzanian study.
The IPTi Consortium, which involves leading malaria research centers in Africa, Europe and the United States, in addition to the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), was formed in 2003 with a $28 million grant from the Bill & Melinda Gates Foundation.
Other promising research findings at the MIM conference
Several other research presentations at the MIM conference provide fresh insights into potentially promising new approaches to fighting malaria in children.
Scientists from the Health Sciences Research Institute (IRSS) in Burkina Faso, a country where 150 of every 1,000 children die from malaria, will discuss a new study of 148 children (74 of them in a control group) that found vitamin A and zinc supplements reduced malaria attacks by 20 percent and the overall severity of infections, including fever attacks, by 50 percent. The researchers have now expanded their project to cover 300 children in an effort to determine the most effective dosage.
"Our key message is that the supplements of vitamin A and zinc confer a solid measure of protection against malaria," said Jean-Bosco Ouedraogo, director of IRSS. "In order to convince public health officials, we need to provide more assurance. Within two years we will have the evidence regarding the most effective dosing and we will be ready to go." (Monday, 4:00 p.m., Bubinga Hall, Parallel Session 1, Presentation 6)
Meanwhile, Jane Achan of Makerere University in Kampala, Uganda will present results from a clinical trial evaluating an approach to administering quinine that could save young lives by making an effective treatment for severe malaria more widely available to African children. Cerebral malaria, malaria's most lethal complication, can be treated by an intravenous administration of quinine. But many communities lack the resources to routinely provide the drug intravenously. Achan's study compared intravenous with intrarectal administration, a method that's cheaper and easier to undertake, and found it to be just as effective and safe in treating severe malaria in children. (Wednesday, 1:00 p.m., Poster Session 9, Poster 167B)
To provide coordinated international approach to fighting malaria, the Roll Back Malaria Partnership (RBM) (www.rollbackmalaria.org) was launched in 1998 by the World Health Organization, the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP) and the World Bank. The Partnership now brings together governments of countries affected by malaria, their bilateral and multilateral development partners, the private sector, non-governmental and community-based organizations, foundations, and research and academic institutions around the common goal of halving the global burden of malaria by 2010. World Malaria Report 2005 http://rbm.
The Multilateral Initiative on Malaria (MIM) (www.mim.su.se), launched in Dakar, Senegal in 1997, is an international alliance of organizations and individuals seeking to maximize the impact of scientific research against malaria in Africa to ensure that research findings yield practical health benefits. The MIM Secretariat was previously hosted for 3-years terms by the Wellcome Trust (UK) and the Fogarty International Center at the National Institutes of Health (US). In 2003, the Secretariat moved to Stockholm, Sweden, where it is hosted by the Karolinska Institute and Stockholm University.
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