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Options for the delivery of intermittent preventive treatment for malaria to children: a community randomised trial.

Kweku M, Webster J, Adjuik M, Abudey S, Greenwood B, Chandramohan D - PLoS ONE (2009)

Bottom Line: The proportion of children who received at least the first dose of 3 or more courses of IPTc was slightly higher in the community based arm (90.5% vs 86.6%; p = 0.059).Completion of the three dose regimen was high and similar with both delivery systems (91.6% and 91.7% respectively).However, in order to maximise the impact of IPTc, both delivery systems may be needed in some settings.

View Article: PubMed Central - PubMed

Affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.

ABSTRACT

Background: Intermittent preventive treatment for malaria in children (IPTc) is a promising new intervention for the prevention of malaria but its delivery is a challenge. We have evaluated the coverage of IPTc that can be achieved by two different delivery systems in Ghana.

Methods: IPTc was delivered by volunteers in six villages (community-based arm) and by health workers at health centres or at Expanded Programme on Immunisation outreach clinics (facility based) in another six communities. The villages were selected randomly and drugs were administered in May, June, September and October 2006. The first dose of a three-dose regimen of amodiaquine plus sulphadoxine-pyrimethamine was administered under supervision to 3-59 month-old children (n = 964) in the 12 study villages; doses for days 2 and 3 were given to parents/guardians to administer at home.

Results: The proportion of children who received at least the first dose of 3 or more courses of IPTc was slightly higher in the community based arm (90.5% vs 86.6%; p = 0.059). Completion of the three dose regimen was high and similar with both delivery systems (91.6% and 91.7% respectively).

Conclusion: Seasonal IPTc delivered through community-based or facility-based systems can achieve a high coverage rate with the support and supervision of the district health management team. However, in order to maximise the impact of IPTc, both delivery systems may be needed in some settings.

Trial registration: ClinicalTrials.gov NCT00119132.

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Related in: MedlinePlus

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pone-0007256-g001: Trial Profile.

Mentions: The study had two arms; IPTc was delivered either at the outpatient department of health centres and at EPI outreach clinics [health facility-based IPTc] or by community volunteers [community-based IPTc] (Figure 1). Sampling was carried out in two stages. From a sampling frame of all villages in the district with a static reproductive and child health facility (nā€Š=ā€Š17), six villages were randomly selected using a sampling interval of 3. From this sample of 6 villages, 3 villages were allocated to the facility based arm and 3 villages to the community based arm by ballot. Similarly from a sampling frame of 80 villages that had no static health facility, 6 villages were randomly selected using a sampling interval of 13. From this sample of 6 villages, 3 villages were assigned to the facility based arm (IPTc was delivered at outreach EPI clinics) and 3 to the community based arm by ballot. The study villages were on average within 5 kilometres from the static health facility. None of the health facilities were inaccessible during the study period.


Options for the delivery of intermittent preventive treatment for malaria to children: a community randomised trial.

Kweku M, Webster J, Adjuik M, Abudey S, Greenwood B, Chandramohan D - PLoS ONE (2009)

Trial Profile.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2748713&req=5

pone-0007256-g001: Trial Profile.
Mentions: The study had two arms; IPTc was delivered either at the outpatient department of health centres and at EPI outreach clinics [health facility-based IPTc] or by community volunteers [community-based IPTc] (Figure 1). Sampling was carried out in two stages. From a sampling frame of all villages in the district with a static reproductive and child health facility (nā€Š=ā€Š17), six villages were randomly selected using a sampling interval of 3. From this sample of 6 villages, 3 villages were allocated to the facility based arm and 3 villages to the community based arm by ballot. Similarly from a sampling frame of 80 villages that had no static health facility, 6 villages were randomly selected using a sampling interval of 13. From this sample of 6 villages, 3 villages were assigned to the facility based arm (IPTc was delivered at outreach EPI clinics) and 3 to the community based arm by ballot. The study villages were on average within 5 kilometres from the static health facility. None of the health facilities were inaccessible during the study period.

Bottom Line: The proportion of children who received at least the first dose of 3 or more courses of IPTc was slightly higher in the community based arm (90.5% vs 86.6%; p = 0.059).Completion of the three dose regimen was high and similar with both delivery systems (91.6% and 91.7% respectively).However, in order to maximise the impact of IPTc, both delivery systems may be needed in some settings.

View Article: PubMed Central - PubMed

Affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.

ABSTRACT

Background: Intermittent preventive treatment for malaria in children (IPTc) is a promising new intervention for the prevention of malaria but its delivery is a challenge. We have evaluated the coverage of IPTc that can be achieved by two different delivery systems in Ghana.

Methods: IPTc was delivered by volunteers in six villages (community-based arm) and by health workers at health centres or at Expanded Programme on Immunisation outreach clinics (facility based) in another six communities. The villages were selected randomly and drugs were administered in May, June, September and October 2006. The first dose of a three-dose regimen of amodiaquine plus sulphadoxine-pyrimethamine was administered under supervision to 3-59 month-old children (n = 964) in the 12 study villages; doses for days 2 and 3 were given to parents/guardians to administer at home.

Results: The proportion of children who received at least the first dose of 3 or more courses of IPTc was slightly higher in the community based arm (90.5% vs 86.6%; p = 0.059). Completion of the three dose regimen was high and similar with both delivery systems (91.6% and 91.7% respectively).

Conclusion: Seasonal IPTc delivered through community-based or facility-based systems can achieve a high coverage rate with the support and supervision of the district health management team. However, in order to maximise the impact of IPTc, both delivery systems may be needed in some settings.

Trial registration: ClinicalTrials.gov NCT00119132.

Show MeSH
Related in: MedlinePlus