Intermittent preventive treatment for malaria control

Despite improvement in malaria control, the disease remains one of the world’s major killers, responsible for 627,000 deaths in 2013, mainly among children in sub-Saharan Africa.

In the late 1990s and 2000s, when malaria claimed the lives of a million people every year, a new strategy, intermittent preventive treatment in infants (IPTi), was trialled by the School. The treatment involves the administration of an antimalarial drug at specified times, regardless of the presence of malaria parasites.

Daniel Chandramohan, professor of public health at the School led randomised controlled trials of IPTi in Ghana and northern Tanzania, both of which showed that the therapy was effective. The study was conducted under the IPTi Consortium, a research collaboration with partners in Europe, the United States and Africa, set up by David Schellenberg, professor of malaria and international health at the School.

As well as evaluating IPTi with a number of drugs across a range of settings the consortium also gained valuable operational experience of the treatment’s implementation. Further studies looked at the treatment’s cost effectiveness and the effect of the routine use of IPTi on drug resistance. A pooled analysis also showed that IPTi reduces clinical malaria by 30% and anaemia by 21% in the first year of life.

The research into IPTi has been a major body of work, involving many of the School’s researchers. Their evidence has been key in persuading the World Health Organization (WHO) of the benefits of IPTi, with the organization recommending it as a malaria control tool in areas of high to moderate transmission in March 2010.

The recommendation was based on the findings of seven studies, including the School’s research, which showed the benefits of IPTi in reducing malaria, anaemia and hospital admissions. Joint WHO/United Nations Children’s Fund implementation guidelines were released in September 2011.

Burkina Faso has become the first country to adopt IPTi into its national malaria control programme, with a further eight countries considering the policy. Unpublished data suggest that up to a million episodes of malaria could be prevented every year if IPTi was introduced in countries where the studies were conducted.

The IPTi Consortium has brought together the world’s leading centres of malaria research and has generated evidence beyond the proof of concept towards a strategy for implementing IPTi. The consortium was also the model for the launch of the Artemisinin-based Combination Therapy (ACT) Consortium in 2007.

The School’s review and modelling-based research to understand the age-pattern of malaria disease and death continues to inform discussions among WHO, regulators and industry about dose scheduling and new tools to control malaria.