Prevention of the recurrence of anaemia in Gambian children following discharge from hospital

In malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective. During the...

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Published in:	PloS one Vol. 5; no. 6; p. e11227
Main Authors:	Bojang, Kalifa A, Milligan, Paul J M, Conway, David J, Sisay-Joof, Fatou, Jallow, Muminatou, Nwakanma, Davis C, Abubakr, Ismaela, Njie, Fanta, Greenwood, Brian
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 21-06-2010 Public Library of Science (PLoS)
Subjects:	Anemia Anemia - prevention & control Animals Antimalarial agents Antimalarials - administration & dosage Antimalarials - adverse effects Antimalarials - pharmacology Blindness Chemotherapy Child health Child mortality Children Children & youth Clinical trials Councils Dietary supplements Disease transmission Drug Combinations Drug dosages Drug Resistance - genetics Drug-Related Side Effects and Adverse Reactions Female Gambia Genetic Markers - genetics Genotype Health care Health care facilities Hemoglobin Hemoglobins Hospitals Humans Infectious Diseases Infectious Diseases/Epidemiology and Control of Infectious Diseases Infectious Diseases/Tropical and Travel-Associated Diseases Iron Laboratories Malaria Malaria - prevention & control Malaria - transmission Male Medical research Morbidity Nutritional status Nutritional Status - drug effects Parasites - drug effects Parasites - genetics Parasites - physiology Patient Compliance Patient Discharge Pediatrics Prevention Pyrimethamine Pyrimethamine - administration & dosage Pyrimethamine - adverse effects Pyrimethamine - pharmacology Recurrence (Disease) Seasons Secondary Prevention Splenomegaly Sulfadoxine Sulfadoxine - administration & dosage Sulfadoxine - adverse effects Sulfadoxine - pharmacology Surveillance Vector-borne diseases Gambia Kenya
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Summary:	In malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective. During the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration <7 g/dL) were randomised to receive either monthly sulfadoxine-pyrimethamine (SP) or placebo until the end of the malaria transmission season in which they were enrolled, in a double-blind trial. All study subjects were treated with oral iron for 28 days and morbidity was monitored through surveillance at health centres. The primary endpoint was the proportion of children with moderate or severe anaemia at the end of the transmission season. Secondary endpoints included the incidence of clinical episodes of malaria during the surveillance period, outpatient attendances, the prevalence of parasitaemia and splenomegaly, nutritional status at the end of the malaria transmission season and compliance with the treatment regimen. The proportions of children with a Hb concentration of <7 g/dL at the end of the malaria transmission season were similar in the two study groups, 14/464 (3.0%) in children who received at least one dose of SP and 16/471 (3.4%) in those who received placebo, prevalence ratio 0.89 (0.44,1.8) P = 0.742. The protective efficacy of SP against episodes of clinical malaria was 53% (95% CI 37%, 65%). Treatment with SP was safe and well tolerated; no serious adverse events related to SP administration were observed. Mortality following discharge from hospital was low among children who received SP or placebo (6 in the SP group and 9 in the placebo group respectively). Intermittent treatment with SP did not reduce the proportion of previously anaemic children with moderate or severe anaemia at the end of the malaria season, although it prevented malaria. The combination of appropriate antimalarial treatment plus one month of iron supplementation and good access to healthcare during follow-up proved effective in restoring haemoglobin to an acceptable level in the Gambian setting. ClinicalTrials.gov NCT00131716.
Bibliography:	Conceived and designed the experiments: KB BG. Performed the experiments: KB MJ DN IA. Analyzed the data: KB PJM DJC BG. Contributed reagents/materials/analysis tools: PJM DJC FSJ FN BG. Wrote the paper: KB PJM DJC BG.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0011227