The effect of mass administration of sulfadoxine-pyrimethamine combined with artesunate on malaria incidence: a double-blind, community-randomized, placebo-controlled trial in The Gambia

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 97; no. 2; pp. 217 - 225
• Main Authors: Seidlein, Lorenz von, Walraven, Gijs, Milligan, Paul J.M., Alexander, Neal, Manneh, Fandingding, Deen, Jacqueline L., Coleman, Roz, Jawara, Musa, Lindsay, Steve W., Drakeley, Chris, Martin, Sarah De, Olliaro, Piero, Bennett, Steve, van der Loeff, Maarten Schim, Okunoye, Kunle, Targett, Geoff A.T., McAdam, Keith P.W.J., Doherty, Justin F., Greenwood, Brian M., Pinder, Margaret
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-03-2003; Royal Society of Tropical Medicine and Hygiene; Elsevier
• Subjects: Adult; Africa; Anemia - epidemiology; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimalarials - administration & dosage; Antiparasitic agents; Artemisinins - administration & dosage; Artesunate; Biological and medical sciences; chemotherapy; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Gambia; Human protozoal diseases; Humans; Incidence; Infant; Infant Mortality; Infant, Newborn; Infectious diseases; Malaria; Malaria, Falciparum - drug therapy; Malaria, Falciparum - mortality; Medical sciences; Parasitemia - drug therapy; Parasitemia - epidemiology; Parasitic diseases; Patient Compliance; Pharmacology. Drug treatments; Plasmodium falciparum; Protozoal diseases; Pyrimethamine - administration & dosage; Risk Factors; Rural Health; Sesquiterpenes - administration & dosage; Sulfadoxine - administration & dosage; sulfadoxine-pyrimethamine; Treatment Outcome; Gambia; Africa; sulfadoxine-pyrimethamine; Plasmodium falciparum; artesunate; malaria; chemotherapy; Africa; Sulfanilamide derivatives; Antimalarial; Protozoal disease; Transmission; Reservoir; Gametocyte; Epidemiology; Incidence; Artesunate; Sulfadoxine; Season; Child; Human; Drug; Rural environment; Sulfonamide; Malaria; Rate; Single dose; Pyrimethamine; Parasitosis; Infection; Treatment; Surveillance; Parasiticide
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/S0035-9203(03)90125-8

A double-blind, community-randomized, placebo-controlled trial was conducted in a rural area of The Gambia between June and December 1999 to test whether a reduction in the infectious reservoir can reduce malaria transmission. Overall 14 017 (85%) individuals living in the study area were treated with either placebo or sulfadoxine-pyrimethamine (SP) combined with a single dose of artesunate (AS). Following the mass drug administration (MDA) 1375 children aged 6 months to 10 years were kept under surveillance for clinical malaria in 18 villages throughout the 1999 malaria transmission season. During a 20-week surveillance period 637 episodes of malaria were detected. The mean incidence rate was
2.5
100
child-weeks in the placebo villages, and
2.3
100
child-weeks in villages that received SP + AS. The mean rate ratio, adjusted for individual and village-level covariates, was 0.91 (95% CI 0.68–1.22,
P = 0.49). During the first 2 months of surveillance, the malaria incidence was lower in treated villages. After 2 months the incidence was slightly higher in the MDA group but this was not statistically significant. Overall, no benefit of the MDA could be detected. The reason for the absence of an impact on malaria transmission is probably the very high basic reproductive number of malaria, and the persistence of mature gametocytes, which are not affected by AS treatment.