Accelerated regime of preventative drugs could prevent malaria infection and deaths in Africa

Malaria infection and deaths could be avoided by more than half a million young children thanks to an accelerated regime of preventative drugs being rolled in four African countries, says global health agency Unitaid.

The intervention, known as the Intermittent Preventive Treatment of malaria in infants-plus (IPTi+), builds upon a World Health Organization (WHO) recommended strategy that uses the antimalarial sulfadoxine-pyrimethamine to prevent malaria in children under one year old.

In its current regimen of IPTi, the protection offered to infants only goes up to one year, but with the IPTi+ there is an increase in dosage and [this] expands the eligible age bracket up to two years which we hope will achieve a bigger impact."

Alexandra Cameron, Senior Technical Manager for Malaria, Unitaid

IPTi is safe and could cut malaria in children under one year of age by 30 per cent but has been underused in Sub-Saharan Africa, according to the health agency.

It comes as the WHO last week endorsed the use of the RTS,S vaccine among children in Sub-Saharan Africa and other regions with moderate to high malaria transmission.

However, health experts maintain that other interventions are necessary since the vaccine is only 30 per cent effective in reducing severe cases of malaria.

The WHO's latest World Malaria Report showed that in 2019 most malaria cases and deaths occurred in Sub-Saharan Africa, which accounted for 94 per cent of the 229 million malaria cases reported globally. Almost 70 per cent of the 409,000 malaria deaths worldwide occurred in children under five years, making children the most vulnerable group.

With a $35 million investment from Unitaid, the IPTI+ program led by Population Services International (PSI) aims to develop scalable models in Benin, Cameroon, Côte d'Ivoire and Mozambique by administering an estimated 2.5 million doses of sulfadoxine-pyrimethamine to protect over half a million children under two years of age from malaria, the Unitaid statement adds.

IPTi+ is a cost-effective measure, with the delivery process providing equitable access through mass campaigns and community outreach, according to Unitaid. The intervention is tied to the immunization schedules of infants to ensure a wider reach, Cameron tells SciDev.Net.

"This has been a country-driven project. And [in] the first nine months of the four-year project, PSI will co-create with the national malaria control programs in the target countries on how the project will be implemented to allow local needs and contextual constraints to be collated and addressed," Cameron explains.

Widespread adoption of IPTi has previously faced challenges including misperceptions about the effectiveness of sulfadoxine-pyrimethamine and a lack of enabling policies, according to Unitaid.

Bedilu Alamirie, an assistant professor of statistics at Addis Ababa University in Ethiopia, says partnerships need to be strengthened with the relevant ministries, research institutions and other key players who can provide further guidance on implementing the project.

Bedilu, who is an expert in mapping malaria risk in children in Mozambique, tells SciDev.Net: "This intervention is good, and I would emphasize that it should be highly data-driven to accurately ensure effectiveness."