Editorial: Intermittent preventive treatment for malaria control in infants: moving towards evidence‐based policy and public health action

It is important to balance the urgency of implementing a new efficacious intervention on a public health scale against the need to acquire convincing evidence on safety and efficacy. Two studies in Tanzania have shown that intermittent preventive treatment in infants (IPTi) the administration of antimalarial drugs at pre-specified times during the first year of life regardless of the presence of clinical symptoms or Plasmodium falciparum parasitaemia reduces episodes of malaria and anaemia by over 50%. Children followed up to the age of 2 years showed a sustained 36% reduction in the risk of malaria. IPTi has the potential to become a major tool for malaria control in Africa as it may be delivered at the time of routine vaccination – through the Expanded Programme on Immunisation (EPI) – which increases the chance of long-term sustainability. Should IPTi now be recommended as a malaria control strategy for Africa? A group of research scientists WHO and UNICEF reviewed the evidence that was available in 2002 and agreed that information would be required in three key areas before a recommendation on the role of IPTi in national malaria control strategies could be made. First the efficacy of IPTi in reducing episodes of clinical malaria and anaemia in different epidemiological settings should be known. Secondly it should be demonstrated that IPTi has no adverse impact on serological responses to EPI vaccines. Thirdly the reassuring safety data that is currently available on IPTi with sulphadoxine-pyrimethamine (SP) should be consolidated. (excerpt)