Intermittent preventive treatment (IPT) in schoolchildren offers a promising option for malaria control. However, the optimal drug and dosing regimens for IPT remain to be determined.
We conducted a randomized, double-blinded, placebo-controlled trial in 740 schoolchildren aged 6-14 years living in a high malaria transmission setting in Uganda. Enrolled children were randomized to dihydroartemisinin-piperaquine (DP) given once every month (IPTm), DP given once a school term (four treatments over 12 months, IPTst) or placebo and followed for 12 months. The primary outcome was the incidence of malaria over 12 months. Secondary outcomes included parasite prevalence and anemia over 12 months. Analyses were conducted on an intention to treat basis.
In the placebo arm the incidence of malaria was 0.34 episodes per person year and the prevalence of parasitemia and anemia was 38% and 20%, respectively. IPTm reduced the incidence of malaria by 96% (95% confidence interval [CI] 88-99%, p<0.0001), the prevalence of asymptomatic parasitemia by 94% (95% CI 92-96%, p<0.0001) and the prevalence of anemia by 40% (95% CI 19-56%, p<0.0001). IPTst had no significant effect on malaria or anemia, but reduced the prevalence of asymptomatic parasitemia by 54% (95% CI 47-60%, p<0.0001).
Monthly IPT with DP offered remarkable protection against clinical malaria, parasitemia and anemia in schoolchildren living in a high malaria transmission setting.