Intermittent preventive antimalarial treatment for children with anaemia

Antimalarial drugs as a treatment of anaemia in children living in malaria-endemic areas

Athuman M1, Kabanywanyi AM2, Rohwer AC3

1Ifakara Health Institute, Dodoma, Tanzania

2Ifakara Health Institute, Dar-es-salaam, Tanzania

3Stellenbosch University, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape Town, South Africa

Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD010767.

To read the full review please follow this link: DOI: 10.1002/14651858. CD010767.pub2.

Children living in malaria areas may develop severe anaemia, often caused by malaria infection, and this can cause death if not treated properly. Intermittent preventive treatment (IPT) is a course of malaria treatment given regularly to these children in order to prevent infection and malaria illness. It has been suggested that IPT could be used to treat children with anaemia in these areas. We aimed to find all the studies looking at treating anaemic children with IPT in order to see what the overall effect is. We examined the evidence available up to 4 December 2014.

We included six trials in this review, with a total number of 3847 participants. In all the trials, one group received IPT and the control group received placebo. Three trials were done in low malaria endemicity areas and the other three in high endemicity areas. In some trials, iron supplements were also given to children, which is also a treatment for anaemia, and we took this into consideration when analysing the data.

Our results did not find that the number of children who died or were admitted to hospital was lower in the group receiving IPT, irrespective of whether they received iron (moderate quality evidence); and there was no difference in the number of children with anaemia at the end of follow-up (moderate quality evidence). Average haemoglobin levels were higher in the IPT group compared to the placebo group, but the effect was modest (low quality evidence).

Although our results show that there are small benefits in haemoglobin levels when treating anaemic children with IPT, we did not detect an effect on death or hospital admissions. However, three of the six included trials were conducted in low endemicity areas where malaria transmission is low and thus any protective effect is likely to be modest.