Full Answer
What is intermittent preventive therapy (IPT)?
Intermittent preventive therapy or intermittent preventive treatment ( IPT) is a public health intervention aimed at treating and preventing malaria episodes in infants (IPTi), children (IPTc), schoolchildren (IPTsc) and pregnant women (IPTp).
What is intermittent preventive treatment for HIV infection?
Intermittent preventive treatment (IPTp) (for HIV negative women in high transmission areas). Women should also receive iron/folate supplementation to protect them against anemia, a common occurrence among all pregnant women.
What is intermittent preventive therapy for malaria?
Intermittent preventive therapy. Intermittent preventive therapy or intermittent preventive treatment (IPT) is a public health intervention aimed at treating and preventing malaria episodes in infants (IPTi), children (IPTc), schoolchildren (IPTsc) and pregnant women (IPTp).
How effective is IPTi in preventing malaria?
If IPTi is widely adopted and implemented in areas recommended by WHO (see below), it could prevent approximately 6 million cases of malaria and save tens of thousands of lives every year in Africa, the region of the world most affected by malaria. A doctor giving an SP injection as part of an IPTi study in Kenya.
What is meant by intermittent preventive treatment?
Intermittent preventive therapy or intermittent preventive treatment (IPT) is a public health intervention aimed at treating and preventing malaria episodes in infants (IPTi), children (IPTc), schoolchildren (IPTsc) and pregnant women (IPTp).
What is intermittent preventive treatment for malaria?
IPTi is similar in concept to IPTp, or intermittent preventive treatment in pregnant women, which is the administration of a full therapeutic course of SP to pregnant women at least twice during pregnancy to prevent the adverse consequences of malaria infection for the mother and her fetus.
What is intermittent preventive treatment of malaria in pregnancy?
Intermittent Preventive Treatment of pregnancy (IPTp) involves the administration of therapeutic doses of an antimalarial drug to a population at risk whether or not they are known to be infected, at specific point intervals usually with the aim of reducing morbidity and mortality.
What is intermittent malaria?
Intermittent preventive treatment (IPT) against malaria is a malaria control strategy aimed at reducing the burden of malaria in certain high-risk groups, namely pregnant women and children.
At what month can a pregnant woman take malaria drugs?
The National malaria control program,6,7 recommends two doses of IPT-SP during normal pregnancy; the first dose to be administered at quickening, which ensures that the woman is in the second trimester, and the second dose given at least one month from the first.
Can a pregnant woman take SP?
IPTp-SP should be given to a pregnant woman at every ANC contact starting from 13 to 16 weeks, with each dose being given at least one month (four weeks) apart. Pregnant women who have an ANC contact twice between 13 and 20 weeks, at least one month apart, should receive IPTp-SP by DOT at both contacts.
How many times should a pregnant woman treat malaria before delivery?
Intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) decreases placental parasitaemia and improves birth outcomes. Currently, WHO recommends three or more doses of SP given during antenatal care (ANC), spaced one month apart after 16 weeks of gestation till delivery.
What is the best treatment for malaria in pregnancy?
Uncomplicated malaria in pregnancy Currently, quinine and clindamycin is the recommended treatment for women in the first trimester of pregnancy31. In many places, clindamycin is unavailable, and quinine monotherapy is prescribed.
Can artemether cause abortion?
Artemether / lumefantrine Pregnancy Warnings Risk summary: Published data from clinical trials and pharmacovigilance data have not associated use of this drug during pregnancy with major birth defects, miscarriage, or adverse maternal/fetal outcomes.
Which of the following drug is used as an intermittent presumptive treatment *?
Intermittent presumptive treatment (IPT) with sulphadoxine-pyrimethamine (SP) in pregnancy and with amodiaquine or SP in infancy has been proposed for use in areas with high levels of malaria transmission. The duration of post treatment prophylaxis is likely to be an important determinant of the benefit of IPT.
Can a pregnant woman Deworm?
Deworming women during pregnancy has a positive effect on child survival and health. A recent study has found that mothers receiving deworming treatment during pregnancy reduce by 14% the risk of their child dying within the first four weeks after birth.
What are the danger signs in pregnancy?
DANGER SIGNS DURING PREGNANCYvaginal bleeding.convulsions/fits.severe headaches with blurred vision.fever and too weak to get out of bed.severe abdominal pain.fast or difficult breathing.
What is IPT in healthcare?
Intermittent preventive therapy or intermittent preventive treatment ( IPT) is a public health intervention aimed at treating and preventing malaria episodes in infants (IPTi), children (IPTc), schoolchildren (IPTsc) and pregnant women (IPTp). The intervention builds on two tested malaria control strategies to clear existing parasites (treatment effect seen in mass drug administrations) and to prevent new infections ( prophylaxis ).
What is IPTP in pregnancy?
IPTp consists in the administration of a single curative dose of an efficacious anti-malarial drug at least twice during pregnancy – regardless whether or not the woman is infected. The drug is administered under supervision during antenatal care (ANC) visits. Sulfadoxine-pyrimethamine is the drug currently recommended by the WHO because of its safety and efficacy in pregnancy. Several studies have shown the high efficacy of IPTp with SP, compared to placebo or CQ prophylaxis, on placental infection, LBW and/or severe maternal anaemia. More recent findings from Tanzania also suggest that IPTp using S/P has reached the end of its lifecycle. The authors found that the "use of partially effective anti-malarial agents for IPTp may exacerbate malaria infections in the setting of widespread drug resistance". As for infants, there is no simple readily available replacement of S/P for malaria in pregnancy. Indeed, the fear of teratogenic effects add a layer of complexity how this intervention will evolve.
What is IPTi in Tanzania?
IPTi using the antimalarial drug sulfadoxine / pyrimethamine (S/P) was pioneered in Ifakara, Tanzania in 1999. Infants received S/P at ages 3, 6, and 9 months in combination with their routine childhood (EPI) vaccinations. IPTi reduced clinical attacks of malaria by 59% (95% CI, 41%–72%) in Ifakara. Remarkably, protection persisted throughout the second year of life, long after SP had disappeared from circulation. A trial conducted in northern Tanzania using the antimalarial drug amodiaquine instead of S/P was similarly successful. Six subsequent trials showed less encouraging results.
What is the politics of IPTi?
The politics of IPTi are well documented and illustrate the working of contemporary international health politics. The promising results of the first two IPTi studies led to the creation of the IPTi Consortium, whose brief is to determine the efficacy, safety, relation of efficacy to drug sensitivity, cost-effectiveness, and acceptability of this intervention. The IPTi Consortium received approximately US$28 million from the Bill & Melinda Gates Foundation (BMGF). A WHO technical advisory group reviewed the evidence relevant for the widespread introduction of IPTi available in 2008, and came to the conclusion that the available evidence was not sufficient to recommend the widespread introduction of IPTi -SP. Program officers of the BMGF as well as scientists funded by the BMGF criticised the WHO conclusions. The criticism from the BMGF in turn triggered a memorandum of the WHO malaria chief Dr. Akira Kochi to the director general of the WHO which was leaked to The New York Times.
Why was the S/P trial closed?
A recent trial of S/P conducted in Tanzania had to be closed early because of high mortality in children receiving S/P. There was uncertainty over the true incidence of serious adverse effects, notably the cutaneous reactions that stopped the use of sulfadoxine pyrimethamine as prophylaxis.
Is IPTi effective at the community level?
This trial showed that IPTi has a protective effect at the individual level but is not effective at the community level. The study had followed up children for two years until 2007 but the findings from the surveillance in 2007 have not been reported.
Summary
What is the problem? Pregnant women living in malaria-endemic areas are particularly susceptible to malaria infection, creating health risks for both the mother and child.
What is the problem?
Pregnant women living in malaria-endemic areas are particularly susceptible to malaria infections and are also more likely to develop severe malaria infections, which may pose health risks to pregnant women and their fetuses.
What is the program?
Intermittent preventive treatment in pregnancy (IPTp) is a prophylactic regimen of antimalarial medicine for pregnant women.
Does the program have strong evidence of effectiveness?
To evaluate the effectiveness of IPTp interventions, we relied on Radeva-Petrova et al. 2014, a Cochrane Collaboration meta-analysis of seventeen randomized controlled trials (RCTs) and quasi-RCTs that compared treatment with various IPTp regimens during pregnancy to no preventive treatment.
Potential negative impacts of the program
Launching a large-scale IPTp program poses several risks. We would need to conduct additional research on these issues to form an opinion on the likelihood that any of these factors would lead to major negative consequences from IPTp.
Is the program cost-effective?
Based on a cost-effectiveness model we put together in October 2018 and updated with our most recent moral weights as of February 2021, we estimate that IPTp is below the range of cost-effectiveness of the opportunities that we expect to direct marginal donations to (about 10x cash or higher, as of 2021).
Does the program have room for more funding?
We would guess that this program has substantial room for more funding as program coverage rates remain low. WHO reports that among countries that have already adopted IPTp-SP, less than 20% of eligible women receive the minimum recommended number of doses. 21
Summary
What is the program? Malaria accounts for a large share of deaths for children under 5 in sub-Saharan Africa. Intermittent preventive treatment for infants (IPTi) is the provision of preventive antimalarial medicine to infants at routine vaccination visits.
What is the problem?
Malaria is the fourth largest cause of death for children under 5 in sub-Saharan Africa, accounting for 12% of deaths. 1 It is transmitted from person to person by infected mosquitoes 2 and involves flu-like symptoms, including fever. 3 When a case of malaria is severe, it leads to life-threatening complications, particularly in children.
What is the program?
According to the World Health Organization (WHO), “IPTi is a full therapeutic course of antimalarial medicine delivered to infants through routine immunization services, regardless of whether the child is infected with malaria. ...
Does the program have strong evidence of effectiveness?
Overall, we believe there is strong evidence that IPTi reduces clinical malaria, which gives us a moderate level of confidence that it reduces deaths due to malaria.
How cost-effective is the program?
We conducted a preliminary cost-effectiveness analysis. We found that IPTi may be highly cost-effective, and may be within the range of programs we would consider recommending funding.
Does the program appear to have room for more funding?
To our knowledge, Sierra Leone is the only country that has implemented IPTi. 39 The government’s policy is that IPTi should be in place at vaccination clinics throughout Sierra Leone, but we have not investigated the coverage that has actually been achieved.
Organizations that implement this program
We are investigating potential charities that could implement IPTi. We are aware that ICAP at Columbia University, a research and technical assistance organization, provided technical assistance to the government of Sierra Leone for its scale-up of IPTi. 40
Overview
Intermittent preventive therapy or intermittent preventive treatment (IPT) is a public health intervention aimed at treating and preventing malaria episodes in infants (IPTi), children (IPTc), schoolchildren (IPTsc) and pregnant women (IPTp). The intervention builds on two tested malaria control strategies to clear existing parasites (treatment effect seen in mass drug administrations) and to prevent new infections (prophylaxis).
IPTi
IPTi using the antimalarial drug sulfadoxine/pyrimethamine (S/P) was pioneered in Ifakara, Tanzania in 1999. Infants received S/P at ages 3, 6, and 9 months in combination with their routine childhood (EPI) vaccinations. IPTi reduced clinical attacks of malaria by 59% (95% CI, 41%–72%) in Ifakara. Remarkably, protection persisted throughout the second year of life, long after SP had disappeared from circulation. A trial conducted in northern Tanzania using the anti…
IPTc
Treating children with S/P and artesunate in Senegal where malaria is highly seasonal repeatedly during the malaria season reduced malaria attacks by 86% (95% CI 80-90)9. A subsequent trial in Mali showed a protective efficacy of 43% [95% CI 29–54%].
IPTsc
Treating schoolchildren in Kenya with S/P and amodiaquine significantly improved anaemia (RR 0.52, 95% CI 0.29-0.93).
IPTp
IPTp consists in the administration of a single curative dose of an efficacious anti-malarial drug at least twice during pregnancy – regardless whether or not the woman is infected. The drug is administered under supervision during antenatal care (ANC) visits. Sulfadoxine-pyrimethamine is the drug currently recommended by the WHO because of its safety and efficacy in pregnancy. Several studies have shown the high efficacy of IPTp with SP, compared to placebo or CQ proph…
Controversy
While some controversial aspects e.g. the drug of choice are shared by all forms of intermittent preventive therapy, the controversy has been reported in greatest detail for IPTi (see also politics below). The reasons which make the large scale introduction of IPTi highly controversial include:
1. The six studies reported subsequent to the first 2 IPTi studies did not confirm the same degree of protection against malaria (59%) nor the protracted period of protective benefit (into the seco…
Politics
The politics of IPTi are well documented and illustrate the working of contemporary international health politics. The promising results of the first two IPTi studies led to the creation of the IPTi Consortium, whose brief is to determine the efficacy, safety, relation of efficacy to drug sensitivity, cost-effectiveness, and acceptability of this intervention. The IPTi Consortium received approximately US$28 million from the Bill & Melinda Gates Foundation (BMGF). A WHO technical …
External links
• IPTi consortium
• New York Times 2/16/08
• IoM report on IPTi
What Is The Problem?
- Pregnant women living in malaria-endemic areas are particularly susceptible to malaria infections and are also more likely to develop severe malaria infections, which may pose health risks to pregnant women and their fetuses.1 Malaria infection during pregnancy may lead to low birthweight and pre-term deliveries, and it may also increase mortality rates for mother and child.2
What Is The Program?
- Intermittent preventive treatment in pregnancy (IPTp) is a prophylactic regimen of antimalarial medicine for pregnant women. The World Health Organization (WHO) recommends administering between three and six doses of IPTp using the antimalarial drug sulfadoxine-pyrimethamine (IPTp-SP) to all pregnant women living in areas with moderate to high mala...
Does The Program Have Strong Evidence of Effectiveness?
- To evaluate the effectiveness of IPTp interventions, we relied on Radeva-Petrova et al. 2014, a Cochrane Collaborationmeta-analysis of seventeen randomized controlled trials (RCTs) and quasi-RCTs that compared treatment with various IPTp regimens during pregnancy to no preventive treatment. Note: this evidence base is complicated because trials sometimes used a …
Potential Negative Impacts of The Program
- Launching a large-scale IPTp program poses several risks. We would need to conduct additional research on these issues to form an opinion on the likelihood that any of these factors would lead to major negative consequences from IPTp. More information is available here, where we have considered similar issues in the context of seasonal malaria chemoprevention programs. The ri…
Is The Program Cost-Effective?
- Based on a cost-effectiveness model we put together in October 2018 and updated with our most recent moral weights as of February 2021, we estimate that IPTp is below the range of cost-effectiveness of the opportunities that we expect to direct marginal donations to (about 10x cash or higher, as of 2021).18However, we have significant uncertainties about several of the assump…
Does The Program Have Room For More Funding?
- We would guess that this program has substantial room for more funding as program coverage rates remain low. WHO reports that among countries that have already adopted IPTp-SP, less than 20% of eligible women receive the minimum recommended number of doses.21
Focus of Further Investigation
- Questions we would ask as part of further investigation include: 1. Why do IPTp treatment outcomes differ so much by birth order? 2. How serious are the program risks that we have identified above (inducing drug resistance, drug interactions, or folic acid interactions)? 3. How do outcomes from the WHO-recommended SP drug compare to other antimalarial drugs used in th…