Preschool children taking antimalarial drugs regularly are less likely to get malaria or severe anaemia, but more trials are needed to show whether survival is improved

Meremikwu MM, Donegan S, Esu E

Published Online:

January 21, 2009

Most children in areas where malaria is endemic are semi-immune against serious malaria by the age of seven, but for children under five the disease can be serious, and a million worldwide die each year from malaria. The review of 21 trials found that children taking regular antimalarial prophylaxis or intermittent treatment were less likely to get malaria, severe anaemia, or be admitted to hospital, but there was no change in the overall death rate. The benefits are similar in intermittent treatment of infants and prolonged prophylaxis, but long-term deleterious effects, including the possibility that it may interfere with the development of children's immunity to malaria, are unknown for either regimen. Further trials with long-term follow up are needed.

Abstract (click to read)

Background:

Malaria causes repeated illness in children living in endemic areas. Policies of giving antimalarial drugs at regular intervals (prophylaxis or intermittent treatment) are being considered for preschool children.

Objectives:

To evaluate prophylaxis and intermittent treatment with antimalarial drugs to prevent malaria in young children living in malaria-endemic areas.

Search strategy:

We searched the Cochrane Infectious Diseases Group Specialized Register (August 2007), CENTRAL (The Cochrane Library 2007, Issue 3), MEDLINE (1966 to August 2007), EMBASE (1974 to August 2007), LILACS (1982 to August 2007), mRCT (February 2007), and reference lists of identified trials. We also contacted researchers.

Selection criteria:

Individually randomized and cluster-randomized controlled trials comparing antimalarial drugs given at regular intervals (prophylaxis or intermittent treatment) with placebo or no drug in children aged one month to six years or less living in a malaria-endemic area.

Data collection and analysis:

Two authors independently extracted data and assessed the risk of bias in the trials. We used risk ratio (RR) or mean difference with 95% confidence intervals (CI) for meta-analyses. Where we detected heterogeneity and considered it appropriate to combine the trials, we used the random-effects model (REM).

Main results:

Twenty-one trials (19,394 participants), including six cluster-randomized trials, met the inclusion criteria. Prophylaxis or intermittent treatment with antimalarial drugs resulted in fewer clinical malaria episodes (RR 0.53, 95% CI 0.38 to 0.74, REM; 7037 participants, 10 trials), less severe anaemia (RR 0.70, 95% CI 0.52 to 0.94, REM; 5445 participants, 9 trials), and fewer hospital admissions for any cause (RR 0.64, 95% CI 0.49 to 0.82; 3722 participants, 5 trials). We did not detect a difference in the number of deaths from any cause (RR 0.90, 95% CI 0.65 to 1.23; 7369 participants, 10 trials), but the CI do not exclude a potentially important difference. One trial reported three serious adverse events with no statistically significant difference between study groups (1070 participants). Eight trials measured morbidity and mortality six months to two years after stopping regular antimalarial drugs; overall, there was no statistically significant difference, but participant numbers were small.

Authors' conclusions:

Prophylaxis and intermittent treatment with antimalarial drugs reduce clinical malaria and severe anaemia in preschool children.

This record should be cited as:

Meremikwu MM, Donegan S, Esu E. Chemoprophylaxis and intermittent treatment for preventing malaria in children. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003756. DOI: 10.1002/14651858.CD003756.pub3

Assessed as up to date:

November 15, 2007

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Primary Review Group:

Infectious Diseases Group

Health topics:

Blood disorders > Malaria > Drugs for preventing malaria

Infectious disease > Malaria > Drugs for preventing malaria

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Preschool children taking antimalarial drugs regularly are less likely to get malaria or severe anaemia, but more trials are needed to show whether survival is improved

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