Prevention of the recurrence of anaemia in Gambian children following discharge from hospital
In malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective. During the...
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| Veröffentlicht in: | PloS one 2010-06, Vol.5 (6), p.e11227 |
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| creator | Bojang, Kalifa A Milligan, Paul J M Conway, David J Sisay-Joof, Fatou Jallow, Muminatou Nwakanma, Davis C Abubakr, Ismaela Njie, Fanta Greenwood, Brian |
| description | In malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective.
During the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration |
| doi_str_mv | 10.1371/journal.pone.0011227 |
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During the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration <7 g/dL) were randomised to receive either monthly sulfadoxine-pyrimethamine (SP) or placebo until the end of the malaria transmission season in which they were enrolled, in a double-blind trial. All study subjects were treated with oral iron for 28 days and morbidity was monitored through surveillance at health centres. The primary endpoint was the proportion of children with moderate or severe anaemia at the end of the transmission season. Secondary endpoints included the incidence of clinical episodes of malaria during the surveillance period, outpatient attendances, the prevalence of parasitaemia and splenomegaly, nutritional status at the end of the malaria transmission season and compliance with the treatment regimen.
The proportions of children with a Hb concentration of <7 g/dL at the end of the malaria transmission season were similar in the two study groups, 14/464 (3.0%) in children who received at least one dose of SP and 16/471 (3.4%) in those who received placebo, prevalence ratio 0.89 (0.44,1.8) P = 0.742. The protective efficacy of SP against episodes of clinical malaria was 53% (95% CI 37%, 65%). Treatment with SP was safe and well tolerated; no serious adverse events related to SP administration were observed. Mortality following discharge from hospital was low among children who received SP or placebo (6 in the SP group and 9 in the placebo group respectively).
Intermittent treatment with SP did not reduce the proportion of previously anaemic children with moderate or severe anaemia at the end of the malaria season, although it prevented malaria. The combination of appropriate antimalarial treatment plus one month of iron supplementation and good access to healthcare during follow-up proved effective in restoring haemoglobin to an acceptable level in the Gambian setting.
ClinicalTrials.gov NCT00131716.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0011227</identifier><identifier>PMID: 20574541</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject><![CDATA[Anemia ; Anemia - prevention & control ; Animals ; Antimalarial agents ; Antimalarials - administration & dosage ; Antimalarials - adverse effects ; Antimalarials - pharmacology ; Blindness ; Chemotherapy ; Child health ; Child mortality ; Children ; Children & youth ; Clinical trials ; Councils ; Dietary supplements ; Disease transmission ; Drug Combinations ; Drug dosages ; Drug Resistance - genetics ; Drug-Related Side Effects and Adverse Reactions ; Female ; Gambia ; Genetic Markers - genetics ; Genotype ; Health care ; Health care facilities ; Hemoglobin ; Hemoglobins ; Hospitals ; Humans ; Infectious Diseases ; Infectious Diseases/Epidemiology and Control of Infectious Diseases ; Infectious Diseases/Tropical and Travel-Associated Diseases ; Iron ; Laboratories ; Malaria ; Malaria - prevention & control ; Malaria - transmission ; Male ; Medical research ; Morbidity ; Nutritional status ; Nutritional Status - drug effects ; Parasites - drug effects ; Parasites - genetics ; Parasites - physiology ; Patient Compliance ; Patient Discharge ; Pediatrics ; Prevention ; Pyrimethamine ; Pyrimethamine - administration & dosage ; Pyrimethamine - adverse effects ; Pyrimethamine - pharmacology ; Recurrence (Disease) ; Seasons ; Secondary Prevention ; Splenomegaly ; Sulfadoxine ; Sulfadoxine - administration & dosage ; Sulfadoxine - adverse effects ; Sulfadoxine - pharmacology ; Surveillance ; Vector-borne diseases]]></subject><ispartof>PloS one, 2010-06, Vol.5 (6), p.e11227</ispartof><rights>COPYRIGHT 2010 Public Library of Science</rights><rights>2010 Bojang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Bojang et al. 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c691t-87735d5ae6e049fe1cd0d6d6005c7846f6c003dc2a90e77dfb9fbf74522be18a3</citedby><cites>FETCH-LOGICAL-c691t-87735d5ae6e049fe1cd0d6d6005c7846f6c003dc2a90e77dfb9fbf74522be18a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888645/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888645/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20574541$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bojang, Kalifa A</creatorcontrib><creatorcontrib>Milligan, Paul J M</creatorcontrib><creatorcontrib>Conway, David J</creatorcontrib><creatorcontrib>Sisay-Joof, Fatou</creatorcontrib><creatorcontrib>Jallow, Muminatou</creatorcontrib><creatorcontrib>Nwakanma, Davis C</creatorcontrib><creatorcontrib>Abubakr, Ismaela</creatorcontrib><creatorcontrib>Njie, Fanta</creatorcontrib><creatorcontrib>Greenwood, Brian</creatorcontrib><title>Prevention of the recurrence of anaemia in Gambian children following discharge from hospital</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective.
During the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration <7 g/dL) were randomised to receive either monthly sulfadoxine-pyrimethamine (SP) or placebo until the end of the malaria transmission season in which they were enrolled, in a double-blind trial. All study subjects were treated with oral iron for 28 days and morbidity was monitored through surveillance at health centres. The primary endpoint was the proportion of children with moderate or severe anaemia at the end of the transmission season. Secondary endpoints included the incidence of clinical episodes of malaria during the surveillance period, outpatient attendances, the prevalence of parasitaemia and splenomegaly, nutritional status at the end of the malaria transmission season and compliance with the treatment regimen.
The proportions of children with a Hb concentration of <7 g/dL at the end of the malaria transmission season were similar in the two study groups, 14/464 (3.0%) in children who received at least one dose of SP and 16/471 (3.4%) in those who received placebo, prevalence ratio 0.89 (0.44,1.8) P = 0.742. The protective efficacy of SP against episodes of clinical malaria was 53% (95% CI 37%, 65%). Treatment with SP was safe and well tolerated; no serious adverse events related to SP administration were observed. Mortality following discharge from hospital was low among children who received SP or placebo (6 in the SP group and 9 in the placebo group respectively).
Intermittent treatment with SP did not reduce the proportion of previously anaemic children with moderate or severe anaemia at the end of the malaria season, although it prevented malaria. The combination of appropriate antimalarial treatment plus one month of iron supplementation and good access to healthcare during follow-up proved effective in restoring haemoglobin to an acceptable level in the Gambian setting.
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There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective.
During the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration <7 g/dL) were randomised to receive either monthly sulfadoxine-pyrimethamine (SP) or placebo until the end of the malaria transmission season in which they were enrolled, in a double-blind trial. All study subjects were treated with oral iron for 28 days and morbidity was monitored through surveillance at health centres. The primary endpoint was the proportion of children with moderate or severe anaemia at the end of the transmission season. Secondary endpoints included the incidence of clinical episodes of malaria during the surveillance period, outpatient attendances, the prevalence of parasitaemia and splenomegaly, nutritional status at the end of the malaria transmission season and compliance with the treatment regimen.
The proportions of children with a Hb concentration of <7 g/dL at the end of the malaria transmission season were similar in the two study groups, 14/464 (3.0%) in children who received at least one dose of SP and 16/471 (3.4%) in those who received placebo, prevalence ratio 0.89 (0.44,1.8) P = 0.742. The protective efficacy of SP against episodes of clinical malaria was 53% (95% CI 37%, 65%). Treatment with SP was safe and well tolerated; no serious adverse events related to SP administration were observed. Mortality following discharge from hospital was low among children who received SP or placebo (6 in the SP group and 9 in the placebo group respectively).
Intermittent treatment with SP did not reduce the proportion of previously anaemic children with moderate or severe anaemia at the end of the malaria season, although it prevented malaria. The combination of appropriate antimalarial treatment plus one month of iron supplementation and good access to healthcare during follow-up proved effective in restoring haemoglobin to an acceptable level in the Gambian setting.
ClinicalTrials.gov NCT00131716.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>20574541</pmid><doi>10.1371/journal.pone.0011227</doi><tpages>e11227</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2010-06, Vol.5 (6), p.e11227 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1292301661 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Anemia Anemia - prevention & control Animals Antimalarial agents Antimalarials - administration & dosage Antimalarials - adverse effects Antimalarials - pharmacology Blindness Chemotherapy Child health Child mortality Children Children & youth Clinical trials Councils Dietary supplements Disease transmission Drug Combinations Drug dosages Drug Resistance - genetics Drug-Related Side Effects and Adverse Reactions Female Gambia Genetic Markers - genetics Genotype Health care Health care facilities Hemoglobin Hemoglobins Hospitals Humans Infectious Diseases Infectious Diseases/Epidemiology and Control of Infectious Diseases Infectious Diseases/Tropical and Travel-Associated Diseases Iron Laboratories Malaria Malaria - prevention & control Malaria - transmission Male Medical research Morbidity Nutritional status Nutritional Status - drug effects Parasites - drug effects Parasites - genetics Parasites - physiology Patient Compliance Patient Discharge Pediatrics Prevention Pyrimethamine Pyrimethamine - administration & dosage Pyrimethamine - adverse effects Pyrimethamine - pharmacology Recurrence (Disease) Seasons Secondary Prevention Splenomegaly Sulfadoxine Sulfadoxine - administration & dosage Sulfadoxine - adverse effects Sulfadoxine - pharmacology Surveillance Vector-borne diseases |
| title | Prevention of the recurrence of anaemia in Gambian children following discharge from hospital |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-06T04%3A00%3A24IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prevention%20of%20the%20recurrence%20of%20anaemia%20in%20Gambian%20children%20following%20discharge%20from%20hospital&rft.jtitle=PloS%20one&rft.au=Bojang,%20Kalifa%20A&rft.date=2010-06-21&rft.volume=5&rft.issue=6&rft.spage=e11227&rft.pages=e11227-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0011227&rft_dat=%3Cgale_plos_%3EA473892347%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1292301661&rft_id=info:pmid/20574541&rft_galeid=A473892347&rft_doaj_id=oai_doaj_org_article_5b4e58f802b54fb6b5a404563b8b980f&rfr_iscdi=true |