Early Childhood Malaria Prevention With Maloprim in The Gambia

Malaria Clinical Trial

Official title:

Comparison of Two Strategies for Control of Malaria Within A Primary Health Care Programme in the Gambia

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00294580
• Other study ID #: SCC-795-835
• Status: Completed
• Phase: Phase 4
• Start date: April 1982
• Est. completion date: September 2001

Study information

• Verified date: October 2023
• Source: Imperial College London
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A trial was conducted in the 1980s to compare two strategies for control of malaria in young children aged 3-59 months: treatment with chloroquine versus treatment combined with fortnightly chemoprophylaxis with Maloprim. The impact on mortality and morbidity was assessed at the time, and their cognitive abilities and educational outcomes were assess 14 years later in 2001. The hypothesis was that the chemoprophylaxis would reduce morbidity and mortality and would improve cognitive abilities and educational outcomes in the long term

Description:

Two drug strategies for the control of malaria in children aged 3-59 months have been compared in a rural area of The Gambia - treatment of presumptive episodes of clinical malaria with chloroquine by village health workers, and treatment combined with fortnightly chemoprophylaxis (pyrimethamine/dapsone) which was also given by village health workers. Treatment alone did not have any significant effect on mortality or morbidity from malaria. In contrast, treatment and chemoprophylaxis reduced overall mortality in children aged 1-4 years, mortality from probable malaria, and episodes of fever associated with malaria parasitaemia. A high level of compliance with chemoprophylaxis was obtained and no harmful consequences of chemoprophylaxis were observed. Chemoprophylaxis was offered to all children at the end of the trial.

14 years after the end of the trial, participants cognitive abilities and educational attainment were assessed. Associations have been found between malaria infection and poor cognitive ability but causality has not yet been demonstrated through preventative trials and the long-term impact of malaria has not been investigated. 1190 children who had participated in the original trial for at least one year were targetted for follow-up. 579 were traced. Those who had received chemoprophylaxis attended school for 0.52 years more than the placebo group (p=.069). There was no overall effect on cognitive abilities but there was a significant treatment effect for cohorts that had not received chemoprophylaxis at the end of the trial or who had received less than one year of post-trial prophylaxis

Recruitment information / eligibility

• Status: Completed
• Enrollment: 2253
• Est. completion date: September 2001
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 3 Months to 59 Months

Eligibility

Inclusion Criteria:

• For original trial: Children aged 3-59 months present in participating villages

• For follow-up: Children who were in original trial for at least 1 year.

Exclusion Criteria:

• For original trial: None

• For follow-up: Children with mental or physical disabilities who were unable to do cognitive tests

Related Conditions & MeSH terms

• Malaria

Intervention

Drug:
• Maloprim

Locations

Country	Name	City	State
Gambia	Medical Research Council Field Station	Farafenni	Central River Division

Sponsors (6)

Lead Sponsor	Collaborator
Imperial College London	Government of the Gambia, London School of Hygiene and Tropical Medicine, Medical Research Council Unit, The Gambia, Partnership for Child Development, Wellcome Trust

Country where clinical trial is conducted

Gambia, 

References & Publications (3)

Greenwood BM, David PH, Otoo-Forbes LN, Allen SJ, Alonso PL, Armstrong Schellenberg JR, Byass P, Hurwitz M, Menon A, Snow RW. Mortality and morbidity from malaria after stopping malaria chemoprophylaxis. Trans R Soc Trop Med Hyg. 1995 Nov-Dec;89(6):629-33 — View Citation

Greenwood BM, Greenwood AM, Bradley AK, Snow RW, Byass P, Hayes RJ, N'Jie AB. Comparison of two strategies for control of malaria within a primary health care programme in the Gambia. Lancet. 1988 May 21;1(8595):1121-7. doi: 10.1016/s0140-6736(88)91949-6. — View Citation

Menon A, Snow RW, Byass P, Greenwood BM, Hayes RJ, N'Jie AB. Sustained protection against mortality and morbidity from malaria in rural Gambian children by chemoprophylaxis given by village health workers. Trans R Soc Trop Med Hyg. 1990 Nov-Dec;84(6):768- — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Mortality
Primary	Episodes of Fever Associated with Malaria Parasitaemia
Primary	Cognitive Abilities in late adolescence
Primary	Educational Attainment (Years spent at school)