BackgroundIntermittent preventive treatment in infants (IPTi) with sulphadoxine-pyrimethamine (SP) given during routine vaccinations is efficacious in preventing malaria disease and shows no interaction with the vaccines. However, there is a fear that IPTi may result in a rapid increase of parasite resistance to SP.MethodsTo evaluate the impact of IPTi on SP-resistance point mutations, the 22 health sub-districts in the district of Kolokani, Mali, were randomized in a 1:1 ratio and starting in December 2006, IPTi with SP was implemented in 11 health sub-districts (intervention zone), while the other 11 health sub-districts served as the control (non-intervention zone). Blood smears and blood dots on filter paper were obtained from children aged 0-5 years, randomly selected in each of heath sub-districts during two cross-sectional surveys. The first survey was conducted in May 2007 before the start of the transmission season to collect baseline prevalence of the molecular markers of resistance to SP and the second in December 2007 after the end of the transmission season and one year after implementation of IPTi. A total of 427 and 923 randomly selected blood samples from the first and second surveys respectively were analysed by PCR for dhfr and dhps mutations.ResultsEach of the three dhfr mutations at codons 51, 59 and 108 was present in 35% and 57% of the samples during the two surveys with no significant differences between the two zones. Dhps mutations at codons 437 and 540 were present respectively in about 20% and 1% of the children during the two surveys in both zones at similar proportion. The prevalence of quadruple mutants (triple dhfr-mutants + dhps-437G) associated with in-vivo resistance to SP in Mali after one year implementation of IPTi was also similar between the two zones (11.6% versus 11.2%, p = 0.90) and to those obtained at baseline survey (10.3% versus 8.1%).ConclusionThis study shows no increase in the frequency of molecular markers of SP resistance in areas where IPTi with SP was implemented for one year.

BackgroundEven though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with Sulfadoxine-Pyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met. However IPTi may also increase the adherence of the community to EPI services and improve EPI coverage, once the benefice of strategy is perceived.MethodsTo assess the impact of IPTi implementation on the coverage of EPI vaccines, 22 health areas of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The EPI vaccines coverage was assessed using cross-sectional surveys at baseline in November 2006 and after one year of IPTi pilot-implementation in December 2007.ResultsAt baseline, the proportion of children of 9-23 months who were completely vaccinated (defined as children who received BGG, 3 doses of DTP/Polio, measles and yellow fever vaccines) was 36.7% (95% CI 25.3% -48.0%). After one year of implementation of IPTi-SP using routine health services, the proportion of children completely vaccinated rose to 53.8% in the non intervention zone and 69.5% in the IPTi intervention zone (P <0.001).The proportion of children in the target age groups who received IPTi with each of the 3 vaccinations DTP2, DTP3 and Measles, were 89.2% (95% CI 85.9%-92.0%), 91.0% (95% CI 87.6% -93.7%) and 77.4% (95% CI 70.7%-83.2%) respectively. The corresponding figures in non intervention zone were 2.3% (95% CI 0.9% -4.7%), 2.6% (95% CI 1.0% -5.6%) and 1.7% (95% CI 0.4% - 4.9%).ConclusionThis study shows that high coverage of the IPTi can be obtained when the strategy is implemented using routine health services and implementation results in a significant increase in coverage of EPI vaccines in the district of Kolokani, Mali.Trial RegistrationClinicalTrials.gov NCT00766662

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In Mali, according to DHS III (Demographic and Health Survey) in 2001, the global rate of malnutrition (weight for age <2 sd) among under-five children was 38%. The purpose of this study was to assess the management of malnutrition in children (0-59 months old) by the professionals in the intervention areas of 'Strategy for Accelerated Child Survival and Growth', according to IMCI guidelines. We carried out a cross-sectional survey in three randomly selected health districts (Kolokani, Niono and Koro) and involved 27 health centres, 180 children and 180 mothers. We did direct observation of consultations and interrogated the mothers. The study found that the equipement and tools necessary for nutritional status assessment were available but seldom used in practice. Nutrition training was provided only to the health staff of Kolokani where 78% of the staff were trained in IMCI and 55% in IEC (Information Education and Communication). The indicatory weight-for-age was used to assess nutritional status of 64% children in Kolokani vs. 42% in Koro and 4% in Niono. IMCI classification was used only in Kolokani (57% of children). The management of severe malnbutrition in children was more correct in Kolokani (100%) than in Koro (33%) and Niono (0%). Twenty- eight percent of mothers/caretakers knew the appropiate duration of exclusive breastfeeding, but only 5% knew that vitamin A supplementation should be done every 6 months. Our findings suggest that nutritional status assessment is performed better in the health districts where staffs are training in IMCI. We recommend training the health staff in the other health districts and the intensification of behavioural change communication for mothers.