Increase in EPI vaccines coverage after implementation of intermittent preventive treatment of malaria in infant with Sulfadoxine -pyrimethamine in the district of Kolokani, Mali: Results from a cluster randomized control trial

Abstract

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

A systematic review of strategies to increase access to health services among children in low and middle income countries

“…There were eight studies evaluating service level improvements which included health care worker training [30, 44, 46], scaling up of services [47] and integration of services such as HIV and immunisation services [34, 45, 48–50]. Overall, three of these studies were classified as positive (37.5%), three as mixed-positive (37.5%) and two as null 25%) (Fig.…”

“…There was some variation in effectiveness between the specific intervention approaches: the two health worker training interventions showed a significant improvement in all ( n  = 1) or in at least one ( n  = 1) of the outcomes of interest (mixed-positive significance). Two of the three studies evaluating service integration were positive [34, 45], and one showed null effect. One study assessed scaling up services and found no significant impact on immunization coverage [47].…”

The implementation of malaria intermittent preventive trialtreatment with sulphadoxine-pyrimethamine in infants reduced all-cause mortality in the district of Kolokani, Mali: results from a cluster randomized control

“…Previous evaluations have shown that the implementation of IPTi has resulted in a significant increase in coverage of EPI vaccines, an increase that was more marked in the intervention zone [7]. The higher increase in vaccine coverage in the intervention zone may have contributed to the increase in child survival in these areas.…”

Acceptability of coupling Intermittent Preventive Treatment in infants with the Expanded Programme on Immunization in three francophone countries in Africa

“…Health workers had a positive attitude towards IPTi because it prevents a high disease burden and it was perceived as an incentive for immunization resulting in increased EPI compliance (Dicko et al. 2011).…”