Background
Methods
Study area and the IPTi strategy
The IPTi Morbidity Monitoring study, data collection and outcome definition
Intervention | Comparison | p value * | |
---|---|---|---|
Number children per health centre [n, (%)]
| n = 5035 | n = 4845 | |
A | 486 (4.9) | ||
B | 869 (8.9) | ||
C | 862 (8.7) | ||
D | 999 (10.1) | ||
E | 951 (9.6) | ||
F | 868 (8.8) | ||
G | 840 (8.5) | ||
H | 519 (5.2) | ||
I | 1198 (12.1) | ||
J | 1610 (16.3) | ||
K | 678 (6.9) | ||
Demographic characteristics
| |||
Sex [n/N, (%)] | |||
Male | 2567/5035 (51) | 2514/4845 (52) | 0.525 |
Birth order [n/N, (%)] | |||
Singleton | 4912/5035(98) | 4685/4845 (97) | 0.533 |
Median age at entry into analysis [months, (IQR)] | 4 m 3 d (2 m-7 m 24 d) | 4 m 12 d (2 m-7 m 27 d) | 0.742 |
Health centre attendance
| |||
≥1 health centre attendance [n/N, (%)] | 2160/5035 (43) | 2067/4845 (43) | 0.799 |
Median number of attendances (IQR) | 2 (1-3) | 2 (1-3) | 0.892 |
EPI vaccine uptake [n/N, (%)]
| |||
DPT dose 2 | 3618/5035(72) | 3181/4845 (66) | 0.204 |
DPT dose 3 | 2889/4794 (60) | 2296/4662 (49) | 0.019 |
Measles vaccine | 1609/3208 (50) | 1009/3065 (33) | 0.003 |
Median age at EPI vaccinations [months, (IQR)]
| |||
DPT dose 2 | 2 m 18 d(2 m 6 d-3 m 9 d) | 2 m 24 d (2 m 9 d-3 m 21 d) | 0.435 |
DPT dose 3 | 4 m 0 d(3 m 9 d-5 m 0 d) | 4 m 3 d (3 m 12 d-5 m 9 d) | 0.585 |
Measles vaccination | 9 m 18 d (9 m 6 d-10 m 15 d) | 9 m 15 d (9 m 3 d-10 m6 d) | 0.099 |
IPTi uptake [n/N, (%)]
| |||
IPTi (at least one dose) | 3627/5035 (72) | ||
IPTi (all three doses) | 1133/5035 (22) | ||
Median age at IPTi doses [months, (IQR)]
| |||
IPTi dose 1 | 2 m 15 d (2 m 3 d-3 m 6 d) | ||
IPTi dose 2 | 4 m 0 d (3 m 9 d-5 m 0 d) | ||
IPTi dose 3 | 9 m 18 d (9 m 3 d-10 m 12 d) |
Statistical methods
Ethics
Results
Characteristics of the Morbidity Monitoring study population
Uptake of EPI vaccinations and IPTi doses
IPTi and malaria, anaemia, and all-cause OPD attendance
Intervention Area | Comparison Area | Effect | |||||||
---|---|---|---|---|---|---|---|---|---|
Intention to treat *
| Events | PYAR | Rate | Events | PYAR | Rate | RR (95% CI) | p value | PE (95% CI) |
Malaria incidence (first or only)
| |||||||||
Crude
| 315 | 2048.3 | 0.154 | 448 | 1882.7 | 0.238 | 0.65 (0.56-0.75) | < 0.001 | 35% (25%,44%) |
adjusted
‡
| 0.75 (0.24-2.31) | 0.584 | 25% (-131%,76%) | ||||||
Malaria incidence (all episodes)
| |||||||||
Crude
| 329 | 2105.9 | 0.156 | 507 | 1946.0 | 0.261 | 0.60 (0.52-0.69) | < 0.001 | 40% (31%,48%) |
adjusted
†
‡
| 0.82 (0.29-2.29) | 0.663 | 18% (-129%,71%) | ||||||
IPTi Intervention Area | Corresponding EPI vaccine Comparison Area | Effect | |||||||
Per protocol **
| Events | PYAR | Rate | Events | PYAR | Rate | RR (95% CI) | p value | PE (95% CI) |
Malaria incidence (all episodes) in ATAR since IPTi dose
| |||||||||
IPTi dose 1 | |||||||||
crude
| 79 | 623.2 | 0.127 | 125 | 513.1 | 0.244 | 0.52 (0.39-0.69) | < 0.001 | 48% (31%,61%) |
adjusted
† ‡
| 0.68 (0.21-2.22) | 0.498 | 32% (-122%,79%) | ||||||
Malaria incidence within 28 days of IPTi dose
| |||||||||
IPTi dose 1 | |||||||||
crude
| 7 | 95.1 | 0.070 | 13 | 81.0 | 0.160 | 0.46 (0.18-1.15) | 0.088 | 54% (-15%,82%) |
adjusted
‡
| 0.48 (0.11-2.13) | 0.341 | 52% (-113%,89%) |
Intervention Area | Comparison Area | Effect | |||||||
---|---|---|---|---|---|---|---|---|---|
Intention to treat *
| Events | PYAR | Rate | Events | PYAR | Rate | RR (95% CI) | p value | PE (95% CI) |
Mild anaemia incidence (first or only)
| |||||||||
Crude
| 1268 | 1771.8 | 0.716 | 1170 | 1689.7 | 0.694 | 1.03 (0.95-1.12) | 0.424 | -3% (-12%,5%) |
adjusted
‡
| 1.13 (0.65-1.97) | 0.597 | -13% (-97%,35%) | ||||||
Severe anaemia incidence (first or only)
| |||||||||
crude
| 318 | 2046.8 | 0.155 | 206 | 1944.1 | 0.106 | 1.47 (1.23-1.75) | < 0.001 | -47% (-75%,-23%) |
adjusted
‡
| 1.59 (0.54-4.68) | 0.360 | -59% (-368%,46%) | ||||||
IPTi Intervention Area | Corresponding EPI vaccine Comparison Area | Effect | |||||||
Per protocol **
| Events | PYAR | Rate | Events | PYAR | Rate | RR (95% CI) | p value | PE (95% CI) |
Mild anaemia incidence (first or only) in ATAR since IPTi dose
| |||||||||
IPTi dose 1 | |||||||||
crude
| 289 | 543.8 | 0.531 | 257 | 455.6 | 0.564 | 0.93 (0.78-1.10) | 0.383 | 7% (-10%,22%) |
adjusted
‡
| 1.04 (0.58-1.87) | 0.878 | -4% (-87%,42%) | ||||||
Severe anaemia incidence (first or only) in ATAR since IPTi dose
| |||||||||
IPTi dose 1 | |||||||||
crude
| 65 | 615.2 | 0.106 | 26 | 518.3 | 0.050 | 2.10 (1.34-3.32) | 0.001 | -110% (-232%,-34%) |
adjusted
‡
| 2.12 (0.41-11.03) | 0.277 | -112% (-1000%,59%) | ||||||
Mild anaemia incidence (first or only) within 28 days of IPTi dose
| |||||||||
IPTi dose 1 | |||||||||
crude
| 45 | 93.8 | 0.480 | 31 | 80.5 | 0.385 | 1.25 (0.79-1.97) | 0.343 | -25% (-97%,21%) |
adjusted
‡
| 1.30 (0.42-4.07) | 0.579 | -30% (-307%,58%) | ||||||
Severe anaemia incidence (first or only) within 28 days of IPTi dose
| |||||||||
IPTi dose 1 | |||||||||
crude
| 4 | 95.1 | 0.042 | 2 | 81.4 | 0.025 | 1.71 (0.31-9.35) | 0.530 | -71% (-835%,69%) |
adjusted
‡
| 1.57 (0.11-22.93) | 0.700 | -57% (-2190%,89%) |
Intervention Area | Comparison Area | Effect | |||||||
---|---|---|---|---|---|---|---|---|---|
Intention to treat *
| Events | PYAR | Rate | Events | PYAR | Rate | RR (95% CI) | p value | PE (95% CI) |
Health centre attendance (first or only)
| |||||||||
crude
| 2160 | 1535.3 | 1.407 | 2067 | 1434.4 | 1.441 | 0.97 (0.92-1.04) | 0.417 | 3% (-4%,8%) |
adjusted
‡
| 1.04 (0.75-1.45) | 0.795 | -4% (-45%,25%) | ||||||
Health centre attendances (all episodes)
| |||||||||
crude
| 3631 | 1810.5 | 2.005 | 3425 | 1699.3 | 2.015 | 0.99 (0.95-1.04) | 0.834 | 1% (-4%,5%) |
adjusted
†
‡
| 1.05 (0.75-1.48) | 0.736 | -5% (-48%,25%) | ||||||
IPTi Intervention Area | Corresponding EPI vaccine Comparison Area | Effect | |||||||
Per protocol **
| Events | PYAR | Rate | Events | PYAR | Rate | RR (95% CI) | p value | PE (95% CI) |
Health centre attendances (all episodes) in ATAR since IPTi dose
| |||||||||
IPTi dose 1 | |||||||||
crude
| 1109 | 565.2 | 1.960 | 1082 | 466.6 | 2.317 | 0.84 (0.78-0.92) | 0.001 | 16% (8%,22%) |
adjusted
†
‡
| 0.98 (0.69-1.38) | 0.907 | 2% (-38%,31%) | ||||||
Health centre attendance (all episodes) within 28 days of IPTi dose
| |||||||||
IPTi dose 1 | |||||||||
crude
| 106 | 93.7 | 1.131 | 125 | 80.3 | 1.556 | 0.73 (0.56-0.94) | 0.016 | 27% (6%,44%) |
adjusted
†
‡
| 0.82 (0.48-1.40) | 0.421 | 18% (-40%,52%) |
Malaria
Anaemia
All-cause attendance at the health centre
Malaria and anaemia prevalence in the 2004 and 2006 IPTi household surveys, restricted to Morbidity Monitoring divisions
2004 IPTi household survey | Intervention | Comparison | p value * |
---|---|---|---|
Parasitaemia [n/N (%)] | 98/156 (63) | 60/101 (59) | 0.677 |
Haemoglobin (g/dL) [mean (95% CI)] | 8.5 (8.3-8.8) | 8.8 (8.5-9.1) | 0.955 |
Net use (last night) [n/N (%)] | 45/156 (29) | 27/101 (27) | 0.739 |
2006 IPTi household survey
|
Intervention
|
Comparison
|
p value *
|
Parasitaemia [n/N (%)] | 62/188 (33) | 47/111 (42) | 0.130 |
Haemoglobin (g/dL) [mean (95% CI)] | 9.6 (9.3-9.9) | 9.3 (8.9-9.6) | 0.640 |
Net use (last night) [n/N (%)] | 102/195 (52) | 77/116 (66) | 0.519 |