MULTIPLY update for World Malaria Day – 25 April 2022
The MULTIPLY project is conducting the pilot introduction of multiple doses of Intermittent Preventive Treatment of infants (IPTi) to reduce malaria during early childhood. MULTIPLY stands for MULTIple doses of IPTi Proposal: a Lifesaving high Yield intervention and is funded by the European and Developing Countries Clinical Trials Partnership (EDCTP2) to implement up to 6 doses of IPTi in children up to 2 years of age in selected districts of Sierra Leone, Togo and Mozambique. IPTi has been shown in clinical trials to reduce malaria illness by 30%, hospital admissions by 23% and anaemia by 21%. It is also cost-effective as the drug used for IPTi (sulfadoxine-pyrimethamine, SP) is inexpensive and IPTi uses the already existing delivery system, the Expanded Programme on Immunization (EPI). The World Health Organization (WHO) currently recommends that 3 doses of IPTi are given to children in the first year of life alongside childhood vaccinations through the EPI.
To date, only one African country – Sierra Leone – has put IPTi into policy and practice. Concerned with this slow adoption, WHO in 2019 recommended adaptations be urgently tested through pilots assessing impact, operational feasibility and cost effectiveness. MULTIPLY is building on the WHO recommendation to give more doses of in the first year of life and to extend into the second year of life, delivered alongside the EPI. This is possible because there are now additional contacts made by the EPI to give children vitamin A supplementation every 6 months up to 2 years of age, and to give a measles booster vaccination in the second year of life. The exact number of doses given will depend on the EPI schedule of the country. By integrating service, combining IPTi with the EPI, we believe that demand for EPI vaccinations and vitamin A supplementation will increase, and this will be supported through a social and behaviour change communication campaign to increase community involvement and empowerment. MULTIPLY will also deliver IPTi through EPI mobile outreach clinics to access hard to reach children and increase equity.
This pilot introduction is led by the Barcelona Institute for Global Health (ISGlobal) in Spain, in coordination with researchers at:
- Fundaçao Manhiça, at Centro de Investigação, Mozambique
- University of Lomé (UL), Togo
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Sierra Leone
- Institut de Recherche pour le Développement (IRD), France
- Medicines for Malaria Venture (MMV), Switzerland
MULTIPLY has made great progress working with the ministry of health in each country to implement multiple doses of IPTi. Implementation in Sierra Leone began February 2022, where up to 6 doses will be given in the first 2 years of life. Togo will start implementation in May 2022, where up to 4 doses of IPTi will be given. It is envisioned that Mozambique will begin implementation in June 2022, where up to 6 doses will be given. Multiple doses of IPTi will be given to up to 45,000 children, 15,000 per country, for 2 years. We are using a paediatric dispersible dose of SP given in a small amount of clean water. In 2024 we will conduct impact and evaluation studies to assess impact, operational feasibility and cost effectiveness of multiple doses of IPTi and discuss the results with the ministries of health, which could lead to the scaling up to other regions of the country with moderate-to-high malaria transmission.
