A new initiative will deliver enhanced malaria prevention to children under two across Africa

To kick-start progress against malaria and improve child health in Africa, a new initiative, funded by Unitaid and led by Population Services International (PSI), will support widespread adoption of an effective but underutilized prevention method that could avert 6.7 million cases of malaria and anemia in children under two by 2030.

Intermittent Preventive Treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a safe, affordable, and effective intervention shown to reduce rates of malaria and anemia in children under one year of age by 30 percent and 21 percent respectively. The World Health Organization (WHO) recommended IPTi for use in 2010, yet the intervention has not been widely adopted in Africa.

With a US $35 million investment from Unitaid, the Intermittent Preventive Treatment in infants – Plus (IPTI+) project will develop scalable models of IPTi+, an innovation on the WHO-recommended IPTi, that expands the number of preventive doses of SP administered to children and extends coverage of IPTi through a child’s second year of life. Over the life of the project, the IPTi+ project will administer an estimated 2.5 million doses of SP for IPTi+ protecting over half a million children under two years of age from malaria and anemia.

Brought to scale, IPTi+ will help reignite progress against malaria in the Africa region, where 94 percent of all malaria cases and deaths occur each year. Progress in reducing malaria rates has plateaued in recent years and the COVID-19 pandemic has caused additional setbacks and interruptions to malaria efforts across the continent.

IPTi+ targets a crucial population: children under the age of five accounted for nearly 70% of the estimated 409,000 malaria deaths globally in 2019. Children under two years of age are among the most vulnerable to malaria; half of the child deaths from malaria (54%) are estimated to have occurred in children under the age of two.

“We cannot afford to leave any effective tool unused in our fight against malaria, or we will see our hard-won progress slip away. Unitaid is pleased to announce this major effort to reach hundreds of thousands of young children with IPTi+ – a highly effective but greatly under-utilized intervention for malaria prevention. This latest investment rounds out Unitaid’s work to innovate on all the current antimalarial interventions and improve access we can reignite the fight against malaria and drive down the burden of disease,” said Dr. Philippe Duneton, Executive Director of Unitaid.

Widespread adoption of IPTi has faced challenges including misperceptions about the effectiveness of the recommended drug, sulfadoxine-pyrimethamine, a lack of evidence on its efficacy in areas of moderate to high resistance, and a lack of enabling policies. As the administration of IPTi can fall within the remit of child health, malaria, and immunization programs, unclear delineation of responsibilities has also contributed to unsuccessful adoption.

The IPTI+ project will address these challenges at a country and global level to accelerate adoption and scale-up of IPTi+ with sulfadoxine-pyrimethamine. At the country level, the IPTi+ project will facilitate a country-led co-design process to design IPTi+ models specific to each country in Benin, Cameroon, Côte d’Ivoire, and Mozambique. These four countries represent diverse health systems, malaria transmission, SP resistance, routine health service access, and implementation of other seasonal antimalarial interventions.

“PSI is proud to be working with the Ministries of Health in Benin, Cameroon, Cote d’Ivoire, and Mozambique, as well as county-level and global malaria partners, and the London School of Hygiene & Tropical Medicine, to accelerate adoption and scale-up of IPTi+. PSI and our partners will engage and convene communities and stakeholders to co-design country-specific IPTi+ models that overcome known barriers to uptake; shape mixed health systems to bring IPTi+ closer to Sara, PSI’s archetypal consumer, and her family; and generate evidence on the impact of IPTi+,” said Karl Hoffman, President, and CEO of PSI.

To ensure scalability of the IPTi+ models being developed, Unitaid is also expanding the scope of an existing and complementary grant, implemented by the not-for-profit product development partnership Medicines for Malaria Venture (MMV). In addition to collaborating with the IPTi+ Project to deliver existing formulations of SP, MMV will work with selected African manufacturers to support local production of properly dosed, dispersible, and quality-assured formulations of SP that are suitable for children to the future-proof supply of the medicine.

The project will collect evidence on the impact, cost-effectiveness, and feasibility of IPTi+ across variable settings to inform scale-up in target countries and beyond. In addition to piloting implementation models in the four focus countries, the IPTi+ project will generate policy, economic, and suitability evidence on IPTi+ in three additional countries.

“In the past five years, annually, there have been approximately 4 million malaria cases and 400,000 hospital admissions for malaria in children under 5 years in Cameroon. To address this, we hope that introducing IPTi+, in addition to the use of long-lasting insecticide nets, will enable us to further reduce malaria incidence and hospital admissions contributing to healthier and happier families. The National Malaria Control Program is excited to work with the IPTi+ Project and two renowned public health institutions, PSI and LSHTM, to introduce and increase access to IPTi+ and ensure accurate monitoring and evaluation of IPTi+ in Cameroon,” said Dr. Dorothy Fosah Achu, Permanent Secretary, National Malaria Control Program, the Ministry of Public Health, Cameroon.