prevention of malaria in pregnancy (WHO/UNICEF, 2003). Benefits in HIV-infected women are unclear, however, as is the efficacy of IPTp in areas where malaria transmission is highly seasonal or endemicity is low (SP resistance is particularly widespread in low transmission areas). In addition, it is not yet clear what drug or combination of drugs will eventually replace SP for intermittent preventive treatment in pregnancy.
The IPT concept has recently been applied to the prevention of malaria in infants. In Tanzania, administration of a full dose of SP to infants concurrent with the second and third doses of diphtheria-pertussistetanus, and measles vaccines reduced the incidence of clinical malaria attacks and severe anemia during the first year of life by 59 and 50 percent, respectively (Schellenberg et al., 2001). Amodiaquine given in full therapeutic dose three times during the first year of life yielded similar results (Massaga et al., 2003). Also important, no rebound in malaria attacks or anemia occurred during the second year of life in children who received IPTi as infants. Trials of IPTi using SP are nearing completion in Ghana and Kenya, and further trials have recently started in Mozambique, Gabon, and Kenya. These trials will help to determine under what conditions IPTi will prove most effective, as well as the EIR threshold below which it will not be useful.
In many areas of Africa, perhaps covering as much as 50 percent of the population at risk, the major burden of malaria is not in infants but in older children. This is especially true in countries of the Sahel and sub-Sahel where malaria transmission is intense but seasonal. A pilot study in Senegal employing SP plus artesunate at 1-month intervals throughout the transmission season is currently exploring whether the IPT principle also can be applied to older children (Greenwood, 2004).
The correct and timely diagnosis of malaria is critically important to the individual patient in whom the disease may quickly progress to a life-threatening stage. Rapid diagnosis, both on an individual and a population level, also is an important tool in overall malaria control. This section reviews currently available methods of diagnosis, with emphasis on newer rapid tests that require relatively little technical expertise to perform. Such tests are now facilitating the delivery of effective treatment in a variety of