Intermittent preventive treatment, the administration of a full course of an
anti-malarial treatment to a population at risk at specified time points regardless of whether or not they are known to be infected, is now a recommended approach to the prevention of
malaria in pregnancy and is being explored as a potential way of preventing
malaria in infants. However, in many
malaria endemic areas, the main burden of
malaria is in older children and increasing use of
insecticide treated bednets is likely to increase further the proportion of episodes of
malaria that occur in older children. Recently, it has been shown in Senegal and in Mali that intermittent preventive treatment given to older children during the
malaria transmission season can be remarkably effective in preventing
malaria. This approach to
malaria control is likely to be most effective in areas with a high level of
malaria transmission concentrated in a short period of the year. However, several issues need to be addressed before intermittent preventive treatment in children can be advocated for use in
malaria control programmes. These include: (1) determination of whether intermittent preventive treatment adds to the protection afforded by other control measures such as
insecticide-treated bednets; (2) whether an effective and sustainable delivery system can be found; (3) choice of drug to be used; (4) optimum timing of drug administration; (5) the requisite interval between treatments. The potential benefits of intermittent preventive treatment in children are substantial; more research is needed to determine if this is a practical approach to
malaria control.