Malaria remains a major public health problem in Africa, despite the decline in malaria incidence reported by most African countries in recent years . Early case detection and prompt effective treatment with ACT are essential tools for malaria control. Intermittent Preventive Treatment (IPT) is a new approach aiming at reducing malaria morbidity and mortality. IPT is recommended by the WHO for pregnant women and infants. In children, the strategy is still debated and several studies are in progress [7–9].
This study assessed the potential benefit of combining home based management of malaria with IPTc in an area with high coverage of ITNs. The trial, conducted in a rural area in Senegal, where malaria is highly seasonal, showed that combination of IPTc and HMM can provide substantial benefit in reducing malaria. Indeed, malaria incidence was lower in villages where HMM was combined with IPTc compared to villages with only HMM strategy. P. falciparum carriage at the end of the transmission season was significantly lower in communities assigned to IPTc + HMM. No severe malaria cases were noted in the HMM + IPTc arm, while five severe malaria cases were registered in the HMM arm; thus the combination of IPTc and HMM can provide substantial benefit in reducing occurrence of severe malaria cases. The combined interventions also provided an additional benefit in reducing the occurrence of anaemia in children less than 10 years of age.
These results are consistent with data from other trials. Tagbor et al., in a randomized controlled trial conducted in children under 5 years in Ghana, demonstrated that combining IPTc with HMM can significantly reduce the incidence of malaria presumptive fevers . Another trial in the Gambia  showed a reduction in the incidence of malaria in children under 5 years of age, when HMM is combined with IPT.
The expansion of malaria control measures at community level has been recommended by the WHO, in order to accelerate malaria elimination . Malaria elimination will require the use of combination of interventions , and this study showed that community health workers can play an important role in scaling up anti-malarial interventions and even contribute to the malaria elimination process.
The study showed that combining HMM to IPTc in an area with high coverage of ITN (95%) will provide additional benefit in reducing malaria burden. The high coverage of ITN in the study area means that study participants had access to two or three interventions (HMM and ITNs or HMM, IPTc, ITNs). Thus, a third arm with only ITNs use would be appropriate to better understand the effect on malaria burden of several anti-malarial interventions. In other trials, conducted in Burkina Faso  and Mali,  IPTc showed a high level of protective efficacy against symptomatic malaria, severe malaria, as well as moderate and severe anaemia in children less than 5 years sleeping under ITNs. It thus appears that IPTc would provide a valuable contribution in reducing malaria by itself, or integrated with other intervention strategies, in areas with highly seasonal malaria .
The combination of IPTc and HMM was effective in reducing the magnitude of malaria and anemia in children less than 10 years. Although combined malaria control strategies at community level are likely to reduce malaria burden drastically, there are however, limited information on how the resultant drug pressure (IPTc drugs, ACT) may impact existing drug resistance. Consequently, it is important to monitor drug resistance while scaling up anti-malarial interventions at community level.
Although HMM + IPTc showed a significant protective effect against anaemia, the prevalence of anaemia at the end of the transmission season was still high. Anaemia was closely associated with P. falciparum carriage and stunting. It is thus important to implement community-based interventions to reduce anaemia among children in rural areas, to complement interventions against malaria, and malaria related anaemia. These interventions could include, among other things, strengthening and improving children's nutritional status and investigating for other possible causes of anaemia.