This study looked at the effectiveness of intermittent preventive treatment for children (IPTC) combined with timely treatment at home for malaria control, targeting children aged six to 60 months old in an all year round malaria endemic area in Ghana. The main finding of the study was a reduction of about 88.0% in the prevalence of malaria parasite infections in the target population (from 25.0% at baseline to 3.0% at evaluation) within one year of the project implementation. It may be argued that the increase in the use of insecticide treated net (from 38.5% to 60.0%) could be implicated in the reduction of the malaria parasite prevalence in the study population. However, it is unlikely that all the reduction of over 80.0% was due to the 55.8% increase in ITN use alone. Several studies in IPT intervention measured clinical incidence rather than prevalence and found between 20% and 86.0% reduction with strong variations depending on transmission duration and intensity, target population and intervals between treatments [9–12, 14, 15]. In this study, prevalence was measured because it is easier to measure as the interventions were delivered by community assistants. The second reason for measuring prevalence was the combination of IPTC with home treatment, which requires that suspected cases were treated once they meet the inclusion criteria and for ethical reasons, the community assistants were not trained to take blood for examination before treating the children. However, this may be seen as a weakness of the study.
Anaemia in the children, defined as haemoglobin <10 g/dl, improved from 27.6% to 16.8%, 12 months after the intervention was implemented. This compares well with a recent randomized trial in Tanzania, which showed that IPT given to infants at the time of childhood immunization reduced the incidence of the first episode of malaria and anaemia by more than 50.0% during the first year of life [10, 11].
There was a noticeable reduction in malaria-related morbidity in the study population as expressed by fever and other malaria-related signs and symptoms reported either in the seven days before prevalence surveys or IPTC administration. The reduction could also be seen from reported treatment sought for the children within the seven days prior to prevalence surveys or IPTC administration. Timely treatment of febrile malaria cases in the community did not follow any pattern as can be seen from the result. However, it could be argued that because the community assistants were on hand to deliver effective treatment in a timely fashion, this could have contributed to the marked reduction of parasitaemia seen at the evaluation survey. The community assistants also contributed to heightened health information in the study community through informal education on the use of treated bed net and timely treatment. This should encourage malaria control programmes to have confidence in community assistants to deliver timely treatment and IPTC to children at the community level, once they are well trained by the programme coupled with reference manual for easy and quick referencing when in doubt.
Findings reported here present a challenge to the existing practice, especially in most sub-Saharan African countries, where malaria diagnosis is based on presumption without confirmation. As community intervention or treatment increases, this may lead to fewer malaria infections and this may lead to over diagnosis and treatment with expensive drugs for people who do not need them. When this happened, control programmes would have to invest in rapid diagnostic test kits where microscopy is not possible. As reported by Zikusooka et al , this may lead to cost savings because anti-malarial drugs are expensive. Goodman et al  also make this point. Furthermore, rational use of anti-malarials will reduce the potential for adverse reactions.
The sharp increases in the number of febrile malaria cases treated at home between IPTC2 and IPTC3 might have been largely due to increased confidence of caretakers in the ability of community assistants to treat their children with suspected febrile malaria effectively and the recognition of caretakers of the importance of timely treatment. The decrease in the numbers between IPTC3 and evaluation could be attributed to the reduction of malaria prevalence in the study community as a result of the interventions implemented.
The use of IPTi which is similar to IPTC in principle was found to reduce malaria incidence in infants . Although this study cannot determine the contribution of IPTC and timely treatment at home to the protection offered to the children because the two interventions were delivered concurrently, the two together in this study offered a major protection against malaria in children, reducing prevalence from 25% to 3%.
The results indicate that it is possible to deliver IPTC and timely home treatment to children between six and 60 months old. Since there were no timely treatment form to collect at some of the biweekly visits to the community, it should be possible to reduce the visit to once in a month to reduce supervision cost.
This indicates that, it is possible to reduce malaria prevalence and this may reduce malaria-related childhood morbidity and mortality and this should be explored by control programme managers as one of the effective options available for the fight against malaria, especially in sub-Saharan Africa.