The impact of intermittent preventive treatment for malaria on school absenteeism among primary school-aged children in Handeni District Council, Tanzania: quasi-experimental study

Abstract

BACKGROUND: Malaria remains a major public health challenge in sub-Saharan Africa, with school-aged children (SAC) increasingly recognized as a high-risk group due to asymptomatic infections that sustain transmission. In Tanzania, where malaria prevalence varies widely by region, SAC experience substantial malaria-related school absenteeism yet are often overlooked in control strategies. To address this, the National Malaria Control Programme introduced Intermittent Preventive Treatment for schoolchildren (IPTsc) using dihydroartemisinin-piperaquine (DP) in high-endemic districts. Although trials show IPTsc reduces parasitaemia, its effect on school attendance is less clear. This study evaluated the impact of IPTsc on school absenteeism among SAC in Handeni District Council (DC). METHODS: A quasi-experimental pre-post design applied in which the same group is measured before and after an intervention, without random assignment to intervention and control groups. In this study within-pupil comparisons were used to assess school absenteeism before and after the introduction of IPTsc. The same pupils were followed from January-May 2024 (pre-intervention) and January-May 2025 (post-intervention) in Handeni DC, Tanzania. A multistage stratified sampling technique was used to select study participants and 346 pupils were selected through simple random sampling from 13 schools implementing IPTsc. Absenteeism and IPTsc dose data were extracted from school and IPTsc registers, and socioeconomic information was collected using structured questionnaires. Descriptive statistics (frequency, median, interquartile range) and inferential analyses (Wilcoxon Signed-Rank, Mann-Whitney, Kruskal-Wallis, chi-square, Stuart-Maxwell, Fisher's exact, and linear regression) were performed. Ethical approval was obtained from MUHAS, and written consent and assent were secured from guardians and pupils. RESULTS: Data from 346 SAC were analysed; most were aged 11-14 years 192 (55.5%) and 175 (50.6%) were female. The largest proportion were in class 3 [74 (21.4%)]. Overall absenteeism decreased from 13 to 10% after IPTsc (p = 0.001). Malaria-related absences declined from 27.8% to 11.3%, and attendance increased by 6.7%. Most pupils [318 (91.9%)] received all three IPTsc doses. SAC not engaged in economic activities had higher absenteeism (β = 0.26; 95% CI 0.17-0.36; p < 0.001). CONCLUSION: IPTsc was associated with reduced overall and malaria-related school absenteeism among SAC, highlighting its dual benefit for health and education in malaria-endemic areas.