The Impact of Intermittent Preventive Treatment for Malaria on School Absenteeism Among Primary School-Aged Children in Handeni District Council, Tanzania: Quasi-Experimental Study

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 community transmission. In Tanzania, where malaria prevalence varies widely by region, SAC experiences significant school absenteeism linked to malaria. To address this, the National Malaria Control Program introduced Intermittent Preventive Treatment for school children (IPTsc) using Dihydroartemisinin-Piperaquine (DP) in high-endemic districts. While clinical trials have shown IPTsc to be effective in reducing parasitemia, its impact on school attendance remains understudied. This study evaluated the effect of IPTsc implementation on school absenteeism and identified socioeconomic factors associated with school absenteeism among SACs in the Handeni District Council (DC). Methods: A quasi-experimental pre-post study was conducted in Handeni District Council, a high malaria-endemic area in Tanga Region, Tanzania, to assess the impact of IPTsc on school absenteeism among primary school children. Data were collected from 346 students sampled from 13 randomly selected public and private schools participating in the IPTsc program. School absenteeism rates were compared before (Jan–May 2024) and after (Jan–May 2025). Absenteeism data were extracted from school registers, IPTsc dose records were reviewed, and additional demographic and socioeconomic data were collected through structured questionnaires. Statistical analysis included descriptive statistics, Statistical analysis was performed using Wilcoxon Signed-Rank, Mann-Whitney, Kruskal-Wallis, chi-square, Stuart-Maxwell, Fisher’s exact tests, univariate and multivariable linear regression. Ethical approval was obtained from MUHAS, and informed consent and child assent procedures were observed. Results : The absenteeism rate decreased from 13% before the Intervention to 10% after the intervention (p = 0.001). Malaria-related absences dropped from 27.8% to 11.3%. Most pupils (91.9%) received all three IPTsc doses. However, the number of doses was not significantly associated with absenteeism. Children involved in economic activities and those living in better-quality housing had lower absenteeism rates. Conclusion: IPTsc significantly reduced overall malaria-related absenteeism among primary school children, with high coverage of all three doses in most participants. However, the number of doses received was not significantly associated with absenteeism. Socioeconomic factors were also strongly associated with school attendance.