Malaria Chemoprevention for the post-discharge management of severe anaemia in children in Malawi

BACKGROUND: Children hospitalised with severe anaemia in Africa are at high risk of readmission or death within 6 months after discharge. No strategy specifically addresses this post-discharge period. We recently showed that 3 months malaria chemoprevention with monthly Intermittent Preventive Therapy post-discharge (IPTpd) in Malawian children with severe anaemia prevented 31% of deaths and readmissions. The effect was in addition to the effect by bednets. These promising findings now need to be confirmed in other settings and the delivery mechanisms evaluated.

OBJECTIVES: To generate the evidence needed by WHO to consider IPTpd as a strategy to reduce post-discharge morbidity and mortality in malaria endemic areas in Africa.

MAJOR ACTIVITIES: This 5-year project comprises of:

1) Confirmatory Efficacy Trial in Kenya and Uganda: multi-centre, 2-arm, placebo-controlled, superiority trial of 3 courses of monthly IPTpd with dihydroartemisinin-piperaquine among 2212 children with severe anaemia. Composite primary endpoint: death and all-cause re-admission by 3 months;

2) Delivery mechanism trial in Malawi: Single-centre, cluster randomized, 4-arm factorial design trial in 380 children comparing the uptake, feasibility and acceptability of IPTpd delivered through outpatient departments or community based village health workers, with or without support from a phone text messaging reminder;

3) Impact analysis to define the target population and map the epidemiological and geographical settings in which IPTpd would be an appropriate intervention and estimate the potential public health impact through systematic reviews and modeling;

4) economical evaluation of the cost-effectiveness of IPTpd; and 5) IPTpd policy taskforce
to liaise with WHO.