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Malaria Chemoprevention in the Postdischarge Management of Severe Anemia

Kwambai, Titus, Dhabangi, Aggrey, Idro, Richard, Opoka, Robert, Watson, Victoria, Kariuki, Simon, Nickline, Kuya, Onyango, Eric D, Otieno, Kephas, Samuels, Aaron, Desai, Meghna, Boele van Hensbroek, Michael, Wang, Duolao ORCID:, John, Chandy C, Robberstad, Bjarne, Phiri, Kamija S and terKuile, Feiko ORCID: (2020) 'Malaria Chemoprevention in the Postdischarge Management of Severe Anemia'. The New England Journal of Medicine, Vol 383, pp. 2242-2254.

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Children hospitalized with severe anemia in malaria-endemic areas of Africa are at high risk of readmission or death within six months post-discharge. No strategy specifically addresses this period. We conducted a multi-center, two-arm, randomized, placebo-controlled trial in nine hospitals in Kenya and Uganda to determine if three months of malaria chemoprevention could reduce morbidity and mortality post-discharge.
Children aged <5 years with admission hemoglobin of <5g/dL were eligible. They received standard in-hospital care for severe anemia and a 3-day course of artemether-lumefantrine at discharge. Two weeks post-discharge, they were randomized to receive 3-day dihydroartemisinin-piperaquine treatment courses or placebo at two, six, and ten weeks post-discharge and followed until week-26 inclusive using passive case-detection. The primary outcome was the time to one or more hospital readmissions or death by six months post-discharge. Conditional risk set modeling for recurrent events (Prentice-Williams-Peterson total-time) was used to calculate hazard ratios (HR).
Between May-2016 and November-2018, 1049 participants were randomized (dihydroartemisinin-piperaquine=524, placebo=525). There were 184 and 316 primary outcome events in the dihydroartemisinin-piperaquine and placebo arms, respectively, between 3-26 weeks post-discharge (HR=0.65, 95% CI 0.54-0.78, p<0.001). The reduction was restricted to the intervention period (3-14 weeks post-discharge) (HR=0.30, 0.22-0.42) and not sustained afterward (15-26 weeks) (HR=1.13, 0.87-1.47). No serious adverse events were attributable to dihydroartemisinin-piperaquine.
In areas with intense malaria transmission, three months of post-discharge malaria chemoprevention with monthly dihydroartemisinin-piperaquine in children recently transfused for severe anemia results in substantial reductions in deaths or all-cause readmissions post-discharge. ( number, NCT02671175).

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 155 Anemia
WS Pediatrics > WS 100 General works
WS Pediatrics > By Age Groups > WS 430 Infancy
Faculty: Department: Biological Sciences > Vector Biology Department
Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Helen Wong
Date Deposited: 09 Dec 2020 15:44
Last Modified: 03 Jun 2021 01:02


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