Malaria chemoprevention after discharge lowers death in anemic children: NEJM
Africa: Three months of malaria chemoprevention with dihydroartemisinin–piperaquine helps in preventing deaths or readmission after hospital discharge in children (younger than 3 years) hospitalized for severe anemia, suggests a recent study. The study, published in the New England Journal of Medicine, was conducted in areas with intense malaria transmission.
In areas of Africa where malaria is endemic, severe anemia leads to substantial increase in childhood mortality and is a leading cause of hospital admission. Such children have a high risk of readmission and death within 6 months after discharge. The strategies aimed to reduce the risk during this postdischarge period may be substantial importance for public health. But no prevention strategy specifically addresses this period. Considering this, the researchers conducted a multicenter, two-group, randomized, placebo-controlled trial in nine hospitals in Kenya and Uganda. Their aim was to determine whether 3 months of malaria chemoprevention could reduce morbidity and mortality after hospital discharge in children younger than 5 years of age who had been admitted with severe anemia.
The researchers hypothesized that administration of malaria prophylaxis during a limited period after transfusion would give sufficient time for bone marrow recovery resulting in a more sustained hematologic recovery.
All children received standard in-hospital care for severe anemia and a 3-day course of artemether–lumefantrine at discharge. Two weeks after discharge, 1049 children were randomly assigned to receive dihydroartemisinin–piperaquine (chemoprevention group; n=524) or placebo (n=525), administered as 3-day courses at 2, 6, and 10 weeks after discharge. Children were followed for 26 weeks after discharge.
The primary outcome was one or more hospital readmissions for any reason or death from the time of randomization to 6 months after discharge.
Key findings of the study include:
- From week 3 through week 26, a total of 184 events of readmission or death occurred in the chemoprevention group and 316 occurred in the placebo group (hazard ratio, 0.65).
- The lower incidence of readmission or death in the chemoprevention group than in the placebo group was restricted to the intervention period (week 3 through week 14) (hazard ratio, 0.30) and was not sustained after that time (week 15 through week 26) (hazard ratio, 1.13).
- No serious adverse events were attributed to dihydroartemisinin–
"In areas with intense malaria transmission, 3 months of postdischarge malaria chemoprevention with monthly dihydroartemisinin–piperaquine in children who had recently received treatment for severe anemia prevented more deaths or readmissions for any reason after discharge than placebo," concluded the authors.
The study, "Malaria Chemoprevention in the Postdischarge Management of Severe Anemia," is published in the New England Journal of Medicine.