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  • Post discharge Malaria...

Post discharge Malaria Chemoprevention reduces mortality in kids with severe Anemia: NEJM

Dr. Nandita MohanWritten by Dr. Nandita Mohan Published On 2021-02-09T14:30:38+05:30  |  Updated On 9 Feb 2021 8:53 AM GMT
Post discharge Malaria Chemoprevention reduces mortality in kids with severe Anemia: NEJM
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It has been observed that 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, according to the study published in the New England Journal of Medicine. Children who have been hospitalized with...

It has been observed that 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, according to the study published in the New England Journal of Medicine.

Children who have been hospitalized with severe anemia in areas of Africa in which malaria is endemic have a high risk of readmission and death within 6 months after discharge. No prevention strategy specifically addresses this period.

Hence, Titus K. Kwambai and colleagues conducted a multicenter, two-group, randomized, a placebo-controlled trial in nine hospitals in Kenya and Uganda 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.

All children received standard in-hospital care for severe anemia and a 3-day course of artemether-lumefantrine at discharge. A total of 1049 children underwent randomization; 524 were assigned to the chemoprevention group and 525 to the placebo group. Two weeks after discharge, children were assigned to receive dihydroartemisinin-piperaquine (chemoprevention group) or placebo, 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. Conditional risk-set modeling for recurrent events were used to calculate hazard ratios with the use of the Prentice–Williams–Peterson total-time approach.

The results showed that –

a. 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; 95% confidence interval [CI], 0.54 to 0.78; P<0.001).

b. 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; 95% CI, 0.22 to 0.42) and was not sustained after that time (week 15 through week 26) (hazard ratio, 1.13; 95% CI, 0.87 to 1.47).

c. No serious adverse events were attributed to dihydroartemisinin-piperaquine.

Therefore, the authors concluded that "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."

malaria chemopreventionPostdischarge Managementsevere anemiaNew England Journal of Medicine
Source : New England Journal of Medicine
Dr. Nandita Mohan
Dr. Nandita Mohan

    BDS, MDS( Pedodontics and Preventive Dentistry)

    Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

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