Post-discharge malaria chemoprevention in children with severe anaemia in Benin, Kenya, Malawi and Uganda: Formative and implementation research for policy decision making and implementation

Background: Young children in sub-Saharan Africa are at high risk of severe anaemia, associated with high mortality.

Children who have recently recovered from severe anaemia in malaria-endemic areas remain at high risk of mortality for about 3-6 months after hospital discharge.

Three months of post-discharge malaria chemoprevention (PDMC) has recently been shown to reduce hospital readmissions by 53% and post-discharge deaths by 77%. WHO now recommends PDMC in all highly malaria-endemic areas of Africa.

However, the optimal strategies for how to deliver PDMC are not yet clear.Objective: To undertake implementation research and translate results into national policy guidelines to promote PDMC uptake into clinical practice so that vulnerable children have access to life-saving medicines.

Study design: i) Formative research in two countries in the process of adopting PDMC (Malawi and Uganda) and two, not yet (Kenya and Benin), to identify key research questions for PDMC implementation. ii) Two implementation trials (Benin and Kenya, N=1,824) in recently discharged children following recovery from severe anaemia, co-designed with national stakeholders, will evaluate at least two PDMC delivery strategies involving community-health workers and automated SMS reminders.

The primary outcome will be adherence.

Secondary outcomes include clinical and cost-effectiveness, and acceptability and feasibility.Interdisciplinary studies: Acceptability and feasibility; Cost-effectiveness; Policy analysis.Timeline: 42 months: 9m preparation/formative research, 18m trial implementation, 6m analysis + 9m dissemination/exploitation and PhD completion.Impact: The project is designed to provide evidence to support PDMC implementation.Partners: Institut De Recherche Pour Le Developpement, France (coordinating partner); LSTM, UK ; EPICENTRE, France; Institut de Recherche Clinique du Benin; Training and Research Unit of Excellence, Malawi; Makerere Uni, Uganda; Kenya Medical Research Institute, Kenya