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Preventing severe anaemia in children in Malawi, Uganda and Kenya

Can the provision of antimalarial medicine after hospitalization prevent new malaria infections that causes deadly anaemia in children?

african child local community
Foto:
african child local community

Anaemia, a condition with decreased levels of red blood cells, is a leading cause of hospitalization in Africa. Many children develop severe anaemia due to previous and current malaria infections. In many sub- Saharan African countries this is a serious threat to children’s health, and causes a substantial number of deaths every year – acute, but also in the months that follows after malaria treatment at the hospital.

Follow-up after hospitalization to prevent new malaria infections 
While the routines for the in-hospital-management of both malaria and anaemia is well- established, there is no systematic follow up of these children – meaning that they face the risk of new malaria infections, with the concequence of severe and deadly anaemia.

For this reason, this project will evaluate whether it is safe and efficacious to routinely prevent new incidences of malaria and anaemia by giving antimalarial drugs during the first three months after discharge from hospital. 

The research – study design and current status
Studies will be conducted in Kenya and Uganda, where two groups of children will be randomly selected. One group will receive antimalarial medicines (dihydroartemisinin-piperaquine), and the other group will be given a placebo. By September 2018, the recruitment into this study has been completed.

The project will also explore how to best deliver prevention strategies in the real world. In Malawi, the effectiveness, acceptability and feasibility of five different delivery strategies will be assessed, and also their cost-effectiveness.  By September 2018, 370 patients have completed the study. In this trial the antimalaria medicine are delivered through community- or facility-based methods – with or without the use of different reminders, including SMS. The research group newly published a study, concluding that this treatment is highly accepted among caregivers in Malawi, revealing that caregivers preferred community-based delivery with the use of health cards.

Additionally, by using modelling techniques the project will determine the epidemiological and geographical settings where this prevention strategy will have the most impact in order to build up evidence for the World Health Organization’s policy development.

Project management by professor Bjarne Robberstad in collaboration with international partners
The project is a part of the Global Health Priorities Research Group, hosted at the Department of Global Public Health and Primary Care (University of Bergen), with Prof. Bjarne Robberstad as project manager. The multidisciplinary team, led by Prof. Phiri (University of Malawi), has an exceptional publication record in this field, and includes senior researchers from Makerere University (Uganda), Kenya Medical Research Institute, Liverpool School of Tropical Medicine, London School of Hygiene and Tropical Medicine, Imperial College London, University of Amsterdam, Indiana University and Chr. Michelsen Institute (Norway).