Projected health impact of post-discharge malaria chemoprevention among children with severe malarial anaemia in Africa

Lucy C. Okell (), Titus K. Kwambai, Aggrey Dhabangi, Carole Khairallah, Thandile Nkosi-Gondwe, Peter Winskill, Robert Opoka, Andria Mousa, Melf-Jakob Kühl, Tim C. D. Lucas, Joseph D. Challenger, Richard Idro, Daniel J. Weiss, Matthew Cairns, Feiko O. Kuile, Kamija Phiri, Bjarne Robberstad and Amani Thomas Mori ()
Additional contact information
Lucy C. Okell: Imperial College
Titus K. Kwambai: Kenya Medical Research Institute (KEMRI)
Aggrey Dhabangi: Makerere University
Carole Khairallah: Liverpool School of Tropical Medicine (LSTM)
Thandile Nkosi-Gondwe: Kamuzu University of Health Sciences
Peter Winskill: Imperial College
Robert Opoka: Makerere University
Andria Mousa: Imperial College
Melf-Jakob Kühl: University of Bergen
Tim C. D. Lucas: University of Oxford
Joseph D. Challenger: Imperial College
Richard Idro: Makerere University
Daniel J. Weiss: Telethon Kids Institute, Perth Children’s Hospital
Matthew Cairns: London School of Hygiene and Tropical Medicine
Feiko O. Kuile: Kenya Medical Research Institute (KEMRI)
Kamija Phiri: Kamuzu University of Health Sciences
Bjarne Robberstad: University of Bergen
Amani Thomas Mori: University of Bergen

Nature Communications, 2023, vol. 14, issue 1, 1-10

Abstract: Abstract Children recovering from severe malarial anaemia (SMA) remain at high risk of readmission and death after discharge from hospital. However, a recent trial found that post-discharge malaria chemoprevention (PDMC) with dihydroartemisinin-piperaquine reduces this risk. We developed a mathematical model describing the daily incidence of uncomplicated and severe malaria requiring readmission among 0–5-year old children after hospitalised SMA. We fitted the model to a multicentre clinical PDMC trial using Bayesian methods and modelled the potential impact of PDMC across malaria-endemic African countries. In the 20 highest-burden countries, we estimate that only 2–5 children need to be given PDMC to prevent one hospitalised malaria episode, and less than 100 to prevent one death. If all hospitalised SMA cases access PDMC in moderate-to-high transmission areas, 38,600 (range 16,900–88,400) malaria-associated readmissions could be prevented annually, depending on access to hospital care. We estimate that recurrent SMA post-discharge constitutes 19% of all SMA episodes in moderate-to-high transmission settings.

Date: 2023
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DOI: 10.1038/s41467-023-35939-w

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