---
title: "Optimising post-discharge malaria chemoprevention delivery for children hospitalised with severe a"
id: "bmj-open-18-delivery-strategies-for-malaria-chemoprevention-in-the-post-discharge"
canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-18-delivery-strategies-for-malaria-chemoprevention-in-the-post-discharge"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "BMJ Open"
source_url: "http://bmjopen.bmj.com/cgi/content/short/16/8/e123067?rss=1"
published_at: "2026-08-28T09:38:04.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Optimising post-discharge malaria chemoprevention delivery for children hospitalised with severe a
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-18-delivery-strategies-for-malaria-chemoprevention-in-the-post-discharge
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** BMJ Open
- **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/8/e123067?rss=1)
- **Published At:** 2026-08-28T09:38:04.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Children discharged after treatment for **severe anaemia** or **severe malaria** in sub-Saharan Africa face high risk of readmission and death from recurrent infections, particularly in malaria-endemic settings. - Post-discharge malaria chemoprevention (**PDMC**) reduces mortality and readmissions and is now recommended by WHO, but optimal delivery strategies within existing health systems remain uncertain, especially in West Africa. - The trial is a cluster-randomised implementation study in central and southern Benin, enrolling children under 10 years who are clinically stable at discharge after hospitalisation for severe anaemia or severe malaria. - Clusters (villages within two hospital catchment areas) are randomised 1:1:1 to three arms: (A) facility-based distribution at discharge with CHW home visit reminders; (B) monthly community-based CHW delivery with phone reminders; (C) dispensing all courses at discharge without adherence support (control). - All participants are to receive three courses of **dihydroartemisinin–piperaquine** at weeks 2, 6 and 10 after discharge and followed for 14 weeks; the primary outcome is incomplete adherence to the full PDMC regimen (three courses/nine doses). - Secondary outcomes include all-cause and malaria-specific readmissions, outpatient visits and mortality; quantitative analysis will use mixed-effects regression under intention-to-treat, and qualitative work will assess acceptability and feasibility among caregivers, providers and policymakers. - Ethical approval was granted by the Benin Institute of Applied Biomedical Sciences and Liverpool School of Tropical Medicine. Results will be shared with national and international stakeholders, WHO and major malaria funding partners. - Trial registrations: ClinicalTrials.gov NCT06601712 (registered 14 September 2024) and Pan African Clinical Trials Registry PACTR202411682724094 (registered 5 November 2024).
## Clinical Analysis & Structured Key Points
Introduction Children discharged after in-hospital treatment for severe anaemia or severe malaria in sub-Saharan Africa remain at high risk of readmission and death, particularly in malaria-endemic settings where recurrent infections are common. Post-discharge malaria chemoprevention (PDMC) has demonstrated substantial reductions in mortality and hospital readmissions and is now recommended by the WHO. However, optimal PDMC delivery strategies, via existing health systems, that optimise adherence remain unclear, particularly in West Africa where implementation and evidence of impact on clinical outcomes are limited. This trial aims to determine the effectiveness of different PDMC delivery strategies and adherence support mechanisms in optimising completion of PDMC courses. Secondary objectives include assessing clinical outcomes (readmissions, outpatient visits, mortality), evaluating health system linkage mechanisms and examining the acceptability and feasibility of the different delivery approaches. Methods and analysis A cluster-randomised implementation trial will be conducted in central and southern Benin across urban and rural settings. Clusters, defined as villages within the catchment areas of two referral hospitals, will be randomly allocated (1:1:1) to one of three arms: (A) facility-based drug distribution (all courses) at discharge with community health worker (CHW) home visit reminders; (B) monthly community-based drug delivery by CHWs combined with phone reminders; and (C) dispensing all courses to caregivers at discharge without adherence support (control). Eligible participants are children under 10 years hospitalised with severe anaemia or severe malaria and clinically stable at discharge. All participants should receive three courses of dihydroartemisinin - piperaquine at weeks 2, 6 and 10 post-discharge and will be followed for 14 weeks. The primary endpoint is incomplete adherence to the full PDMC regimen (3 courses/9 doses). Secondary endpoints include all-cause and malaria-specific readmissions, outpatient visits and mortality. Quantitative outcomes will be analysed using mixed-effects regression models under an intention-to-treat approach. Qualitative methods will assess acceptability and feasibility among caregivers, providers and policymakers. Ethics and dissemination Ethical approval was received from the institutional review boards of the Benin Institute of Applied Biomedical Sciences and Liverpool School of Tropical Medicine. Trial findings will be disseminated to national and international stakeholders through meetings, peer-reviewed publications and major conferences to inform PDMC policy, implementation guidelines and global malaria scale-up efforts, particularly through engagement with the World Health Organization and major malaria funding partners Trial registration number ClinicalTrials.gov, NCT06601712 , registered on 14 September 2024 ( https://clinicaltrials.gov/study/NCT06601712 ); and Pan African Clinical Trials Registry, PACTR202411682724094, registered on 5 November 2024 ( https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=31962 ).
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