To determine the efficacy, safety, cost-effectiveness, and uptake of weekly courses of Dihydroartemisinin-Piperaquine (DP) compared to the current standard of care regime in most of eastern and southern Africa, monthly sulphadoxine-pyrimethamine (SP).
Rationale and Abstract
Sickle Cell Anaemia (SCA) is one of the most common inherited disorders in the world. The disorder causes complications and substantial morbidity and death in children under five in sub-Saharan Africa. Malaria remains widespread and is a major cause of morbidity and mortality. Children with SCA have higher mortality compared to those without SCA when infected with malaria, making prevention of malaria important. Standard prevention of malaria among children with SCA is either difficult to administer due to requirements of daily dosing (progruanil), or is no longer effective due to high levels of parasite resistance (sulphadoxine-pyrimethamine (SP)).
Evidence suggests that dihydroartemisinin-piperaquine (DP) might be a better alternative than the drugs presently recommended. . The main objective of this project is to evaluate whether it is safe and more efficacious to give monthly DP compared to monthly SP in preventing malaria among children with SCA in eastern and southern Africa. We will also consider if DP is feasible, acceptable and cost effective. Children with SCA will be recruited from health centres in Uganda and Malawi and randomized to either DP or SP. We hope that this project will generate evidence to support policy change toward a more effective treatment in preventing malaria in a vulnerable population and thereby reduce morbidity and mortality. The multidisciplinary team, led by Dr. Idro Richard (Makerere University, Uganda), has an exceptional publication record in this field, and includes senior researchers from University of Malawi, Makerere University (Uganda), Kenya Medical Research Institute and Liverpool School of Tropical Medicine. This is the same team that recently successfully completed a major multi-centre project on the use of DP in the post-discharge chemoprevention of malaria in children discharged from hospital with severe anaemia.
The project is hosted at the University of Bergen, with Prof. Bjarne Robberstad as project manager. The project has undergone ethical approvals in Uganda, Malawi, England and Norway. The Covid-19 situation has caused national lock-downs in Uganda and Malawi with subesequent project delays, but despite this we recruitment of patients is already well underway.