05:52pm Friday 28 April 2017

Does prolonged malaria treatment save lives?

A large multinational project seeks to find out whether malaria treatment will improve the health of children with anaemia after discharge from hospital. The researchers will also study whether this could be a simple, cost-effective method to prevent disease, readmission to hospital and even death.

The overall budget of the project is NOK 35.6 million, of which NOK 32.8 million is being funded under the Research Council’s Programme for Global Health and Vaccination Research (GLOBVAC).

Malaria-induced anaemia is one of the leading causes of admission to hospital of children in Africa. It is a major component of the disease burden in African countries. While many children die in the acute phase while still hospitalised, many also die at home up to several months after being discharged. Although management of malaria and severe anaemia follow well-established protocols when patients are in hospital, systematic follow-up management has not been established for the post-discharge period. This is precisely what the researchers behind this project are currently investigating.

Major clinical study in Uganda and Kenya
The project is examining whether it is safe and effective to routinely provide antimalarial drugs during the first three months after discharge from hospital. The project comprises two primary components. In Kenya and Uganda, a randomised placebo-controlled clinical trial is currently underway involving three courses of the malaria drug, dihydroartemisinin-piperaquine or placebo. At present, 300 children who were discharged from hospital after being admitted for anaemia have been enrolled in the study. The researchers are expecting to recruit a total of 2 212 children by the end of 2018.

Malawi: can mobile telephones and local healthcare personnel help to improve access to medicine?

In Malawi, different follow-up routines after hospital discharge are being studied to determine the best course of action in practice. Zomba District Hospital is serving as a base and 110 children have been recruited upon their discharge from hospital. All children participating in the study will have access to antimalarial drugs, but the children are divided into different groups to see which methods ensure the best effectuation of treatment: should a child’s family or caregiver be given the medicine to take home or should they come back to the hospital to get them? Should local healthcare personnel distribute medicine or help to remind caregivers that a child needs to take it? Can mobile phones be used to communicate follow-up reminders to local healthcare personnel in villages or even to send text messages directly to caregivers?

Is the treatment cost-effective and fair?

If successful, the treatment under trial in this study may lead to new measures and routines in the health services of one of the world’s poorest countries. At present, Malawi is highly dependent on development assistance. Development aid is used to fund over 60 per cent of the costs of its health system and certain national health initiatives are more than 90 per cent aid-financed. This means that funding is limited and authorities and donors alike must prioritise carefully. In addition to testing a new treatment method in this clinical study, researchers will also be trying to determine whether the existing health system is able to adapt and implement new routines and at what cost. The researchers will conduct cost-benefit analyses to look at, among other things, the significance of a village’s location relative to the closest hospital and what this means in terms of the routines recommended. Will it be worthwhile to implement one routine in urban areas but a different one in rural villages? In order to gain the most precise cost-benefit recommendations possible, researchers in the three countries will also examine the significance of the incidence of malaria infection, seasonal variations of malaria and other antimalarial measures such as the distribution of mosquito nets. The study has already initiated qualitative surveys in which they interview both healthcare personnel and caregivers. The objective is to find out how well the new treatment routines are perceived and, thus, to be able to provide more detailed explanations of the recommendations to be presented after concluding the study.

Key information:

Funding:

The total budget of the programme is NOK 35.6 million over five years, of which NOK 32.8 million is funded under the Research Council’s GLOBVAC programme. The study will be completed in 2019.

Partnership and capacity-building:

Professor in Health Economics, Bjarne Robberstad, is project manager for the Norwegian part of the project. The project is hosted at the Centre for International Health (University of Bergen). Professor Kamija Phiri (University of Malawi) has overall responsibility for completion of the study, which will build important management expertise at the College of Medicine. The group includes leading 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. Michelsens Institute in Bergen (Norway).

The project is funding four doctoral fellowships in Malawi, Uganda, Kenya and Norway, respectively, as well as one Norwegian post-doctoral fellowship. Also involved in the project are Master’s degree students and Norwegian medical school students.

English translation: Carol B. Eckmann

Written by: Åse-Marit Kristiansen

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