PDMC Saves Lives

The challenge

Children leaving hospital after being treated for severe anaemia are at greatly increased risk of readmission and death over the following months. Often, this is due to malaria infection, to which they remain highly vulnerable.

Several studies have shown that this increased risk of death can be dramatically cut by providing children with a course of antimalarial drugs to prevent malaria infections – an approach known as post-discharge malaria chemoprevention (PDMC).

Some countries, including Malawi and Uganda, have made a policy decision to begin PDMC. However, there is little evidence, and therefore no formal guidance, on exactly how PDMC should be introduced. Hence, while PDMC has been recommended by WHO, no practical guidance on implementation has yet been produced.  Key issues include choice of antimalarial, optimal delivery method, and integration with other malaria control strategies, such as seasonal malaria chemoprevention.

The project

The PDMC Saves Lives project aims to close this knowledge gap by generating additional evidence on the practicalities of PDMC implementation. It includes collaborations with policymakers in Malawi and Uganda, as well as in Benin and Kenya, four malaria-endemic countries that have not yet developed a PDMC policy.

The project team will undertake extensive consultation with stakeholders at different levels – national policymakers, district-level health staff, frontline health workers and community representatives – to explore the issues that could influence the success of a PDMC programme. Approaches that could be used include self-administration of antimalarial drugs prompted by mobile phone calls or texts, or distribution of drugs to households by community health workers.

Initial research will inform the design of implementation trials in Benin and Kenya, which will be co-designed with national ministries of health. A multifactorial design will be used so that multiple different variants of implementation strategies can be assessed in a single study. Running the trial in two countries will provide evidence relating to two different health systems and populations. The trial’s key outcome measure will be the adherence of children to the recommended course of antimalarial treatment. 

Based on the trial results, the project team will engage with policymakers to develop or update guidance. A health economic analysis will also be undertaken to inform decision-making.

Impact

The PDMC Saves Lives project will provide important evidence on the practicalities of PDMC delivery within health systems. The project’s findings will:

• Facilitate the development of PDMC policy in different malaria-endemic countries in East and West Africa.
• Identify key factors affecting the implementation of PDMC, helping to shape countries’ implementation plans.
• Generate guidance for policymakers and a practical toolbox to support national implementation of PDMC.
• Generate evidence to inform WHO implementation guidance.

Ultimately, the findings of the project will enable more malaria-endemic countries to introduce a strategy that, as well as preventing the deaths of young children, is also likely to deliver cost savings to health systems.