Artemisinin combination therapy at delivery to prevent postpartum malaria: a randomized open-label controlled trial.: Preventing postpartum malaria.

Although the incidence of malaria is increased in women in endemic areas after delivery compared to non-pregnant women, no studies have assessed the benefit of presumptive antimalarial treatment given postpartum.A randomised controlled trial investigating the efficacy of antimalarial treatment in preventing postpartum malaria was performed in healthy PNG mothers immediately following delivery. Participants were randomised 1:1 to no treatment (n=90) or artemisinin combination therapy (ACT), with further 1:1 ACT randomization to artemether-lumefantrine (AL; n=45) or dihydroartemisinin-piperaquine (DP; n=45). Standardised reviews were conducted monthly for six-months, including clinical assessment, malaria screening and haemoglobin measurement. The primary endpoint was incidence of slide-positive malaria within six-months of delivery.Of 183 recruited participants, 151 completed study procedures and were included in per protocol analyses (no treatment n=71, AL n=40, DP, n=40). Those allocated to ACT were significantly less likely to develop slide-positive malaria during the six-month follow-up period compared to those who were untreated (n=17 (21%) versus n=27 (38%); P=0·016; HR 0·49 (95% CI 0·27 to 0·90). There was no significant difference in malaria incidence between the two ACT groups.A treatment course of ACT at time of delivery halved the incidence of malaria infection during the first 6-months postpartum.Copyright © 2024. Published by Elsevier Ltd.

Citation

Paula Tesine, Sze-Ann Woon, Moses Laman, Gumul Yadi, Phantica Yambo, Bernadine Kasian, Lina Lorry, Leanne J Robinson, Sam Salman, Kevin T Batty, William Pomat, Laurens Manning, Wendy A Davis, Timothy M E Davis, Brioni R Moore. Artemisinin combination therapy at delivery to prevent postpartum malaria: a randomized open-label controlled trial.: Preventing postpartum malaria. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2024 Oct 11:107258107258

PMID: 39396742

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