Artemisinin combination therapy at delivery to prevent postpartum malaria: A randomised open-label controlled trial.

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 Papua New Guinea mothers immediately following delivery. Participants were randomised 1:1 to no treatment (n = 90) or artemisinin combination therapy (ACT), with further 1:1 ACT randomisation to artemether-lumefantrine (AL; n = 45) or dihydroartemisinin-piperaquine (DP; n = 45). Standardised reviews were conducted monthly for 6 months, including clinical assessment, malaria screening and haemoglobin measurement. The primary endpoint was incidence of slide-positive malaria within 6 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 6-month follow-up period compared to those who were untreated (n = 17 (21%) vs n = 27 (38%); P = 0.016; hazard ratio 0.49 (95% confidence intervals 0.27-0.90). 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-month postpartum. Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

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 randomised open-label controlled trial. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2024 Dec;149:107258

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PMID: 39396742

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