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

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

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: 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. Methods: 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. Results: 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. Conclusion: A treatment course of ACT at time of delivery halved the incidence of malaria infection during the first 6-month postpartum.

Original languageEnglish
Article number107258
Number of pages8
JournalInternational Journal of Infectious Diseases
Volume149
Early online date10 Oct 2024
DOIs
Publication statusPublished - Dec 2024

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