Project 08
PDMC-SAM
Severe acute malnutrition (SAM) is a devastating condition affecting millions of children under five in sub-Saharan Africa. While hospitals can stabilize these children during their initial stay, the danger doesn’t end when they go home. Tragically, research shows that up to 48% of children with SAM die within six months of leaving the hospital—far higher than almost any other hospitalized group. These children are discharged when they start eating again and are sent to community nutrition programs for ongoing rehabilitation. However, their immune systems and nutritional status have not fully recovered, leaving them extremely vulnerable to infections, including malaria. Our previous research demonstrated that giving malaria prevention medicine for three months after discharge to children with severe anaemia, another high-risk group, reduced their risk of death by 77%. Based on this success, the World Health Organization now recommends this approach, called post-discharge malaria chemoprevention (PDMC), for children with severe anaemia in malaria-endemic areas. However, PDMC has never been tested in children with SAM, who have an even higher post-discharge death rate. This project aims to address this critical knowledge gap.
The project will test whether providing four months of weekly malaria prevention medicine to children with SAM after they leave the hospital can reduce deaths and hospital readmissions. Unlike the monthly medicine courses used in previous studies, this project will use a weekly regimen of dihydroartemisinin-piperaquine (DP), which pharmacological modeling suggests may provide more consistent protection and be easier for families to manage. Children will receive their first dose while still in the hospital, followed by weekly directly observed doses during their routine nutrition rehabilitation clinic visits, creating a seamless integration with existing care pathways. The study will involve 538 children across hospitals in Malawi and Uganda, where malaria transmission is moderate to high. Half will receive the active malaria prevention medicine, while the other half will receive an identical-looking placebo. All children will be carefully followed for six months to track deaths, hospital readmissions, and malaria episodes. The study is designed to provide the rigorous evidence needed for WHO and national health ministries to consider expanding PDMC recommendations to include children with SAM.
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