Dihydroartemisinin-Piperaquine Based Post Discharge Malaria Chemoprevention Improved Parasite Clearance and Haemoglobin Recovery in Children

Severe malarial anaemia (SMA) remains a leading cause of paediatric hospitalisation and mortality in sub-Saharan Africa, particularly in high-transmission settings such as Nigeria's Niger Delta region. This study evaluated the clinical efficacy of dihydroartemisinin–piperaquine (DHAPQ) in children with severe malarial anaemia;, by assessing parasite clearance and haemoglobin recovery. A prospective, randomized, open-label comparative study was conducted involving 108 children aged 6–59 months with SMA recruited from Niger Delta University Teaching Hospital and Bayelsa State Specialist Hospital. After completing standard treatment intravenous artesunate followed by an oral artemisinin-based combination therapy (ACT)], participants were randomly allocated to receive either four 3-day courses of DHA-PQ, with the first course administered at discharge and subsequent courses during weeks 2–3, 6–7 and 10–11 after discharge (12 doses in total over approximately 3 months; verify the dosing schedule and number of doses per course) (n=71), or a placebo comparator of paracetamol and vitamin C as the control regimen on the same schedule (control, n=37). Outcomes measured included parasite clearance and haemoglobin recovery. Baseline characteristics Baseline characteristics showed profound anaemia (mean haemoglobin 3.8 ± 0.5 g/dL), high parasite density (60,864 ± 8,096 parasites/μL), and significant nutritional heterogeneity. DHA-PQ demonstrated superior parasite clearance, with parasite density falling to 113 ± 93 parasites/μL after the third dose of week 6-7, third course (compared to 1,245 ± 866 parasites/μL in the control group (p < 0.001). Haemoglobin recovery was significantly greater in the DHA-PQ group (7.1 ± 0.8 g/dL vs 6.2 ± 0.9 g/dL; p < 0.001). Logistic regression identified DHA-PQ treatment (AOR = 3.84, p = 0.008), parasite density (AOR = 0.62, p < 0.001), and haemoglobin (AOR = 1.56, p = 0.002). Children who received DHA-PQ had 3.84 times the adjusted odds of treatment success compared with children who did not receive DHAPQ. Since the 95% CI (1.42-10.37) does not include 1 and the association was statistically significant (p = 0.008), DHA-PQ treatment was therefore a significant positive predictor of treatment success. DHA-PQ was well tolerated, and was associated with faster parasite clearance, and greater haemoglobin recovery.