Implementing Post-discharge Malaria Chemoprevention (PMC) to reduce child mortality and morbidity among children with severe anaemia

We will study the implementation of routine malaria prevention among children in Malawi who have suffered and treated at hospital for severe anaemia. Severe anaemia each year kills many children in Africa south of Sahara, and it does so even after a successful treatment that typically includes blood transfusion and pharmaceutical treatments. Our research collaboration has earlier demonstrated that routine malaria prevention with the drug DP is very effective in reducing deaths and new severe cases of anaemia, and the government of Malawi is therefore in the process of considering how to scale this up nationally. The purpose of this research is to study in real-time various aspects of the scale-up. We will first study which new knowledge that will be most valuable when introducing the treatment, in order for us to focus the research properly. We will involve health care decision makers in deciding how to design the treatment alternatives, so that our research becomes as relevant as possible. We will conduct an experiment where we compare the most promising implementation strategies in terms of how well they are accepted by patients and families. We will investigate which factors that enable and constrain treatment uptake, both from the perspectives of the patients and the health care providers. We will analyse costs- and conduct a cost-effectiveness analysis to ensure the best value for money, and we will engage decision makers in a policy translation process based on our research, so that our results may make a difference both at regional and international levels. We have gathered an interdisciplinary team of leading researchers from Africa and Europe. In Malawi, we collaborate with the Training and Research Unit of Excellence, Kamuzu University of Health Sciences and the National Malaria Control Programme. University of York in the UK contribute health economic expertise, while the University of Bergen leads the consortium. This project is funded by GLOBVAC and is part of the EDCTP2-Program supported by the European Union.

We will use an innovative two-stage formative research approach to prospectively study the full-scale implementation of PMC in Malawi. This interdisciplinary study will incorporate both provider and patient perspectives of the implementation at all levels of the care-continuum. PMC is safe and efficacious, but with less convincing results regarding adherence. Alternative approaches to implement PMC may differ in their costs, feasibility, acceptability, and breadth of coverage and uptake. This proposal combines observational and experimental approaches to maximize the potential impact and value for money. We will prospectively study the national implementations of PMC in Malawi using the following three stages and 7 work-packages: ? Formative research to design intervention packages (WP1-WP2), ? Implementation stage, representing large scale natural experiments (WP3-WP6) ? Evaluation and dissemination (WP7) WP1: Early economic assessment WP2: Stakeholder engagement WP3: Implementation of incremental benefit packages in Malawi WP4: Supply side constraints for implementation WP5: Demand-side - Enablers, barriers and access among caregivers WP6: Economic evaluation of PMC implementation WP7: Policy taskforce Our main hypothesis is that variations in implementation strategies for PMC within the country will translate into variations in access to care, that barriers exist on supply and demand sides that predict effective uptake, and that the costs and effectiveness of different modes of delivery determine relative cost-effectiveness. Our ambition is to represent an interdisciplinary and wholistic research process to demonstrate how clinical milestones can be translated into scientific advancement by integrating and transcending distinct, disciplinary contributions. The different thematic, disciplinary, and methodological contributions will contribute to a comprehensive evidence package, and enable decision makers to make better informed implementation decisions.