Artemisinin combination therapy at delivery to prevent postpartum malaria: a randomized open-label controlled trial.: Preventing postpartum malaria.

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 PNG mothers immediately following delivery. Participants were randomised 1:1 to no treatment (n=90) or artemisinin combination therapy (ACT), with further 1:1 ACT randomization to artemether-lumefantrine (AL; n=45) or dihydroartemisinin-piperaquine (DP; n=45). Standardised reviews were conducted monthly for six-months, including clinical assessment, malaria screening and haemoglobin measurement. The primary endpoint was incidence of slide-positive malaria within six-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 six-month follow-up period compared to those who were untreated (n=17 (21%) versus n=27 (38%); P=0·016; HR 0·49 (95% CI 0·27 to 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-months postpartum.

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Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.