Theme 3: Implementation Trials

Formative research will be conducted in Malawi, Uganda, Benin, and Kenya to determine the most effective ways to introduce PDMC into routine care for children discharged after treatment for severe anaemia. The research will begin with a document review and context analysis to map key considerations, including existing malaria control policies and healthcare strategies. In-depth interviews with healthcare policymakers, providers, caregivers, and community leaders will assess views on PDMC, preferred drug regimens, and delivery mechanisms. Findings will guide the Ministries of Health in Malawi and Uganda on implementation strategies and inform pilot trials in Benin and Kenya. The results will be analyzed and discussed with stakeholders to select the PDMC drug and regimen, evaluating at least two alternative delivery strategies in the implementation trials.

The two independent implementation trials in Benin and Kenya will include the below key elements:

• Design: Factorial design comparing different PDMC delivery strategies, including SMS reminders, Community Health Worker (CHW) support, or a combination of both, versus control.
• Primary Outcome: Full adherence to 9 doses of PDMC.
• Interventions: Evaluating effectiveness of SMS reminders and CHW support, with design adjustments based on formative research and stakeholder input.
• Sites: Conducted in hospitals with high severe anaemia rates; trials will be powered to analyze each country’s data separately with potential for meta-analysis.
• Economic Evaluation: Assessing cost-effectiveness, including societal and gendered impacts.
• Technology: SMS reminders to improve adherence and monitoring.