{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:07:14Z","timestamp":1789798034614,"version":"4.0.1"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004104","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T00:00:00Z","timestamp":1666569600000}}],"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL134211"],"award-info":[{"award-number":["R01HL134211"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Guilin Pharmaceuticals"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"\n Background<\/jats:title>\n Children with sickle cell anemia (SCA) in areas of Africa with endemic malaria transmission are commonly prescribed malaria chemoprevention. Chemoprevention regimens vary between countries, and the comparative efficacy of prevention regimens is largely unknown.<\/jats:p>\n <\/jats:sec>\n \n Methods and findings<\/jats:title>\n \n We enrolled Kenyan children aged 1 to 10 years with homozygous hemoglobin S (HbSS) in a randomized, open-label trial conducted between January 23, 2018, and December 15, 2020, in Homa Bay, Kenya. Children were assigned 1:1:1 to daily Proguanil (the standard of care), monthly sulfadoxine\/pyrimethamine-amodiaquine (SP-AQ), or monthly dihydroartemisinin-piperaquine (DP) and followed monthly for 12 months. The primary outcome was the cumulative incidence of clinical malaria at 12 months, and the main secondary outcome was the cumulative incidence of painful events by self-report. Secondary outcomes included other parasitologic, hematologic, and general events. Negative binomial models were used to estimate incidence rate ratios (IRRs) per patient-year (PPY) at risk relative to Proguanil. The primary analytic population was the As-Treated population. A total of 246 children were randomized to daily Proguanil (\n n<\/jats:italic>\n = 81), monthly SP-AQ (\n n<\/jats:italic>\n = 83), or monthly DP (\n n<\/jats:italic>\n = 82). Overall, 53.3% (\n n<\/jats:italic>\n = 131) were boys and the mean age was 4.6 \u00b1 2.5 years. The clinical malaria incidence was 0.04 episodes\/PPY; relative to the daily Proguanil group, incidence rates were not significantly different in the monthly SP-AQ (IRR: 3.05, 95% confidence interval [CI]: 0.36 to 26.14;\n p<\/jats:italic>\n = 0.39) and DP (IRR: 1.36, 95% CI: 0.21 to 8.85;\n p<\/jats:italic>\n = 0.90) groups. Among secondary outcomes, relative to the daily Proguanil group, the incidence of painful events was not significantly different in the monthly SP-AQ and DP groups, while monthly DP was associated with a reduced rate of dactylitis (IRR: 0.47; 95% CI: 0.23 to 0.96;\n p<\/jats:italic>\n = 0.038). The incidence of\n Plasmodium falciparum<\/jats:italic>\n infection relative to daily Proguanil was similar in the monthly SP-AQ group (IRR 0.46; 95% CI: 0.17 to 1.20;\n p<\/jats:italic>\n = 0.13) but reduced with monthly DP (IRR 0.21; 95% CI: 0.08 to 0.56;\n p<\/jats:italic>\n = 0.002). Serious adverse events were common and distributed between groups, although compared to daily Proguanil (\n n<\/jats:italic>\n = 2), more children died receiving monthly SP-AQ (\n n<\/jats:italic>\n = 7; hazard ratio [HR] 5.44; 95% CI: 0.92 to 32.11;\n p<\/jats:italic>\n = 0.064) but not DP (\n n<\/jats:italic>\n = 1; HR 0.61; 95% CI 0.04 to 9.22;\n p<\/jats:italic>\n = 0.89), although differences did not reach statistical significance for either SP-AQ or DP. Study limitations include the unexpectedly limited transmission of\n P<\/jats:italic>\n .\n falciparum<\/jats:italic>\n in the study setting, the high use of hydroxyurea, and the enhanced supportive care for trial participants, which may limit generalizability to higher-transmission settings where routine sickle cell care is more limited.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In this study with limited malaria transmission, malaria chemoprevention in Kenyan children with SCA with monthly SP-AQ or DP did not reduce clinical malaria, but DP was associated with reduced dactylitis and\n P<\/jats:italic>\n .\n falciparum<\/jats:italic>\n parasitization. Pragmatic studies of chemoprevention in higher malaria transmission settings are warranted.\n <\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n clinicaltrials.gov<\/jats:ext-link>\n (\n NCT03178643<\/jats:ext-link>\n ).\n <\/jats:p>\n \n Pan-African Clinical Trials Registry:\n PACTR201707002371165<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004104","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T13:58:06Z","timestamp":1665410286000},"page":"e1004104","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Monthly sulfadoxine\/pyrimethamine-amodiaquine or dihydroartemisinin-piperaquine as malaria chemoprevention in young Kenyan children with sickle cell anemia: A randomized controlled trial"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2783-0990","authenticated-orcid":true,"given":"Steve M.","family":"Taylor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Korwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angie","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia L.","family":"Green","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7093-535X","authenticated-orcid":true,"given":"Betsy","family":"Freedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Clapp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5833-7608","authenticated-orcid":true,"given":"Joseph Kipkoech","family":"Kirui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy P.","family":"O\u2019Meara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Festus M.","family":"Njuguna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"issue":"7","key":"pmed.1004104.ref001","doi-asserted-by":"crossref","first-page":"e1001484","DOI":"10.1371\/journal.pmed.1001484","article-title":"Global burden of sickle cell anaemia in children under five, 2010\u20132050: modelling based on demographics, excess mortality, and interventions","volume":"10","author":"FB Piel","year":"2013","journal-title":"PLoS Med"},{"issue":"10","key":"pmed.1004104.ref002","doi-asserted-by":"crossref","first-page":"e1458","DOI":"10.1016\/S2214-109X(19)30328-6","article-title":"The epidemiology of sickle cell disease in children recruited in infancy in Kilifi, Kenya: a prospective cohort study","author":"S Uyoga","year":"2019","journal-title":"Lancet Glob Health."},{"issue":"6","key":"pmed.1004104.ref003","doi-asserted-by":"crossref","first-page":"S398","DOI":"10.1016\/j.amepre.2011.09.013","article-title":"Sickle cell disease in Africa: a neglected cause of early childhood mortality.","volume":"41","author":"SD Grosse","year":"2011","journal-title":"Am J Prev Med"},{"issue":"10","key":"pmed.1004104.ref004","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1182\/blood-2010-01-265249","article-title":"High mortality from Plasmodium falciparum malaria in children living with sickle cell anemia on the coast of Kenya","volume":"116","author":"CF McAuley","year":"2010","journal-title":"Blood"},{"issue":"2","key":"pmed.1004104.ref005","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1182\/blood-2009-07-233528","article-title":"Malaria in patients with sickle cell anemia: burden, risk factors, and outcome at the outpatient clinic and during hospitalization","volume":"115","author":"J Makani","year":"2010","journal-title":"Blood"},{"issue":"5763","key":"pmed.1004104.ref006","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1136\/bmj.2.5763.710-d","article-title":"Malaria and sickle-cell disease","volume":"2","author":"FI Konotey-Ahulu","year":"1971","journal-title":"Br Med J"},{"issue":"1","key":"pmed.1004104.ref007","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/0268-960X(89)90022-2","article-title":"The presentation, management and prevention of crisis in sickle cell disease in Africa.","volume":"3","author":"AF Fleming","year":"1989","journal-title":"Blood Rev"},{"key":"pmed.1004104.ref008","article-title":"National Guidelines for the Diagnosis, Treatment, and Prevention of Malaria in Kenya","author":"Ministry of Public Health and Sanitation Republic of Kenya","year":"2010"},{"key":"pmed.1004104.ref009","unstructured":"Federal Republic of Nigeria. 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