Background Children hospitalised with severe anaemia in Africa are at high risk of readmission or death within 6 months after discharge. No strategy addresses this post-discharge period. In Malawi, 3 months of post-discharge malaria chemoprevention (PMC) with monthly 3 day courses of artemether-lumefantrine (AL) in children with severe malarial anaemia prevented 31% of deaths and readmissions. There is now a need to design and evaluate an effective delivery strategy for PMC.

Methods This is a cluster-randomised trial whose primary objective is to determine the optimum PMC delivery strategy by comparing community versus health facility-based strategies with the aim to inform policy. Convalescent children under 5 years old, weighing >5 kg, admitted with severe anaemia and clinically stable are included. All children received dihydroartemisinin-piperaquine 2, 6 and 10 weeks after discharge, either: 1) at discharge with SMS reminder; 2) at discharge without an SMS reminder; 3) at discharge and community health worker reminder; 4) at the hospital with an SMS reminder; or 5) at the hospital without an SMS reminder. The primary outcome measure is uptake of courses of PMC drugs. Children will be followed up for 15 weeks. The sample size is 75 children per arm (375 total).

Results The study has nearly completed enrollment and preliminary data analysis is in progress. We expect to identify the most effective, cost-effective, acceptable and feasible strategy for delivering intermittent preventive therapy post-discharge for management of severe anaemia in under-five children.

Conclusion The findings of this study will be presented; they address the knowledge gap regarding the potentially preventable component of the burden that occurs after discharge from hospital, and inform the optimal delivery strategy for PMC.