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Background Malaria during pregnancy can cause serious consequences including maternal anemia and low birthweight (LBW). Routine antenatal care (ANC) in Rwanda includes malaria symptom screening at each ANC visit. This cluster randomized controlled trial investigated whether adding intermittent screening with a malaria rapid diagnostic test at each routine ANC visit and treatment of positives during pregnancy (ISTp) is more effective than routine ANC for reducing malaria prevalence at delivery. Methods Between September 2016 and June 2018, pregnant women initiating ANC at 14 health centers in Rwanda were enrolled into ISTp or control arms. All women received an insecticide-treated bed net at enrollment. Hemoglobin concentration, placental and peripheral parasitemia, newborn outcome, birthweight, and prematurity were assessed at delivery. Results Nine hundred seventy-five women were enrolled in ISTp and 811 in the control group. Routine ANC plus ISTp did not significantly reduce polymerase chain reaction–confirmed placental malaria compared to control (adjusted relative risk [aRR], 0.94 [95% confidence interval {CI},.59–1.50]; P =.799). ISTp had no impact on anemia (aRR, 1.08 [95% CI,.57–2.04]; P =.821). The mean birthweight of singleton newborns was not significantly different between arms (3054 g vs 3096 g, P =.395); however, women in the ISTp arm had a higher proportion of LBW (aRR, 1.59 [95% CI, 1.02–2.49]; P =.042). Conclusions This is the only study to compare ISTp to symptomatic screening at ANC in a setting where intermittent preventive treatment is not routinely provided. ISTp did not reduce the prevalence of malaria or anemia at delivery and was associated with an increased risk of LBW. Clinical Trials Registration NCT03508349. [ABSTRACT FROM AUTHOR]

The article offers a study on the efficacy of Artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DHP). It mentions Artemether–lumefantrine (AL) was introduced in 2005 as a first-line Artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria in Rwanda; and also mentions DHP demonstrated a greater post-treatment prophylactic effect against new infections compared with AL.

Background: In response to a resurgence of malaria in Rwanda, home-based management (HBM) was expanded to enable community-health workers (CHWs) to provide malaria treatment to patients of all ages. We assessed the effect of the expanded HBM program on malaria case presentations at health facilities., Methods: Services provided by CHWs and health facility presentations among individuals >5 y of age were considered. Presentations to CHWs were analyzed descriptively to assess acceptability and segmented regression modeling using facility-level data was employed to compare changes between the pre- and postintervention periods for intervention and control districts., Results: Individuals >5 y of age readily accessed malaria diagnosis and treatment services from CHWs. Severe and uncomplicated malaria increased in the postintervention period for both the intervention and control districts. Presentations for uncomplicated malaria increased in the intervention and control districts to a similar degree. Severe cases increased to a greater degree in the intervention districts immediately after HBM was expanded compared with controls, but the monthly rate of increase was lower in the intervention districts., Conclusions: Services were shifted to CHWs, as demonstrated by the number of individuals treated through the expanded program. The rate of severe malaria increased immediately after implementation within intervention districts relative to controls, potentially because of enhanced case-finding. The rate of increase in severe cases was lower in the intervention districts comparatively, likely due to expedited treatment.