It is a malaria prevention study for children between the ages of 1 to 10 years with sickle cell anaemia. They should be living in Homabay county and 2 subcounties of Migori county  i.e Rongo and Awendo.

The study clinic is based in Homabay County Teaching and refferal hospital.

The study is to enrol 246 children confirmed to have sickle cell anaemia HbSS.

In the study there are 3 antimalarial drugs being used which are already in the market. They are randomly given to the participants. The drugs are namely; Proguanil and Dihydroartemisinin(DP) which are given based on weight then Sulphadoxine pyrimethamine Amodiaquine( SPAQ) given based on age.

Follow-up period is 12 months per participant and the clinic visits are monthly.

Reason for doing the study  is to compare whether DP or SPAQ is better at preventing malaria than Proguanil.

Broad Objectives: Children with SCA are particularly vulnerable to infectious diseases and in malaria endemic areas, malaria is one of the leading causes of hospitalization and death among children with SCA. The current recommendation is chemoprevention with daily proguanil. However, this regimen suffers from suspected low adherence rates and probable reduced efficacy due to parasite resistance to antifolate drugs. We are conducting a randomized, three-arm, open-label, clinical trial of malaria chemoprevention in children with sickle-cell anemia at a single site in Homa Bay, Kenya in order to identify more effective chemotherapy regimens for malaria in children with SCA.

Specific Objectives:Primary: To compare the efficacy of daily proguanil with monthly sulfadoxine/pyrimethanine-amodiaquine (SP-AQ) and with monthly dihydroartemisinin-piperaquine (DP) on the incidence of falciparum malaria in children with SCA.Secondary: To compare the efficacy of these malaria chemoprevention strategies on the incidence of major complications of SCA.

Study setting: Homa Bay County Hospital, Homa Bay, Kenya

Study population: Children of both genders between 1 and 10 years of age with laboratory-confirmed SCA living in malaria-endemic portions of Homa Bay or Migori Counties, Kenya

Number of subjects to be contacted: 246 children to be enrolled

Study procedures (main) done on participants: This is a randomized, three-arm, open-label, clinical trial of malaria chemoprevention in children with sickle-cell anemia (SCA) at a single site in Homa Bay, Kenya. The study will enroll 246 children under 10 years of age, randomize participants 1:1:1 to one of three malaria chemoprevention regimens, and follow participants monthly for 12 months in order to record clinical episodes of malaria or SCA-related morbidity. Analyses will compare the efficacy of each regimen to prevent malaria and SCA morbidity. Blood samples will be taken every three months (5 time points – baseline, 3, 6, 9, 12months) for laboratory testing and dried bloodspots will also be collected. Participants will also receive a malaria rapid diagnostic test using a finger-prick blood sample when they are ill.