A research paper of the FEAST (Fluid Expansion As Supportive Therapy) Investigatory group has been awarded first place in the British Medical Journal (BMJ) Group Improving Health Awards 2012. The paper was written after the evidence shown during clinical trials involving severely ill African children, supported by Malaria Consortium and other partners, challenged existing medical practice.
Among the four short-listed papers, the FEAST paper Mortality after fluid bolus in African children with severe infection, was judged to have the greatest potential to improve health and healthcare; to help doctors make better decisions about clinical practice, public health, research methodology, or health policy; and to improve health outcomes for patients or populations.
The FEAST trial, funded by the British Medical Council, was conducted in Kenya, Tanzania and Uganda and involved over 3,000 severely ill children who presented with shock. Shock affects around 10 percent of children admitted to African hospitals of whom around 11-22 percent die, often within hours of admission. Although intravenous fluid resuscitation has been regarded as standard approach to treating shock in developed nations, it was unclear whether this approach could be safely used for African children.
The trial data confirm the detrimental effect of fluid bolus (the rapid administration of fluid intravenously) in children with the most severe shock and demonstrate the importance of testing interventions for effectiveness in different settings. The trial serves as a model for future trials in resource poor settings and it is hoped that it will help avert thousands of deaths a year from the inappropriate use of fluid.
Technical leadership for the trial was provided by the Clinical Trials Unit of the Medical Research Council in London (MRC-CTU) and the Paediatric Tropical Infectious Diseases and Critical Care Department, Imperial College London based at the KEMRI-Wellcome Trust Research Programme in Kenya. Professor Kathryn Maitland of Imperial College, the chief investigator (pictured holding the award above) and colleagues, received international praise and their results have been recognised as representing a landmark in clinical practice in Africa.
Malaria Consortium worked closely with the study investigators and the hospitals in Uganda to integrate the study into the routine service delivery systems.
“Malaria Consortium provided management oversight support through the trial management committee and played a critical role in ensuring that quality-assured life-saving medical commodities reached the hospitals in time,” said Dr James Tibenderana, Africa Technical Director for Malaria Consortium. “Our medical personnel worked with the hospitals teams to manage patients and participated in quality-control activities.”
Find out more about Malaria Consortium’s work with FEAST here.