Winning the BMJ ‘Research paper of the year’ award was a real boost to the FEAST trial team. The results of the trial were negative (showing that fluid boluses given to children with severe febrile illness and shock lead to worse outcome), and came as a surprise to all paediatricians. Because of this the trial has attracted a lot of interest, debate and even criticism. The award panel’s recognition of the importance of trial and its quality helped spur on the efforts to make sure the results make a difference to how children in Africa are treated, to prevent unnecessary deaths.
Before winning the award, African and UK members of the FEAST team had already presented results in scientific conferences, in Africa and worldwide. Since winning the award these activities have continued, and also involved workshops and informal discussions with key stakeholders such as Medicins Sans Frontiers and the World Health Organisation (WHO). Importantly, the trialists also recently took part in a meeting hosted by Kenya Paediatric Association in Nairobi, and attended by paediatricians from 10 sub-Saharan African countries. The meeting looked at the evidence on fluid resuscitation, including the FEAST trial and a subsequent meta-analysis. Participants strongly concluded that national and international guidelines must change in the light of the FEAST results, and they are calling on WHO to update their guidelines. Following this meeting, a group is now working on revising the Emergency Triage and Treatment Plus (ETAT+) guidelines that are used in many African countries.
The FEAST trial demonstrated that high-quality randomised controlled trials can be conducted in African hospitals without access to high-tech facilities. It also showed the importance of testing approaches that are used routinely in high-income settings before they are adopted in places with very different epidemiology and resources. The FEAST trialists have also been working with a film-maker to produce a film that uses the research as an example, to encourage more randomised controlled trials in these settings.