Paediatric infections, especially
malaria, sepsis (also referred to as blood poisoning) and
tuberculosis pose a major health burden for children in Africa,
accounting for millions of deaths every year.
Although some of these children would die at
home, a proportion will make it to hospital for treatment but in a
critically ill state. The mortality rates for children admitted to
hospital with life-threatening infections in Africa, particularly
sub-Saharan Africa, are still as high as 15-30%, and little
progress has been made towards reducing them.
It is still not known how best to treat these
children when they arrive in hospital, other than giving
anti-malaria treatment and antibiotics as required. This question
needs urgent attention, as 50% of those children who die do so in
the first 24 hours after hospital admission. The other key
question is what package of care is best to help prevent later
re-admission and death after children have left hospital.
Through its work in this research area MRC CTU
aims to improve outcomes for children with infectious diseases
worldwide. We plan to do this by working with a committed network
of paediatricians in Africa, and by looking at the whole scientific
picture (for example using clinical trials to answer questions
other than the main clinical trial question, or looking to use
observational studies to address questions that clinical trials
would not be able to answer). We are currently involved in
one trial in this area - FEAST (Fluid Expansion as Supportive
Therapy in critically ill African children). This trial is
examining fluid resuscitation on admission to hospital, and aims to
find out whether it is better to give fluid quickly (as a bolus) or
slowly (the current standard of care) and which particular fluid it
is best to give.