Childhood illness
Large-scale studies of paediatric admissions are helping to clarify the spectrum of diseases affecting young children in Kilifi, and pointing the way to improved treatments for the severely ill.
The KEMRI-Wellcome Programme is closely linked to Kilifi District Hospital, which sees more than 5000 paediatric admissions a year. This link provides the basis for a comprehensive clinical surveillance system and underpins the Programme's activities into severe childhood illnesses. Although the children's ward is run and maintained by the District Hospital, extra staffing and resources come via the Programme.
Intensive studies of severely ill children are carried out in a separate well-equipped high-dependency unit. Clinical studies provide a clear description of the nature and importance of life-threatening syndromes within the context of a rural African hospital. The high-dependency unit also provides facilities for sophisticated research to be carried out safely, and has been selected for multi-centre clinical trials.
One of the earliest and most substantial pieces of work carried out at Kilifi was a landmark series of studies mapping out local patterns of disease - an area that, somewhat surprisingly, was not well researched in the African context.
FEAST
The FEAST trial is a large randomised controlled trial in African children hospitalised with severe illness examining whether the addition of rapid fluid infusion (fluid resusciation or expansion) at admission to hospital standard case management improves survival compared to standard management alone.
More specifically, the trial has been designed with the aim of resolving the current debate over:
a) Whether rapid correction of intravascular volume, using colloidal or electrolyte solutions, is safe and improves both survival and neurological outcome in children with severe falciparum malaria; and
b) Whether this approach is preferable to slow restoration of total body water deficits, as suggested by other clinical researchers and currently recommended in international guidelines.
Why is this trial important?
In sub-Saharan Africa case fatality rates in hospital for severe infections in children remains at 15-30%. In this region well over a million children die of severe infection in hospital each year. Currently, antimalarial and antimicrobial drugs are the mainstay of treatment, however most deaths occur early, due to the complications of severe illness, and before definitive treatments have time to act. In this situation doctors have to rely upon supportive therapies to treat complications to try to improve outcome. Defining which are the best life-saving treatments has been frustrated by the lack of clinical studies.
Rapid fluid infusion to correct fluid deficits is a standard supportive treatment and practised routinely for the emergency management of children with severe illness. Currently, reticence to adopt this approach remains and thus in African hospitals children are managed with little fluid or no additional fluid. If the benefits of rapid fluid infusion were shown, then FEAST trial could potentially save thousands of lives of young children annually.
For more information see http://www.feast-trial.org/