Severe Malaria Africa – A consortium for Research and Trials (SMAART)

Objectives

This programme is made up of several different studies all with the aim of optimising the treatment pathway for children with severe malaria from the hospital entrance to survival 6 months post-discharge, and hence improving their outcomes in the current era. The key components are:

1. An observational study to characterise the diagnostic and treatment pathway for children currently suffering from severe malaria (as cases) and compare this to those without severe malaria (controls). This will also be a comprehensive data platform to use as a resource for determining the relative burden and clinical spectra of severe malaria in children in hospitals in Africa.
2. To help develop and evaluate a point-of-care quantitative plasma Plasmodium falciparum histidine-rich protein2 (pfHRP2) test for estimating total body parasite burden, which could be used to identify those at most significant risk of poor outcomes swiftly.
3. Evaluating a low-tech ‘iron-lung’ as a mechanism to augment biphasic (inspiration and expiration) breathing and prevent the most common cause of death in children with cerebral malaria (respiratory arrest).
4. Conducting Phase II studies in adjunctive therapies targeting different presentations of severe malaria such as cerebral malaria, blackwater fever, renal impairment and acidosis to identify the most effective interventions to take forward into a large Phase III trial.