Transfusion and Treatment of severe Anaemia in African Children: a randomised controlled Trial
TRACT is evaluating three different ways to reduce short and longer-term mortality and morbidity following admission to hospital with severe anaemia in African children
What is this study about?
In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of children being admitted to hospital, but the evidence to support current treatment recommendations is limited. To avert overuse of blood products, the World Health Organization advocate a conservative transfusion policy and recommend iron, folate and anti-helminthics at discharge. Outcomes are unsatisfactory with high rates of in-hospital mortality (9-10%), 6-month mortality and relapse (6%).
TRACT will therefore compare three different ways that outcomes could be improved
(i) liberal transfusion (30ml/kg whole blood) versus conservative transfusion (20ml/kg) versus no transfusion (control). The control is only for children with uncomplicated severe anaemia (haemoglobin 4-6 g/dl);
(ii) post-discharge multi-vitamin multi-mineral supplementation (including folate and iron) versus routine care (folate and iron) for 3 months;
(iii) post-discharge cotrimoxazole prophylaxis for 3 months versus no prophylaxis.
Type of study
Who is funding the study?
MRC Global Health.
When is it taking place?
April 2013 - September 2017
Where is it taking place?
Uganda (Mbale Regional Referral Hospital; Soroti Regional Referral Hospital; Mulago Hospital, Kampala)
Malawi (Queen Elizabeth Central Hospital)
Who is included?
3954 children aged 2 months to 12 years admitted to hospitals in Uganda and Malawi with severe anaemia (haemoglobin <6g/dl).
Algorithm for transfusion management of children with severe anaemia published
10 May 2021
Antibiotic prophylaxis and multi-vitamin multi-mineral supplements provide no benefit for children with severe anaemia
17 Sep 2019
Giving the right amount of blood in transfusions can halve deaths among children with severe anaemia
02 Aug 2019