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

Randomised trial

Contact details

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).