Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

A project by the KEMRI Wellcome Trust Research Programme at NDM highlighted the importance of future trials focussing on high-risk, undernourished children and using feeds tailored to their metabolic needs.

Severe pneumonia remains the leading cause of illness and hospital admission in children in Africa. Outcomes remain poor including death and hospital readmission in the six months following hospital discharge. Metabolic requirements are high during severe pneumonia which results in the breakdown of vital tissues (especially muscle) to release additional nutrients to these demands. In a paper published in eClinicalMedicine, the KEMRI Wellcome Trust Research Programme has proposed that the excess post-discharge mortality associated with pneumonia may relate to the catabolic response and muscle wasting induced by severe infection and inadequacy of the diet to aid recovery.

Early nutritional support is commonly practised including in patients with severe pneumonia worldwide, however, currently, there are no recommendations for nutritional support for African children with severe pneumonia. We therefore conducted a clinical trial in 846 children hospitalised with severe pneumonia in Uganda and Kenya testing whether their usual diet supplemented with ready-to-use feed, an existing nutrition feed developed for the treatment of malnutrition, given for 56 days compared to children who only had their usual diet improves outcomes.

They found no benefit of the addition of diet supplemented with ready-to-use feed nutritional paste in children aged 6 months to 12 years on the composite endpoint of increased mid-upper arm circumference (a measure of muscle mass) or death at Day 90. Other than a marginal increase in skin fold thickness at Day 28 in the interventional arm they found no benefits on any anthropometric outcome measure. Additionally, they found an increase in adverse events to Day 180 (death and readmission) in the intervention arm but these were not significantly greater than in the control arm so there may have been a chance finding.

The project outcome suggests that future trials of nutritional support following pneumonia should aim to focus on the high-risk undernourished group and use a feed designed to target the metabolic needs of children with severe infection to optimise outcomes.

This project is part of the EDCTP2 programme supported by the European Union, and UK Joint Global Health Trials scheme: Medical Research Council, Department for International Development, Wellcome Trust.

Read the full paper here: