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@article{Maitland:2019:10.1016/S2214-109X(19)30345-6,
author = {Maitland, K and Olupot-Olupot, P and Kiguli, S and Chagaluka, G and Alaroker, F and Opoka, RO and Mpoya, A and Walsh, K and Engoru, C and Nteziyaremye, J and Mallewa, M and Kennedy, N and Nakuya, M and Namayanja, C and Kayaga, J and Nabawanuka, E and Sennyondo, T and Aromut, D and Williams, Musika C and Kumwenda, F and Thomason, M and Bates, I and Boele, von Hensbroek M and Evans, JA and Uyoga, S and Williams, TN and Frost, G and George, EC and Gibb, DM and Walker, AS},
doi = {10.1016/S2214-109X(19)30345-6},
journal = {The Lancet Global Health},
pages = {e1435--e1447},
title = {Co-trimoxazole or multi-mineral multi-vitamins to improve post-discharge outcomes following severe anaemia in African children: a randomised controlled trial},
url = {http://dx.doi.org/10.1016/S2214-109X(19)30345-6},
volume = {7},
year = {2019}
}

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TY  - JOUR
AB  - Background: Severe anaemia (haemoglobin<6g/dl) is a leading cause of paediatric admission inAfrica; post-discharge outcomes remain poor with high 6-month mortality (8%) and re-admission(17%). This trial aimed to investigate pragmatic post-discharge interventions that might improveoutcomes.Methods: Within the factorial open-label TRACT trial, Ugandan and Malawian children aged 2months-12 years with severe anaemia (haemoglobin <6g/dl) at hospital admission wererandomised (using sequentially-numbered envelopes linked to a second set of non-sequentiallynumbered allocations, stratified by centre and severity) to enhanced nutritional supplementationwith iron and folate-containing multi-vitamin multi-mineral supplements (MVMM) or iron/folateat treatment doses (usual care), and to cotrimoxazole versus no cotrimoxazole, both given for 3months post-discharge. Separately-reported randomisations investigated transfusionmanagement. The primary outcome was 180-day mortality analysed by intention-to-treat; followup was to 180-days (completed).Findings: 3983 eligible children were randomised and followed for 180-days [164(4%) lost-tofollow-up]. Treatment was initiated in 1901(95%) MVMM, 1911(96%) iron/folate and 1922(96%)cotrimoxazole. By day-180, 166(8%) MVMM vs 169(9%) iron/folate had died (hazardratio(HR)=0.97 (95% CI 0.79-1.21); p=0.81) and 172(9%) cotrimoxazole vs 163(8%) nocotrimoxazole had died (HR=1.07 (95% CI 0.86-1.32); p=0.56). No evidence was seen ofinteractions between these randomisations or with transfusion randomisations (p>0.2). By day180, 489(24%) MVMM vs 509(26%) iron/folate had experienced one or more SAEs (HR=0.95 (0.84-1.07), p=0.40) and 500(25%) cotrimoxazole vs 498(25%) no cotrimoxazole (HR=1.01 (0.89,1.15)p=0.85). Most SAEs were readmissions, occurring in 692(17%) children (175(4%) with ≥2 readmissions).Interpretation: Neither enhanced supplementation with MVMM versus iron/folate treatment orcotrimoxazole prophylaxis improved 6-month survival. H
AU  - Maitland,K
AU  - Olupot-Olupot,P
AU  - Kiguli,S
AU  - Chagaluka,G
AU  - Alaroker,F
AU  - Opoka,RO
AU  - Mpoya,A
AU  - Walsh,K
AU  - Engoru,C
AU  - Nteziyaremye,J
AU  - Mallewa,M
AU  - Kennedy,N
AU  - Nakuya,M
AU  - Namayanja,C
AU  - Kayaga,J
AU  - Nabawanuka,E
AU  - Sennyondo,T
AU  - Aromut,D
AU  - Williams,Musika C
AU  - Kumwenda,F
AU  - Thomason,M
AU  - Bates,I
AU  - Boele,von Hensbroek M
AU  - Evans,JA
AU  - Uyoga,S
AU  - Williams,TN
AU  - Frost,G
AU  - George,EC
AU  - Gibb,DM
AU  - Walker,AS
DO  - 10.1016/S2214-109X(19)30345-6
EP  - 1447
PY  - 2019///
SN  - 2214-109X
SP  - 1435
TI  - Co-trimoxazole or multi-mineral multi-vitamins to improve post-discharge outcomes following severe anaemia in African children: a randomised controlled trial
T2  - The Lancet Global Health
UR  - http://dx.doi.org/10.1016/S2214-109X(19)30345-6
UR  - https://www.sciencedirect.com/science/article/pii/S2214109X19303456?via%3Dihub
UR  - http://hdl.handle.net/10044/1/72216
VL  - 7
ER  -

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