Imperial College London

ProfessorKathMaitland

Faculty of MedicineDepartment of Medicine

Professor of Tropical Paediatric Infectious Diseases
 
 
 
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Contact

 

k.maitland CV

 
 
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Assistant

 

Ms Sian Haynes +44 (0)20 7594 3683

 
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Location

 

Based full-time at KEMRI/Wellcome Programme, KenyaNorfolk PlaceSt Mary's Campus

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Summary

 

Summary

Professor of Paediatric Tropical Infectious Diseases at the Faculty of Medicine and Director of the ICCARE Centre at the Institute for Global Health Innovation, Imperial College, London and an Honorary Fellow at MRC Clinical Trials Unit, University College, London.

Over the last 18 years, I have been based full-time in East Africa, where I lead a research group that have highlighted the unique importance of emergency-care research, previously poorly appreciated as an area for specific funder or policy investment, as a highly targeted and cost-effective means of tackling childhood mortality in resource-limited hospitals in sub-Saharan Africa. My major research portfolio includes severe malaria, bacterial sepsis and severe malnutrition and large Phase III pragmatic clinical trials in emergency care. My team conducted the largest trial in critically children ever undertaken in Africa (FEAST trial) examining fluid resuscitation strategies in children with severe febrile illness, showing that fluid boluses increased mortality compared to no-bolus (control). This went on to win the prestigious BMJ Research Paper of the Year award and led to changes in management guidelines.


Current work

My team is running two other large clinical trials investigating transfusion and other treatment strategies in 4,000 African children with severe life-threatening anaemia (TRACT) and the optimum oxygen saturation threshold for which oxygen should be targeted and how best to administer oxygen in 4,200 children (COAST: Children Oxygenation Administration Strategies Trial). In 2018, through an EDCTP award, a further randomisation at 48 hours will investigate whether supplementary feeding using Ready to Use Feeds improves long-term outcomes (COAST-Nutrition). In 2017, our trial group expanded their work in fluid resuscitation to two key groups excluded from the FEAST trial, children with gastroenteritis and severe malnutrition. We are undertaking Phase II safety and efficacy in these two groups in the GASTRO and GASTROSAM rehydration protocols respectively.

In 2018, through a collaborative award in science from Wellcome, I will lead SMAART (Severe Malaria Africa – A consortium for Research and Trials) consortium. SMAART consortium involves a multi-disciplinary team whose membership includes world leaders in severe malaria and experts in clinical trials. The overarching aim of SMAART is to improve outcomes from severe malaria in African children (since one in ten hospitalised with severe malaria continue to die) by conducting better research studies faster and enabling evidence-based continuous updates of disease definitions and treatment guidelines for severe malaria.

Key References


Clinical Trials

Hakim J, Musiime V, Szubert AJ, Mallewa J, Siika A, Agutu C, Walker S, Pett SL, Bwakura-Dangarembizi M, Lugemwa A, Kaunda S, Karoney M, Musoro G, Kabahenda S, Nathoo K, Maitland K, Griffiths A, Thomason MJ, Kityo C, Mugyenyi P, Prendergast AJ, Walker AS, Gibb DM, Team RT: Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa. N Engl J Med 2017, 377:233-245. 10.1056/NEJMoa1615822

Hassall OW, Thitiri J, Fegan G, Hamid F, Mwarumba S, Denje D, Wambua K, Mandaliya K, Maitland K, Bates I: Safety and efficacy of allogeneic umbilical cord red blood cell transfusion for children with severe anaemia in a Kenyan hospital: an open-label single-arm trial. The Lancet Haematology 2015, 2:e101-e107. 10.1016/s2352-3026(15)00005-8

Olupot-Olupot P, Engoru C, Thompson J, Nteziyaremye J, Chebet M, Ssenyondo T, Dambisya CM, Okuuny V, Wokulira R, Amorut D, Ongodia P, Mpoya A, Williams TN, Uyoga S, Macharia A, Gibb DM, Walker AS, Maitland K: Phase II trial of standard versus increased transfusion volume in Ugandan children with acute severe anemia. BMC Med 2014, 12:67, 4101869. 10.1186/1741-7015-12-67

Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, Nyeko R, Mtove G, Reyburn H, Lang T, Brent B, Evans JA, Tibenderana JK, Crawley J, Russell EC, Levin M, Babiker AG, Gibb DM, Group FT: Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011, 364:2483-2495. 10.1056/NEJMoa1101549

Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, Bojang K, Olaosebikan R, Anunobi N, Maitland K, Kivaya E, Agbenyega T, Nguah SB, Evans J, Gesase S, Kahabuka C, Mtove G, Nadjm B, Deen J, Mwanga-Amumpaire J, Nansumba M, Karema C, Umulisa N, Uwimana A, Mokuolu OA, Adedoyin OT, Johnson WB, Tshefu AK, Onyamboko MA, Sakulthaew T, Ngum WP, Silamut K, Stepniewska K, Woodrow CJ, Bethell D, Wills B, Oneko M, Peto TE, von Seidlein L, Day NP, White NJ: Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet 2010, 376:1647-1657, 3033534. 10.1016/S0140-6736(10)61924-1

Akech SO, Karisa J, Nakamya P, Boga M, Maitland K: Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia. BMC Pediatr 2010, 10:71, 2973932. 10.1186/1471-2431-10-71

Akech SO, Jemutai J, Timbwa M, Kivaya E, Boga M, Fegan G, Maitland K: Phase II trial on the use of Dextran 70 or starch for supportive therapy in Kenyan children with severe malaria. Crit Care Med 2010, 38:1630-1636. 10.1097/CCM.0b013e3181e81165

Akech S, Gwer S, Idro R, Fegan G, Eziefula AC, Newton CR, Levin M, Maitland K: Volume expansion with albumin compared to gelofusine in children with severe malaria: results of a controlled trial. PLoS Clin Trials 2006, 1:e21, 1569382. 10.1371/journal.pctr.0010021

Maitland K, Pamba A, Newton CR, Levin M: Response to volume resuscitation in children with severe malaria. Pediatr Crit Care Med 2003, 4:426-431. 10.1097/01.PCC.0000090293.32810.4E


Clinical Trial Protocols

Maitland K, Kiguli S, Opoka R, Olupot-Olupot P, Engoru C, Njuguna P, Bandika V, Mpoya A, Bush A, Williams T, Grieve R, Sadique Z, Fraser J, Harrison D, Rowan K: Children’s Oxygen Administration Strategies Trial (COAST):  A randomised controlled trial of high flow versus oxygen versus control in African children with severe pneumonia. Wellcome Open Res 2018, 2. 10.12688/wellcomeopenres.12747.2

Houston KA, Gibb JG, Mpoya A, Obonyo N, Olupot-Olupot P, Nakuya M, Evans JA, George EC, Gibb DM, Maitland K: Gastroenteritis Aggressive Versus Slow Treatment For Rehydration (GASTRO). A pilot rehydration study for severe dehydration: WHO plan C versus slower rehydration. Wellcome Open Res 2017, 2PMC5571888. 10.12688/wellcomeopenres.12261.1

Mpoya A, Kiguli S, Olupot-Olupot P, Opoka RO, Engoru C, Mallewa M, Chimalizeni Y, Kennedy N, Kyeyune D, Wabwire B, M'Baya B, Bates I, Urban B, von Hensbroek MB, Heyderman R, Thomason MJ, Uyoga S, Williams TN, Gibb DM, George EC, Walker AS, Maitland K: Transfusion and Treatment of severe anaemia in African children (TRACT): a study protocol for a randomised controlled trial. Trials 2015, 16:593, PMC4696199. 10.1186/s13063-015-1112-4


FEAST Trial and Linked Manuscripts

Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, Nyeko R, Mtove G, Reyburn H, Lang T, Brent B, Evans JA, Tibenderana JK, Crawley J, Russell EC, Levin M, Babiker AG, Gibb DM, Group FT: Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011, 364:2483-2495. 10.1056/NEJMoa1101549

Maitland K, Akech SO, Russell EC: Mortality after Fluid Bolus in African Children with Sepsis: Reply. N Engl J Med 2011, 365:1348-1353. 10.1056/NEJMc1108712

Maitland K, Molyneux S, Boga M, Kiguli S, Lang T: Use of deferred consent for severely ill children in a multi-centre phase III trial. Trials 2011, 12:90, 3077324. 10.1186/1745-6215-12-90

Maitland K, Babiker A, Kiguli S, Molyneux E: The FEAST trial of fluid bolus in African children with severe infection. Lancet 2012, 379:613; author reply 613-614. 10.1016/S0140-6736(12)60260-8

Maitland K, George EC, Evans JA, Kiguli S, Olupot-Olupot P, Akech SO, Opoka RO, Engoru C, Nyeko R, Mtove G, Reyburn H, Brent B, Nteziyaremye J, Mpoya A, Prevatt N, Dambisya CM, Semakula D, Ddungu A, Okuuny V, Wokulira R, Timbwa M, Otii B, Levin M, Crawley J, Babiker AG, Gibb DM, group Ft: Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial. BMC Med 2013, 11:68, 3599745. 10.1186/1741-7015-11-68

Molyneux S, Njue M, Boga M, Akello L, Olupot-Olupot P, Engoru C, Kiguli S, Maitland K: 'The words will pass with the blowing wind': staff and parent views of the deferred consent process, with prior assent, used in an emergency fluids trial in two African hospitals. PLoS One 2013, 8:e54894, 3569446. 10.1371/journal.pone.0054894

Todd J, Heyderman RS, Musoke P, Peto T: When enough is enough: how the decision was made to stop the FEAST trial: data and safety monitoring in an African trial of Fluid Expansion As Supportive Therapy (FEAST) for critically ill children. Trials 2013, 14:85, PMC3617035. 10.1186/1745-6215-14-85

Kiguli S, Akech SO, Mtove G, Opoka RO, Engoru C, Olupot-Olupot P, Nyeko R, Evans J, Crawley J, Prevatt N, Reyburn H, Levin M, George EC, South A, Babiker AG, Gibb DM, Maitland K: WHO guidelines on fluid resuscitation in children: missing the FEAST data. BMJ 2014, 348:f7003. 10.1136/bmj.f7003

George EC, Walker AS, Kiguli S, Olupot-Olupot P, Opoka RO, Engoru C, Akech SO, Nyeko R, Mtove G, Reyburn H, Berkley JA, Mpoya A, Levin M, Crawley J, Gibb DM, Maitland K, Babiker AG: Predicting mortality in sick African children: the FEAST Paediatric Emergency Triage (PET) Score. BMC Med 2015, 13:174, 4521500. 10.1186/s12916-015-0407-3

Kiguli S, Maitland K, George EC, Olupot-Olupot P, Opoka RO, Engoru C, Akech SO, Nyeko R, Mtove G, Reyburn H, Levin M, Babiker AG, Gibb DM, Crawley J: Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness. BMC Med 2015, 13:21, 4313469. 10.1186/s12916-014-0246-7

Aramburo A, Todd J, George EC, Kiguli S, Olupot-Olupot P, RO O, Akech S, R N, G M, Gibb DM, AG B, Maitland K: Lactate clearance as a prognostic marker of mortality in severely ill febrile children in East Africa. BMC Med 2017, submitted.

Olupot-Olupot P, Engoru C, Uyoga S, Muhindo R, Macharia A, Kiguli S, Opoka RO, Akech S, Ndila C, Nyeko R, Mtove G, Nteziyaremye J, Chebet M, George EC, Babiker AG, Gibb DM, Williams TN, Maitland K: High Frequency of Blackwater Fever Among Children Presenting to Hospital With Severe Febrile Illnesses in Eastern Uganda. Clin Infect Dis 2017, 64:939-946. 10.1093/cid/cix003


Malnutrition

Akech SO, Karisa J, Nakamya P, Boga M, Maitland K: Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia. BMC Pediatr 2010, 10:71, 2973932. 10.1186/1471-2431-10-71

Obonyo N, Brent B, Olupot-Olupot P, Boele van Hensbroek M, Kuipers I, Wong S, Shiino K, Chan J, Fraser J, van Woensel JBM, Maitland K: Myocardial and haemodynamic responses to two fluid regimens in African children with severe malnutrition and hypovolaemic shock (AFRIM study). Crit Care 2017, 21:103, PMC5415747. 10.1186/s13054-017-1679-0

Brent B: Cardiovascular physiology in children with acute severe malnutrition in Kenya London: Imperial College; 2015.

Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, Berkley JA, Toromo C, Atkinson S, Maitland K: Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome. PLoS One 2012, 7:e38321, 3366921. 10.1371/journal.pone.0038321

Thuo N, Ungphakorn W, Karisa J, Muchohi S, Muturi A, Kokwaro G, Thomson AH, Maitland K: Dosing regimens of oral ciprofloxacin for children with severe malnutrition: a population pharmacokinetic study with Monte Carlo simulation. J Antimicrob Chemother 2011, 66:2336-2345, 3172043. 10.1093/jac/dkr314

Muchohi SN, Thuo N, Karisa J, Muturi A, Kokwaro GO, Maitland K: Determination of ciprofloxacin in human plasma using high-performance liquid chromatography coupled with fluorescence detection: application to a population pharmacokinetics study in children with severe malnutrition. J Chromatogr B Analyt Technol Biomed Life Sci 2011, 879:146-152, 3025326. 10.1016/j.jchromb.2010.11.032

Mogeni P, Twahir H, Bandika V, Mwalekwa L, Thitiri J, Ngari M, Toromo C, Maitland K, Berkley JA: Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya. Bull World Health Organ 2011, 89:900-906, 3260901. 10.2471/BLT.11.091280

Thuo N, Ohuma E, Karisa J, Talbert A, Berkley JA, Maitland K: The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition. Arch Dis Child 2010, 95:422-426. 10.1136/adc.2009.168211

Talbert A, Atkinson S, Karisa J, Ignas J, Chesaro C, Maitland K: Hypothermia in children with severe malnutrition: low prevalence on the tropical coast of Kenya. J Trop Pediatr 2009, 55:413-416. 10.1093/tropej/fmp038

Berkley JA, Bejon P, Mwangi T, Gwer S, Maitland K, Williams TN, Mohammed S, Osier F, Kinyanjui S, Fegan G, Lowe BS, English M, Peshu N, Marsh K, Newton CR: HIV infection, malnutrition, and invasive bacterial infection among children with severe malaria. Clin Infect Dis 2009, 49:336-343, 2853703. 10.1086/600299

Bejon P, Mohammed S, Mwangi I, Atkinson SH, Osier F, Peshu N, Newton CR, Maitland K, Berkley JA: Fraction of all hospital admissions and deaths attributable to malnutrition among children in rural Kenya. Am J Clin Nutr 2008, 88:1626-1631, 2635111. 10.3945/ajcn.2008.26510

Seaton C, Ignas J, Muchohi S, Kokwaro G, Maitland K, Thomson AH: Population pharmacokinetics of a single daily intramuscular dose of gentamicin in children with severe malnutrition. J Antimicrob Chemother 2007, 59:681-689. 10.1093/jac/dkl561

Maitland K, Berkley JA, Shebbe M, Peshu N, English M, Newton CR: Children with severe malnutrition: can those at highest risk of death be identified with the WHO protocol? PLoS Med 2006, 3:e500, 1716191. 10.1371/journal.pmed.0030500

Berkley J, Mwangi I, Griffiths K, Ahmed I, Mithwani S, English M, Newton C, Maitland K: Assessment of severe malnutrition among hospitalized children in rural Kenya: comparison of weight for height and mid upper arm circumference. JAMA 2005, 294:591-597. 10.1001/jama.294.5.591

Williams TN, Maitland K, Phelps L, Bennett S, Peto TE, Viji J, Timothy R, Clegg JB, Weatherall DJ, Bowden DK: Plasmodium vivax: a cause of malnutrition in young children. QJM 1997, 90:751-757. http://www.ncbi.nlm.nih.gov/pubmed/9536339


Selected Publications

Journal Articles

Hakim J, Musiime V, Szubert AJ, et al., 2017, Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa, New England Journal of Medicine, Vol:377, ISSN:0028-4793, Pages:233-245

Olupot-Olupot P, Engoru C, Uyoga S, et al., 2017, High Frequency of Blackwater Fever Among Children Presenting to Hospital With Severe Febrile Illnesses in Eastern Uganda, Clinical Infectious Diseases, Vol:64, ISSN:1058-4838, Pages:939-946

Maitland K, 2015, Management of severe paediatric malaria in resource-limited settings, BMC Medicine, Vol:13, ISSN:1741-7015

Kiguli S, Akech SO, Mtove G, et al., 2014, WHO guidelines on fluid resuscitation in children: missing the FEAST data, British Medical Journal, Vol:348, ISSN:1756-1833

Church J, Maitland K, 2014, Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review, BMC Medicine, Vol:12, ISSN:1741-7015

Maitland K, George EC, Evans JA, et al., 2013, Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial, BMC Medicine, Vol:11, ISSN:1741-7015

Mogeni P, Twahir H, Bandika V, et al., 2011, Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya, Bulletin of the World Health Organization, Vol:89, ISSN:0042-9686, Pages:900-906

Dondorp AM, Fanello CI, Hendriksen ICE, et al., 2010, Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial, The Lancet, Vol:376, ISSN:0140-6736, Pages:1647-1657

Maitland K, Akech SO, Russell EC, 2011, Mortality after Fluid Bolus in African Children with Sepsis REPLY, New England Journal of Medicine, Vol:365, ISSN:0028-4793, Pages:1351-1353

Maitland K, Kiguli S, Opoka RO, et al., 2011, Mortality after Fluid Bolus in African Children with Severe Infection, New England Journal of Medicine, Vol:364, ISSN:0028-4793, Pages:2483-2495

Akech S, Ledermann H, Maitland K, 2010, Choice of fluids for resuscitation in children with severe infection and shock: systematic review, British Medical Journal, Vol:341, ISSN:0959-535X

Akech SO, Jemutai J, Timbwa M, et al., 2010, Phase II trial on the use of Dextran 70 or starch for supportive therapy in Kenyan children with severe malaria, Critical Care Medicine, Vol:38, ISSN:0090-3493, Pages:1630-1636

Khor CC, Vannberg FO, Chapman SJ, et al., 2010, CISH and Susceptibility to Infectious Diseases, New England Journal of Medicine, Vol:362, ISSN:0028-4793, Pages:2092-2101

Maitland K, Pamba A, Newton CRJC, et al., 2003, Response to volume resuscitation in children with severe malaria., Pediatric Critical Care Medicine, Vol:4, ISSN:1529-7535, Pages:426-431

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