Severe Malaria Africa: A consortium for Research and Trials (SMAART) 

Malaria is a key cause of deaths and hospital admissions in children in Sub-Saharan Africa (SSA). It accounts for an estimated 600,000 deaths in children under five each year. Although there are effective treatments, the SMAART study shows that about eight per cent of children admitted to hospital with severe malaria still die. The SMAART consortium was created in 2018 to translate recent advances in platform trial design to improve outcomes for severe childhood malaria across SSA.  

The SMAART consortium involves partners in SSA, Europe and Thailand experienced at delivering high-impact guideline-changing treatment trials in paediatric severe malaria. SMAART aims to improve short and long-term outcomes for children with severe malaria in SSA by conducting better research studies faster, coordinating current and future research more productively, and using the latest evidence to improve how the disease is defined and treated. 

In 2026, we published a paper which examined a new health threat to artesunate (the main treatment for severe malaria) posed by mutated parasites (PfK13) which are resistant to artesunate and take longer to clear from the body. We found, contrary to expectations, that death rates and other health outcomes were low in the children with PfK13 mutations and comparable to children infected by parasites without the mutation.

These data support continuing to use injectable artesunate to treat severe malaria, even in areas with high rates of PfK13 mutations. 

SMAART is the only existing multi-site, multi-country collaboration conducting research in paediatric severe malaria in Africa.  

SMAART-MAP, a large clinical trial (ISRCTN79071535) is evaluating three therapies in Phase II trials that could be given alongside standard malaria treatments. They aim to prevent or treat severe malaria complications, including seizures, conditions needing blood transfusions and kidney damage. The most promising interventions will be tested in trials to see if they can prevent death. The trial is being run in eight hospitals in six African countries (Ghana, Democratic Republic of Congo, Uganda, Kenya, Zambia and Mozambique).  

Latest research publication

Read the latest SEVUSMART study, ‘Sevuparin in children with severe malaria: A phase I safety and dose finding trial’, published in Nature Communications.

Read the accompanying Imperial news story: ‘African trial optimises dose of a drug with potential to improve outcomes in children with severe malaria’.