At the MHTF, we have a mandate to build consensus within the maternal health community on a variety of issues based on evidence.
A recent trial in Africa, publish in the New England Journal of Medicine has found that a routine treatment for children suffering from shock (often due to meningitis) may lead to higher child mortality. Children receiving the treatment, known as fluid resuscitation, were nearly 50% more likely to die within 48 hours. Approximately 10.5% of the children who received the treatment died compared to 7.3% in the control group. While the difference is only three percentage points, because of the large sample size (N=3141), the findings are statistically significant at a 95% confidence interval.
According to the Guardian, “Fluid resuscitation for shock was introduced in Europe and the US several decades ago without a trial, on the basis that it worked for children in shock who were seriously dehydrated from conditions such as gastroenteritis.” However, the authors of the study conclude: “the results of this study challenge the importance of bolus resuscitation as a lifesaving intervention in resource-limited settings for children with shock who do not have hypotension and raise questions regarding fluid-resuscitation guidelines in other settings as well.”
Cases such as these illustrate the need for evidence based practices to ensure not only the efficient use of scarce global health resources, but also to ensure that interventions that seem effective are not causing harm.