Severe Malaria in Remote Areas- Closing the Evidence Gap

The goal of this observational study is to assess whether the giving of rectal artesunate and a three day course of an Artemisinin based Combination Therapy (ACT) to children aged 6 months and ≤ 5 years with severe malaria when referral is not feasible is non inferior to giving of injectable artesunate and three day course of an ACT. The three primary objectives are:

* To evaluate the 28-day PCR corrected cure rate in children aged 6 months to ≤ 5 years treated with RAS+ACT or RAS+injectable artesunate, assessing whether each treatment achieves the clinically acceptable cure rate of 97% ± 5%. * To evaluate feasibility of provision of rapid treatment of severe malaria with rectal artesunate in children 6 months to ≤ 5 years not able to access a referral health facility, by a community health worker or in health facility where there is no injectable artesunate available. * To evaluate the impact of reinforcing the integrated Community Case Management (iCCM) on access to the formal health care system

The study is being done in Nchelenge district in Zambia and Kapolowe district in the Democratic Republic of Congo. It will enrol 1008 children with severe malaria and an equal number of children with simple malaria

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Key information

Conditions

Severe Malaria Infections Malaria Mosquito-Borne Diseases Parasitic Diseases Protozoan Infections Vector Borne Diseases

Age range

6 month–5 year

Sex eligibility

All sexes

Study type

Observational

Primary location

University of Kinshasa, Kinshasa, Kinshasa City, Democratic Republic of the Congo

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

for severe malaria

From a village without other research interventions
Children aged from 6 months to ≤5 years that present at the health system and are either; with fever (or history of fever within 2 days) and have a positive mRDT test plus at least one of the following danger signs for malaria (as per standardized national iCCM guidelines):

convulsions
inability to drink, eat, or suck
vomiting all liquids and solids
altered consciousness/coma
lethargy
chest in-drawing Inclusion for uncomplicated malaria
Children aged from 6 months to ≤5 years; with fever (or history of fever within 2 days) with no danger signs for malaria (as per the standardized national Integrated Management of Childhood Illnesses guidelines) with a positive mRDT for Plasmodium falciparum histidine-rich protein.

Inclusion for severe non-malaria

From a village without other research interventions
Children aged from 6 months to ≤5 years that present at the health system and are either; with fever (or history of fever within 2 days) and have a negative mRDT test plus at least one of the following danger signs as per standardized national iCCM guidelines:

convulsions
inability to drink, eat, or suck
vomiting all liquids and solids
altered consciousness/coma
lethargy
chest in-drawing
For participants in sentinel sites, a written informed consent will be provided by the patient's parent or guardian to take filter paper blood samples and to participate in interviews (questionnaires and IDI) at enrolment, day 14 and day 28 (to assess malaria recurrence and look for markers of resistance). If the parent or guardian is unable to write, thumb print witnessed consent is permitted. The informed consent shall be administered by the CHWs. Willingness and ability of the patient and the parent or guardian to comply with the treatment policy.

Exclusion criteria

Use of any investigational or non-registered product or planned use during the study period.
Participation in other studies within 30 days before the current study begins and/or during study participation.
Inability to comprehend and/or unwillingness to follow the study protocol.
For RAS use: if the child has reacted badly to artesunate in the past (in sites where RAS is administered)

Treatment and study plan

Treatment of severe malaria with either RAS + ACT or RAS + injectable artesunate + ACT will each achieve the clinically acceptable cure rate of 97% ± 5% in remote areas

Drug

The Community Health Worker will give rectal artesunate (RAS) +artemisinin based combination Therapy (ACT) to children aged 6 months to less than or equal to 5 years who fail to make the referral trip. Those who make the referral trip will receive injectable artesunate and artemisinin based Combination Therapy for three days. Giving of RAS +ACT is unique to this study. Children with non malaria severe disease will also receive amoxicillin from the community health worker before they are referred to the next level of care

Primary outcomes

The time from onset of symptoms to initiating treatment

Time frame: The time from onset of symptoms to initiating treatment

The time from onset of symptoms to initiating treatment among children 6 months to ≤5 years with severe malaria and/or not able to take oral treatment that seek health care from the CHW or other HF system as primary first contact
PCR-corrected cure rate at 28 days from enrollment in patients aged 6 months to ≤5 years.

Time frame: 28 Days from enrollment

PCR-corrected cure rate at 28 Days from enrollment in patients aged 6 months to ≤5 years in areas where referral for follow-up treatment with injectable artesunate is not feasible, compared to outcomes obtained after full referral is completed
Change from baseline proportion of sick children 6 months - ≤5 years at population level that went to the formal health system during the last 6 months including suspected (severe) malaria at month 20 (phase 4).

Time frame: At month 20 (phase 4)

Two cross section surveys one at month 1 (baseline) and the other at month 20 (phase 4) will be used to obtain the proportion of sick children 6 months to ≤5 years at population level that were either attended by a Community Health Worker, Health post or Health Centre in the last 6 months

Sponsors and collaborators

Lead sponsor

Tropical Diseases Research Centre, Zambia

Other Gov

Collaborators

Medicines for Malaria Venture
National Institute for Medical Research, Tanzania
Universiteit Antwerpen
University of Kinshasa
Université de Lubumbashi

Registry information

Official study title

Severe Malaria Treatment With Rectal Artesunate and Artemisinin-based Combination Therapy in Remote Settings

Acronym: SEMA ReACT

Important dates

Study start: 2024
Primary completion: 2027
Study completion: 2027
First posted: Feb 4, 2025
Registry last updated: Jan 27, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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