Welcome to the COAST trials web space. This site is under development and aims to bring together knowledge, tools and methods to support researchers working on or interested in the COAST trials.

About the Trial

Pneumonia is the leading cause of mortality in children under 5 years old. The World Health Organization recommends presumptive antibiotic treatment and oxygen for children hospitalised with clinically severe pneumonia and hypoxaemia. Yet, there is substantial evidence that current management guidelines are not working resulting in high in hospital and longer term mortality. There are major gaps between treatment policies and their implementation stemming from unpredictable oxygen supplies, high costs and lack of relevant research to inform guidelines. Systematic and policy reviews indicate the need for a formal evaluation of the hypoxaemia threshold at which oxygen should be targeted and the best mechanism of oxygen administration. As undernutrition is the major determinate of longerm mortality early and supplementary feeding to avert post-discharge mortality has been recommended but not yet tested in clinical trials. A platform trial incorporating both COAST and COAST-Nutrition are designed to address these key research gaps in oxygen delivery and nutritional support, with the overarching goal of providing better evidence base for future guidelines to improving the poor global outcomes in severe pneumonia.

COAST will simultaneously evaluate two related oxygenation strategies in 4200 children:

* Liberal oxygenation (recommended care) compared with a strategy that permits hypoxia to SpO2 ≥80% (routine care); and

* High flow oxygen delivery (via AIRVO 2, which provides positive airway pressure) compared with low flow delivery (routine care)

COAST-Nutrition will evaluate a nutrition strategy in 2000 children:

* Supplementary feeding for 56 days with Ready-to-use Therapeutic Feeds compared to the child’s usual diet (routine care)

Alongside these outcomes, the COAST trials aim to evaluate whether point-of-care test and other biomarkers can predict clinical and radiologically-defined pneumonia in those with viral and bacterial aetiologies. This will help refine endpoints for the COAST trial and guide future targeting of definitive and supportive therapies, including tailoring antibiotic management in hospitals lacking microbiology services.

About the Consortium

The COAST-Nutrition trial consortium is a multidisciplinary collaboration between partners in Uganda, Kenya, the Netherlands, Finland, and the UK. The consortium includes research scientists who are leaders in their specialties, this ensures the highest quality of the scientific investigations as well as the opportunity for additional sub-studies to increase our knowledge and understanding of the underlying aetiology and host response.

The consortia also have a successful history of leadership, mentorship and capacity development through scientific enquiry. The multi-faceted approach we have adopted, within the framework of a GCP-compliant trial, will provide additional new knowledge to the relevant academic disciplines such as pneumonia, critical illness, infection, and nutrition.

About the COAST-Nutrition Platform

The objectives of the COAST-Nutrition platform are to:

* To provide capacity development in Africa through training, workshops, and web-learning courses

* To facilitate professional development via on scientific exchange visits across sites and with EU partners

* To enable knowledge sharing throughout the study sites

* To equip and support sites to become independent and self-starting research groups

The platform will include:

• Press releases for local, national and international media

• Journal articles for Open Access publication in high impact journals

• News articles for partner websites, written in plain language

• Powerpoint slide sets for scientific audiences

• Briefing papers summarising the results for policymakers at national and international levels