 Caramel was a large observational study conducted in Nigeria, Uganda, and the Democratic Republic of the Congo to assess the effects of rectal artesanate, IS, on child mortality. The study found that IS did not reduce mortality rates among children with suspected severe malaria. However, the study also highlighted the importance of having well-functioning referral systems for treating severe malaria cases. This article was offered by James A. Watson, Thomas J. Pito and Nicholas J. White.