Coalition for Epidemic Preparedness Innovations (CEPI) Visit

We hosted a delegation from Coalition for Epidemic Preparedness Innovations (CEPI) led by the CEO Dr. Richard Hatchett who paid us a courtesy visit. The team was interested in learning more about ongoing activities at KEMRI- Wellcome Trust Research Programme and our robust contribution to Kenya’s response to the COVID-19 pandemic.

Radio Engagement

We hosted Radio Maisha and Spice Fm radio teams for an open day and training on KWTRP research work. This culminated with a live on location broadcast at KWTRP for the launch of our radio programmes on both stations. The live broadcast, which aired from 6am -12 Noon, featured interviews with our researchers on epilepsy, mental health, Sickle cell, a former schools engagement programme student and 2 community members who discussed the role of KEMRI Community Representatives and the impact of our research work in the community. You can watch the interviews here https://www.youtube. com/watch?v=B0UGDJQzoQ4

The Standard Chartered Marathon 2022

Programme members from Kilifi and Nairobi attended the Standard Chartered Marathon 2022 in Nairobi. The team actively participated in 42km, 21km and 5km distances.

Thank You!

Did you know that 1 unit of blood could save up to 4 lives? KEMRI – Wellcome Trust Research Programme Blood Drive Team wishes to thank everyone who turned up to donate blood during October blood donation exercise. 38 units of blood was donated. Special thanks to our colleagues from KEMRI Management who were visiting and found time to donate as well. We also want to laud Sophie Uyoga and Munga Mwachiro for their continuous efforts in supporting this initiative. Nyinyi ni Mashujaa!

Congratulations Jacqueline Mutai

Congratulations to Jacqueline Mutai on the successful defense of her PhD. Her work was an analysis of the immunoglobulin gene repertoire in the human B cell response to Plasmodium falciparum malaria during natural and experimental malaria infections.

Congratulations Patience kiyuka

Congratulations to Patience Kiyuka on receiving the inaugural Eric and Wendy Schmidt Awards for Excellence in Science Communications. The prestigious award recognizes science journalists and research scientists who have developed creative, original work that addresses issues and advances in science, engineering, and/or medicinefor the public.

Congratulations Prof. George Warimwe

Congratulations to George Warimwe for being conferred the title full Professor of Vaccinology at the University of Oxford. “I’m truly honoured by this recognition. It is testimony to the excellent mentorship received over the years and the immense contribution to vaccine R&D in Africa by the team of amazingly talented scientists that work with me in Kenya and Oxford” said Prof Warimwe. Prof Warimwe was among six researchers awarded, in recognition of their distinction in research, and their contributions to teaching, and to the general work of the Nuffield Department of Medicine in Oxford University. Prof Warimwe works on viral infections transmitted between humans and animals in Africa, developing vaccines for their control. An example is Rift Valley Fever – a mosquito-borne viral illness that primarily affects humans and livestock (sheep, goats, cattle) in Africa – for which Prof Warimwe has developed a novel chimpanzee adenovirus vectored vaccine, that is highly efficacious in livestock and is currently in human phase I clinical trials. His previous work includes a similar One Health vaccine for use against Middle East Respiratory Syndrome (MERS) in camels and humans, with his veterinary research programmes continuing to inform advances in human vaccinology. Prof Warimwe’s other work includes addressing the global shortage in Yellow Fever (YF) vaccine supply through leadership of trials to evaluate the utility of fractional vaccine dosing for epidemic control. Findings from this work will have a major impact on the number of doses that can be given based on the current global stock of YF vaccine and the number of doses that are produced for future use. His recent work on COVID-19 serology in Kenya has informed decisions on the national pandemic response and remains one of the most comprehensive COVID-19 seroepidemiological programmes in Africa to date. Congratulations again Prof Warimwe!

Quality of care, health workers’ well-being and COVID-19

Nurses are central players in the provision of quality health care globally. In the COVID-19 pandemic, factors such as a shortage of medical resources, long busy shifts, restrictions on socialization, and the pain of losing infected colleagues, as well as the fear getting infected and infecting family members, have contributed to high levels of stress among nurses. Although neonatal units have not been at the epicenter of the current pandemic, similar challenges have also been raised for neonatal nurses. In this brief, we share their COVID-19 related experiences and challenges, highlight strategies they used to manage the challenges and show how elements of the communication skills and emotional competence course helped them cope. Quality of care health workers well being and COVID-19.

High prevalence of antibodies against COVID-19 within the general population: Evidence from Nairobi and Kilifi

The prevalence of malaria parasite in the population is a key metric used for disease stratification at national and sub-national levels. It is striking that the prevalence of malaria at sub-national levels is heterogenous, transcending national borders in Kenya, Tanzania and Uganda. Nationally it is predicted as 4.7% (2.6–36.9) in Kenya, 10.6% (3.4–39.2) in mainland Tanzania, and 9.5% (4.0–48.3) in Uganda translating. Approximately 12.7 million people in East Africa continue to live in areas where prevalence is ≥ 30%, including 6.4%, 12.1% and 6.3% of Kenya, mainland Tanzania and Uganda populations, respectively. This mapping highlights why countries must work together or jointly to reduce burden and prevent further malaria deaths. Read more about this research in a recently published article https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000014#sec013

Policy Brief; Modelling the Cost-Effectiveness of COVID-19 Vaccination Strategies in Kenya

The KEMRI-Wellcome Trust Research Programme today released the results of its latest modelling on COVID-19 vaccine scale-up within the country. The analysis found that the country’s COVID-19 vaccination campaign can achieve greater value for money if it focuses on the elderly, rather than a strategy that pursues scaling up vaccines to the whole population.;  Find the Policy Brief

Determining the causal role of malaria in elevating blood pressure and pulse wave velocity in Kenyan adolescents and adults.

INTRODUCTION: High blood pressure is recognized as a leading risk factor for stroke and death in sub-Saharan Africa (sSA). While many studies have examined the role of established risk factors such as obesity and salt consumption, less is known about other factors, such as infection, that could be of particular importance in sSA. Ambulatory blood pressure measurement has emerged as the optimal method in recent years in Western settings, but there has been limited use to date in sSA. This work presents the results of a study investigating whether malaria, which is widespread in sSA could contribute to the development of high blood pressure using ambulatory measurements. METHODS: Preliminary work involved determining the prevalence of hypertension in Kilifi, Kenya and examining the population-level effects of using ambulatory blood pressure monitoring (ABPM) for diagnosing hypertension. A literature review outlining the basis of the malaria-high blood pressure hypothesis and the Mendelian randomization method for testing the hypothesis was conducted. Sickle cell trait and alpha (+) thalassemia were chosen as instrumental variables to represent malaria exposure because they protect against malaria. Two studies were performed in Nairobi, Kenya among the same cohort to confirm that sickle-cell trait and alpha-thalassemia do not influence blood pressure in the absence of malaria and were therefore valid instrumental variables to test the malaria-high blood pressure hypothesis in Kilifi where there is malaria transmission. A Mendelian randomization study was then conducted in Kilifi, Kenya where 24-hour blood pressure and arterial stiffness indices were compared in individuals with and without sickle cell trait and alpha thalassemia. RESULTS: The prevalence of hypertension in Kilifi, a rural area, was found to be as high as in urban areas of Kenya despite the low frequency of classical risk factors such as obesity and excessive salt consumption. Use of ambulatory blood pressure monitoring for diagnosing hypertension was found to improve the accuracy of detection of high blood pressure. Neither Sickle-cell trait (SCT) nor alpha+ thalassemia influenced blood pressure or arterial stiffness indices among adolescents that had been lifelong residents of Nairobi, where there is no malaria transmission. Among individuals that had been lifelong residents of Kilifi, Kenya where there has been on-going malaria transmission, blood pressure was found to be lower among individuals with SCT, which protects against malaria episodes compared to those without SCT. The difference in BP by SCT status was larger in women than in men. There were no significant differences in arterial stiffness based on SCT status. CONCLUSION: This work suggests that malaria contributes to the burden of hypertension in sSA, and the control of malaria may lead to a reduction in blood pressure in this group. Future work should focus on confirming the findings using alternative study designs such as examining blood pressure in cohorts born before and after complete malaria elimination in parts of the world where this has been achieved. Subsequent work would involve delineating the pathophysiological mechanisms involved in malaria induced BP elevation with a view to generating new drugs to control hypertension.

Geostatistical Methods for Disease Mapping and Visualisation Using Data from Spatio-temporally Referenced Prevalence Surveys

Summary In this paper, we set out general principles and develop geostatistical methods for the analysis of data from spatio-temporally referenced prevalence surveys. Our objective is to provide a tutorial guide that can be used in order to identify parsimonious geostatistical models for prevalence mapping. A general variogram-based Monte Carlo procedure is proposed to check the validity of the modelling assumptions. We describe and contrast likelihood-based and Bayesian methods of inference, showing how to account for parameter uncertainty under each of the two paradigms. We also describe extensions of the standard model for disease prevalence that can be used when stationarity of the spatio-temporal covariance function is not supported by the data. We discuss how to define predictive targets and argue that exceedance probabilities provide one of the most effective ways to convey uncertainty in prevalence estimates. We describe statistical software for the visualisation of spatio-temporal predictive summaries of prevalence through interactive animations. Finally, we illustrate an application to historical malaria prevalence data from 1 334 surveys conducted in Senegal between 1905 and 2014.

Malaria risk: Estimating clinical episodes of malaria (reply)

ABSTRACT Nature Snow, Robert W., Guerra, Carlos A., Noor, Abdisalan M., Myint, Hly Y., Hay, Simon I. Pages:E4-E5, Volume:437, Edition:, Date, Link: http://hinari-gw.who.int/whalecomdx.doi.org/whalecom0/10.1038/nature04180 Notes:10.1038/nature04180 ISBN: 0028-0836 Permanent ID: Accession Number: Author Address: STATISTICS

New Research Highlights Need to Adjust COVID Vaccination Approach

The new analysis demonstrates that quickly channelling doses to vulnerable groups can save both lives and money. The KEMRI-Wellcome Trust Research Programme today released the results of its latest modelling on COVID-19 vaccine scale-up within the country. The analysis found that the country’s COVID-19 vaccination campaign can achieve greater value for money if it focuses on the elderly, rather than a strategy that pursues scaling up vaccines to the whole population. “This new data suggests that we can fight COVID more effectively by re-focusing our efforts on those who need it most,” said Prof Edwine Barasa, Director at the Nairobi Programme of the KEMRI-Wellcome Trust Research Programme. “Vaccines work; and ensuring older adults and other at-risk groups receive them quickly is the best way to achieve greater health outcomes and is better value for money. We hope this data helps policymakers across the continent determine how to structure impactful, cost-effective, long-term COVID-19 responses.” COVID-19 has had a number of negative impacts on the health system in Kenya over the past two years. Between 2019 and 2020, data from the Global Fund to Fight AIDS, TB and Malaria show that the number of malaria cases treated in the country fell by 27%, while HIV testing fell by 37% percent. More than 10,000 fewer individuals were treated for tuberculosis. The KEMRI-Wellcome Trust research team modelled a broad range of COVID vaccine scale-up scenarios and tested each one for cost-effectiveness and its impact on the spread of the disease. These forecasts estimate what would happen if vaccine scale-up reached 30%, 50% or 70% of the Kenyan population, under both slow (18 month) and rapid (6 month) scenarios. A no vaccination scenario was modelled as a baseline. In all cases, the model scales up vaccination to adults over 50 years before extending to the broader population. Under both the slow and rapid scale-up scenarios, reaching 30% coverage with priority given to adults over 50 averts a substantial number of new infections and deaths – 32 per 100,000 new infections in the 18-month scenario, and 39 per 100,000 in the rapid scenario; as well as ~8,100 or ~9,400 deaths respectively. Reaching a threshold of 50% and subsequently 70% a would avert an additional ~1,100 deaths under the slow scenario, and an additional ~400 deaths in the rapid scenario. “The game has changed on COVID-19,” said Justice Novignon, head of the Africa CDC’s Health Economics Unit. “Countries need to re-focus their COVID-19 vaccination programs on the kinds of strategies that will save more lives for less money, especially in settings with overall low risk of severe disease and death and high natural immunity, and constrained resources as is the case in Kenya and Africa more broadly, targeting the elderly and those with risk increasing comorbidities rather than to the whole population. We have to make every last dollar count.” The research found that scaling-up to 30% vaccine coverage is highly cost effective; while the 50% and 70% scenarios were not, given the lower risk of severe

Individualized breastfeeding support for acutely ill, malnourished infants under 6 months old

Reestablishing exclusive breastfeeding is the cornerstone of the 2013 World Health Organization (WHO) treatment guidelines for acute malnutrition in infants less than 6 months. However, no studies have investigated guideline implementation and subsequent outcomes in a public hospital setting in Africa. To facilitate implementation of the WHO 2013 guidelines in Kilifi County Hospital, Kenya, we developed standard operating procedure, recruited, and trained three breastfeeding peer supporters (BFPS). Between September 2016 and January 2018, the BFPS provided individual breastfeeding support to mothers of infants aged 4 weeks to 4 months admitted to Kilifi County Hospital with an illness and acute malnutrition (mid-upper-arm circumference < 11.0 cm OR weight-for-age z score < -2 OR weight-for-length z score < -2). Infants were followed daily while in hospital then every 2 weeks for 6 weeks after discharge with data collected on breastfeeding, infant growth, morbidity, and mortality. Of 106 infants with acute malnutrition at admission, 51 met the inclusion criteria for the study. Most enrolled mothers had multiple breastfeeding challenges, which were predominantly technique based. Exclusive breastfeeding was 55% at admission and 81% at discharge; at discharge 67% of infants had attained a weight velocity of >5 g/kg/day for three consecutive days on breastmilk alone. Gains in weight-for-length z score and weight-for-age z score were generally not sustained beyond 2 weeks after discharge. BFPS operated effectively in an inpatient setting, applying the 2013 updated WHO guidelines and increasing rates of exclusive breastfeeding at discharge. However, lack of continued increase in anthropometric Z scores after discharge suggests the need for more sustained interventions.

Geostatistical Methods for Disease Mapping and Visualisation Using Data from Spatio-temporally Referenced Prevalence Surveys

Summary In this paper, we set out general principles and develop geostatistical methods for the analysis of data from spatio-temporally referenced prevalence surveys. Our objective is to provide a tutorial guide that can be used in order to identify parsimonious geostatistical models for prevalence mapping. A general variogram-based Monte Carlo procedure is proposed to check the validity of the modelling assumptions. We describe and contrast likelihood-based and Bayesian methods of inference, showing how to account for parameter uncertainty under each of the two paradigms. We also describe extensions of the standard model for disease prevalence that can be used when stationarity of the spatio-temporal covariance function is not supported by the data. We discuss how to define predictive targets and argue that exceedance probabilities provide one of the most effective ways to convey uncertainty in prevalence estimates. We describe statistical software for the visualisation of spatio-temporal predictive summaries of prevalence through interactive animations. Finally, we illustrate an application to historical malaria prevalence data from 1 334 surveys conducted in Senegal between 1905 and 2014.

Malaria risk: Estimating clinical episodes of malaria (reply)

ABSTRACT Nature Snow, Robert W., Guerra, Carlos A., Noor, Abdisalan M., Myint, Hly Y., Hay, Simon I. Pages:E4-E5, Volume:437, Edition:, Date, Link: http://hinari-gw.who.int/whalecomdx.doi.org/whalecom0/10.1038/nature04180 Notes:10.1038/nature04180 ISBN: 0028-0836 Permanent ID: Accession Number: Author Address: STATISTICS

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