The Kenyan Medical Research Institute (KEMRI) was established through the Science and Technology (Amendment) Act of 1979, which has since been amended to Science, Technology and Innovation Act, 2013 with the mandate to carry out health science research in Kenya. The Kilifi-based Centre for Geographic Medicine Coast (CGMR-C) is among the 12 KEMRI centers.
The Wellcome Trust was established in 1936 by an endowment left by Henry Wellcome in his will. Henry Wellcome was a rich businessman and philanthropist in the UK. He also travelled in Sudan and Egypt, where he took an interest in malaria control and commissioned a floating laboratory on the Nile. The Wellcome Trust continues to support research in Africa and was one of the first research institutions to partner with the new independent Government of Kenya in 1964, creating the Wellcome Trust Research Laboratories in Nairobi. In the 1980s a few Wellcome Trust funded scientists including Stephen Oppenheimer and Bill Watkins began working in Kilifi District Hospital in collaboration with KEMRI. In 1989 the KEMRI-Wellcome Trust Research Programme (KWTRP) was formed, led by Kevin Marsh and Norbert Peshu. Due to the continued growth of research activities in Kilifi, in 1995 KEMRI granted the Kilifi Station a full Centre status as “KEMRI Centre for Geographic Medicine Research – Coast (KEMRI CGMRC).
Finding ways to beat malaria; Initial work focused on malaria, a devastating disease that was causing the deaths of many children. Working closely with colleagues in the Ministry of Health, researchers conducted studies on insecticide-treated bed nets, antimalarial drugs to prevent malaria in pregnant women and descriptions of severe malaria. Over the last 15 years there has been impressive improvements in malaria control across Africa with Kilifi registering 90 percent drop in malaria cases. Today KWTRP continues to build on its early success in bed net trials with work led from Nairobi that provides information and advice to the national malaria control Programme’s of 14 countries, supported by statistical models to generate maps of malaria risk.
In Kilifi Hospital, KWTRP facilitated the creation of a High Dependency Paediatric Unit where severely sick children had intensive monitoring and treatment. The first studies on clinical definitions of severe malaria in children were based on simple observation by the bedside. Work on severe malaria continues today with increasingly sophisticated laboratory work, DNA sequencing and retinal imaging, and clinical trials that have informed the use of anti-epilepsy drugs and fluids in severely unwell children.
As the Programme developed it was apparent that malaria was just one of a host of health problems confronting children on the coast and that often these problems were interrelated. The focus therefore expanded to include work including pneumonia, meningitis, HIV and malnutrition. Other studies included social science and health systems perspectives, as well as research on community involvement.
In early studies KWTRP engaged shopkeepers with a training programme to ensure they gave anti-malarials at the correct dose. If done well this prevents the need for hospital admissions. These successes have been built on in recent times, with KWTRP studies now showing that SMS messages can help doctors and patients to use anti-malarials correctly. KWTRP has also shown how training and support packages can help doctors and nurses in hospital to improve their patient care. These interventions result in patients getting the correct treatment and saving lives.
The cornerstone of research success is community involvement. This is done through regular interactions with opinion leaders and a network of community representatives, the Schools Engagement Programme, social media and regular open days. The programme builds mutual understanding between researchers and the community, and ensures that research is responsive to community views and interests. This research findings have done much to improve the health of the partnering community in Kilifi, and health around Africa. The work has been enhanced by modern technology which now includes online interaction with secondary schools.
Apart from conducting the highest quality research, one of the objectives is to support the development of scientific leadership in Kenya through deliberate capacity building initiatives. KWTRP has a particular focus on building links with schools in the community, which involves promoting better understanding of science and research. In addition, it has a structured internship programme for introducing Kenyan graduates to research training master’s degree and PhD students. Young researchers are supported through a system of career development to join other research institutions in the region or to develop careers with the programme.