Our clinical research approach has gradually evolved from smaller scale work centred around Kilifi Hospital to multi-centre international work with significant work now led from our collaboration in Uganda and the Programme in Nairobi. Work in Nairobi includes a network spanning 14 hospitals where clinical information systems have been established as part of health systems research. This network supports monitoring case burdens, management practices and outcomes, and will form the basis for pragmatic randomized clinical trials and implementation studies. We also lead a network of sites working on malnutrition (the CHAIN network) which includes work on pathophysiology and epidemiology, and will also form the basis of multi-centre international trials.
We have established a unique position in neuro-cognitive assessments in Africa, having pioneered the use of the Kilifi Development Assessment scale which is now widely used across Africa. Combined with our demographic surveillance to optimize follow up, we will develop systematic monitoring of neuro-cognitive outcomes to determine the longer term burden of morbidity, their association with interventions, access to care and treatment decisions.
Work on malnutrition in includes studies on interventions to support breast feeding and re-lactation for mothers of wasted young infants admitted to the ward, work on biochemical and proteinomic characterizations of malnutrition and their relation to clinical phenotype, and clinical trials on the use of broad versus narrow spectrum antibiotics during hospital admissions (beginning with pharmacokinetic studies in Kilifi then multi-centre studies powered for to detect differences in mortality).
Following the FEAST trial we have an ongoing interest in acute critical care in Sub-Saharan Africa and are conducting trials randomizing children to different blood-transfusion and iron supplementation regimens, with ancillary studies on the quality of blood, and trials randomizing children to different oxygen deliveries with sub-studies acquiring physiological data on respiratory and myocardial function.
These multi-centre trials will recruit across sites in Kilifi, Mombasa, Nairobi, Uganda (multiple sites), Blantyre, and Kinshasa DRC.