The Wellcome Trust Major Overseas Programme in East Africa is centred in Kenya, and conducts work in Kenya and a number of surrounding countries. It began in 1989 as a series of projects involving three major stakeholders: KEMRI, Oxford University and the Wellcome Trust. Over twenty years it has grown from a total staff of 15 to one of over 600 and is one of the most productive research programmes in Africa. The central aim of the programme is to conduct research to the highest international scientific and ethical standards on the major causes of morbidity and mortality in the region.
The research model has developed to one of undertaking detailed clinical descriptions and linking these with epidemiological studies. These studies lead to further detailed pathophysiological and clinical work, generating testable hypotheses of conditions that are common in Africa. These hypotheses are tested in smaller ‘proof of principle’ trials, before being tested in large definitive trials that will provide firm evidence for the management of common conditions. The underlying ethos is to conduct research that can be applied to health facilities in the remainder of Africa and will influence public health policy.
The Clinical Research Cluster
The clinical unit has played a central role in the development of the overall research programme in Kenya over the last 15 years. Our location in a busy district hospital provides a unique opportunity to define and optimise management of major causes of morbidity and mortality presenting to health services in a malaria endemic area. Data from numerous clinical studies have fed into National and WHO guidelines on the management of malaria and other common childhood illnesses. Key components of the current clinical program include the standardization of the admission management through protocol directed therapy for the leading causes of hospital admission (eg: malaria, respiratory tract infection, malnutrition and neonatal sepsis) and the development of uniform admission process guided by a proforma. These have allowed comprehensive description and identification of prognostic factors for the core childhood syndromes, as well as identifying emerging diseases (esp HIV) and generated a number of research studies aimed at validating current (WHO) recommendations. In April 2002 online data entry of ward admission, linking these events has proved a powerful tool in describing community incidence of hospital admission for a range of conditions.