CDC Activities in Kenya
In Kenya, there are an estimated 3.5 million new clinical cases and 10,700 deaths each year, and those living in western Kenya have an especially high risk of malaria. As it does in many countries around the world, CDC has worked closely with the Kenya Ministry of Health to fight malaria. CDC’s efforts in Kenya are also supported by the U.S. President’s Malaria Initiative.
Over three decades ago, CDC established a collaboration with the Kenya Medical Research Institute (KEMRI), which is part of Kenya’s Ministry of Health. Led by the Division of Parasitic Diseases and Malaria, CDC’s malaria work in Kenya includes
- Capacity building and technical support
- Surveillance, monitoring and evaluation
- Case management
- Transmission reduction research
Capacity building and technical support
Throughout the world, CDC works with Ministries of Health to build capacity and to offer technical support to protect the public’s health. In Kenya, CDC provides onsite technical assistance and funding for malaria research. Over the past three decades, CDC’s investment in Kenya has resulted in a well-trained staff of Kenyan scientists, clinicians, laboratory technicians, and field workers. This achievement is due to CDC’s subject matter experts who serve as advisors for degree-seeking Kenyan students, providing regular trainings and seminars. Technology transfer from CDC to KEMRI has also played an important role. CDC has provided KEMRI with key technological resources that now allow work to be performed locally, which was not possible in the past.
Surveillance, monitoring, and evaluation
CDC and KEMRI work together to conduct health facility surveillance. This surveillance activity involves documenting infections discovered during hospital or health center admission. As many people infected with malaria in western Kenya do not feel ill and therefore do not go to health facilities for malaria treatment, and because malaria transmission fluctuates throughout the year, CDC and KEMRI have developed a novel surveillance platform where we test community members in their households every working day of the year.. Both of these surveillance activities allow the Kenya Ministry of Health to monitor progress in their implementation of malaria control strategies. Vector and insecticide resistance surveillance is also conducted to better understand how mosquitoes interact with malaria parasites and to measure effectiveness of indoor residual spray and long lasting insecticide-treated nets. Lastly, surveillance of deaths using the verbal autopsy and minimally invasive tissue sampling (MITS) is supported through our health and demographic surveillance system (HDSS) and the Child Health and Mortality Prevention Surveillance (CHAMPS) Network study in order to assess the impact of malaria intervention scale-up on malaria-associated mortality over time.
Vaccines are critical to reducing malaria morbidity and mortality. CDC works closely with KEMRI in both areas. CDC, KEMRI, and other partners conducted a phase III trial on an experimental malaria vaccine (RTS,S/AS01 vaccine candidate). Findings from this study resulted in a positive opinion of the vaccine from the European Medicines Agency (EMA), and a decision from the World Health Organization to sponsor the evaluation of it’s feasibility, impact and safety in 720,000 children in Ghana, Malawi and Kenya beginning in 2018. CDC and KEMRI are also collaborating on a phase II evaluation of a Plasmodium falciparum Sporozoite Vaccine, and a phase II study of a fractionated dose of the RTS,S/AS01E vaccine.
Vector control is one of the interventions CDC and other global partners use to control malaria. Current activities include:
- Evaluating the durability of different types of long-lasting insecticide-treated nets against malaria vectors (anopheline mosquitoes)
- Evaluating the efficacy of a new attractive targeted sugar bait (ATSB)
- Evaluating the efficacy of a novel host decoy trap for vector surveillance and for transmission reduction
- Evaluating the efficacy of spatial repellents for malaria transmission reduction
Prevention in Pregnancy
Collaborating with the Global Malaria in Pregnancy Consortium, CDC works with KEMRI to control malaria by
- Assessment of the effectiveness of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy
- Evaluation of new drugs and strategies for prevention of malaria in pregnancy, including women who are living with HIV
- Evaluation of health systems and sociocultural obstacles to improve uptake of intermittent preventive treatment of malaria in pregnancy
Artemisinin combination therapies (ACTs) are the standard treatments for malaria across Africa. It is important to monitor the efficacy of ACTs and to test new therapies. Continued monitoring will provide information that can be used to make decisions about changes to national policy if drug resistance develops. CDC, in partnership with KEMRI, has been performing drug efficacy studies for this purpose since 2007.
ACTs are not recommended for use in the first trimester of pregnancy due to lack of safety data. Thus, CDC and KEMRI have developed and validated a pharmacovigilance system for monitoring the safety of antimalarial drugs during pregnancy. A study was conducted to assess health-care workers’ and drug vendors’ knowledge of and adherence to treatment guidelines for malaria in pregnancy. Data are being collated to evaluate the safety of these drugs in pregnant women.
In 2014, with partners from the Malaria Elimination Consortium of Western Kenya, CDC and KEMRI conducted drug dosing and safety studies for low-dose primaquine and high-dose ivermectin as novel tools for malaria transmission reduction strategies (e.g., mass screen and treat or mass drug administration) when provided in combination with ACTs.
CDC is a member of the Global Malaria Transmission Consortium. The Consortium’s initial focus was identifying the best way of measuring malaria transmission. This research has included investigating indoor residual spraying and durable wall liners. In 2015, CDC and KEMRI completed a large-scale intermittent mass test and treat (MTaT) study targeting nearly 30,000 people 3 times a year for 2 years. Results of this study are being analyzed for dissemination in mid-2018. Additional transmission reduction activities include evaluating ATSBs, spatial repellents, and the use of surveillance platforms to identify transmission foci for targeted interventions.
KEMRI has state-of-the-art malaria laboratories that can support epidemiologic studies and conduct research on
- The immunology of malaria in children and pregnant women
- Parasite resistance to antimalarial drugs
- Host genetic risk factors for severe malaria
KEMRI’s and CDC’s Atlanta-based laboratory staff collaborate regularly to evaluate substandard antimalarial drug use in the community and conduct pharmacokinetic studies of antimalarials.