Samuel Akech: Improving paediatric treatments in Africa
Clinical trials may devise better treatments, but only by working with the hospitals implementing those treatments can researchers monitor their effectiveness in practice. By monitoring the care routinely given to children, we can identify treatments that work and those needing improvement, whether assessing the effectiveness of a malaria vaccine, or prescriptions for diarrhoea and dehydration or other severe illnesses.
My name is Dr Sam Akech, I am a paediatrician and research scientist, currently working at the KEMRI Wellcome Trust Research Programme in Nairobi. I do research around 14 hospitals in Kenya, where we monitor the care given to children to identify what treatments work and what treatments need to be improved.
My research focus is on 3 big killers in the tropics: I look at children with malaria, at children with diarrhoea and dehydration, and children with severe illness, often caused by conditions such as bacterial infections. We work with a number of hospitals in Kenya; we are able to monitor the care that is given, and identify treatments that work and treatments that require improvement.
Using those hospitals, we work with the WHO and the Kenyan government to monitor whether the malaria vaccine introduced in 2019 actually reduces cases of severe malaria, and we will be able to check whether the vaccine has any side effects. We will do that by monitoring children admitted to these hospitals. We will monitor them to identify cases of severe malaria, and we will be able to pick out rare severe adverse events that may not have been picked out during clinical trials. This will be quite relevant to the world since the results of that evaluation will be able to inform policy recommendations for the wider use of the malaria vaccine which has been developed for over 30 years. Now the real question is how it should be given, going forward.
Over the last 5-10 years we have looked at a number of things. One of them is how treatments developed in clinical trials work in real life. Using the hospital network that we work with, we have been able to identify children at risk of dying, identify treatments that work, and treatments that require improvement. One of the areas that I have been focusing on previously has been looking at children with diarrhoea and dehydration, and looking at whether if you give the correct fluid prescription, it results in a reduced risk of death. We have found that when clinicians do the right thing, if they give the correct treatment, that results in less risk of death. Other things we have investigated are different strategies of identifying children who require antibiotics, and now we are moving to the stage where we are thinking of how to incorporate this into routine practice by clinicians.
What we do is look at things that are very important. We look at conditions that still cause a lot of deaths in children in this region. Then you realise that funders put in a lot of money for research in terms of developing interventions, but a lot of these interventions are often at the shelves, they do not reach the patient who is the intended beneficiary. Through the research that we do, which is embedded within routine practice and routine hospitals where patients come in, we are able to identify how best to give treatments that have been shown to work in research. This is quite important when people are thinking of new interventions and innovations that are really being funded, so working with hospitals routinely is very important.
This really fits into what is intended because the real goal for any research is to improve lives and reduce risks of death. But the gap between research and improving lives, usually, is how to implement the treatment, how to give the treatment in real life. The research that we do, working with hospitals that provide care routinely has been important in finding ways to give care, and getting treatments to work in real practice.
This podcast was recorded in May 2019