Pingilikani - It's a small village in Chonyi deep in the Kilifi District of Kenya. Just like its Swahili name suggests it's a place of stunning rolling hills and steep undulating knolls. To reach Pingilikani, tough terrain four-wheel drives are highly recommended. Though the area is extremely fertile and with friendly people, it has its fair share of poverty. At this time of the year, with heavy rains all over the republic, the remote village is a mosaic of appealing greenery. Pingilikani is important not because of the vast swathes of sisal plantations but because it may hold the key to the fight against Malaria - Africa's worst social and economic nightmare. A disease that is responsible for the continent's highest mortality rate. At the Kilifi health facility, the Kenya Medical Research Institute (KEMRI), the country's principal medical research arm, has a malaria vaccine trial site. KEMRI in collaboration with various partners namely, the Wellcome Trust, Indepth Network and a host of other collaborators, together with the community, run a specialized research programme on Malaria. “Research is the key to get the right information. Armed with research data we are able to plan better and identify the right tools not only for malaria control but also for the treatment of Malaria.” Dr Norman Peshu, Director of KEMRI Kilifi, says. This field trial and surveillance site is one of the Indepth Network's Malaria Clinical Trials Alliance (MCTA) in nine African countries where medical researchers hope to come up with a malaria vaccine. The nine African countries where these clinical trials are being undertaken are Gabon, Gambia, Ghana, Kenya, Malawi, Mozambique, Nigeria, Senegal and Tanzania. In these countries various sites have been identified for vaccine tests. “Malaria is the leading killer disease in the continent. It places a heavy socio-economic burden on Sub-Saharan Africa. We are hoping that the current research goes on as scheduled. Our aim is to come up with appropriate drugs and a possible malaria vaccine to help reduce the heavy malaria burden on the continent.” Dr. Bernard Ogutu, a scientist at KEMRI and one of the lead researchers in the MCTA programme says.

Pingilikani is monitored from KEMRI Centre for Geographic Medicine - better known as KEMRI Welcome Trust in Kilifi, which shares the same compound with the district hospital. The KEMRI Wellcome Trust is a hi-tech research facility complete with the latest ultra-modern medical research gadgets and laboratories that match the best in the world.

“We have a holistic approach to the research we are undertaking here. Our research is not just based on medicine. It encompasses social issues, taboos, myths and every aspect that may have an input on our research.” Dr Kevin Marsh, Director of the KEMRI Wellcome Programme explains.

“While undertaking our research we came to discover a very crucial aspect of the community. This was home based care. We realized that when it comes to malaria, many people, on the first sign of a fever, preferred self medication by going to the local shopkeeper and getting drugs, without getting tested. This made us to train shopkeepers. Owing to this finding, the Ministry of Health has now adopted it as a policy.” Dr Marsh reveals.

According to Professor Isaac Nyamongo, a Medical Anthropologist at the University of Nairobi, “though largely ignored and taken 'as usual' by policy makers and African governments alike, 75% of the over one million deaths associated with malaria are children under five years of age.”

KEMRI Kilifi centre came into being in 1989. While it has continuously generated research for the last 18 years, the pace seems to have been heightened in the last five years. At the moment there is 90 Kenyan scientific staff, 18 expatriates supported by Government of Kenya funding with support from 80 collaborative partners.

“You realize that in Kenya we have had to change our malaria treatment policy about three times in the last two decades. The reason we have done so is because our research findings have revealed that the malaria parasite has evolved over time. Issues pertaining to drug resistance, climatic changes and even lack of understanding of the pathogens have made us to be more thorough in disease surveillance and investigation.” Dr Ogutu says.
Malaria control strategies adopted include, communication, drugs, diagnostics and fogging.

“The reason why our research on the malaria vaccine appears to be on course and has experienced little hardship is because of the support we get from the community, right from the trial site at Pingilikani with a spill-over effect in Kilifi. While it is true we have been extremely sensitive to their needs, they have gone out of their way to assist this programme and ensure it doesn't falter.” Dr Sam Kinyanjui, a Malaria Immunologist at the Kilifi facility says.
Public education and sensitization on malaria control and treatment were also undertaken to complement research.

“We are happy that KEMRI really takes us seriously when it comes to our plight. If you see the desperation of children and pregnant mothers when afflicted by this disease, that's when you would appreciate why we are keen on these trials to succeed.” Joseph Nzilani, a resident in the hamlet says.
A highly successful malarial drug, LapDap, manufactured by drug multinational GlaxoSmithKline (GSK) was actually developed from the findings gleaned at Kilifi. This is an issue that has given the residents ribbons of optimism and anticipation that in the not too distant future, it will be possible to be immunized against malaria.