Wellcome Trust Research Programme

Kilifi, Kenya

Wellcome Trust Research Programme

Kilifi, Kenya
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GENEVA--(BUSINESS WIRE)--At this year’s World Health Assembly, GE Healthcare and Women in Global Health, a movement that strives for greater gender equality in global health leadership, are joining forces to honor and celebrate women in global health. Today, women make up 75 percent of the global healthcare workforce in many regions1 and contribute nearly $3 trillion to the industry. But too often their contributions go unpaid and unrecognized – and stories of their impact go untold. As we seek to increase the numbers of women in leadership in the field of global health, we are highlighting the valuable work and achievements of these women. Research has shown that women and girls are disproportionately affected by disease2, and that when women are in leadership roles, they will make decisions that are more supportive of women and children and lead to improved women’s health outcomes.3 Improving women’s health is a central focus of the global health community4 and advancing gender equality is therefore seen by many as a means of benefitting communities and public health. “These women are working tirelessly to improve global health with dedication and passion to champion better healthcare for all. To change the face of global health for the future, we are committed to help recognize, develop and grow women’s leadership – and to start by sharing the stories of women leading the charge,” said Terri Bresenham, President and CEO of Sustainable Healthcare Solutions, GE Healthcare. “At GE Healthcare, we place tremendous value on training and education of healthcare professionals across emerging markets and we are starting from the frontlines by ensuring that 50 percent of our training places are available for women.” "Investing in girls and women results in greater societal return. It is acknowledged that women are underpaid and under-recognized in many workforces. In the global health field, it becomes more pervasive as women are at the front lines, taking on the toughest health challenges to ensure there are healthier communities, yet they are not represented in decision-making positions. As we celebrate women in global health, we are taking a moment to recognize women's contributions to health and highlight their achievements. Through shining a light on the great leaders we have in the field, we aim to inspire everyone to do more to advance gender equality for the benefit of communities and public health all over the world,” said Roopa Dhatt, Director and Co-founder of Women in Global Health. The nominees have been selected across a number of focus areas and countries: Dr. Sharmila Anand (India) – Dr. Anand leads Santosh Educational & Health Care Pvt Ltd. (SEHPL), a social enterprise which focuses on developing the next generation of healthcare professionals and leaders who can transform the way healthcare is delivered in India. She works on various initiatives that focus on enhancing the skills of people in healthcare at various levels. Sreytouch Vong (Cambodia) – Vong is a research fellow, affiliated with ReBUILD and RinGs consortium which deals with gender analysis. She has engaged in extensive health system research and public health research, that focuses on improving health financing, gender and human resources, and nutrition within healthcare systems. Vong is also working to form a group of health researchers to bridge gaps between users of evidence and the research community in Cambodia. Elvira Dayrit (Philippines) – Dayrit has worked in the Philippine Department of Health for 27 years. She is dedicated to making government health programs work effectively, efficiently, and in a wide enough scale to create health impact. She is currently the Bureau Director for Health Human Resources where she works to streamline the Bureau. Dr. Semakaleng Phafol (Lesotho) – Dr. Phafol is a Lesotho Professional Nurse and Education Specialist with more than 25 years of experience in nursing practice, nursing education, community/public health and management of clinical services. She has helped to establish and strengthen clinical placements for over 1000 nursing midwifery students at over 60 health centres. Mwanamvua Boga (Kenya) – Boga is a nurse manager working with the Kenya Medical Research Institute – Wellcome Trust Research Programme in Kilifi on the Kenyan coast. She works in a high dependency pediatric unit at the Kilifi County Hospital that provides clinical care in parallel to conducting medical research in tropical diseases. The unit admits children with a range of conditions including extremely premature babies, children with meningitis, severe malaria, sepsis, cancers and more. Mercy Owuor (Kenya) - Owuor is a Community Programs Director at Lwala Community Alliance where she provides leadership for community programs including efforts to improve maternal and child health, adolescent sexual and reproductive health and HIV care, treatment and stigma reduction. She also works to build the independence of young adolescent girls through mentorship and economic empowerment. Rohani Dg Te’ne (Indonesia) – Te’ne has worked in health for more than 20 years and is now a volunteer community health motivator for Tamaona community health centre. The rural area where Te’ne lives is not accessible by vehicle so she escorts local villagers needing healthcare and especially pregnant women, to the community health centre through difficult terrain which can take over an hour by foot. Margaret Gyapong (Ghana) – Gyapong is currently a Medical Anthropologist at the University of Health and Allied Science in Ghana. Until March 2017, she was the Deputy Director for Research and Development in the Ghana Health Service. Gyapong has also helped turn the Dodowa Health Research Centre into an institution of international repute. Emmah Kariuki (Kenya) – As a Service Delivery Officer with Jhpiego in Kenya, Kariuki works to bring low cost health innovations to disadvantaged communities. This entails providing technical support for service delivery in family planning reproductive health. Kariuki also provides training to healthcare providers, develops training materials, coordinates research activities and supports the Ministry of Health in the implementation of family planning and reproductive activities. Kwanele Asante (South Africa) – Patient activist, lawyer and bioethicist, Asante serves as Chair of the Ministerial Advisory Committee on Cancer and has founded and led an effort to end disparities in global cancer. Asante works to ensure that the voice of patients facing barriers to care is elevated to give them a greater chance at prolonging their life. Dr. Aula Abbara (Greece) – Dr. Abbara is the project lead in Greece for the Syrian American Medical Society Global Response, which provides primary healthcare to refugees together with the Greek authorities and International Non-Governmental Organisations. The range of services provided includes: pediatric and maternal health and delivering a Teaching Recovery Techniques program with the Children and War Foundation. Dr. Abbara also teaches healthcare workers in Turkey on topics related to infectious disease. Samalie Kitooleko (Uganda) – Kitooleko is a nurse in charge of the Uganda Rheumatic Heart Disease Registry. She takes care of patients with chronic cardiovascular illnesses such as congenital heart disease, myocardial infarction and rheumatic heart disease (RHD). She realized an increasing number of RHD patients, especially young women, lacked knowledge about their illness and were dying due to preventable complications which inspired her to champion for patient education. Louise Nilunger Mannheimer (Sweden) – Mannheimer is Head of Unit at the Health and Sexuality Unit at the Public Health Agency of Sweden where she is currently leading a team responsible for the national coordination of sexual and reproductive health and rights. Her work also includes HIV prevention of young adults, LGBT rights and tackling male violence against women. With these awards, Women in Global Health, GE Healthcare and our partners aim to celebrate the contributions of women leaders in global health, whose work is championing better health in their communities. We worked closely with our partner organisations to identify women who have made an impact in categories listed above. This list is by no means comprehensive and we are aware that there are many more women out there making great achievements and advances to improve global healthcare at all ends of the spectrum. The focus of this honor is telling the stories of those women who are making an impact at the local, grassroots level and in traditionally under-represented communities. Recognizing the need for these untold stories to reach beyond Geneva, GE Healthcare will be previewing a new documentary that follows three of these women from sunrise to sunset to answer one question: how have these individuals made an impact on the disparity that exists in global health in a way much of the world is still striving to do? Premiering in June, Heroines of Health takes us from South Sulawesi, Indonesia, where Mrs. Rohani wakes up at 4 a.m. for her morning prayer so she can walk pregnant mothers to the nearest health center; to Lwala, Kenya, where Mercy Owuor educates her community about health issues; to Chennai, India, where Dr.. Sharmila Anand is enabling young women to gain employment through a radiology training program. Three women. Three countries. Three stories untold. Until now. Watch the trailer at https://www.youtube.com/watch?v=Iy6YJHcPr8I. GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter - great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. For more information about GE Healthcare, visit our website at www.gehealthcare.com. Women in Global Health (WGH) is a global movement that brings together all genders and backgrounds to achieve gender equality in global health leadership. We believe that everyone has the right to attain equal levels of participation in leadership and decision-making regardless of gender. WGH creates a platform for discussions and collaborative space for leadership, facilitates specific education and training, garners support and commitment from the global community, and demands change for Gender Transformative Leadership. WGH is a virtually based network, registered in California, USA. 1 WHO, Spotlight on statistics: A fact file on health workforce statistics. Gender and health workforce statistics, Issue 2, February 2008. Available online at: http://www.who.int/hrh/statistics/spotlight_2.pdf 4 United Nations: We can end poverty: Millenium development goals and beyond 2015. http://www.un.org/millenniumgoals/bkgd.shtml.

Jokinen J.,Finnish National Institute for Health and Welfare | Scott J.A.G.,Wellcome Trust Research Programme | Scott J.A.G.,University of Oxford
Epidemiology | Year: 2010

Background: Community-acquired pneumonia is a common cause of hospitalization among African adults, and Streptococcus pneumoniae is assumed to be a frequent cause. Pneumococcal conjugate vaccine is currently being introduced into childhood immunization programs in Africa. The case for adult vaccination is dependent on the contribution of the pneumococcus to the hospital pneumonia burden. Methods: Pneumococcal diagnosis is complex because there is no gold standard, and culture methods are invalidated by antibiotic use. We used latent class analysis to estimate the proportion of pneumonia episodes caused by pneumococcus. Furthermore, we extended this methodology to evaluate the effect of antimicrobial treatment on test accuracies and the prevalence of the disease. The study combined data from 5 validation studies of pneumococcal diagnostic tests performed on 281 Kenyan adults with pneumonia. Results: The proportion of pneumonia episodes attributable to pneumococcus was 0.46 (95% confidence interval = 0.36-0.57). Failure to account for the effect of antimicrobial exposure underestimates this proportion as 0.32. A history of antibiotic exposure was a poor predictor of antimicrobial activity in patients' urine. Blood culture sensitivity for pneumococcus was estimated at 0.24 among patients with antibiotic exposure, and 0.75 among those without. Conclusions: The large contribution of pneumococcus to adult pneumonia provides a strong case for the investigation of pneumococcal vaccines in African adults. © 2010 by Lippincott Williams & Wilkins.

Feikin D.R.,International Vaccine Access Center | Feikin D.R.,Centers for Disease Control and Prevention | Scott J.A.G.,Wellcome Trust Research Programme | Scott J.A.G.,London School of Hygiene and Tropical Medicine | Gessner B.D.,Voltaire
The Lancet | Year: 2014

Vaccine probe studies have emerged in the past 15 years as a useful way to characterise disease. By contrast, traditional studies of vaccines focus on defining the vaccine effectiveness or efficacy. The underlying basis for the vaccine probe approach is that the difference in disease burden between vaccinated and unvaccinated individuals can be ascribed to the vaccine-specific pathogen. Vaccine probe studies can increase understanding of a vaccine's public health value. For instance, even when a vaccine has a seemingly low efficacy, a high baseline disease incidence can lead to a large vaccine-preventable disease burden and thus that population-based vaccine introduction would be justified. So far, vaccines have been used as probes to characterise disease syndromes caused by Haemophilus influenzae type b, pneumococcus, rotavirus, and early infant influenza. However, vaccine probe studies have enormous potential and could be used more widely in epidemiology, for example, to define the vaccine-preventable burden of malaria, typhoid, paediatric influenza, and dengue, and to identify causal interactions between different pathogens.

Seale A.C.,University College London | Seale A.C.,Imperial College London | Obiero C.W.,Wellcome Trust Research Programme | Berkley J.A.,Wellcome Trust Research Programme | Berkley J.A.,University of Oxford
Current Opinion in Infectious Diseases | Year: 2015

Purpose of review This review discusses the rational development of guidelines for the management of neonatal sepsis in developing countries. Recent findings Diagnosis of neonatal sepsis with high specificity remains challenging in developing countries. Aetiology data, particularly from rural, community-based studies, are very limited, but molecular tests to improve diagnostics are being tested in a community-based study in South Asia. Antibiotic susceptibility data are limited, but suggest reducing susceptibility to first-and second-line antibiotics in both hospital and community-acquired neonatal sepsis. Results of clinical trials in South Asia and sub-Saharan Africa assessing feasibility of simplified antibiotic regimens are awaited. Summary Effective management of neonatal sepsis in developing countries is essential to reduce neonatal mortality and morbidity. Simplified antibiotic regimens are currently being examined in clinical trials, but reduced antimicrobial susceptibility threatens current empiric treatment strategies. Improved clinical and microbiological surveillance is essential, to inform current practice, treatment guidelines, and monitor implementation of policy changes. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Ibinda F.,Wellcome Trust Research Programme | Wagner R.G.,University of Witwatersrand | Wagner R.G.,Umeå University | Bertram M.Y.,World Health Organization | And 9 more authors.
Epilepsia | Year: 2014

Summary Objectives The burden of epilepsy, in terms of both morbidity and mortality, is likely to vary depending on the etiology (primary [genetic/unknown] vs. secondary [structural/metabolic]) and with the use of antiepileptic drugs (AEDs). We estimated the disability-adjusted life years (DALYs) and modeled the remission rates of active convulsive epilepsy (ACE) using epidemiologic data collected over the last decade in rural Kilifi, Kenya.Methods We used measures of prevalence, incidence, and mortality to model the remission of epilepsy using disease-modeling software (DisMod II). DALYs were calculated as the sum of Years Lost to Disability (YLD) and Years of Life Lost (YLL) due to premature death using the prevalence approach, with disability weights (DWs) from the 2010 Global Burden of Disease (GBD) study. DALYs were calculated with R statistical software with the associated uncertainty intervals (UIs) computed by bootstrapping.Results A total of 1,005 (95% UI 797-1,213) DALYs were lost to ACE, which is 433 (95% UI 393-469) DALYs lost per 100,000 people. Twenty-six percent (113/100,000/year, 95% UI 106-117) of the DALYs were due to YLD and 74% (320/100,000/year, 95% UI 248-416) to YLL. Primary epilepsy accounted for fewer DALYs than secondary epilepsy (98 vs. 334 DALYs per 100,000 people). Those taking AEDs contributed fewer DALYs than those not taking AEDs (167 vs. 266 DALYs per 100,000 people). The proportion of people with ACE in remission per year was estimated at 11.0% in males and 12.0% in females, with highest rates in the 0-5 year age group.Significance The DALYs for ACE are high in rural Kenya, but less than the estimates of 2010 GBD study. Three-fourths of DALYs resulted from secondary epilepsy. Use of AEDs was associated with 40% reduction of DALYs. Improving adherence to AEDs may reduce the burden of epilepsy in this area. © © 2014 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

Hassan A.S.,Wellcome Trust Research Programme | Nabwera H.M.,Wellcome Trust Research Programme | Mwaringa S.M.,Wellcome Trust Research Programme | Obonyo C.A.,Kilifi District Hospital | And 7 more authors.
AIDS Research and Therapy | Year: 2014

Background: An increasing number of people on antiretroviral therapy (ART) in sub-Saharan Africa has led to declines in HIV related morbidity and mortality. However, virologic failure (VF) and acquired drug resistance (ADR) may negatively affect these gains. This study describes the prevalence and correlates of HIV-1 VF and ADR among first-line ART experienced adults at a rural HIV clinic in Coastal Kenya.Methods: HIV-infected adults on first-line ART for ≥6 months were cross-sectionally recruited between November 2008 and March 2011. The primary outcome was VF, defined as a one-off plasma viral load of ≥400 copies/ml. The secondary outcome was ADR, defined as the presence of resistance associated mutations. Logistic regression and Fishers exact test were used to describe correlates of VF and ADR respectively.Results: Of the 232 eligible participants on ART over a median duration of 13.9 months, 57 (24.6% [95% CI: 19.2 - 30.6]) had VF. Fifty-five viraemic samples were successfully amplified and sequenced. Of these, 29 (52.7% [95% CI: 38.8 - 66.3]) had at least one ADR, with 25 samples having dual-class resistance mutations. The most prevalent ADR mutations were the M184V (n = 24), K103N/S (n = 14) and Y181C/Y/I/V (n = 8). Twenty-six of the 55 successfully amplified viraemic samples (47.3%) did not have any detectable resistance mutation. Younger age (15-34 vs. ≥35 years: adjusted odd ratios [95% CI], p-value: 0.3 [0.1-0.6], p = 0.002) and unsatisfactory adherence (<95% vs. ≥95%: 3.0 [1.5-6.5], p = 0.003) were strong correlates of VF. Younger age, unsatisfactory adherence and high viral load were also strong correlates of ADR.Conclusions: High levels of VF and ADR were observed in younger patients and those with unsatisfactory adherence. Youth-friendly ART initiatives and strengthened adherence support should be prioritized in this Coastal Kenyan setting. To prevent unnecessary/premature switches, targeted HIV drug resistance testing for patients with confirmed VF should be considered. © 2014 Hassan et al.; licensee BioMed Central Ltd.

Wafula F.,Aidspan | Agweyu A.,Wellcome Trust Research Programme | Macintyre K.,Aidspan
Malaria Journal | Year: 2013

Background: Although procurement consumes nearly 40% of Global Fund's money, no analyses have been published to show how costs vary across regions and time. This paper presents an analysis of malaria-related commodity procurement data from 79 countries, as reported through the Global Fund's price and quality reporting (PQR) system for the 2005-2012 period. Methods. Data were analysed for the three most widely procured commodities for prevention, diagnosis and treatment of malaria. These were long-lasting insecticide-treated nets (LLINs), malaria rapid diagnostic tests (RDTs) and the artemether/lumefantrine (AL) combination treatment. Costs were compared across time (2005-2012), regions, and between individual procurement reported through the PQR and pooled procurement reported through the Global Fund's voluntary pooled procurement (VPP) system. All costs were adjusted for inflation and reported in US dollars. Results: The data included 1,514 entries reported from 79 countries over seven years. Of these, 492 entries were for LLINs, 330 for RDTs and 692 for AL. Considerable variations were seen by commodity, although none showed an increase in cost. The costs for LLINs, RDTs and AL all dropped significantly over the period of analysis. Regional variations were also seen, with the cost for all three commodities showing significant variations. The median cost for a single LLIN ranged from USD 4.3 in East Asia to USD 5.0 in West and Central Africa. The cost of a single RDT was lowest in West and Central Africa at US$ 0.57, and highest in the Latin American region at US$ 1.1. AL had the narrowest margin of between US$ 0.06 per tablet in sub-Saharan Africa and South Asia, and US$ 0.08 in the Latin American and Eastern Europe regions. Conclusion: This paper concludes that global procurement costs do vary by region and have reduced overall over time. This suggests a mature market is operating when viewed from the global level, but regional variation needs further attention. Such analyses should be done more often to identify and correct market insufficiencies. © 2013 Wafula et al.; licensee BioMed Central Ltd.

Sutherland C.J.,London School of Hygiene and Tropical Medicine | Babiker H.,Sultan Qaboos University | Babiker H.,University of Edinburgh | MacKinnon M.J.,Wellcome Trust Research Programme | And 3 more authors.
Parasitology | Year: 2011

Artemisinin-based combination therapy is exerting novel selective pressure upon populations of Plasmodium falciparum across Africa. Levels of resistance to non-artemisinin partner drugs differ among parasite populations, and so the artemisinins are not uniformly protected from developing resistance, already present in South East Asia. Here, we consider strategies for prolonging the period of high level efficacy of combination therapy for two particular endemicities common in Africa. Under high intensity transmission, two alternating first-line combinations, ideally with antagonistic selective effects on the parasite genome, are advocated for paediatric malaria cases. This leaves second-line and other therapies for adult cases, and for intermittent preventive therapy. The drug portfolio would be selected to protect the "premier" combination regimen from selection for resistance, while maximising impact on severe disease and mortality in children. In endemic areas subject to low, seasonal transmission of Plasmodium falciparum, such a strategy may deliver little benefit, as children represent a minority of cases. Nevertheless, the deployment of other drug-based interventions in low transmission and highly seasonal areas, such as mass drug administration aimed to interrupt malaria transmission, or intermittent preventive therapy, does provide an opportunity to diversify drug pressure. We thus propose an integrated approach to drug deployment, which minimises direct selective pressure on parasite populations from any one drug component. This approach is suitable for qualitatively and quantitatively different burdens of malaria, and should be supported by a programme of routine surveillance for emerging resistance. Copyright © 2011 Cambridge University Press.

Sullivan P.S.,Emory University | Carballo-Dieguez A.,Columbia University | Coates T.,University of California at Los Angeles | Goodreau S.M.,University of Washington | And 6 more authors.
The Lancet | Year: 2012

Men who have sex with men (MSM) have been substantially affected by HIV epidemics worldwide. Epidemics in MSM are re-emerging in many high-income countries and gaining greater recognition in many low-income and middle-income countries. Better HIV prevention strategies are urgently needed. Our review of HIV prevention strategies for MSM identified several important themes. At the beginning of the epidemic, stand-alone behavioural interventions mostly aimed to reduce unprotected anal intercourse, which, although somewhat efficacious, did not reduce HIV transmission. Biomedical prevention strategies reduce the incidence of HIV infection. Delivery of barrier and biomedical interventions with coordinated behavioural and structural strategies could optimise the effectiveness of prevention. Modelling suggests that, with sufficient coverage, available interventions are sufficient to avert at least a quarter of new HIV infections in MSM in diverse countries. Scale-up of HIV prevention programmes for MSM is difficult because of homophobia and bias, suboptimum access to HIV testing and care, and financial constraints.

News Article | November 22, 2016
Site: www.eurekalert.org

Giving preventive antimalarial drugs to children up to age 10 during active malaria season reduced the cases of malaria in that age group and lowered the malaria incidence in adults, according to a randomized trial carried out in Senegal and published in PLOS Medicine by researchers from the Université Cheikh Anta Diop, Senegal, the London School of Hygiene & Tropical Medicine, UK, and other collaborators. In 2012, the World Health Organization recommended that children under 5 years of age living in central Africa receive Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine for up to 4 months of the year to prevent malaria. However, in many areas there is a substantial burden of disease in older children. The investigators designed a study in which 54 health posts in central Senegal were randomized to provide SMC to children up to age 10, or act as controls. For the years of the study, between 2008 and 2011, malaria cases and deaths in each community were monitored at outpatient clinics and hospitals. Over three years, 780,000 SMC treatments were given to children. Mortality, the primary study endpoint, was similar between the test and control areas (4.6 and 4.5 per 1000 respectively in children under 5 years and 1.3 and 1.2 per 1000 in children 5-9 years of age, with a mortality rate ratio 0.90; 95 percent confidence interval 0.68-1.2, p=0.496). However, SMC was found to reduce the incidence of malaria in those under age 10 by 60% (95 percent confidence interval 54-64%, p "Apart from in Senegal, SMC is currently being provided only for children up to 5 years of age, but in many areas the burden in older children may justify extending this range," says author Paul Milligan of the London School of Hygiene & Tropical Medicine. "Our study shows that in some areas expanding the age range for SMC could have a substantial impact on the malaria burden and could contribute to reducing malaria transmission." In an accompanying Perspective, Robert Snow of the Kenya Medical Research Institute/Wellcome Trust Research Programme discusses the history of SMC in Africa and compares the costs and benefits of expanding the targeted age range. "[Seasonal malaria chemoprevention] is notable for incorporating the idea that different approaches may be appropriate in different settings," he notes. "Even if a fraction of the costs of delivering SMC were dedicated to intensive surveillance and a sustained research agenda, national malaria programmes could adapt to a changing epidemiology, parasite resistance and community acceptability." This study was funded by the Bill and Melinda Gates Foundation, grant number 40099. MC received support through a Population Health Scientist Fellowship jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID). JLN is supported by a Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist. Cissé B, Ba EH, Sokhna C, NDiaye JL, Gomis JF, Dial Y, et al. (2016) Effectiveness of Seasonal Malaria Chemoprevention in Children under Ten Years of Age in Senegal: A Stepped-Wedge Cluster-Randomised Trial. PLoS Med 13(11): e1002175. doi:10.1371/journal.pmed.1002175 IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:http://journals. RWS is funded as a Principal Research Fellow by the Wellcome Trust wellcome.ac.uk (# 103602). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The author has declared that no competing interests exist. KEMRI-Wellcome Trust Collaborative Programme, Nairobi, Kenya Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:http://journals.

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