The first is a descriptive case-control study looking at the pathophysiology of rickets in Mathare. Although rickets is very common in our paediatric population, its aetiology is unclear. In many parts of the world rickets is caused by vitamin D deficiency, but in some other African settings, calcium deficiency is to blame. Understanding which the cause in Kenya is will have major implications for treatment and preventative strategies. The Kenyan Ministry of Health’s Division of Nutrition has delayed producing national guidelines on the case-management of rickets until the results of our study are known, which will be later in 2014.
The second project is a randomised placebo-controlled trial of the use of mesalazine in severely acutely malnourished children. This ambitious trial has been completed and results are currently being analysed. It is the first ever trial of treating malnutrition with immunomodulatory agents alongside nutritional rehabilitation and the results will have a significant impact on the scientific understanding of how nutrition and immune function interact, with potentially enormous implications for their treatment. A fascinating by-product of the research has been the revelation that malnourished children in Mathare have some of the highest rates of Giardia infection ever recorded.
Our involvement in research (all of which is funded by the Wellcome Trust, a UK-based biomedical research charity entirely independent of the pharmaceutical industry) has seen additional training for members of staff throughout the clinic, and has been enthusiastically supported by the whole Baraka team. In 2014 we hope to build on some of these results and are in the process of designing further studies with colleagues from the Wellcome Trust. All of our research is subject to rigorous scientific and ethical review both in the UK and Kenya.