The anti-malarial clinical trial that is changing Ghana’s public health landscape 

About 12 years ago, a team of journalists from Accra undertook a fact-finding journey to Kintampo, now part of the Bono East region, to talk to researchers, parents and other local community members in order to seek answers to some critical questions such as why any mother or parent in Ghana would allow their young children to be used in vaccine trials.

At the time trials were being conducted by the Kintampo Health Research Centre (KHRC) and among some vexing questions asked were: was the vaccine safe? What about the blood being drawn from these children? Were the parents coerced into offering their children for such a trial?

The RTS,S malaria vaccine was then being tested for the first time in Ghana and in some selected African countries.

This particular clinical trial was aimed primarily at testing the safety of the vaccine as a first step and it had started in September 2006 at the KHRC and projected to last 20 months.

Dorcas Agyei, Hafizu Haruna and Rachael Asantewa, children in the Kintampo area, were part of the 270 children, all below two years, who had started receiving the vaccine under a phase two experiment.

This phase two stage, led to a large-scale phase three trials later on around 2009 to further evaluate the vaccine for efficacy.

The trials were conducted under the Malaria Clinical Trials Alliance, (MCTA) an African-led institution set up to conduct research into malaria, with funding from the Bill and Melinda Gates Foundation.

Parents in Kintampo had told the journalists from the Africa Media and Malaria Research Network visiting the trial site, that they were not coerced or given money to persuade them to allow their children to be used in the experiment.

According to them, they had voluntarily handed over their children for the trial because of their battles with malaria. The area is known for high malaria transmission. The outcome of these experiments have today yielded positive results.

Currently the RTS,S vaccine is being deployed in Ghana, Malawi and Kenya under a World Health Organisation-led Malaria Vaccine Implementation Programme to assess the performance of the vaccine when used in routine child immunization programmes.

The KHRC’s contribution to the development of the world’s first malaria vaccine is changing the public health landscape of Ghana and also contributing to relieving Africa of a major developmental problem, malaria.

The vaccine is an additional tool to be used together with existing malaria preventive and control strategies, when its use is eventually scaled up, after this pilot stage in the three countries.

Shaping health policies and practices

The KHRC has for several years served as a meeting place and an intersection for assembling researchers, nurses, doctors and field workers for research activities.

It has been collaborating with other stakeholders in and outside Ghana, with one major aim of contributing to shaping health policy and practice in and outside Ghana through networking and cross-site studies.

The institution was set up to conduct public health research and develop health research capacity to contribute to the reduction of ill-health with the aim of guiding decision-making and policy development within the health delivery system in Ghana.

This year, the KHRC is marking 25 years of its existence and contributions to the national and global public health agenda, under the theme “sustaining 25 years of excellence in health research: impacting communities, shaping health policy and practice.”

The WHO Country Representative in Ghana, Dr Owen Kaluwa, speaking at a ceremony in Accra to launch the anniversary celebrations, commended the centre and scientists for their work on the vaccine.

He called for increased utilization of research results to inform policy and programming.

Mr Alexander Abban, Deputy Minister of Health, said the centre’s research activities is based on the needs of African communities and on continuous improvement.

Adding that it is “result-oriented, based on the well-tested research approaches.”

He noted that the slow translation of research into policy is a hindrance to global health and said the ministry is working at ensuring that research outcomes are used to improve the lives of people.

Dr Anthony Nsiah Asare, the Director-General of the Ghana Health Service touched on the role that research has played in the health sector, which resulted in the introduction of the CHPs concept, now a bedrock for the development and implementation of primary health care.

He said the vision of the Ghana Health Service is to see a healthy population with universal access to quality health care.

He called for innovations in health care delivery through research and added that the Ghana Health Service is faltering in the area of prevention of mother to child transmission of HIV and also grappling with low TB case detection.

According to Dr Nsiah Asare, research is one way to find solutions to some of these challenges.

Dr Kwaku Poku Asante, Director of KHRC, touched on some challenges facing the centre such as funding and staffing.

He mentioned some areas that the centre has contributed to in shaping health policies in the country, such as Vitamin A, maternal health and malaria drugs.

Various malaria studies carried out by the centre have helped in policies and programmes in the country. KHRC, for instance, did some studies on anti-malarials, which informed policy and discussions, leading to the replacement of chloroquine and the changeover to artesunate-amodiaquine.

It also trained chemical sellers to use the rapid diagnostic test kits to test before selling anti-malarials to clients.  Other areas of focus have included malaria epidemiological studies and non-communicable diseases.

At the global level, the KHRC was one of the sites across four African countries, which took part in the first-ever phase 4 malaria clinical trials under the INDEPTH Effectiveness and Safety Studies of Antimalarial Drugs in Africa (INESS) project.

The INESS study introduced innovative ways of monitoring patients after treatment for malaria to determine progress, ensure adherence to instructions on drug intake and any possible side effects.

By Eunice Menka
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