Dr Victor Akelo is a medical doctor, based at the Centre for Global Health Research of the Kenya Medical Research Institute (KEMRI) in Kisumu, Kenya, as part of the collaboration between KEMRI, LSTM and the USA’s Centers for Disease Control (CDC). He has recently joined LSTM’s Department of Clinical Sciences and here talks about his past achievements and current research focus.
Good to meet you, Victor. Can you tell us a bit about your new role at LSTM?
I've come in as the Senior Science Director for site strategy and implementation for the Child Health and Mortality Prevention Surveillance (CHAMPS) network project. CHAMPS is a Gates Foundation-funded project that is largely coordinated by Emory University in the USA, with an aim of identifying and tracking definitive causes of stillbirths and child deaths using minimally invasive autopsy. CHAMPS now operates in sites in eight African and South Asian countries with high burden of child deaths, and a further two sites in Nigeria are preparing to join the network. I’m also overseeing an ongoing pregnancy cohort study – PRiSMA (Pregnancy Risk, Infant Surveillance, and Measurement Alliance) and associated nested pregnancy sub-studies.
Can you tell me a bit about your background? How did you enter this field of study?
I have a medical degree from University of Nairobi here in Kenya and I practised in health facilities for a few years before I transitioned to KEMRI where I joined as a research medical doctor, rising to the position of branch chief/Principal Research Officer -in-charge of HIV research. And that’s basically how I started my public health and research career. I mainly managed NIH clinical trials and observational studies, largely around maternal and child health and HIV in particular. I got my master’s in public health from Emory University in Atlanta, USA where I enrolled as a William H Foege fellow – that’s a global health fellowship. Later I undertook a CDC Epidemic Intelligence Service fellowship in the US, working in applied epidemiology, surveillance, and outbreak response before coming back to Kenya to head the CHAMPS project. In July 2023, I started as Senior Science Director for site strategy and implementation for CHAMPS, helping oversee scientific, technical and implementation of the project across the nine sites.
So you will still be based in Kenya and continuing your current research?
Yes, that’s right. Seven of the nine CHAMPS sites are based in sub-Saharan Africa where under-five deaths are highest, so it made sense to stay within the continent to better support the work and to oversee the on-going work in Kenya. To provide you with a little bit more context on “why CHAMPS?”— while under-5 mortality has been dropping globally, newborn deaths are not declining fast enough, and there is no change in the high number of stillbirths. Each year 5 million children across the world don’t reach their 5th birthday, and nearly 2 million babies each year never take their first breath—they’re stillborn. Efforts to reach high-burden geographies in Africa and South Asia, regions that account for 82% of under-5 child deaths, have fallen short. A lot of it has been thought to be related to a lack of data that accurately captures the causes of death and which could help inform policies and decision making. In situations where data do exist, they are either incomplete or delayed in their transmission and that affects the utility of the data for decision making. So, the knowledge we are generating in CHAMPS is being funnelled into child health mortality prevention platforms, to create a surveillance network that could define causes of death in a much more rigorous manner in the areas where there is high under-5s mortality. As we better understand the causes of death we feed that information to the family, facility, sub-national and national levels to inform decision making, guidelines and policies with regards to the development of under-5 mortality prevention tools. It's also been shared on the global stage and is informing different practises, including the WHO guidelines. More importantly, our ability to characterise the leading causes of mortality is impacting on the development of vaccines for under-5s. For example, the RSV (respiratory syncytial virus) vaccine has long been in the pipeline, but its development has been accelerated a little because of the corroborating data coming from projects such as CHAMPS.
With regards to maternal health, there's been a challenge in understanding what is causing mortality and disease in mothers, mainly due to fragmented data. So, that PRiSMA cohort of pregnant women will also help us understand the causes of problems in a much more rigorous way. PRiSMA will help improve global understanding of key risk factors for disease and death among pregnant women and their babies, provide population baseline estimates of major maternal and child health outcomes, as well as enabling use of novel analytical techniques such as machine learning to create risk prediction tools. PRiSMA data will inform development of innovative strategies, clinical care protocols, or interventions to optimise pregnancy outcomes for mothers and their newborn.
Looking to the future and how LSTM might work more equitably with partners such as KEMRI, what do you see as the big challenges that we should be addressing in the coming years if we are to achieve that equity?
I won’t call it a challenge - I would call it a potential opportunity that needs to be looked into - but more collaboration with the Global South is needed, without necessarily having those staff based in the UK. Strengthening that global reach goes a long way in building resilient and inclusive societies towards the attainment of internationally-agreed development goals, including the 2030 Agenda for Sustainable Development.
Another issue is the different governance and ethical architectures around research. Each country has its own rules, its own ways of doing things, and it can be challenging to navigate all of these. If teams are to work globally, I think putting heads together to think through some of those differences would be helpful.
Also, balance in both grant and project management. More capacity building in institutions such as KEMRI. The capacity building frameworks may differ between LSTM and the collaborating institutions, but I think it's important so that LSTM is also grounded in terms of strong collaborators within the continent, who bring Global South perspectives and contributions for a holistic health outcome.
In my mind, Kenya is one of the LSTM’s top countries in terms of collaboration and research work – along with Malawi - so it is important to think about the research strategy that LSTM wishes to engage in with each of those country partners. Of course, that will need to be developed in a collaborative manner so that research is impactful – a synergistic approach, a vision for working together.
That's great. Good luck with your new post.