The Muriithi-Wellde Clinical Research Centre (Kombewa)
The New Nyanza Provincial General Hospital | Kisian

The Muriithi-Wellde Clinical Research Centre is located in the village of Kombam (near Kombewa Town), in Kombewa Division, Kisumu District, Nyanza Province, Kenya. Kombewa Town is about 40 kilometers (40 minutes drive) west of Kisumu Town.

The population of Kombewa Division is primarily Luo. The majority of the population speaks both Dholuo and Kiswahili. Families are large with many small children in each household.  Villages in this area are typically a loose conglomeration of family compounds near a family garden plot and grazing land. Houses are typically made of mud with thatched or corrugated roofs. In Kombewa Town, homes are often attached to family shops/businesses. Most homes do not have glass windows or screens. Water source is mainly from community wells and local streams though some households have their own wells and the lake for those living along the shores. Most water sources are not chlorinated or covered.

The Muriithi-Wellde CRC is located directly across the Kombewa-Maseno road (a murram road) from the Kombewa Sub-District Hospital (KSDH) where it is less than one kilometer north of the Kisumu-Bondo road (a macadamized road), a Kenya Ministry of Health sub-district hospital.The hospital is being established as a study site to complement the current facilities in the conduct of both an inpatient and outpatient facility.

The Muriithi-Wellde Clinical Trial Center (CRC) was initially developed by the US Army Medical Research Unit-Kenya (USAMRU-K) and the Kenya Medical Research Institute (KEMRI), with other partners, for the study of malaria vaccines and drugs.  Since then it has developed into a still growing facility that is capable of conducting regulated clinical trials to evaluate vaccines, drugs, or diagnostic platforms for a variety pathogens found in sub-Saharan Africa. 

The Muriithi-Wellde CRC is readily accessible by foot or ground vehicle to all study subjects. It is a one-story, 836 m² building which includes a clinical laboratory equipped to carry out malaria diagnosis and basic clinical laboratory assays (such as measurement of serum chemistries and complete blood counts), a phlebotomy room, an outpatient facility that includes six examination/consultation rooms, a pharmacy, an active records room, and a records archive. Subject records and CRFs will be kept in locked cabinets in the latter two rooms. The facility has a dedicated data entry room, offices for clinical officers and CRCs, on-call rooms, an urgent treatment room, a four-bed observation suite, a washroom, a general store, and a kitchen with dining area.

The PI, associate investigators, and clinical officers (physician assistants) carry out clinical evaluations, including basic laboratory studies, at the Muriithi-Wellde CRC Management of symptomatic malaria during studies is routinely undertaken. During the course of evaluation for malaria in the study subjects, other acute illnesses such as upper respiratory infections and other minor bacterial or viral infections may be uncovered. The pharmacy at the Muriithi-Wellde CRC provides subjects with common over-the-counter analgesics such as paracetamol, as well as antibiotics (for the treatment of minor infections) as prescribed by the clinicians. During studies, the Muriithi-Wellde CRC is staffed at all times (24 hours a day, 7 days a week) by at least one clinical officer and one community nurse. A medical officer (physician) will be on site during working hours Monday through Friday. Additionally, a pediatrician is on site on most working days and will always be available by telephone.

This facility recently underwent expansion with the construction of a two-story, 450 m² annex block including new office spaces, more commodious general storage areas, a secure records archive room, meeting rooms, and a library. As with the main clinic building, the annex is wired for intra- and internet connectivity. A microwave repeater on a tower halfway between Kombewa and Kisumu provides connectivity to the VSAT and servers at the WRP-Kondele main building. The physical plant includes a 130 kVA generator housed in a  disattached building. This generator serves as a backup power supply in the event of power grid failure. The generator also supplies power to the KSDH. There is also a 30,000 liter underground water tank and a 10,000 liter tank mounted on a tower. Water for these tanks is pumped from a nearby borehole to the base of the water tower and by another pump up to the elevated tank.

To facilitate accessibility to the study participants, several field stations have been designated within Kombewa Division; all are located within one-mile radii of the homes of study subjects. Twelve field stations, of which three will be designated as field follow-up centers, will be utilized. Field stations and follow-up field centers are intended to be points of first contact for sick children; therefore, they are staffed 24 hours a day and are equipped to communicate with the WRP KC to summon transportation.