Karonga Prevention Study

The Karonga Prevention Study (KPS) is a large research project covering the whole of Karonga District, a rural area in northern Malawi, and associated closely with the London School of Hygiene and Tropical Medicine. The programme is focused on epidemiological research and also undertakes clinical trials and microbiology and immunology studies of the prevalent diseases.
The project originated in 1979 as a cohort study of leprosy, funded primarily by the British Leprosy Relief Association (LEPRA). It assumed responsibility for tuberculosis diagnosis and outpatient care from 1982, and became a large WHO-supported vaccine trial in 1986, incorporating studies of HIV and skin diseases other than leprosy.

The trial revealed that BCG vaccine imparts considerable protection against leprosy in this population, but none against tuberculosis. This led to the initiation of a broad (primarily Wellcome Trust supported) programme of research concentrating upon genetical and immunological factors which determine natural and vaccine-derived protection against tuberculosis and leprosy, upon the detailed epidemiology of tuberculosis, upon the patterns, impact and control of HIV, upon the development of immune responsiveness in infants, and extending to studies of helminths.
A demographic surveillance system was initiated in 2002, and is now providing a platform for studies of HIV epidemiology, of antiretroviral therapy, and of S. pneumoniae epidemiology and pneumococcal vaccines.

In addition to the Malawi operations, involving six international and 200 local staff, the programme involves several staff at LSHTM and has ongoing collaborations with scientists at Oxford, the University of Sussex Medical School, the National Institute of Medical Research (NIMR), the Health Protection Agency (HPA), the Jenner Institute of Vaccine Research, Rothamsted Experimental Station, the National University of Ireland at Maynooth, The University of Cape Town, South Africa, The National Public health Institute, Helsinki, Finland, The Max Plank Institute, Berlin, Germany, Stellenbosch University, South Africa, the College of Medicine, Blantyre

As well as funding from the Wellcome Trust, KPS receives grant support from the European Union, Bill and Melinda Gates Foundation, LEPRA, Meningitis Research Foundation,  ESRC (UK) and EDCTP.

About the Karonga District

Location
Karonga is the northernmost district of Malawi, bordered by Lake Malawi on the East, by the Songwe River (border with Tanzania) on the North and the Nyika Plateau and highlands on the West and South. The district was isolated until 1981, when the national highway was extended into the district from the south. In 1988 a bridge was built across the Songwe, facilitating road contact with Tanzania.
The District and project headquarters are approximately six hours drive from Lilongwe (Malawi’s capital city and location of the closest international airport). Mzuzu, the capital of the northern region, is three hours drive away and has an airport, as does Karonga town (boma) but at present flights are limited to light aircraft charters . Mbeya in Tanzania is five hours to the north.
The current population (approximately 270,000 in 2009, increasing at 3 % per annum: crude birth rate c. 40/1000, infant mortality c.80/1000 live births) is rural, dependent upon subsistence agriculture and fish from the lake. It consists primarily of Tumbuka and Nkhonde speaking peoples, with small numbers of several other language groups represented.

Climate and terrain
Karonga is hot and dry from September to December, rainy from January to May, and cool and dry June to August. The terrain is flat and fertile along the lake, and increasingly hilly towards the west. There are several rivers, fed from the Nyika highlands to the west, and the northern sector is dominated by the floodplain of the Songwe river, some of which is accessible only by canoe for several months each year.

Health and services
Pneumonia, diarrhea and malaria are highly prevalent and are the principal causes of death in children. HIV is the principal killer of young adults. Life expectancy for adults is of the order of 60 years for both sexes. There are about 300 newly registered tuberculosis cases each year, of which about 150 are bacteriologically confirmed. Leprosy has now virtually disappeared. HIV had appeared by 1982, and approximately 10 % of adults are infected.
Government health services are basic, with one 200 bed District Hospital in Karonga town staffed by two doctors and six clinical officers. There are two rural hospitals (in Chilumba and Kaporo) and ten health centres throughout the district.