April / May 2008 Report
Summary:
With the rains finished for the year, the climate remained dry throughout April and May, except for one isolated shower in April. The lush green grass gradually turned brown, small wind gusts began to blow fine soil into everything left uncovered, and the nights became cool, resulting in a marked decrease in the anopheline mosquito population, but interestingly with more culicines seen lingering in offices and houses in May.
Two publications from Macha were published in May in the scientific literature, with the lead authors of both being from our own lab scientific staff and graduates of the University of Zambia.
The field work with mosquitoes was stopped for this season in late April, but the anopheline colony continued to thrive under the watchful eye of our resident entomologist. The cross-sectional and longitudinal aspects of the epidemiology study continued, while a backlog of malaria smears that had accumulated from this study was decreased. The molecular lab remained busy with data being developed for four abstracts that were subsequently submitted for the American Society of Tropical Medicine and Hygiene meeting later this year.
Minor renovations on two buildings, and road maintenance work, was carried out during the two months by the maintenance department, with the help of a volunteer from the USA.
The two newest MIAM vehicles were both involved in separate accidents, with one vehicle being rolled and subsequently being declared a total write-off by the insurance company. Fortunately, there were no injuries to the drivers.
I - General Site Development and Maintenance
The MIAM campus began to take on its "cold season" look, as the ground became dry and grass turned brown, with no regular rain since March. The scattered flower beds maintained by the grounds-keepers added some bright colors.
Internal road maintenance, with the hauling of many lorry loads of gravel to strengthen and repair the road beds, was on-going for much of the period. In addition, a set of culverts were re-positioned, and larger drainage ditches constructed, to try to better control the water that runs across the campus during the heavy rainy season.
The back-up diesel generator was used on average several times each week, as the national electrical "load-shedding" continued, with electrical outages of several hours many evenings, as well as sometimes over lunch time. Fuel costs in Zambia also continue to increase, as in all parts of the world. A review of costs for the first quarter of this year shows that expenditures on diesel for the generator were nearly 50% above the same period of 2007.
Mr. Chet Sollenbergrer, a "recurrent" volunteer - and now over 80 years old - is back again at MIAM this year with his wife. He will be here for four months to assist with renovations at MIAM. Alterations on the "Host House" have been completed - installing an outside door on the east side of the building, and also installing a kitchen sink in the east room, in order to make the apartment into a self-contained unit. That will free up the rest of the house to be used as a library and a venue for staff meetings, as well as the place where staff members will have their "tea time". In the molecular biology lab, a partition with a door was placed in the data entry area, to isolate it from the main laboratory. The other major renovation that will be carried out in the coming months is to convert the present large library/classroom into a separate smaller classroom - plus six office cubicles, to cater for our ever-expanding staff that need a place to work on their computers.
II - Information Technology
The wired and wireless internet system continued to work for the most part, though the newest "mesh" network system installed in the newer buildings seemed to work intermittently and somewhat poorly for much of the time. LinkNet, the organization now responsible for internet access at Macha and under contract to MIAM, sent their staff a number of times to try and get the wireless system working better, but this resulted in only brief activity before it malfunctioned again. One has to be constantly reminded that considering we are far in the bush in Africa, we have better internet access than many people in this part of the world living in the cities! Despite that, the high cost of internet fees paid by MIAM, motivates us to continue to work towards better service availability.
Several office computers also "died" during the last two months, with repairs being done where possible, or replacement computers installed where repairs were not possible. In fact, MIAM now has nearly 30 computers that must be maintained by our one IT technician. The harsh elements and a dusty environment tend to cause frequent breakdown of computer power supplies, fans, and various other computer components on a regular basis. In addition to the hardware issues, there are always software problems to trouble-shoot, and antivirus software to be kept up to date - a never ending job!
III - Vehicles/Transport
In April, an unfortunate accident occurred when the Scientific Director was returning to Macha from Lusaka late one night. Control was lost of the new Ford Everest just a few kilometers from Macha on the bad gravel road, resulting in a "roll-over" and extensive damage to the vehicle. Fortunately, he was the only person in the vehicle, and was not injured other than minor abrasions and bruises. The vehicle was fully insured, but it has taken more than six weeks for the insurance company to process the claim and finally decide the vehicle is a "total loss". Hopefully the cost will be refunded soon, and then another vehicle can be acquired to replace this one, which was primarily used for the many trips to and from Lusaka.
In May, the newest MIAM vehicle, a double cab Toyota Hilux bought in February, was involved in an accident in Lusaka while the Maintenance Manager was crossing an intersection. Fortunately, there were again no personal injuries, but the vehicle suffered moderate damage on both doors on the left side and to the rear wheel well, and is now in the shop getting repairs. While in both cases there is full insurance to pay the cost, the police considered both accidents to be the fault of the MIAM drivers, so there is a high likelihood that our vehicle insurance rates will increase substantially in the next premium cycle.
The old Hilux 2.8 was not sold as planned, since it was needed as a result of having two vehicles off the road. It continued to be used for field work, as were the Toyota Surf and Hilux 3.0. The Toyota Condor, though now several years old with nearly 100,000 kms on bad roads, continued to be used for weekly trips to Choma for banking and obtaining supplies, and also is now used for Lusaka trips for meetings, etc. Unfortunately, its engine does not tolerate the higher driving speed that some drivers use when travelling to and from Lusaka.
A new Honda 200 motorcycle was purchased in April, and subsequently put into service in May to be available for field work use. While the old 125 and 185 Hondas are operational, they are getting older and less reliable from the constant use, and one no longer has a working speedometer cable, making it impossible to keep records of the mileage used on the various projects.
Two more MIAM employees (S. Habbanti and M. Musapa) obtained vehicle driving licenses, after first being instructed over several months by the Maintenance Manager, and then passing on their first attempt at the license examination in Choma.
IV - Research Activities
Entomology:
The insectary continues to rear its Anopheles arabiensis colony under the watchful eye and constant care of our lab scientist/entomologist, M. Musapa. Plans are already underway for some experiments utilizing the mosquitoes to be carried out in July. In addition, the National Malaria Control Centre has asked MIAM for assistance to help establish their colony in the newly rehabilitated insectary in Lusaka.
Field mosquito collections continued on a regular basis until the end of April / early May, and the electric grid work also stopped in early May, as numbers collected became low. With the Field Worker involved in the entomology collections no longer needed for data entry during the off-season, it was decided to assign him to assist in the insectary for the coming months.
Two Hopkins Ph D students left to return to the USA in mid-April, after carrying out various studies on the local mosquitoes.
Epidemiology and GIS:
The Epidemiology study resumed in late March after a brief hiatus, waiting for renewed IRB clearance. The team has continued over the past two months to carry out screening surveys in the randomly chosen areas, utilizing both a longitudinal and cross-sectional approach. The numbers of those found to be asymptomatic carriers have remained very low this year, generally less than 5% of those screened.
J. Sikalima, the lab technologist assigned to the study, completed his training at Hopkins in RT-PCR, and returned to MIAM in early April to set up the same system here. Reagents for the technique did not arrive until late May, and the plans were to start the RT-PCR work in June. There is still some debate as to whether this new system will be more sensitive than microscopy to detect gametocytes, so there will be necessary studies to carry out, to determine its sensitivity and specificity in a field setting.
One of the two locally trained microscopists, P. Cheelo, continues to do good work and keeps up with the malaria parasite first readings for the study, though there continues to be backlog of slides missing the second reading. A second microscopist has been hired to also be trained locally and assist this project.
The Hopkins post-doc assisting with the GIS studies, completed her local data collection and returned to the USA in mid April.
Molecular Biology:
PCR work on the Fitness Study continued, as well work on non-blood based diagnostic methods for malaria, with new data generated and submitted for an abstract to the American Society of Tropical Medicine meeting planned for December in Louisiana.
Dr. Mharakurwa traveled to Holland to present his work on potential saliva diagnosis of malaria at an international meeting, the 7th European Symposium on Saliva.
Two publications from work done in the molecular biology lab appeared in the scientific literature during the month of May. One publication was the lead article in the Zambia Medical Journal, on prevalence of schistosomiasis in school children screened at schools in Namwala District (by S. Chishimba et al). The other publication was by M. Mkulama et al, in Malaria Journal, on the increases in the malaria parasite resistance to SP as determined by molecular markers.
Pharmacokinetic Study:
The 25 women studied during pregnancy to determine their metabolism of SP, have now mostly delivered and are coming for their return visits for the repeat PK study carried out post-partum. The study PI from Hopkins, M. Nyunt, carried out a site visit during April. Drug levels are being performed in collaboration with University of Capetown, and preliminary results of the samples from Macha show adequate levels, and in a similar range as those from the other study site in Mali.
Tuberculosis Study:
The Rifaquin study is now in the final stages of preparation, with an anticipated start date of patient recruitment of early August. The TB lab remains busy, with a project currently being carried out by students from Erasmus University in Holland on identification, culturing and determination of the species of mycobacteria obtained from sputum samples.
Another lab tech from Erasmus arrived in late May, to replace M. Pronk who returned to Holland after assisting for several months.
HIV/AIDS Studies:
A total of 172 children have now been enrolled in this longitudinal study, looking at the variables involved in the outcome of these children exposed to and infected by the HIV/AIDS virus.
Hospital Data Collection and Analysis:
On-going data collection from the hospital continued to show a very low case-load level this year for malaria, with most cases of severe malaria coming from the west in Kalomo District. An informal survey of local rural health centers was carried out, revealing that most of them were also seeing record low numbers of malaria cases this year.
Documentation that most of the RHCs were accessible to cell phone communication was also done, in an effort to acquire some preliminary data for a grant application proposing an early warning network system to assist in malaria control, as the country moves from hyperendemicity to hypoendemicity with malaria.
V - Personnel
The Director (P. Thuma) spent several weeks in the USA in May, for family matters (a new grandchild), the annual MMRI audit, and a meeting at Hopkins with the JHMRI director and faculty members. He then returned to Zambia and attended a planning meeting for 2009 country-wide activities at the National Malaria Control Centre in late May. The meeting was attended by all the major donors to Zambia assisting with malaria control, including World Bank and President's Malaria Initiative (PMI) people. The PMI group includes scientists from both USAID and CDC, and they have indicated interest in visiting Macha the next time they are in the country in mid September.
The Scientific Director (S. Mharakurwa) attended and presented a poster at the 7th European Symposium on Saliva in Holland in May. He and one of the lab scientists (M. Mkulama) attended the Zambia Medical Association meeting in May in Lusaka, and presented abstracts on the work they are doing at MIAM.
The Manager for Clinical Studies attended a meeting in Maputo, Mozambique for final planning for the upcoming Rifaqin TB study, for which she is the local PI. She then left in mid-May for a two month leave in Holland.
A short term doctor, H. Stewart, joined MIAM in mid-May to assist with the SP-PK and PART studies while J. van Dijk is on leave in Holland.
One lab scientist in the molecular biology lab submitted his resignation (M. Mkulama), with plans to join the government service in agriculture research.
An additional night watchman was hired to meet the need of a larger campus to be covered, and one housekeeping staff left employment while another was hired to replace her.
Five year employment awards were given to four MIAM employees at monthly staff meetings, namely M. Hamahuwa, P. Sinywimaanzi, G. Moono and D. Haadinke. These were the first full time employees that were hired by MIAM in early 2003.
Two of our staff members (A. Kamanga and E. Pandawe) were married in late April, and returned to live in one of the two bed-roomed duplexes in May.
Two Canadian students arrived at MIAM in early May to assist with projects in the molecular biology lab for summer internship experience. In addition, an MPH student from Michigan came to work on a PCR project in the lab, and a nursing student from Pennsylvania arrived to observe and learn about malaria research.
VII - Other
April 25 was "World Malaria Day", and while there were national celebrations in Livingstone, MIAM participated in a local celebration held at the Macha Community Hall and attended by most all of the local headmen. The MIAM Director was asked to be the guest of honor by the local organizing committee, affording an opportunity to thank the community leaders for their cooperation in all of the malaria studies that are carried out in this area.