August 2008 Report
Summary:
August ushered in much warmer weather, with the noontime temperature often reaching the 90's (Fahrenheit) by the end of the month. The campus grounds became more desert-looking as all the grass dried up and the winds blew dust into everything, but the new green leaves on the trees, and flowers in the flower-beds, kept some color in the landscape.
All of the remaining short term volunteers in the molecular biology research lab left Macha in August, but we had a number of other visitors during the month including Dr. Clive Shiff, the Hopkins PI for MIAM. A number of MIAM staff took their annual leave time in August.
Insectary work continued with on-going development of the anopheline colony, as well as molecular biology work, TB culture and pediatric HIV/AIDS studies. The bednet distribution project was completed in August, with over 2,000 ITNs hung in villagers' houses by the MIAM team. A project to collect weekly "real-time" malaria data using cell phone messaging from the 12 rural health centres in the Macha area was begun, and the malaria epidemiology project began field work again in August after a break in July.
The month of August 2008 will be remembered in Zambia as a month when the Zambian president died while still in office, after suffering a stroke in late June. The government declared 21 days of mourning, with the result that a number of national-level meetings were cancelled or postponed. The late president's good governance policies have made a difference in the past seven years, and the country's economic stability and growth has led to a rapidly growing middle class.
I - General Site Development and Maintenance
The MIAM campus continued to be well-groomed by the dedicated grounds staff, and all utility services were maintained through-out the month. The work on the internal roads and new culverts continued with many loads of gravel being hauled and spread by hand, and custom concrete work on the new culverts carried out by our own staff.
The national electricity provider continued to have frequent "load-shedding" with periods of no electricity, leaving the back-up generator to run frequently in order to supply MIAM's needs.
II - Information Technology
The local area wireless network continued to function most of the time, with our ISP provider, Linknet, looking into why some areas of the wireless "mesh" network were still not functional. The modem connecting the network to the satellite dish suffered outages many early mornings due to a faulty UPS, and this required re-setting it by hand on numerous occasions to restore internet connectivity.
III - Vehicles/Transport
All MIAM vehicles and motorcycles remained in good working condition in August, though usage was down from the peak months of field work. By month's end, the insurance settlement check for the wrecked Ford Everest had still not been received, but was promised in early September.
A replacement vehicle was ordered for the Everest, and after many considerations, a used Toyota Land Cruiser Prado was purchased from Japan, and hopefully should arrive via Dar es Salaam, Tanzania by late October.
IV - Research Activities
Entomology:
The mosquito colony now has one line of Anopheles arabienses in the F8 generation, while the other four lines are in the F6 generation. Preparations have been underway to start a mouse colony to provide the required blood meals for the mosquitoes. This process is requiring liaison with the University of Zambia to determine national standards and guidelines for animal colonies, and also contact with the local district veterinary officer to provide local inspection services for us. It is hoped that the necessary mouse cages will be obtained in September to house the mouse colony, after which a colony will be begun.
Epidemiology and GIS studies:
The Epi team resumed field activities in August, though as expected for this time of the year, they are finding very few people with positive malaria smears. The two locally trained microscopists continue to perform well under the supervision of our medical lab technologist, and data entry of the many questionnaires is generally keeping up to date.
The part of the project to carry out RT-PCR on filter paper samples to determine levels of gametocytemia in the local population had still not begun by the end of the month, pending the receipt of positive controls needed for the assay.
Molecular Biology:
The molecular biology lab continued to work on various projects under the direction of Dr Mharakurwa. The work produced by the summer students was being analyzed and written up for possible publication, while other previous work was also undergoing final "polishing" for submission for publication.
Pharmacokinetic Study:
The last participant in this study was scheduled for her post-partum pharmacokinetic study in early September, after which the study will be closed out locally. The lab procedures to detect the anti-malarial drug amounts that were actually in the blood at various times, is being carried out at University of Cape Town. The study has done very well with excellent follow-up visits of the participants.
Tuberculosis Study:
Activities continued in order to prepare for the planned September "Site Initiation Visit" for the long-awaited Rifaquin study. The TB culture lab was able to bring down further the contamination rate to an acceptable 5% level, after modifying certain procedures with the help of a visiting TB lab technician from Erasmus University in the Netherlands.
HIV/AIDS Studies:
This longitudinal study continues to enroll new children, now well over 200, but aiming to follow at least 300 children. The completed questionnaires and lab data being obtained will form a rich database with which to better understand the progression of this disease in rural children, and help to determine the various factors that influence that progression.
Hospital Data Collection and Analysis:
On-going prospective collection and data entry of the malaria admissions to the hospital children's ward continues, with patterns continuing to show very low levels of malaria.
Rural Health Centre Malaria Data:
A project to collect weekly disease statistics on malaria from the 12 rural health centers (RHC) in the greater Macha area was begun in August during the site visit of Dr Shiff from Hopkins. A methodology was devised whereby the officers in charge of each RHC will send a text message of the data requested to MIAM every Monday using their cell phones. In return, they will be given additional "talk time" for use on their phones the following week. It is hoped that this new method of rapid communication will allow us to better monitor where malaria cases are occurring, and thus be able to rapidly respond to any outbreaks.
Bednet Distribution Project:
A total of 2,472 long lasting insecticide-treated bednets were distributed by MIAM field workers during July and August, with 2,281 of them being personally hung in the villager's house by one of our field workers or volunteers, to make sure the nets were properly utilized. The nets were primarily distributed in villages where we have previously carried out malaria surveys or research projects, as a token of appreciation to the study participants. Each hut or house was geo-positioned for later mapping of the exercise, and the number of nets already hanging before the donated ones were added, was recorded.
Interestingly, this project was "costed" out to be approximately $1.75 per bednet hung. This figure included all associated labor, use of vehicles and purchase of the heavy string to hang the nets. A map is attached to the "pictures" in this report, showing the areas where the nets were distributed. A follow up next year will document how many of them are still being used, in order to obtain good data on the utilization of these freely donated bednets.
V - Personnel
The MIAM Management committee and staff meeting did not take place as scheduled in August, due to other meetings and conflicts.
Three potential new lab scientists for MIAM were interviewed in Lusaka by Drs. Shiff and Mharakurwa, after being short-listed from those responding to a national advertisement for this position. It is hoped that one or two of them can be recruited as full time staff members at MIAM, though it seems to be increasingly difficult to find young university graduates willing to work in the "bush" and also to not receive a salary that will bring them rapid wealth accumulation.
The MIAM executive director was appointed to the National Health Ethics Research Committee as Vice Chair by the Minister of Health. This new committee has responsibility to oversee the various institutional ethics committees in the country, as well as to help formulate national policy on research ethics.
A new volunteer lab technologist arrived from Erasmus University in Holland to help in the TB culture part of the Clinical Research Lab, while the previous one returned to Holland.
VI - Other
Lab equipment obtained from the recent USAID grant, including a new flake ice machine, vortexers and additional gel electrophoresis units, was received in August for the molecular biology lab, with a water bath, vortexers and pipettes received for the clinical research lab.
The visit by Dr Shiff to Macha was coordinated with a visit to Lusaka by Dr Kumar from Hopkins, and a "kick-off" event was held at the University of Zambia School of Medicine for the new malaria research training grant recently received by Hopkins from NIH Fogarty funding. This included several days of meetings to plan the training program over the coming years, and included visits to the Deputy Minister of Health, the Dean of the School of Medicine and other key people. A visit to the National Malaria Control Centre for Dr Shiff to meet the Coordinator about ways that Hopkins and MIAM can continue to collaborate and assist resulted in a fruitful discussion.
The final completed documents for the formation of the "Macha Research Trust" were submitted to the appropriate government authority for legal registration, with a result expected in early September. A separate Memorandum of Understanding, being developed to document the work in Zambia of Hopkins in cooperation with the Ministry of Health, was re-submitted in its revised form to the Deputy Director for Research and Public Health for onward processing.