Dec 2007 - Jan 2008 Report
Summary:
This report again covers two months. The intention is to provide monthly reports, but other events conspired to make that impossible. Hopefully we can now get back on track with monthly reports.
Activities at MIAM in December were much as usual, with preparations continuing for the expanded epidemiology study and also for the entomology work to be done in January. The lab scientists also prepared and submitted abstracts for the planned scientific conference to be held at TDRC, Ndola. With the arrival in January of Dr. Doug Norris and three graduate students and two post-docs - all involved in entomological studies - we found this kept MIAM support and scientific staff busy with the field work, lab work and vehicle maintenance necessary to keep the studies all going as well as possible.
January was also a month of visitors to MIAM, not just with Dr Shiff's annual visit, but also visits by various other people, including representatives of the Presidential Malaria Initiative.
Construction work continued with completion of the dormitory, and an increased pace of activity at House 'D' - the last staff house to be constructed under the USAID grant.
I - General Site Development and Maintenance
The steady and heavy rains that began in mid-December, continued nearly daily throughout January, causing the grass on campus to grow rapidly and the roads to become muddy messes. The response by MIAM staff was to keep up with the slashing of the grass by hand, and to repair the campus roads as necessary.
During January, the national electricity supply company began frequent "load-shedding", with electricity turned off for several hours in the evenings to conserve power. The whole region also suffered through several country-wide black-outs, evidently due to faulty switching from over-use of electricity in other countries with inter-connectors to Zambia. These frequent outages resulted in the need to run the back-up generator fairly often during January.
II - Construction of Buildings
With the completion of the cafeteria in October, and the dormitory in December, both buildings were put to good use in January with the many guests on the MIAM campus. A group of 8 US college students spent three weeks in the dorm in early January, followed by two British medical students, a US medical student, and various others for shorter periods of time. All the guests found the facilities very comfortable and suitable.
House 'D' construction continued as the internal plastering, painting, electrical, carpentry and plumbing work moved forward. By the end of January, wall plastering was complete, ceilings had been installed, doors were being hung, and tiles being placed. The plastered walls will need to completely dry out before painting, and with the daily rains and increased humidity, this will take some time. Despite this, it is anticipated that the project will be finished by the end of March, the deadline for the USAID project to be completed.
III - Information Technology
The heavy rains and daily cloud cover made the smaller Ku band VSAT less reliable for internet access, but the larger C band VSAT continued to work fairly well throughout the two month period. Internal network problems resulted in intermittent access to the internet some of the days.
The wireless network was expanded on the MIAM campus to include the new buildings, using a newer method of "mesh" networking. The installation was carried out by Linknet under a contractual agreement. This new mesh system theoretically should be more stable than the earlier wireless system used, and the plan is to eventually convert the original wireless network to the new mesh system.
Several of the MIAM computers developed problems with hard drives, motherboards, and other parts during January, requiring frequent calls to the MIAM IT technician for help.
The servers for the network remain housed in a room in the molecular biology lab. The air conditioning unit for this IT room, though only bought and installed about two years ago, has had frequent breakdowns and has proved difficult to keep functional. Funds will need to be found to replace it, since as the weather gets warmer, it will be important to have adequate cooling for the equipment in this room.
IV - Vehicles/Transport
The fleet of MIAM vehicles was kept on the road by our two mechanics, through constant maintenance and repairs. The old FUSO lorry was not sold in 2007 as planned, since no suitable buyer was found. In addition, while a buyer was found for the Pajero, it was realized that since it was imported under duty-free status, if sold before June 2008 we would have to pay heavy taxes and customs duty. Thus the decision was made to hold onto it and use it until June '08.
The new Toyota Hilux 4 X 4 purchased from Toyota Gibraltar arrived in Lusaka in late January, and at month's end was still being cleared through customs. It is anticipated that it will be ready for work at Macha by February.
A new motorcycle for the expanded field work remains to be bought, and this is planned for the 1st quarter 2008.
V - Research Activities
Entomology: The specially ordered programmable light dimmer arrived from South Africa, and was installed in the insectary, allowing us to mimic day and night periods automatically.
The insectary was busy in January as larvae caught in the wild were hatched and prepared for various entomological studies, including a small study to determine levels of insecticide resistance among local mosquitoes.
Various new types of baited traps and grids were being evaluated in the field during January to see if they would increase the yield of anophelines. In addition, after some initial problems with escaping calves, an improvised system using a calf as the attractant for mosquitoes, placed in a pen with a suspended net above it, proved helpful in increasing the nightly yield of captured mosquitoes.
Epidemiology and GIS: Community sensitization meetings continued in preparation for a planned launch of the expanded epidemiology study in February. Training of two microscopists to help with the reading of the malaria smears continued.
Molecular Biology: Sequencing carried out at Hopkins has verified that the results of work at MIAM on molecular variations in malaria parasites found in mosquitoes were indeed the expected molecular fragments. This clarifies that the results of preliminary studies on drug resistant markers (present in the mosquito phase of the malaria parasite lifecycle) are accurate, and hence work is now planned on trying to obtain further funding to carry this work forward.
A manuscript detailing the changing levels in the Macha area over the past 20 years in parasite molecular markers, indicating developing resistance to the anti-folate drugs, was in the final stage of preparation for submission for publication.
An R21 grant application re-submission was finalized to try and obtain funding to pursue the discovery at MIAM, that malaria parasite DNA is present in urine and saliva of infected people. This finding could be pursued to develop improved diagnostic methods for detecting malarial infection, without having to obtain blood from individuals.
Pharmacokinetic Study: The study involves pregnant women both before and after delivery and assessing the way they metabolize the anti-malarial drug sulfadoxine/pyrimethamine. By the end of January, 24 of the planned 25 participants had been enrolled on this study, with a very good follow-up rate so far.
Tuberculosis Study: The start of the EDCTP-sponsored Rifaquin drug study was again delayed due to the fact that several of the other sites in the multi-site study had not yet received full ethical approval to move forward. In addition, we have been unable to recruit a Zambian lab technologist willing to work at Macha on this and other clinical research projects.
Schistosomiasis Studies: This work, being directed by Dr. Clive Shiff, with local lab scientist Miss Sandra Chishimba, continues to keep snail colonies going with Schistosoma hematobium infection. Data entry and analysis of the schistosomiasis survey carried out in the Chitongo area of Namwala district is being carried out, with an abstract submitted for the planned TDRC conference.
HIV/AIDS Studies: The CDC/JHPIEGO funded Pediatric Anti-Retroviral Treatment (PART) study, a collaborative research project involving Dr. Janneke van Dijk and Dr. Bill Moss, continued to enroll patients. By the end of January, about 140 of the planned 150 subjects had been enrolled. Collecting data on HIV infected children in this prospective way has revealed a higher than expected mortality rate, and allowed for better review of case management to detect ways that the mortality rates can be improved.
On-going Hospital Data Collection and Analysis: The data entry team continues to work on entering hospitalized patient data into the dataset, so that on-going and future analysis can be done to follow trends in malaria morbidity and mortality over time. A presentation of the data on the relationship between malaria and pediatric blood transfusions was made in Rwanda at a meeting on pediatric blood transfusions, organized by the American Association for Blood Banks.
VI - Personnel
Several new personnel have been hired in the past two months at MIAM. A new full time driver / mechanic has joined the maintenance staff, and has been helping keep the vehicles ready for the many field trips. Two staff were hired to be trained as microscopists to help with the many malaria smears that will be processed from the expanded Epidemiology study. The accounts assistant who began work three months earlier resigned to go back to school for further training in her field, and has not yet been replaced.
January saw Dr. Thuma travel to Rwanda to give a presentation on Macha's experience with the remarkable decrease in pediatric blood transfusions as the malaria caseload has decreased in recent years.
VII - Other
A meeting was held by the senior management at MIAM with the Director, Public Health and Research at the Zambian Ministry of Health, to discuss the next five year Memorandum of Understanding for MIAM. The meeting was cordial and MIAM management was told that the government had no problems with the way in which the Institute was progressing.