January 2009 Report
Summary:
Rain showers continued nearly daily throughout January, leading to washed out roads, but also resulting in plenty of Anopheles mosquitoes being caught in the local villages. Despite the many mosquitoes being trapped, the malaria caseload remained relatively low at the hospital, though there were increasing numbers of people seen with malaria at some of the local Rural Health Centers being monitored through weekly reports sent to MIAM.
Research projects continued both in the molecular biology lab and insectary, as well as in the field, the latter involving both the on-going malaria epidemiology survey, as well as extensive entomology work. In addition to the malaria projects, a project involving a TB drug trial as well as an on-going study on pediatric HIV/AIDS, were carried out.
The physical plant, vehicles, internet system and utilities continued to all function well, most of the time, with the many pieces of electronic equipment in offices and the research labs surviving the severe thunder and lightning storms that passed over the research campus during the month.
I - General Site Development and Maintenance
The MIAM maintenance team kept the roads in shape by hauling of gravel and dirt to repair the areas that washed out with the heavy downpours. A number of building roofs on campus developed leaks and were repaired, while a team of men were seen most days with slashers, keeping the rapidly growing grass on the campus under control. As usual, the scattered flower beds brought color to the campus, and the grounds crew also began planting a row of cassia trees along both sides of the road leading to the main entrance of the campus.
During January, the national phone company Zamtel, installed and commissioned a "land-line" for the MIAM campus, which has been ordered in October. This means that MIAM finally has a local phone number and also a fax machine in place (+260 21 3 261022). The link to the national phone grid uses CDMA Wireless Local Loop technology, but functions seamlessly as though it is directly wired to the national phone grid. This should enhance communication to and from Lusaka as MIAM becomes more involved in national malaria control efforts, as well as other areas of research and policy development.
The frequent electricity "load-shedding" that had been on-going for many months and led to frequent running of the back-up generator for much of 2008, was significantly decreased in January. In fact, while the generator ran for a total of 599 hours in 2008, making an average of 50 hours per month for the year, it was only utilized 14 hours during January.
II - Information Technology
While there had been a major outage of the internet VSAT system during December, it functioned fairly well during all of January, though it was extremely slow at times. On-going monitoring by the LinkNet team suggests that the available bandwidth is being used at its maximum capacity for much of the time. New software systems are being put into place to try to control excessive use by individuals and block certain web sites used for down-loading large files (like music or videos) or inappropriate material.
At a meeting with LinkNet management late in the month, it was agreed that a new system that allows for every person that logs onto the network to be identified by a user name and password, will be put into place in the coming months. This will provide information to better identify those individuals that, either on purpose or because their computers are infected with viruses, overuse the network and the available bandwidth.
III - Vehicles/Transport
The new vehicle shelter was used regularly by the fleet of six MIAM vehicles, shielding them from the hot sun and the pounding rain. It also kept them out of the mud when parked. The recently purchased used Toyota Land Cruiser Prado developed a fault with the air conditioning system, leading to a few uncomfortable rides in the hot and more humid air at this time of year, but this was repaired in Lusaka.
The Maintenance Manager reported that during 2008, the six MIAM utility vehicles and one truck were used for a total of 79,980 kms, while the four motorcycles were used for 14,230 kms for field work.
A decision was made to plan to sell the oldest Toyota Hilux double cab pickup this year, and replace it with a similar vehicle, to be used primarily for field work, but also for trips to town to haul fuel, etc.
IV - Research Activities
Entomology:
The insectary continued to rear the various Anopheles arabiensis lines, with adaptation to feeding of blood meals from the recently developed mouse colony. Appropriate dosing for effective mouse anesthesia proved to be a challenge, but with help from various sources, this is getting worked out.
Entomology field work, including use of CDC light traps, landing catches and calf-baited traps, continued throughout the month with larger numbers of A. arabiensis being captured at some villages than in previous years.
A post-doc from Dr. George Dimopoulos' lab at Hopkins, Dr. Chris Cirimotich, arrived at MIAM during the month to begin a project aimed at identifying the various bacteria carried by anophelines. The hope is that with such knowledge, it would be possible to identify which bacteria may be harmful to the mosquito and potentially lead to a shorter life span, thus contributing to a decreased ability of the mosquito to transmit malaria.
Epidemiology:
Field work for this study was increased to include 24 households to be screened per month, keeping the team busy most working days of the month. Despite the inconvenience of heavy rains and muddy roads, the work went well during January. The people who were screened in the randomly selected villages were found to have essentially no malaria, with nearly all of the Rapid Diagnostic Tests (RDTs) being negative during the month, though at least one subsequent malaria smear was read as positive.
The RT-PCR work for gametocyte detection, and ELISA assays to determine the presence of malaria antibodies, was carried out by the two lab scientists (Sandra Chishimba and Jodi Chondoka) assigned to the project. One PCR machine was out for repairs in the USA, but was shipped back to Zambia during the month.
Genotyping, Drug Resistance and Diagnostics:
Dr. Mharakurwa's various related projects looking at P. falciparum genotypes and also the development of non-blood methods of diagnosing malaria, continued in the molecular biology lab, with the assistance of lab scientist, Mwiche Siame. Work was on-going to understand an earlier unexpected finding of rare antifolate alleles found more commonly in the mosquito, but hardly ever found in the human host. Some additional work in the MIAM lab suggests that augmenting the usual PCR methodology may help "uncover" the alleles in humans as well, where they seem to exist as latent "minority variants" - as originally reported by Meshnick and others using a heteroduplex tracking assay (HTA) technique.
Tuberculosis Study:
The multi-site clinical trial of a new drug for pulmonary tuberculosis continued at MIAM, though new patient enrolment remained much lower than anticipated, with only two enrollees into the study to date. A review of lab records has shown that while there were 119 sputum samples of patients presenting to Macha in 2006 that were positive for TB, in 2008 that number was only 62. Based on the 2006 data, it had been hoped that at least 50 participants could be recruited each year, but this now looks unlikely.
HIV/AIDS Study:
The pediatric HIV longitudinal observational study continued to enroll HIV infected children from the Macha Hospital HIV clinic into the cohort, with 260 enrollees by the end of Jan 2009. Continuous data entry and data cleaning is taking place, and arrangements have been made for viral load studies to be done on samples in Lusaka.
A process whereby our investigators can have access to the same patient's data that has been entered into the Zambia SmartCard database system has been begun, but there are several steps to this request, and it may take some time.
Hospital Data Collection and Analysis:
Data entry for the paediatric inpatient ward continued as in previous months, expanding a database of detailed case records for all children admitted to Macha Hospital. Review of 2008 data shows that the number of malaria cases admitted to the Children's Ward at Macha Hospital in the year 2008 was at an all time low, with only 52 cases and 2 deaths. This contrasts with the year 2001, when there were 1,778 malaria cases and 65 deaths from malaria admitted to the Children's Ward.
Rural Health Centre Malaria Surveillance:
The on-going health centre-based malaria surveillance study continued to run steadily under GIS Scientist Aniset Kamanga's supervision, with assistance from Senior Fieldworker Petros Moono. The number of health centers reporting weekly cases of confirmed malaria to MIAM using SMS via cell phones, was expanded to include three additional centres in the Namwala district, north of the hospital's catchment area. The data being collected show increasing numbers of cases at many centers, as expected for this time of the year, though some centers still have very few cases.
V - Personnel
Late in January, the MIAM Scientific Director, Dr. Sungano Mharakurwa traveled to the USA to spend time working with potential grant collaborators at both New York University and at Johns Hopkins, and also planned to attend a Gordon Research Conference on "Molecular Approaches For Emergent / Re-Emergent Tropical Diseases."
The MIAM Clinical Research Director, Dr. Janneke van Dijk, continues to work with several medical and other students who come to MIAM to carry out small research projects as part of their Masters degree or medical school requirements. Many hours are spent working on finalizing protocols and submitting them for ethical approval, arranging for lab supplies that will be needed, getting all local logistics worked out, and then supervising and advising the students in their local projects.
The lab scientist (Pisgah Sikwangala) from the MIAM CRL, spent January at Erasmus University Medical Center, getting the first of two months of on-site training in lab techniques. This will enhance his ability to work with TB cultures and also carry out PCR work for HIV/AIDS diagnosis in small infants. The Dutch lab technician from Erasmus that has been assisting and training in the CRL will be returning to Holland in February.
Jay Sikalima, medical lab technologist from the CRL, attended the Choma District Malaria Task Force meeting in January, and is now assisting local communities in the Macha area to apply for grant funds that are available through the district for enhanced communication of malaria control methods.
Seven MIAM employees were given five year service awards at the January MIAM Staff meeting, bringing to thirteen the number of employees so far that have received their five year awards. The MIAM incentive bonus scheme for employees who have worked for more than three years at MIAM, also began payouts this month, with five employees receiving bonuses in January, which was their anniversary month.
VI - Other
A recent agreement was finalized and signed with the Zambia National AIDS Network (ZNAN) to supervise a student from Lusaka who has received an award to carry out an AIDS-related research project at MIAM.
A visit to MIAM by Dr. Cecilia Shinondo and others from the Zambia National Malaria Control Centre insectary to see first-hand the MIAM insectary in operation, gave insight to that team on how to successfully develop the insectary at NMCC in Lusaka.
Dr. Thuma and Mr. Aniset Kamanga, Project Coordinator for the RHC data collection study, visited the Deputy Director of Public Health and Research - Malaria in Lusaka, to present the data from MIAM, and to discuss ways in which MIAM and NMCC can collaborate on future studies on the changing malaria incidence at the community level.
Daily rainfall and temperature data continue to be collected at MIAM. The rainfall for the month of January 2009 was 265mm, against a 15 year average for the month of January of 211mm.
Floor plans for the new Clinical Research Lab (CRL) building, to be funded through contacts with Prof Jan Nouwen at Erasmus University Medical Center and also the Privaserve Foundation in the Netherlands, were finalized. Construction is due to begin once funds are available and once the rains have subsided.