July 2008 Report
The temperature remained cool throughout most of July, with no anophelene mosquitoes but plenty of culicines seen hovering around the rooms. Fortunately, the culicines do not transmit malaria.
Visitors to MIAM in July included George Dimopoulos, Bill Moss and Katie Sutcliffe from Hopkins, and a fact-finding team from the Zambian National Science and Technology Council.
The Molecular Biology lab was busy with several visiting students working on their projects under Dr. Mharakurwa. The insectary continues to maintain its Anopheles arabiensis colony, now in its 5th generation. The Clinical Research lab was involved in a medical student project to determine drug sensitivities to TB isolates from the local community, and also continued providing service for the pediatric HIV/AIDS (PART) and the SP-PK studies.
Field workers were on a break from the Epi study, but spent their time collecting disease prevalence data from the local Rural Health Centers, and also distributing bednets to villagers in areas where we had previously carried out community studies.
With the national electricity provider continuing to have frequent black-outs or "load shedding", the MIAM generator ran three to five days per week, some times 5 or 6 hours in a day, to keep supplying electricity for the many lab freezers and other vital equipment at MIAM.
I - General Site Development and Maintenance
The MIAM Maintenance department, with assistance from Mr Chet Sollenberger as a volunteer, kept all the vehicles running, as well as maintained the water and electrical systems.
ZESCO, the national electricity supplier, continued to have insufficient power supply production for the country, so there were frequent electrical cuts or "load shedding" periods. Some of these lasted 5 or 6 hour blocks in a day, other times power was turned off abruptly for several hours around the regular meal times. These "load shedding" periods resulted in the frequent running of the MIAM generator to maintain the power for the lab and especially for the many freezers containing reagents and specimens. Media reports state that the "load shedding" will continue until probably March 2009, after which time the country is expected to once again be self-sufficient in electrical generation capacity.
The various minor building renovations were completed in July, and the names of buildings were changed through a naming contest open to MIAM employees. The former Host House has been renamed "Gobelo House", while the former library/classroom/office building has been renamed "Lusumpuko House".
II - Information Technology
The frequent electrical outages were not kind to the many computers and UPS's in the MIAM buildings, with at least three of UPS's becoming inoperable due to overheated and subsequently damaged batteries. Several computers also developed software problems apparently from spikes in the current not controlled by the spike protectors - or else computer viruses that got in despite up-to-date antivirus software on all computers. Despite these issues, productivity was maintained, including data entry and regular use.
Both the wired and wireless local area network remained intact, though certain segments of the network had down-times due to various problems with the servers. LinkNet, the IT provider to MIAM, continues to work on network measures to try to control excessive bandwidth use of the sole VSAT system shared by all at Macha, as well as work with the MIAM IT technician to upgrade and maintain the IT system.
III - Vehicles/Transport
MIAM vehicles were not as heavily used in July, though changes of shock absorbers and tires were necessary on several vehicles to replace warn ones.
The repaired Toyota Hilux was picked up from the body shop in Lusaka early in the month and driven back to Macha. The body work was done very professionally, with no sign of the damage on the left-sided doors as before. Although fully insured, the deductible was 10% or about $400, and we will also most likely lose our "no claim" 15% discount on all insurance policies next year.
The insurance company also continued to "discuss" the refund check amount for the Ford Everest, which was involved in a rollover accident in April, and was subsequently agreed to be a total "write-off". By month end it had been agreed to surrender the vehicle body to the insurance company, rather than keeping it as salvage with less insurance being paid to us. Hopefully by the end of next month the reimbursement check will have been issued, so that we can proceed to purchase a replacement vehicle.
IV - Research Activities
The mosquito colony, consisting of five different lines of Anopheles arabienses, is now in its F5 and F6 generation. The process to establish a mouse colony to serve as blood meal sources for the mosquitoes made progress with a visit by our resident entomologist to the University of Zambia to see that mouse colony set-up. The presence at Macha this month of Dr George Dimopoulos, an entomology prof from Hopkins who visited for a week, resulted in some experiments using the colony mosquitoes, as well as discussions on improving the insectary. This resulted in the purchase of another heater which, as compared to the present heating system, would restart automatcially after the frequent electrical outages. Unfortunately, the new heater that was bought was not powerful enough to maintain the insectary temperature at the preferred 22 degrees C on the chilly nights and mornings.
Epidemiology and GIS studies:
The field team on the Epidemiology study were given time off in the month of July, with plans to resume the study in August. The gametocyte RT-PCR work in the lab on the dried blood spots that have been collected was not yet started by month's end, due to delays in acquiring appropriate positive controls.
Utilizing insecticide treated bednets that had been donated to MIAM, and funds from MMRI-USA to pay for logistics, a project was begun in July to distribute bednets to households in the grid areas where previous baseline malaria epidemiology surveys were carried out. This project was met with great appreciation by the communities involved, some of whom still had no bednets despite district-level programs to distribute bednets late last year. The MIAM field team workers took GPS coordinates of each house, recorded how many nets were already hanging, and also physically hung the new donated bednets, so that each family member could now sleep under a mosquito net. By the end of the month, around one thousand nets had been hung, with more to be distributed in August.
A small field survey project carried out by a visiting international student, looked at what factors were associated with families that had been found to have malaria positive smears in the 2005 field work, as compared to families that did not have malaria positive smears in those surveys. Interestingly, he found that the proximity of animals to houses was associated with less malaria in the human occupants, including not only having nearby cattle and goats, but also households that had a cat. He also documented that in the 71 households surveyed, 56% of the people said they slept under a bednet. This increasing proportion of people sleeping under a bednet reflects the active programs by various partners and the Zambian government to distribute insecticide treated nets in the area around Macha.
The three international students assisting in the lab completed their work in July. The projects they worked on with Dr. Mharakurwa included looking at the presence of PfHRP II (a malaria parasite protein), in human saliva in those infected with malaria, and continuing the on-going work on the MSP1 / MSP2 system of typing parasites to improve the determination of recrudesence versus reinfection after treatment.
In addition to the international students, several local student volunteers also assisted with the various PCR-based projects that are on-going in the lab.
All 25 of the enrolled study participants have delivered their babies, with only one remaining to have the post-partum pharmacokinetic studies completed. It is anticipated that the study will be closed out in August.
A site visit by the study monitor to initiate the launch of the TB drug trial study has now been scheduled for September. The two Dutch med students completed their project in the TB culture lab, and gave a presentation of their findings to the hospital community.
Around 200 children have been enrolled in this longitudinal observational study, now in its second year. Dr van Dijk, who manages the study locally, returned from two months of leave, and Dr Stewart, a volunteer physician who had helped for the two months, left soon after her return. Dr Bill Moss, the Hopkins PI on the study, together with his post-doctoral student Dr Katie Sutcliffe, visited Macha in early July to review the study progress.
A visit by the post-doc student together with Dr van Dijk to Mukinge Hospital in North Western Zambia was carried out, to collect additional data from that site on the pediatric HIV / AIDS cases. While there, the hospital's malaria case and lab data were reviewed, to see if there might be enough malaria still in that community to warrant Mukinge as another site for malaria studies.
A review publication on the effectiveness of antiretroviral therapy in children appeared in the August issue of Lancet Infectious Diseases, co-authored by K Sutcliffe, J van Dijk and W Moss, among others.
Hospital Data Collection and Analysis:
An international student volunteer assisted in July with data collection from the hospital lab and maternity wards, in an effort to update previous work on the number of pediatric blood transfusions, and the change in median term birth weight, as the malaria control efforts increase.
In an effort to augment the hospital inpatient data on malaria cases, during July the MIAM field workers visited each of the twelve rural health centers that refer patients to Macha, and collected their data on disease prevalence over the previous twelve months. This database of RHC diagnoses was added to that which has been previously collected since 2003. Interestingly, a quick review of the data for 2008 showed that most RHCs had seen a 50% decrease in pediatric malaria cases as compared to 2007, reflecting the hospital's similar experience this year.
I - Personnel
MIAM staff were trained in inventory control and record keeping, as a new inventory control system was begun in all departments.
July saw the resignation and departure of two MIAM employees, who found jobs in Lusaka that evidently were more to their liking. Those leaving were Mtawa Mkulama, a lab scientist who had worked in the molecular biology lab for over a year, and Maggie Zulu, a medical lab technologist who had completed her initial three months in the clinical research lab.
The MIAM Management committee continued to work on an assessment of the current MIAM administrative structure, looking at a possible re-organization and re-alignment of some management positions. It also will be assessing the current salary structure for employees, to make sure that MIAM remains competitive in its salaries so that it retains its employees as much as possible.
VI - Other
Lab equipment to enable the diagnosis of HIV in infants was received from the UK in July for the Clinical Research lab, including an ELISA plate reader and washer. The ELISA equipment can also be utilized for other studies in the future. A new small scale water distiller was also purchased and shipped from South Africa for the molecular biology lab, to replace the previous one which no longer functions.
A high level fact-finding team from the Zambia National Science and Technology Council, which included the director of the government's Tropical Diseases Research Centre (TDRC) in Ndola, visited MIAM in July. The purpose of the visit was to inspect MIAM, which is an institute registered under the Ministry of Science and Technology, and also seek input from MIAM on the proposed changes in the Zambian government's Science policy.
Additional meetings were held with the lawyer in Lusaka working with us on the legal registration and establishment of a new legal entity in Zambia to be named the Macha Research Trust. More documents were compiled and additional signatures acquired as the application moves through the necessary processes.
The MIAM Executive Director was invited to attend a meeting in Lusaka sponsored by the National AIDS Council on AIDS research in Zambia. One of the presentations given was a recent survey on research capacity in Zambia. Interestingly, it was stated that of the 19 institutions in Zambia capable of carrying out research (including social research), 17 of them were based in Lusaka, with one in Ndola and the other in Macha.