March 2009 Report
Summary:
March continued to have rainy periods, with mosquitoes still found in good numbers, though many of them being non-anophelines. Attempts to study the potential use of larvacides such as Bti proved difficult because of the frequent heavy rains washing away mosquito larvae.
The 15 pediatric malaria cases admitted to the hospital in March were mostly from far off villages, with one severe malaria case that expired. Despite this one malaria fatality so far this year, the case load for malaria has remained the lowest it has been for many years, and compares with over 300 cases admitted in March 2002, with seven fatalities.
Lab and field work research on malaria continued with Epidemiology projects involving RT-PCR for gametocyte carrier detection, ELISA for malaria antibody testing, as well as the other molecular biology work on molecular markers for drug resistance. The insectary continued to successfully maintain an Anopheline arabiensis colony for various studies, with mouse feeding adaptation of the mosquitoes proceeding well.
The TB drug study and HIV/ AIDS pediatric projects continued, though with few new enrollees on the TB study.
I - General Site Development and Maintenance
The Maintenance team continued to carry out their jobs with pride, keeping the campus looking nice despite the rapidly growing grass, which required a team of 5+ people with slashers working on the grass on a daily basis. Gravel continued to be hauled to repair washed out roads and paths, and re-painting of the original houses began.
II - Information Technology
Internet accessibility proved reliable throughout the month. A new "login" system to secure internet access was introduced during the month, with plans in the future to require unique user ID's and passwords for each individual to access the internet. This system will allow us to better monitor bandwidth use and track any un-authorized use of the wireless network.
III - Vehicles/Transport
MIAM vehicles continued to have heavy use during March, as this is a peak month for malaria field activities. The Toyota Surf was off the road for about a week, while it waited for new ball joints to be brought from Lusaka. The Toyota Prado remained in the repair shop in Lusaka, getting the engine rebuilt, after developing a badly warn and damaged piston, presumably from oil not circulating to that cylinder properly. The cause of this problem is still being debated, but the MIAM maintenance department had records to show the repairing mechanic that proper and regular engine maintenance had been carried out on the vehicle, including use of the recommended type of diesel grade oil.
IV - Research Activities
Entomology:
The Anopheles arabiensis colony primary strain was officially named the "Macha" strain this month, after agreement with all concerned parties. After many months of discussion to determine the best way to help the Zambia National Malaria Control Centre (NMCC) to establish their own anopheline colony, it was determined that a Material Transfer Agreement would be signed between NMCC and MIAM, with NMCC sending two techs to work at MIAM for two weeks to get their own colony going under the supervision of Mr. M. Musapa, and then transfer the new colony back to NMCC.
Entomology field work continued throughout the month, with CDC light traps and landing catches being carried out three or more times per week. Towards the end of the month, as the rains became infrequent and the weather cooled down, fewer mosquitoes were being caught.
Epidemiology:
This study has managed to nearly meet its goal of screening 24 randomly selected households per month, keeping the field team busy. Parasite rates among community members screened remain extremely low, as compared to previous years.
The lab component of the study, namely the microscopy, the RT-PCR and the antibody titre work, continued. Unfortunately, problems developed with the antibody ELISA system, and so assays had to be stopped until further trouble-shooting and obtainment of new positive controls could be arranged. The RT-PCR work continued at a slow but steady rate, though by month end one of the reagents was out of stock, curtailing the running of the PCRs until more reagent could be obtained.
Genotyping, Drug Resistance and Diagnostics:
The projects of Dr Mharakurwa looking at markers and genotyping continued, spearheaded by Ms Mwiche Siame. Plans were being made to start field sampling in local villages by early April, in order to obtain more positive samples to continue the genotyping work, as well as optimizing assays for the diagnosis of malaria from saliva.
In trying to understand the fact that using short primers gives a much higher positivity rate, a pilot study to look at changes in parasite marker detection by PCR both before and after artemisinin combination therapy was being planned to run concurrently during these field data collections.
Tuberculosis Study:
The Rifaquin drug trial and associated TB culture lab continued to function well. One new patient was enrolled in the study during the month.
HIV/AIDS Study:
The pediatric AIDS (PART) study had enrolled 285 children as of the end of the month, with on-going data collection. Specimens have been sent for viral load determination at the UTH virology labs. A final draft of a paper on the first year of follow up was being finalized in preparation for submission for publication in an AIDS related journal. An abstract on the study was submitted for an international conference to be held in Lusaka in May 2009.
Hospital Data Collection and Analysis:
Data entry of all cases of hospitalized children continued. Malaria cases remained lower in March than any previous years for this month, with only fifteen hospital discharges on the children's ward for malaria. There was one malaria-related death. See chart of malaria cases under "Pictures" for this month.
Rural Health Centre Malaria Surveillance:
The cell phone SMS system for collecting rural health centre cases of malaria continued. Plans are being made to begin the next phase of the project in April or May, which is to screen local households from which a person with a positive RDT has come from, to see whether there are asymptomatic malaria carriers in the same household. A survey of healthcare providers at the rural health centres was planned to determine the exact criteria being used for performing an Rapid Diagnostic Test (RDT) for malaria on patients.
V - Other
Ms Pamela Sinywimaanzi spent two weeks in Lusaka receiving training at an HIV child counseling workshop.
The Macha Research Trust / MIAM Management Committee met for its monthly meeting, with newly elected representatives present from two of the four employee categories at MIAM. The other two representatives will join the Management Committee next month after a re-election in those two employee categories.
The MIAM Sports Committee announced at the March staff meeting that it had won all three of its recent friendly soccer matches, and that it had raised funds to pay for new soccer balls, etc.
Dr. Bill Moss from Hopkins paid a visit to MIAM in March to review work on the Epi and PART studies for which he is the Principal Investigator. He also brought with him, for a fruitful visit to MIAM, the JHPIEGO Zambia Director, Dr. Oscar Cordon.
Christine Fornadel and Laura Norris, the two Hopkins Ph D students, completed their work at Macha for this season and gave a joint MIAM seminar before returning to Baltimore.
MIAM was visited during the month by the Executive Secretary and his team from the Zambian National Science and Technology Council, to carry out a registration and inspection tour of the facilities.