May - June 2009 Report
Summary:
The months of May and June are always a transitional period - from active malaria transmission in the warm wet months of the early part of the calendar year, to dry cool weather with Anophelines no longer found, and thus no active malaria transmission. While a few human malaria cases are still detected in May, by June most cases detected are no doubt individuals who have carried it for some time before developing disease.
The MIAM campus gradually lost its vibrant green color over the two months covered in this report, and by the end of June, the drying grass and dust blowing everywhere from the frequent wind, turned most things a brown color.
Despite the changes in the weather and thus the malaria transmission pattern, the activity at MIAM continued. Field work on the Epi and Fitness studies was carried out in May but tapered off in June, with on-going data entry. Lab work on the above studies continued at a good pace, with the usual trouble-shooting challenges. A follow up study on the previous years' bednet distribution program was begun in June, and the TB and HIV studies also continued to recruit patients and enter data into the databases.
A fair amount of time was spent in May and June preparing for a new study in collaboration with Yale, on Learning Disorders in children, due to start in a Pilot phase in July. Time was also spent preparing several new grant applications for submission with other partners.
I - General Site Development, Maintenance, Vehicles and IT
The maintenance team continued to provide timely repairs and general maintenance for the campus and labs, although the frequent power outages and low voltages supplied from the national grid wreaked havoc on various devices. Two large battery-backup units used in the labs stopped working, as well as one large refrigerator/freezer in hospitality. These frequent equipment failures, in addition to the regular running of the back-up generator, keeps operating costs above what has been planned and budgeted for.
Repairs and rehabilitation were carried out on some of the older MIAM buildings, including re-painting of some areas. No new building projects have yet been started, since there are no funds for such, even though there continues to be a need for additional staff housing. Construction for the new Clinical Research Lab building was not started, since the expected funding from the Netherlands has not yet materialized.
The MIAM vehicles remained on the road most of the time, with the Toyota Prado once again going to Lusaka for major engine repairs. This time it appears that the fault was properly found and repaired, and by the end of June the vehicle was back at MIAM and running well. Efforts to get quotes to replace the Toyota Condor with a Toyota Landcruiser hardtop are on-going, as well as investigation into the possibility of acquiring a mini-bus for trips for supplies and shopping in Choma.
Internet accessibility was largely reliable, although a few brief spells of instability and lack of connection were experienced. Some parts of the campus continue to have difficulty accessing the wireless network, with frequent "tweaking" of the network by the LinkNet staff to try to get better wireless service.
II - Research Activities
In May two abstracts were presented at the 3rd International 'Interest Workshop' on HIV Treatment, Pathogenesis and Prevention Research in Resource-Poor Settings. Five abstracts from research work being done at MIAM were accepted for the upcoming Multinational Initiative for Malaria (MIM) conference to be held in Nairobi, Kenya in November. An abstract was also accepted for the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention to be held in Capetown, South Africa in July.
Entomology:
The Anopheles arabiensis colony continued to thrive under the watchful care of our resident entomologist and his assistant. The colony is now completely adapted to blood feedings on mice, and continues to have several different strains in continuous propagation. Additional studies to utilize the colony will continue when the Hopkins Ph. D student returns to MIAM next year.
Field collections of mosquitoes ended in May, with the expectation that collections will resume at the end of the year, nearer to the time when the rains begin again.
Epidemiology:
Longitudinal and cross-sectional surveys of households continued during the two months for the Epidemiology study, with plans to stop the Epi fieldwork during the month of July. Data entry continued, with the data now cleaned and being analyzed for the study years 2007 and 2008.
The lab scientist running the RT-PCR work resigned the end of May to enter medical school. A replacement lab scientist was recruited, and she had about a month of turn-over to learn the techniques involved. The ELISA system for determining malaria antibody changes in children over time continued to have technical difficulties, with trouble-shooting being an on-going challenge.
With the arrival of a graduate student from Hopkins in June, the pilot program to begin tracing active cases of recently diagnosed malaria began. Each case is to be traced back to their homestead, with screening of household occupants to identify who else may be a malaria carrier. To start with, one Rural Health Centre was used for active cases, though the numbers of positive RDTs were rather low, such that additional health centres are being approached to see about also using their case records.
Genotyping, Drug Resistance and Diagnostics:
Field and laboratory work continued on developing data on the changes in genotype of malaria parasites over time and under drug pressure, as well as on-going efforts to develop a malaria diagnostic using saliva. Several of the abstracts accepted for the MIM conference will be on this work being done under the direction of the MIAM Scientific Director.
Tuberculosis Study:
The Rifaquin study continued to be open for patient enrollment, though the inclusion and exclusion criteria and the few patients seen with sputum positive TB continued to limit the number of study participants being enrolled. Efforts to expand the enrollment to include TB patients at Choma General Hospital failed due to the national health-care workers strike in June.
HIV/AIDS Study:
The PART study had enrolled 380 children by the end of June. Two abstracts were presented at the INTEREST conference held in Lusaka in June, and one abstract was accepted to be presented as a poster at a conference on HIV Pathogenesis, Treatment and Prevention to be held in Capetown, South Africa in July.
In collaboration with two Dutch medical students, data from patients enrolled during the first three and a half years of ART clinic at Macha are being evaluated. From March 2005 up to August 2008, 3,369 patients were registered at the HIV clinic, and 2,458 are included in the analyses.
In collaboration with a Dutch student working on her Master's in International Public Health, data from the Prevention of Mother to Child Transmission (PMTCT) program at Macha is also being evaluated.
Hospital Data Collection and Analysis:
Malaria caseload continued to be very low in May and June, with the lowest numbers of malaria cases seen in over 25 years at Macha Hospital. Under a new arrangement with the CDC- Zambia office and the President's Malaria Initiative (PMI), monthly inpatient data from Macha Hospital on pediatric malaria cases will be shared with them on a regular basis, and in appreciation the CDC will supply some much needed reagents to the MIAM molecular biology lab.
Rural Health Centre Malaria Surveillance:
The system of receiving weekly malaria Rapid Diagnostic Test (RDT) data from the local Rural Health Centres continued, though at times there was a time lag on the data being received from some of the centres. As expected, RDT positive cases dropped in June at most clinics, since this is no longer the malaria transmission season.
III - Other
Two new personnel were hired, one to replace the lab scientist that resigned, and one to help with clerical work in the Yale Learning Disorder study.
A group of 21 university students from Messiah College spent two weeks on the MIAM campus attending a course being taught called "Health Care in the Developing World".
Dr. Jan Nouwen, from Erasmus University School of Medicine brought a group of researchers from Holland to visit MIAM in May, and to discuss further collaboration on TB studies.
The MIAM Scientific Director attended a donor's planning meeting at the National Malaria Control Centre in Lusaka in early June.
A group of executives from Novartis in Switzerland visited MIAM in June to see the research work being done and to hear about the changes in malaria case load subsequent to the introduction of artemisinin combination therapy in 2004.