October / November 2007 Report
Summary:
This report actually covers two months. No report was compiled for October, since both of the people that usually write the reports were at the American Society of Tropical Medicine and Health (ASTMH) meeting in Philadelphia. In fact, six different abstracts based on work done at MIAM (three given orally, three as posters), were presented at the ASTMH annual conference in early November.
Despite both the Scientific Director and Executive Director being away from MIAM in the last part of October and early November, work did continue. The molecular biology lab work continued unabated, the clinical research lab continued to expand and develop, with field-work and the building project keeping active.
Two new clinical studies were begun - one on the pharmacokinetics of SP in pregnancy, the other on progression of pediatric HIV / AIDS patients. In addition, Dr. van Dijk assisted a Dutch medical student Femke Mollena, on a project to determine carriage of Strep pneumo and Staph aureus in patients with HIV / AIDS.
I - General Site Development and Maintenance
With only a few scattered showers in Oct and Nov, the ground remained dry with minimal grass growth. The two deep borehole wells continued to service the MIAM campus effectively, without any water outages, despite heavy water use on gardens and the building project. Both submersible pumps empty into one large holding tank, and are controlled with an automatic switch in the tank, which has worked flawlessly and without any on-going human intervention.
The back-up generator was called on for use fairly often, with one instance where an electrical fault within the generator control panel did not allow the generator to be switched off. A work-around was temporarily used until the panel fault could be found and repaired.
II - Construction of Buildings
The dining room/kitchen facility was officially opened in late October, with a celebration attended by MIAM workers and invited guests from the hospital. While construction and fitting of appliances and furniture is now complete, it is likely that the facility will not be put into full use until January 2008, when many MIAM visitors are expected.
The dormitory was nearly completed by late November, with a few minor carpentry, plumbing, electrical and painting parts to be done. It is expected that occupancy will be possible for at least the one half, if not the whole of the building, by January 2008.
Staff House D, the last of the USAID-funded buildings, has now been roofed, and is undergoing wall plastering and plumbing and electrical work. It is projected that it will be completed by the end of March 2008, which is when the USAID project is to be completed.
Due to cost-overruns as a result of the weakening dollar and increased prices of building supplies in Zambia, an additional amount of funding was made available by receiving re-budgeting approval within the USAID grant. This should allow us to complete the building project.
III - Information Technology
Internet access throughout the two month period remained reliable, though the wireless network servicing the MIAM offices and houses was not always accessible on a daily basis. A contract was signed with LinkNet to provide additional wireless access to the new staff houses on the MIAM campus. The plan was to provide this through a newer "MESH" technique, which should be more efficient and reliable that the current wireless method being used. Once this is complete, additional work will include providing wireless access to the new dormitory, and eventually completing a MESH wireless network for the entire MIAM campus.
A tragic fire in the Vision Community Centre at Macha occurred in late November, affecting the LinkNet office and destroying the Vision Internet Cafe, Radio Macha, Vision Restaurant, Craft Shop and the MIC School. No one was injured, and about 60% of the internal furnishings and equipment were removed before the fire spread throughout the building. Fortunately, the VSAT and internet server equipment managed by LinkNet was still housed in the MIAM molecular biology lab building, so no equipment involved in internet access was affected by the fire, and thus MIAM's access to the internet was not affected.
IV - Vehicles/Transport
The used Toyota Hilux Surf arrived at Macha, and has been put into use on field work. This is a petrol vehicle, in keeping with our principle of having at least one MIAM vehicle run on petrol, rather than diesel, due to the intermittent and unpredictable fuel shortages in Zambia.
The new Toyota double cab pick-up ordered through Toyota-Gibraltar (where it has been "tropicalized" and prepared for "rough" use), was delayed in being shipped, and should now arrive in the country by early January 2008.
All other vehicles remained in use, with regular maintenance and repairs, especially on the aging Toyota Hilux 2.4 pickup. The Pajero and old FUSO lorry are in the process of being sold, with no definite sales agreements by the end of November, but with a plan to have both of these vehicles sold by the year's end.
V - Research Activities
Entomology: Mosquito catches as part of the various field studies resumed in November, with mostly non-anophelines being captured so far. Our entomologist, Mr. Mulenga Musapa, attended the ASTMH meeting in Philadelphia in early November and presented a poster on his work on the Anophelines. The specially ordered programmable light dimmer arrived from South Africa, and will be installed in the insectary, allowing for us to mimic day and night periods. This is part of an effort to get the mosquitoes to grow and mate better.
A visit to MIAM by an entomology team from the National Malaria Control Centre took place in late November to discuss future collaboration.
Approval was obtained in November from the UNZA Research Ethics Committee to include additional Ph D student investigators from Hopkins in the on-going entomological studies in the Macha area.
Epidemiology and GIS: The Epidemiology project staff continued field work in Oct and early November. After a site visit in early November by the project PI, Dr Bill Moss, it was decided to wrap-up field work in the present Epi Pilot study site area, and prepare to move the expanded epidemiology study into a larger area just east of Macha, which is closer to MIAM. This will allow for better field work support and logistics. Preliminary meetings with headmen and village leaders in the new expanded area began, while microscopy readings on the many previously collected blood slides is continuing, and analysis on the data collected over the past year is now being carried out.
Molecular Biology: Both Dr. Mharakurwa and a Hopkins student who spent several months at MIAM, Petricia Rouse, presented work at the ASTMH meeting in Philadelphia in early November on molecular aspects of malaria parasites. In addition, Mtawa Mkulama submitted an abstract for the December TDRC conference on work from the molecular biology lab.
The recent work in the lab has focused on the genetic changes that the parasite undergoes while in the mosquito phase of the life cycle, and comparing these to the genetic changes while in the human part of the lifecycle. Interestingly and counter-intuitively, it appears that genetic changes bringing about drug resistant parasites are more likely to happen in the mosquito phase of the life cycle, especially for the anti-folate anti-malarials. Further on-going work is being carried out to clarify and understand this phenomenon better, including DNA sequencing of some samples at Hopkins.
A poster presented at the ASTMH meeting in November by a research group based at the MRC labs in the Gambia, has now confirmed the previous finding from MIAM that malaria parasite DNA can be found in saliva and urine. This is the first independent confirmation of our similar findings, which were first presented publicly in 2005. We continue to seek funding to further refine and advance this discovery, but so far we have been unsuccessful in getting more grants to continue this ground-breaking work.
Pharmacokinetic Study: Dr Myaing Nyunt arrived from Baltimore in early October to work with Dr van Dijk in initiating the pharmacokinetic study of sulfadoxine/pyrimethamine (SP or Fansidar) in pregnant mothers. The study got under way after hiring Mrs. Maria Mudenda as a study assistant, and recruiting nurses and study assistants, and carrying out training in "Good Clinical Practice". A Dutch medical student on a rotation at Macha assisted in the project, and by late November twelve of the planned 25 participants had been enrolled in the study.
Tuberculosis Studies: Dr. Sue Penno continued to work on optimizing the TB culture facility for the upcoming EDCTP-sponsored Rifaquin drug study, with plans to begin enrolling patients in late December or early 2008. The delay has been because this is a multi-country study, and other countries have not yet received final ethical approval, as we have in Zambia. Plans are now being made to possibly start the study in the countries and at the sites that already have full approval.
Recruiting another lab technologist to work in the Clinical Research Lab has proved difficult, with the salary scales currently used by MIAM no longer competitive for this category of personnel. It appears that an experienced lab tech from Lusaka is willing to come and help on the project for six months, with hopes that a more permanent agreement can later be negotiated with him.
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 TDRC conference in December.
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, began enrolling patients in September and had enrolled 90 patients by late November. The aim is to enroll a total of 150 pediatric patients with HIV/AIDS, and follow them over several years to determine contributing factors to the various outcomes.
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. This data was used for two presentations in November at the ASTMH meeting in Philadelphia - one showing the decreasing number of pediatric malaria cases at Macha Hospital. The other presentation showed the close correlation between malaria cases and pediatric blood transfusions, providing evidence that tracking pediatric blood transfusions at community-level hospitals may be another good indicator to follow the success of malaria control programs.
VI - Personnel
A new accounts officer, Miss Esther Pandawe, began work at MIAM in October. She has been assigned the responsibility of keeping accounting records and sending reports for all the Hopkins Imprest accounts.
Two new housekeeping staff, Edith Mwaanga and Priscilla Hansumo were hired in October, and after several months of on-the-job training, will assist with the increased work-load as the new kitchen/dining room is used and the dormitory opens in early 2008.
Dr. Mharakurwa traveled to the USA in October, giving talks in Baltimore, New York and Philadelphia, before returning to Zambia in November. Mr. Mulenga Musapa also traveled to the USA in November for his poster presentation at the ASTMH meeting in Philadelphia, returning to Zambia with Dr. Mharakurwa. Dr. Thuma also traveled to the USA to present two talks at the ASTMH meeting, then stayed on to have additional meetings, work at MMRI, and spend time with family over the holiday season.