September 2008 Report
Summary:
The month of September continued with dry heat and blowing dust for much of the month. In fact, according to the MIAM temp / humidity logger, the daily maximum temperature was above 90 degrees F for all but three of the days in the month.
September was marked by the continuation of the various field-based studies on malaria, continued success with the anopheline colony, and on-going work in the molecular biology lab with initiation of the RT-PR aspect of the Epidemiology study. In addition the Pediatric AIDS study continued and baseline work was carried out in the TB lab.
Visitors to MIAM in September included the head of the Presidential Malaria Initiative in Zambia, the head of entomology in the Malaria Division of the CDC, Atlanta and an epidemiologist from the CDC, as well as a brief visit by Dr. Doug Norris from JHMRI.
I - General Site Development and Maintenance
Road work on the MIAM campus continued, with more culverts being laid out, and many truck loads of gravel hauled and spread out on the roads. All this work is an attempt to prepare the roads for the upcoming rains.
Frequent electrical grid "load shedding" continued in September. That meant the back-up generator had to run for many days and some times for long stretches of time. The high cost of diesel and the calculated fuel consumption showed that the cost to run the gen-set was about K80,000 per hour (currently $22.85 per hour). This on-going cost puts us way above the generator budget for this year. The concern was that in the first half of September the gen-set ran for over 52 hours, which was the average for the whole month in the previous four months.
Despite discussion on how to function without constant electricity, no conclusion was reached on how to manage the situation. Concern was raised that the valuable mosquito colony and other critical lab equipment such as freezers, incubators, etc., need constant power to maintain the many specimens, reagents and culture samples that are currently being stored and processed. By month end, the fuel prices had been reduced by nearly 20%, giving some relief to the hemorrhaging budget for gen-set running costs.
II - Information Technology
The IT system remained relatively stable throughout the month. While there were times when the network bandwidth was saturated and came to a standstill, there were other times when it was a very fast connection. The satellite vendor apparently at times gives us higher download rates than are contracted for, allowing for increased download speed of large files.
III - Vehicles/Transport
All vehicles remained on the road, with excellent support staff to take care of repairs and maintenance. The insurance settlement check for the wrecked Ford Everest was finally received, and the damaged vehicle removed by the insurance company.
The replacement vehicle for the Everest, a used Toyota Land Cruiser Prado, was purchased and being shipped from Japan, with expected arrival in Dar es Salaam by mid October.
The old FUSO lorry was finally sold to the highest bidder, and driven away in late September by the purchaser.
IV - Research Activities
Entomology:
The anophelene colony continued to thrive, with five distinct genetic lines. The "oldest" one is now in the F9 generation, with the others lagging behind in F8 and F7. Mouse cages arrived from the USA and were being prepared to house the mouse colony which will be used to provide blood meals for the mosquitoes, once all final protocols are in place. A few mice to start the mouse colony have been arranged through the University of Zambia, and the local and district veterinary departments have been helpful in agreeing to advise and then subsequently inspect and approve the conditions for the appropriate keeping of an animal colony at MIAM. This will all hopefully be in place by the end of October, so that the mosquito colony size can be increased in preparation for the planned experiments next year.
Epidemiology and GIS studies:
The field workers continued to carry out the Epi study, going out many days to complete the questionnaires and carry out surveys for malaria prevalence. One village near to Mapanza Rural Health Centre was found to have several people with active malaria, an unusual finding for this time of the year.
The RT-PCR assays on filter paper samples to determine levels of gametocytemia have been started, as the out-going lab tech trained the newly recruited lab scientist to perform these assays. There were still no appropriate positive controls available to start running the main samples, but at least 7 samples were processed during the training exercise.
Molecular Biology:
The molecular biology lab was quieter during September, with less active work going on. The results from the extensive lab work by the summer students was still being analyzed and written up for possible publication, while other previous work was submitted for publication during the month. Preparation of oral and poster presentations, as well as finalization of travel plans to the forthcoming ASTMH meeting in New Orleans, were under way, for presentation of four accepted abstracts from work done at MIAM. Grant applications were also being polished and prepared for submission - and re-submission in some cases.
Pharmacokinetic Study of SP:
The last pharmacokinetic sample was obtained from the last participant in this study and was sent for analysis, and study was closed out. An abstract was accepted to be presented at the upcoming American Society of Tropical Medicine and Hygiene meeting in New Orleans in December, at which time preliminary results of the study will be presented.
Tuberculosis Study:
Volunteer lab technicians from Erasmus University in Holland continued to work with local staff to prepare the MIAM TB culture lab for the Rifaquin trial. A TB strain was obtained from the Chest Diseases lab in Lusaka to be used as control strain, and it has now been successfully cultured by our own lab for that use.
HIV/AIDS Study:
The prospective study on pediatric HIV /AIDS continued. A planned visit by a Ph D student from Hopkins to help with the data collection and analysis on this study was expected in early October. Viral load samples are being prepared to be sent off for analysis in Lusaka through the UTH virology lab.
Hospital Data Collection and Analysis:
On-going prospective collection and data entry of the malaria admissions to the hospital children's ward continues, with patterns continuing to show very low levels of malaria. So far this year there were only two pediatric deaths from malaria - a number even lower than the record low 6 deaths in 2005 - and much lower than the average of 44 deaths per year caused by malaria in the pre-2004 era.
Rural Health Centre Malaria data:
This new pilot project has now run for a month and has shown that it is feasible to collect weekly data on malaria diagnoses at the rural health centres in the Macha area. Not all centres were compliant in transmitting the information by cell phone on a regular basis, but 11 of the 12 have done fairly well with the weekly reports. The data has been shared with the District Health Management Team and the District Medical Officer in Choma, who has agreed that the rapid collection and the results obtained from this data collection method, is very helpful.
Bednet Distribution and Survey Project:
Some preliminary data analysis has been done on the project reported on last month designed to survey Insecticide Treated Net (ITN) use, and also distribute and hang new ITNs in households that were lacking them. Of the 748 households surveyed, there were a total of 6,518 people sleeping there at night in 2,194 separate sleeping structures, but only 819 bednets were found hanging. This is after the widespread distribution of bednets carried out by the government and its partners late in 2007. This gives an average of:
0.1 bednets per person, or
0.4 bednets per structure, and only
1.1 bednets per household.
Since it has been shown that there needs to be 60-70% coverage of ITNs before malaria transmission reduces significantly, it would seem we are still a long way off from effective bednet distribution and usage. The MIAM team hung a total of 2,281 new ITNs in the surveyed households, bringing the new statistics to an average of:
0.5 bednets per person, or
1.6 bednets per sleeping structure, and
4.1 bednets per household
While this is still less than ideal, we will follow up the households next year to see the situation in regards to malaria prevalence, and also see how many of the nets that our team hung are still being used.
V - Personnel
Three new employees joined MIAM in September; Mr. Jodi Chondoka, a new lab scientist who will work on the RT-PCR part of the Epidemiology study; Mr Francis Hamangaba, a clinical officer to help with the TB and HIV / AIDS studies; and Miss Choolwe Nachibattu a lab assistant for the molecular biology lab.
In addition, Mr Gift Moono was promoted to the position of Senior Lab Assistant, and Miss Pamela Sinywimaanzi was assigned to be a Study Assistant rather than be the Receptionist/Data Entry Clerk. This necessitated the hiring of a temporary receptionist, Mrs. Flair Kasakola.
A policy to allow all MIAM employees to be off on Saturdays and Sundays, unless needed for specific projects, was instituted in September, and will continue through November. In December, as the various studies become more active again, employees will revert to working half days on the weekend days, as before.
A half-day Good Clinical Practice training seminar was carried out in Sept, to prepare various employees and others to be study assistants in the up-coming Rifaquin TB study, now delayed until November to start patient recruitment.
VI - Other
A visit by Dr Doug Norris from Hopkins was coordinated with the visit by the PMI / CDC team, and led to many fruitful discussions on the best way to develop and utilize the mosquito colony. An invitation was given by the CDC personnel for Dr Norris and Dr Mharakurwa to visit the CDC later in the year for on-going collaborative study discussions.
The Federal Wide Assurance for Macha Hospital to continue clinical research with human subjects was renewed during September.
An application was submitted to the national phone company Zamtel, to install a CDMA phone at MIAM. This type of phone could be used to accept faxes from the regular telephone network, and would provide a functional "landline" and permanent phone number for MIAM, even though it works through a wireless system.
The "Macha Research Trust" registration papers were received from the lawyer in Lusaka, and efforts are now being made to register this new entity for tax purposes with the Zambia Revenue Authority.