February 2008 Report
SUMMARY:
February was a busy month with many activities, highlighted by a visit to MIAM by the newly appointed director of JHMRI, Dr. Peter Agre.
Intensive work on entomology was carried out during the month in both the insectary as well as the field, and the Epidemiology study resumed its program in February, with twelve households screened by month end.
Work in the molecular biology lab continued, with several manuscripts from the work there being finalized for submission.
The SP-PK and PART studies continued to enroll and follow up study participants, keeping clinical and lab staff busy.
Final touches were being carried out on Staff House 'D' as the USAID construction project comes to a completion in March.
I - GENERAL SITE DEVELOPMENT AND MAINTENANCE
After the heavy rains for most of January, the weather in February turned hot and dry for the latter part of the month. The lack of mud everywhere was welcome, though the grass kept growing on the campus, necessitating a constant team of "grass-slashers" working to keep up.
For most of the month, there were frequent planned electrical outages of the national grid (load-shedding), due to the acute shortage of power in the country and region. This meant that MIAM had to run its back-up generator for several hours many evenings to replace the electricity not being fed from the national grid. According to press reports, it is expected that this national and regional shortage of electricity may persist for several years. With the costs of local electricity generation much higher than that obtained from the national grid, we thus expect our utility costs to raise significantly both for this year and in the future.
The guest flats experienced several electrical problems, including shorting and burning out of the elements in the hot water geysers. This required several replacement elements to be inserted, at considerable cost, before the faults were finally located and rectified.
Hospitality services remained busy, with visitors on campus throughout the month. The new cafeteria served meals every day, and the dorm had anywhere from 1 to 15 people in it during the month, while the guest flats were occupied for most of the time with visiting scientists, students and other visitors.
II - CONSTRUCTION OF BUILDINGS
The final phase of the USAID building project was projected to complete Staff House 'D' by the end of March. The progress on this has been good, with essentially only internal wall painting remaining to be done. It is expected that this will be completed in good time. No new construction on the MIAM campus is planned for now, though we are looking for funds to build additional staff houses for the junior scientific staff. This level of housing is badly needed as MIAM expands.
III - INFORMATION TECHNOLOGY
The internet access at MIAM offices and houses was generally available throughout the month, though there were times when users noted that access was slow or erratic. The LinkNet team under contract to provide internet access to MIAM was notified and working on making the system more reliable. It should be remembered, though, that just having any daily internet access is a luxury in rural Africa, with very few other such rural institutions having the broadband internet access that we have become accustomed to.
With frequent voltage fluctuations, the various office computers, some nearly five years old, continued to have difficulties, with several computers undergoing repairs at any given time for bad hard drives, motherboards or memory.
The new MESH wireless network now installed and active in the new staff houses, dormitory and cafeteria, remained stable and reliable. Plans are now being made to replace the original wireless network on the MIAM campus using this new MESH technology.
The air conditioning unit for the IT equipment room was still not repaired by month end, but efforts are being made to repair or replace it before the weather gets hotter.
IV - VEHICLES/TRANSPORT
The new Hilux 4 X 4 arrived at MIAM in early February, and was immediately put to use in the field work. Final paper work for it to be licensed was received late in the month, and so permanent number plates can now be obtained to officially license it for use on public roads.
The other vehicles continued to work well, with no particular major problems other than minor repairs needed from the heavy use on bad roads. With the heavy rains in January, most trunk and feeder roads in the Macha vicinity are badly rutted and washed out, causing significant wear and tear on tires, shocks and frames of the MIAM vehicles.
V - RESEACRH ACTIVITIES
a) Entomology:
The identification and classification of the mosquitoes being caught on three different studies was done on a daily basis in the lab, keeping the Hopkins doctoral students and MIAM entomologist busy.
In addition, an attempt was once again being made to establish a local in-house mosquito colony of Anopheles arabiensis. Mosquitoes being caught in the CDC light traps and in human landing catches were placed in cages in the insectary, and are being fed regularly. By month end, mosquitoes had been hatched from eggs of these wild mosquitoes, these F1 generation mosquitoes had grown, been fed and mated, and we were waiting to see if eggs would be laid by them. If they do lay eggs, it will be the first time we have managed to complete the cycle, and thus pave the way for a continuous colony.
The electrical grid-based collection method for mosquitoes was modified to also include a calf as "bait", and this resulted in improved catches. The Hopkins post-doc working on this study left in early February, and turned the project over to a MIAM field worker to continue.
A pilot study to establish the method for determining insecticide resistance in local mosquitoes was put in place with the help of a Hopkins doctoral student, and the plan was to continue the project by the MIAM entomologist.
b) Epidemiology and GIS:
The Epidemiology study began again in February in the new study area closer to Macha (as compared to last year), with twelve households, selected as longitudinal sites, having been screened by month end. Of the 72 individuals screened, about 3% were found to be parasite positive.
The GIS work continued with the Hopkins post- doc working together with the MIAM GIS Manager, mapping areas and establishing correlations with satellite imagery and local conditions. It is hoped that this study will lead to a better ability to predict mosquito breeding sites based on interpretation of satellite imagery. The GIS Manager also assisted the Epi Study team in mapping and locating the randomly selected households for the longitudinal and cross-sectional components of that study.
The two local microscopists trained for use in the Epi study have proved reliable, and have begun reading slides. One will be leaving for university and will be replaced by another trainee. The lab tech responsible for the RT-PCR to determine gametocyte carriage rates, traveled to Baltimore in late Feb to undergo a month of training in Dr. Kumar's lab. The plans are for him to then return to MIAM and initiate this methodology in the molecular biology lab, as part of the Epi study.
Data entry for the previous years Pilot Epi study was nearing completion, after significant delay in obtaining all of the readings of the malaria slides.
c) Molecular Biology:
Lab work continued with efforts being made to analyze past specimen collections for malaria drug resistance, in order to complete a longitudinal study of changes in the patterns of drug resistance in the Macha area over the past 10 to 15 years. In addition, data was generated and analyzed to use in the grant applications being submitted for further funding in the study of saliva and urine as potential specimen sources for determining the presence of malaria parasites in humans.
In early February, a manuscript was submitted to the Malaria Journal entitled: "Escalating Plasmodium falciparum antifolate drug resistance mutations in Macha, rural Zambia." Three additional manuscripts were in preparation during the month on various projects carried out in the molecular biology lab, including a manuscript on the schistosomiasis prevalence in the Chitongo area.
Two grant applications were being finalized in February, one being a re-submission of an R21, the other to a new source.
d) Pharmacokinetic Study:
This study enrolled the last of the planned 25 participants, and also had repeated the pharmacokinetic study as per protocol in several of the pregnant mothers who had already delivered. Follow-up and compliance by study participants has been excellent so far.
e) Tuberculosis Study:
The EDCTP-sponsored multi-country Rifaquin drug study finally received approval in South Africa in late February, clearing the way to move forward with initiating this study on TB drug resistance. A visit by a study monitor to inspect the TB lab for readiness occurred in February, and it appears that all is in place to begin enrollment, once the study drugs have been shipped and some final changes to the study protocol have been approved by the national Research Ethics Committee.
A recent University of Zambia graduate joined the clinical research lab staff to help with this and the PART study, and efforts are on-going to also recruit a lab technologist.
f) Schistosomiasis Studies:
The studies on schisto prevalence have been completed and a manuscript has been prepared for submission for publication.
g) HIV/AIDS Studies:
The CDC/JHPIEGO funded Pediatric Anti-Retroviral Treatment (PART) study continues to keep staff busy, with 150 children now enrolled and being followed and tracked on a regular basis. Data entry for the study is being done on an on-going basis. Approved funding for the study has yet to be received by MIAM, but final documents to affect the transfer of funds now seems imminent.
h) On-going Hospital Data Collection and Analysis:
The daily on-going entry of current hospital data continues, so that on-going and future analysis can be done to follow trends in malaria morbidity and mortality over time. A presentation was given by the MIAM Director in late February at a Zambian National Blood Transfusion Service workshop in Lusaka, attended by doctors and nurses from all over Zambia, showing the strong relationship between decreases in malaria case load in recent years and the use of blood transfusions. It has been estimated from Macha data that 40% or more of all transfusions at a district-level hospital are for children with severe malaria anemia. Thus, control of malaria should provide a considerable decrease on the national needs for donor blood for transfusion.
By late February, Macha Hospital had admitted only a few cases of children with malaria - unusually low compared to historical records for this month. One case was of cerebral malaria from west of Macha about 60 km, and one of severe malarial anemia from the south east area. The latter case had been seen at a local rural health center the previous week, but was only treated with SP and not AL as is the current recommended treatment.
VI - PERSONNEL
Several employees were hired as full time workers to assist with housekeeping and hospitality in February.
The first MIAM Five Year Service Award was presented at the February staff meeting to Marjorie Hamahuwa, the MIAM Office Manager.
Late in February, the Scientific Director and Lab Technologist traveled to Baltimore for the annual Hopkins Malaria Conference and to also gain training and lab experience in the RT-PCR technique.
VII - OTHER
The week-long visit to MIAM early in the month by the new JHMRI director Dr Peter Agre, gave him a chance to see the day to day routine on the research campus and labs, as well as an opportunity to join various research teams in the field and also visit the local chief. He gave a stimulating lecture to MIAM staff on his work with aquaporins and the potential relationship of them to malaria. Before he left Zambia, he was able to meet the Director of Public Health and Research at the Ministry of Health in Lusaka.
The Memorandum of Understanding for the period 2008 - 2012 that was delivered to the Ministry of Health in January for signatures has not yet been received back, but was undergoing changes to standardize it.
A Nature news feature article entitled "Malaria - The Big Push" was published in late February and talked about the work at MIAM, in addition to featuring the MIAM Scientific Director, Dr. Sungano Mharakurwa and his studies.