Posts or Comments 28 September 2021

Monthly Archive for "October 2013"



Economics &Treatment Bill Brieger | 31 Oct 2013

Household cost of treating fevers in Ghana

Researchers at the Dodowa Health Research Center and the other centers affiliated with Ghana’s Ministry of Health/Ghana Health Service have shared with us their findings and concerns about the costs of treating malaria and febrile illness in Ghana.  We can see that despite efforts to reduce costs through such efforts as the Affordable Medicines Facility malaria (AMFm), households are burdened when malaria strikes.  Alexander A. A. Nartey, Patricia Akweongo, Elizabeth Awini1, Maxwell Darlaba, Theresa Tawiah, Jonas Akpakli, Doris Sarpong, Christine Clerk, Martin Adjuik, Moses Aikins, Fred Binka and Margaret Gyapong explain in more detail below.

AMFm certified quality drugs available in Chemical Seller Shops in Ghana

AMFm certified quality drugs available in Chemical Seller Shops in Ghana

The burden of malaria seems to be reducing globally but sub-Saharan African countries continue to bear the greater burden of the disease considering the economic burden on the households. Malaria continues to be the number one cause of morbidity and mortality in Ghana. The household cost burden of malaria is both direct and indirect costs.

The study was a cross sectional cost-of-illness design. The study used self-reported fever as an indicator of malaria. The study household sample was drawn from the entire Health and Demographic Surveillance System (HDSS) databases of the Dangme West, Kintampo (North and South) and Kassena-Nankana (East and West) districts. All patients from such households that have a history of fever in the previous two weeks were interviewed on their care seeking, health providers used, treatment received and the related costs.

The average direct OPD cost of treating fevers was GH¢16.54 (US$11.25) and the average cost of self-treatment was 5 times less than seeking care at health facilities OPDs  in Ghana. A household in Ghana was likely to pay GH¢31.43 (US$ 21.38) as direct cost per episode of fever treatment which was equivalent to 32.7% of monthly minimum income in Ghana.

Government of Ghana in its effort to keep the direct cost of treating fever relatively low through the provision of Health Insurance Scheme and the introduction of a subsidized AMFm drugs, the overall lost of productivity to the patient play a significant role especially when there are multiple fever cases within households in a year.

IPTp &ITNs &Treatment Bill Brieger | 24 Oct 2013

Awareness, Accessibility and Use of Malaria Control Interventions Among At-Risk Groups In Lagos State, Nigeria

AK Adeneye, PO Ossai and TS Awolola are sharing with us a pilot study they conducted based from the Nigerian Institute of Medical Research in Yaba, Lagos.

With two years to the MDGs deadline, there is limited evidence of decreases in malaria-related mortality and morbidity in Nigeria. We therefore wanted to evaluate the awareness, accessibility and use of malaria control interventions among at-risk groups in Lagos State, Nigeria.

Lagos State Ministry of Health http://www.lsmoh.com/news/lagos-treats-300-for-malaria#.UmlR9RAQ5aw

In planning for a broader assessment we conducted a descriptive, cross-sectional pilot study of 80 consenting pregnant women and mothers of children below five years of age. It was carried out using a household survey questionnaire and observation in Ikotun and Ketu communities of Lagos State

All respondents identified mosquito as the malaria vector. Respondents’ preferred drugs for malaria treatment were as follows: sulphadoxine-pyrimethamine (31.3%); ACTs (20.2%); artemisinin monotherapies (15.0%); chloroquine (13.8); and analgesics (12.5%). Only (30.0%) had used ACTs, and 55.0% of these had practiced self-medication.

Nearly all knew of and had LLINs. From room observation, only 53.8% (31.5% mothers of under-five vs. 11.3% pregnant women) actually hung the LLINs. Reasons for non-use of LLIN included: “prefer house spraying” (28.8%) and “causes heat” (7.5%).

LLIN use was positively associated with education (p<0.05), ranging from 50.0% (no education) to 77.8% (post-secondary). Only 41.8% got their LLINs through house-to-house mass distribution. Women averaged washing their nets 3 times within an average of 21.7 months of use.

LLIN washing practices showed that 30.5% used toilet soaps compared to detergents and hard soaps (66.7%). Unfortunately, 19.4% sun dried their nets.

While 52.6% of the pregnant women were aware of IPTp, 42.1% actually had received at least one dose.

Results of this pilot showed high awareness but low and poor use of malaria control interventions in populations studied. A wider survey in the near future will inform public health education on the different malaria control interventions that need to be intensified among the women so they can benefit from improved pregnancy and child health outcomes. This is important if the malaria-related MDG targets are to be realized in Lagos and in Nigeria in general.

Diagnosis &Treatment Bill Brieger | 18 Oct 2013

Knowledge of Senior Local Government Level (LGA) Health Workers on Malaria Treatment Guidelines in a South Western Nigerian State

CAM01466Esther Ayandipo, Bolatito Aiyenigba, Bukola Omobowale, Adebola Karim?Mohamed, Olusimbo Ige & Abbar Umar from the USAID PMI/MAPS Project (Nigeria) and the Department of Community Medicine University of Ibadan recently presented their findings from interviews with key local government health managers at the Multilateral Initiative for Malaria 6th Pan African Malaria Conference in Durban South Africa. They have shared their presentation below.

The risk of severe malaria is reduced when the disease is diagnosed accurately and on time [1]. Artemisinin Combination Therapy (ACTs) is the first line of According to the Nigerian national guidelines, parasitological confirmation is recommended in all suspected cases of malaria [2]. Malaria treatment practices have remained suboptimal in many primary health facilities (PHCs) in Oyo State. Routine monitoring visits to public primary health facilities show use of Chloroquine for malaria treatment and indiscriminate use of injection Arthemether for treatment of uncomplicated malaria.

The Medical Officer of Health (MOH) /primary health care coordinator as the apex officers at the Local Government Areas (LGAs) are expected to supervise and ensure compliance to national malaria treatment guidelines at PHCs within their LGAs. This study aims to assess the knowledge of MOHs on malaria treatment guidelines as a measure of their supervisory effectiveness.

Oyo State has 33 LGAs. A cross sectional survey of all 33 MOHs and 17 assistant MOHs was conducted to assess knowledge of current malaria treatment guidelines using a semi structured questionnaire. Knowledge assessed include; current management of fever cases including diagnosis before treatment for malaria; preferred choice of antimalarial drug, symptoms of severe malaria and management of malaria in pregnancy. Descriptive analysis was done using SPSS version 16.

knowledge aA total of 50 health workers responded to the questionnaire. Doctors constituted 27%, nurse/midwives 62.5%, and CHOs 10.4% of respondents. Overall, 87.8% had been trained on malaria case management.

Even though 98% believed that not all fever is malaria, 76% will still treat all fever cases for malaria. Just 62% knew that other causes of fever should be looked for when RDT is negative while 8% will go ahead and treat RDT negatives for malaria.

Many (93.8%) will use ACTs to treat RDT positive cases however 10.6% still felt Chloroquine is the mainstay treatment for malaria. 15.2% will give injection Arthemeter to all malaria cases.

RDT aSymptoms of severe malaria could be recognized by 70% while just 50% knew the correct pre?referral treatment. About two thirds (64.6%) knew quinine was safe for malaria treatment throughout pregnancy while 92% knew the required doses of IPT in pregnancy.

This study shows substantial knowledge gap on malaria case management among top LGA health workers. Gaps identified include the use of chloroquine and indiscriminate use of injection Arthemeter. Referral procedures for severe malaria remain fair. Individual capacity building at improving malaria treatment practices need to begin with the supervisors if a significant change in treatment practices is to be expected at PHC level.

References

[1] Daniel J Kyabayinze et al. Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda. Malaria Journal 2010, 9:200.

[2] National Guidelines for diagnosis and treatment of malaria. Federal Ministry of Health. March 2011

Uncategorized Bill Brieger | 17 Oct 2013

Mass Screening And Treatment Of Malaria, An Intervention In Flood Disaster Situation, Bayelsa State, Nigeria

Opadiran Oluwatunmobi, Oluwafemi Ajumobi, Victoria Ibeh, Ogu Omede, and Godwin Ntadom from the National Malaria Control Programme, Federal Ministry of Health, Abuja, Nigeria presented their experiences on malaria in an emergency setting at the recently concluded Multilateral Initiative on Malaria 6th Pan Africa malaria Conference in Durban, South Africa. Below, they have shared their experiences with our readers.

IMG_1382 (1024x768) aNigeria accounts for 25% malarial disease burden in Africa. Malaria accounts for 25% under-five mortality. In 2012, flood disaster ravaged certain areas of the country leading to internal displacement and significant environmental degradation. Though mass screening and treatment (MSAT) is recommended by world health organization (WHO) in areas in the pre-elimination phase for detection of asymptomatic parasite carriers and rapid reduction of the parasite pool, we explored its use in a disaster situation. We conducted MSAT for malaria amongst displaced persons and at risk groups in Bayelsa, Nigeria.

Residents in Yenogoa local government area, Bayelsa state, Nigeria were mobilised for MSAT and screened for malaria using Histidine Rich Protein-II-based Standard Diagnostic Bioline malaria rapid diagnostic (RDT) test in November 2012. All RDT positive cases were treated with Artemisinin-combination therapy (ACT). Data were analysed using Epi Info version 3.5.3 and Microsoft excel.

Of the 1684 tested, 611(36.3%) were male, 43 (2.6%) were pregnant women, 303 (18%) had fever ?37.5oC, 447 (26.5%): generalised weakness, 536 (31.8%): headache, 368 (21.9%): joint pains, 111 (6.6%): vomiting, 113 (6.7%): diarrhea, 454 (27%): cough, 180 (10.7%) tested positive and 5 (0.3%) had invalid test result. Of the 180 RDT positives, 138 (76.7%) received ACT. Of the 1504 RDT negatives, 64 (0.1%) received ACT.  Of 480 (28.5%) under-fives (U5), 81(16.9%) had fever, 67(14%) had danger signs. Of 51 RDT positive U5, 39 (76.5%) received ACT. Of the 429 RDT negative U5, 29 (6.8%) received ACT. Two RDT positive pregnant women received ACT. Severe malaria cases in U5 were referred to the health facility.

The prevalence of malaria is low. The RDT met the WHO criteria for invalid rate of <5%. Non-rational use of ACTs thought relatively low, was higher in U5. It cannot be assumed that prevalence of malaria is higher in flood disaster victims. The use of MSAT in internally displaced population in disaster situation is necessary to ensure rational use of ACTs.

IRS &Vector Control Bill Brieger | 15 Oct 2013

Impact of Indoor Residual Spraying on the Parity rate of Anopheles mosquitoes in Nasarawa State, North Central Nigeria

Picture3 aInyama, P.U., Samdi, L., Nsa, H., Iwuchukwu, N. Suleiman, H., Kolyada, L.,  Dengela, D., Lucas, B., Seyoum, A. and Fornadel, C. Are associated with the PMI/AIRS Project in Nigeria. They presented their experiences with IRS at the recently concluded Multilateral Initiative for Malaria 6th Pan African Malaria Conference in Durban South Africa.  They have shared their presentation here.

The President’s Malaria Initiative’s Africa Indoor Residual project (PMI/AIRS), IRS 2 Task Order 4, executed the year 2 spray operation in Nasarawa Eggon and Doma Local Government Areas (LGA) of Nasarawa State, Nigeria. The objectives of the program being the reduction of malaria – associated morbidity and mortality, a total of 62,592 structures were sprayed.  To measure the impact of the IRS program on the malaria vectors  the proportion of parous mosquitoes in  the  vector population  was determined before and after Indoor Residual Spraying.

Picture1 aOne thousand, six hundred and twenty one (1,621) female Anopheles gambiae s.l. specimens drawn from a pool of 3,356  Female Anopheline   mosquitoes  captured by Human Landing Catches  from  three LGAs of Nassarawa Eggon and Doma (intervention areas)  and Lafia (Control) of Nasarawa State Nigeria    were dissected using WHO-recommended techniques for parity. The degree of coiling of ovarian tracheoles was observed  pre-IRS intervention in March 2013  and monthly post IRS intervention up to September 2013. Proportion of parous females was compared pre-and between intervention and control villages. Similarly, pre-and post-spray proportion of parous comparison was made within both intervention and control villages.

Picture2 aOverall, a total of 1,621 ovaries of An. gambiae s.l. were dissected before and after IRS intervention.  Of the ovaries dissected at baseline, 71.43% were parous in Nassarawa Eggon, 76.70% in Doma and 77% in the control area. After IRS in May 2013, it was found that the parity had declined dramatically to 17.69% in Nassarawa Eggon, 27.98% in Doma (p <0.05) while in the control area (Lafia) Parity remained as high as 68%. As insecticide residual efficacy continued to decline, slight increase in parity rate was observed in the intervention areas (38% and 31% in N/Eggon and Doma respectively for September) while it remained high (71%) in the control area for the same month.

spraying 2This study has shown a reduction in the longevity of Anopheles mosquitoes post spraying as compared to pre-spraying in the intervention villages.   The longevity of the vector was also significantly declined post spraying in the intervention villages as compared to unsprayed villages. The observed reduction of the expectation of life of the vector associated with IRS is promising. But further study is needed to fully understand how this will be translated to reduction of malaria transmission in the area.

spraying 3We wish to thank all technicians who participated in the entomological surveillance activities and dissection of mosquitoes. This work was funded by the President’s Malaria Initiative. www.africairs.net and info@africairs.net

Plasmodium/Parasite Bill Brieger | 14 Oct 2013

Ghanaian school children harbour antibody responses to antigens on the surface of Plasmodium falciparum gametocyte-infected erythrocytes

Bismarck Dinko of the School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana and his colleagues Teun Bousema and Colin Sutherland from the Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK. Presented their research findings at the just concluded Multilateral Initiative for Malaria 6th Pan African Malaria Conference in Durban. Bismark Dinko can be contacted as bismcck@gmail.com, bdinko@uhas.edu.gh for more information.

Malaria transmission-reducing interventions are key to malaria control and possibly elimination.1 Therefore, the development of new tools targeting malaria transmission reduction would mean a major leap forward in malaria control efforts. However, little is known about the immune responses directed at circulating P. falciparum gametocytes in the human host, knowledge of which will be useful in developing transmission reducing interventions targeting gametocytes.

Studies in the Gambia showed P. falciparum gametocytes carry antigens (GSA) which were recognized by malaria patients’ antibodies. These anti-GSA antibodies were found to be associated with lower duration of gametocyte carriage in these patients2,3.  Thus, we aimed to determine the presence of anti-GSA antibodies in an asymptomatic population and their relevance to gametocytaemia.

The study was conducted in Ahafo Ano South District, Ashanti Region, Ghana. 274 asymptomatic children aged 6-17yrs were screened by microscopy for malaria, 66% were asymptomatic parasite positive. 155 were treated with DHA-piperaquine upon second visit and enrolled. Enrolled children were followed-up for finger-prick blood donation weekly for 1 month.

1 Dinko 1a

Developing stages of P. falciparum gametocytes in culture

Gametocytaemia were determined by Microscopy and QT-NASBA.Gametocytes were produced according to established protocols.3   Mature stage V gametocytes were magnet-purified and tested with plasma samples for antibody recognition by flow cytometry as described elsewhere3 and we present here a summary of the findings.

Prevalence of asexual parasites and gametocytes in malaria asymptomatics

Prevalence of asexual parasites and gametocytes in malaria asymptomatics

From a cohort of 113 children, all the children harboured plasma antibody responses that recognized GSA on a proportion of mature gametocyte-infected RBCs of 3D7 by flow cytometry. However, 56% of the children exhibited strong antibody responses to GSA (immune response above the median within the cohort per sampling time) by both the proportion of mature gametocytes bound to antibodies and the intensity of the antibody binding to GSA. Longitudinal data provided an additional 10% developing strong GSA responses during the 1 month follow-up.

Plasma antibodies recognised mature gametocyte-infected RBCs Serum from asymptomatic individuals were incubated with mature stage V gametocytes (or trophozoites) and analysed by flow cytometry. Parasites were dual labelled with Alexflour conjugate directly recognizing human IgG and EB staining nuclear DNA. Antibody binding was estimated from the percentage of cells with both EB and Alexaflour, and quadrant settings is based on the single staining controls for EB and Alexaflour.

Plasma antibodies recognised mature gametocyte-infected RBCs. Serum from asymptomatic individuals were incubated with mature stage V gametocytes (or trophozoites) and analysed by flow cytometry. Parasites were dual labelled with Alexflour conjugate directly recognizing human IgG and EB staining nuclear DNA. Antibody binding was estimated from the percentage of cells with both EB and Alexaflour, and quadrant settings is based on the single staining controls for EB and Alexaflour.

There were some children with antibody responses fluctuating around the median immune response within the cohort. Children with GSA antibodies present at enrolment were less likely to develop new gametocytaemia at subsequent visits (odds ratio = 0.29, 95% CI 0.06 – 1.05; P = 0.034).

Plasma antibodies from Ghana recognised mature gametocyte-infected RBCs from recent patient isolate from Kenya (HL1204)

Plasma antibodies from Ghana recognised mature gametocyte-infected RBCs from recent patient isolate from Kenya (HL1204)

3D7 is a laboratory adapted parasite line, so a selection of positive plasma samples was tested against mature gametocyte preparations from HL1204, and strong plasma antibody binding was again shown. No binding to the surface of RBCs infected with immature gametocytes of HL1204 was detected.

In conclusion, a proportion of malaria-infected children carry antibodies that recognized cultured stage V P. falciparum gametocytes from 3D7 and clinical isolates. Strong plasma antibody responses may contribute to gametocytaemia control in vivo. Further work is currently being carried out to identify GSA in collaboration with colleagues at Johns Hopkins School of Public Health, Baltimore, USA.

Antibody recognition to the surface of gametocyte-infected RBCs is distinct from the surface of trophozoite-infected RBCs in some children

Antibody recognition to the surface of gametocyte-infected RBCs is distinct from the surface of trophozoite-infected RBCs in some children

References

  1. Alonson et al., 2011. PLoS Med, 8, e1000406.
  2. Sutherland, 2009, Mol Biochem Parasitol, 166, 93-8.
  3. Saeed et al., 2008, PLoS One, 3, e2280.

Note that Bismarck Dinko was supported by a MIM travel award.

Human Resources &Research Bill Brieger | 13 Oct 2013

MIM/TDR Grant Alumni Make an Impact

MIMDuring his talk in the final sessions of the MIM2013 6th Pan African Malaria Conference Dr. Olumide Ogundahunsi of WHO/TDR Geneva, highlighted four people who have demonstrated the multiplier effects of MIM research grants. Below are Dr. Ogundahunsi’s remarks.

In 1999, Lizette Koekemoer obtained her PhD from Witts.  Her first independent research grant was in 2003 and between 2004 and 2007 she was supported by MIM to study insecticide resistance in Anopheles arabiensis in southern Africa. She subsequently receieved funding from the national and international agencies to support her work on insecticide resistance mechanisms and novel control interventions.  She now heads the  Vector Control Reference Laboratory (VERL), National Institute For Communicable Diseases (NIED) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa

CAM01488 SamSam Awolola obtained his PhD from the University of Ibadan in 1997 and received a grant to support his research on insecticide resistance of the malaria vector mosquitoes in Nigeria from MIM/TDR in 2003 after his post doc in South Africa. He subsequently received research grants from the welcome trust, European Commission and several other agencies.  He is currently the Deputy Director (research), Coordinator Malaria Research Program at the Nigerian Institute for Medical Research and chairs the indoor residual spraying subcommittee of the National Malaria Elimination Program In Nigeria.

Eric Achidi obtained his PhD in 1994 at Ibadan, Nigeria.  He was supported by MIM & TDR from 1998 to 2009 and over time has successfully competed for and received grants from WT, EU, FNIH.  He is presently the Vice Dean Faculty of Science at the University of Buea Cameroon … an institution that did not feature in the 3 publications per year list of the 1999 WT report.

Jane Chuma is one of the more recent recipients of capacity building support from MIM.  She obtained her PhD in 2006 from the University of Cape Town and received MIM support about the same time to study access to effective malaria treatment and prevention among the poorest groups in Kenya. She is now a researcher at the KEMRI-Wellcome Trust Research Programme where she is working on health financing for universal health coverage with funding from the Wellcome Trust and DfID. She supports the health financing task group in her country, helped initiate the establishment of a masters in health economics and policy at University of Nairobi and supports researchers in various countries in their work on health systems and health financing.

These are among the 90 plus MIM alumni, the vast majority of whom have remained in Africa and resisted the pressures of brain drain.  Our congratulations go to MIM-TDR with hopes that other agencies can step up and match this track record.

Human Resources &Research Bill Brieger | 11 Oct 2013

Looking toward Generation F3 and Beyond – Sustaining Malaria Research Capacity in Africa

Olumide Ogundahunsi, of WHO/TDR Geneva, Switzerland provided a look back and toward the future of the Multilateral Initiative for Malaria (MIM) during one of the final plenary sessions at the MIM2013 6th Pan-African Malaria Conference in Durban.  Excerpts from his talk and slides are presented below…

Sustaining research capacity aTwenty years ago, we were asleep, malaria elimination was a dream, and the reality was a nightmare.  After the serial failures of the malaria eradication campaign in Africa, malaria control was barely moving along. But today we are wide awake, it is not yet “uhuru” as far as malaria goes but we are making gains having learnt the importance of combined interventions, we are applying them with success in a number of places.

However, there is still some distance to go in this war and many battles ahead.  To quote one of the plenary speakers during this conference, “the fight against malaria can only be won by well-trained people” (Dr Robert Newman).  …..

  • People who have the necessary capacity to optimise the available tools and develop new ones.
  • People who are embedded in the endemic countries
  • People who know and understand the contexts in which the tools and interventions will be deployed.
  • Communities empowered to implement and sustain interventions

The issue I would like to ponder in the next half hour is how we ensure that we have enough of these people to do the job!

pub research papers aThe last time we were in Durban (as the MIM), the Welcome Trust, the MIM secretariat at that time, had just published a comprehensive report on malaria research capacity in Africa.  The report included data on for example the number of African institutions publishing more than 10 malaria related papers in the 3 years preceding the report – a mere 15 in the whole continent! This has changed significantly in the past 14 years to 38 Institutions.

Fifteen years ago only a handful of agencies and programs were interested in research capacity strengthening and there were even those who considered capacity building poor investments…..the situation has of course changed since and the members of my generation – the so called F2 generation who were either graduate students or post docs at that time maturing as

  • Established researchers in reputable and highly successful institutions
  • Working in Africa and meeting the challenges of working in a challenging environment
  • Highly motivated scientists recognised by their peers and the international scientific community
  • Contributing to research and control of malaria in their countries and the continent

 Of the 90 plus researchers in the F2 generation only 4 are no longer working in Africa.  They remain committed and well recognized experts in their fields.

CNRFP aThere are also several institutions that have evolved in the past 14 years because of support for RCS…. Noguchi Memorial Institute or medical research in Ghana and the health research facilities in Kitampo, Bagamoyo, Centre Muraz Bobo Diolasso and the Centre Nationale de Recherche et de Formation Paludisme (CNRFP) in Ouagadougou.   CNRFP received the first grant in 1999 (slide 11) to study the relationship between malaria transmission intensity and clinical malaria, immune response and plasmodic index. The institution has since grown from a modest staff of six in 1999 to 36 currently.

It has acquired well established capacities for operational / implementation research, clinical trials and studies on vector management (slide 113, and funding from several international partners.

These stories illustrate how capacity is being built in Africa not only by WHO/TDR and the MIM but also MCDC, the WT, EDCTP/EC, the NIH, BMGF and SIDA/SAREC among others.

Is this enough? And can we rest content on the success and contributions of the current generation of African malaria researchers?  Is the capacity adequate?

It will be naive to look at Africa as a single entity as is often done.  The capacity (human resource and infrastructure) for research and control against malaria does not match the burden or the scope of the battle.  There are still places where there are:

  • Limited human resources
  • Lack of infrastructure
  • Funding disparity
  • Limited access to technology
  • Limited interactions between the research and control communities

CNRFP Scientific staff aThe last of these….. “limited interactions between research and control communities“ in particular pose a significant barrier to effective deployment of interventions and strategies.

It is not enough to prove that a strategy or an intervention works (often in a controlled setting).  In the real life context, there are multiple factors ranging from the quality and structure of the health system, to culture, the political, and the socio economic  that impact on our ability to effectively implement or scale up for impact.

The next generation of malaria researchers in Africa must be able to better address this gap if we must extend the frontiers of malaria elimination and shrink the malaria map further.

I can say most of the current generation (my generation) stood on the shoulders of an older generation of African scientists and their collaborators in other continents (someone referred to them as baobab trees a few days ago), the exposure, training, mentorship and the opportunities they created following Dakar have helped us along……

However when you consider the proportion of Africans speaking at the plenaries during this conference and the number of young scientists and graduate students attending as a whole, I think we have still have a long way to go!

How can we foster the next generation and further strengthen capacity for malaria research in Africa – within the unique context of each country.

As I conclude I want to reflect on the African perspective of training needs and solutions. 14 years ago in identifying enhancers of developing and maintaining a research career in tropical medicine in Africa, we put forward the following:

  • Research funding
  • Research infrastructure
  • Communications
  • Better salaries and career development
  • High quality training

To this I could add one more …. Mentoring

CAM01526 smThese issues remain highly relevant and must be continuously addressed if we are to sustain and indeed improve malaria research capacity in Africa.

Since the creation of MIM, we have seen an increase in research funding in Africa, emergence of centers of excellence, better communication and collaboration to a large extent driven by the global it boom. Better salaries, career development and high quality training!

However in general, funding for research including operations research (and capacity building) in Africa is to a large extent dependent on external funding.

National efforts at capacity building are to a large extent limited to statutory funding for graduate, postgraduate and diploma programmes. Beyond this there is little funding for post-doctoral research training, operational research within programs or innovative product research and development.

In the more than almost one and a half decade since the global community committed to Roll Back Malaria, we have had malaria initiatives from presidents but the human resources to under pin these efforts remain inadequate. We have to do better in capacity building so that 10 years down the road, there is a new generation of well-trained people embedded in the endemic countries with the capacity to optimise the tools and develop new ones if necessary.  Now is the time ……….

  • To lobby and convince African political leaders and governments to invest in research and capacity building
  • To convince the African billionaires who feature in Forbes list to invest in African scientists
  • And to the senior, successful and established African scientists and managers…. It is time to invest in younger talent as mentors.

In 1997, MIM was in the vanguard of an effort to address the issues of

  • Research funding
  • Research infrastructure
  • Communications
  • Better salaries and career development
  • High quality training

Bringing these issues to the attention of the international community and in some cases providing inputs to address them is still an important part of the MIM agenda.

The MIM is even more important now as an advocate for research and capacity building in Africa. WHO/TDR will work with the MIM secretariat to conduct an independent review of the MIM for continued relevance and contribution to the fight against malaria.

Uncategorized Bill Brieger | 10 Oct 2013

Pan-African Moquito Control Association Launches at MIM2013

The idea for a Pan-African Mosquito Control Association (PPAMCA) was floated at the 2009 Multilateral Initiative for Malaria Conference in Nairobi.  As a result, both Kenya and Nigeria formed associations. Now the ground is set for a true launching of the continent-wide association.

PAMCA President outlines development steps

PAMCA President outlines development steps

The formal launching took place at the 6th Pan-African Malaria Conference in Durban today. Chioma Amajoh, former Director of the Nigeria National Malaria Control Program (NMCP), chaired the event.

The PAMAC President, Charles Mbogo, outlined the steps in the formation of PMACA as seen in the photo. He also explained that strong ties with the World Mosquito Control Association and the American Mosquito Control Association would provide guidance in training and new tools for PAMCA and the new country chapters that will hopefully soon be formed.

Maureen Coetzee emphasized that PAMCA can develop new entomological talent

Maureen Coetzee emphasized that PAMCA can develop new entomological talent

Maureen Coetzee of the Wits University in Johannesburg and a reknown entomologist gave the keynote address. She was worried about predictions that entomologists were going extinct and welcomed PAMCA as a way to foster new talent. She stressed the need for support for vector control, not just from the malaria community but also from the corporate world, examples of while have been presented at MIM2013, the different types of disease organisms ranging from viruses, filarial worms to plasmodia parasites were evidence of the huge job awaiting PAMCA. PAMCA as the umbrella to national chapters can liaise with the AMCA, for example, to develop better monitoring and evaluation tools and with country chapters to facilitate the registration and regulation of chemicals.

PAMCA CAM01482Michael MacDonald, Co-Chair of the Roll Back Malaria Vector Control Working Group emphasized the need for qualified vector control workers at national, provincial, district and local levels. As a consultant to WHO, he outlined new WHO publications on capacity building in vector control that can guide PAMCA.  Dr MacDonald also noted that PAMCA could help members take advantage of new technologies from Geographical Information Systems to mobile technologies.

Sam Awolowo a quiet but dedicated leader of Nigeria's MCA

Sam Awolowo a quiet but dedicated leader of Nigeria’s MCA

Sam Awolowo, President of the Nigeria Chapter lamented that their NMCP could find only 20 qualified medical entomologists in 2010 (although there were more in the agricultural sciences). He said that their chapter is working closely with the NMCP on technical committees as well as strategizing ways to create a arger pool of qualified vector control workers.

Finally the famous singer Yvonne Chaka Chaka, who is also a RBM Good Will Ambassador, lent her support to PAMCA in words and song. In her introduction the Chair noted that not only was she involved in the fight against apartheid in South Africa, but had now transferred her considerable energies to the battle against mosquitoes.

Yvonne Chalka Chaka and RBM Communicationms co-chair Louis da Gama carry the malaria message far and wide

Yvonne Chalka Chaka and RBM Communicationms co-chair Louis da Gama carry the malaria message far and wide

Ms Chaka Chalka said that while she is happy to be some WOMen (well organized men), she would not want to be a female mosquito who carries malaria parasites. She observed that mosquitoes do not carry passports or visas, echoing the importance of cross-border transmission highlighted during MIM2013. She called on Africa’s leaders to train the young ones in skills to control malaria and mosquitoes and offered 100% support for PAMCA as it demonstrates Africans working together to help Africans.

Those who are interested and able to get involved, check out the www.pamca.org and join for the $40 membership fee.  Everyone should add their voices to the fight against malaria and mosquitoes in Africa.

Vector Control Bill Brieger | 10 Oct 2013

Launching PAMCA: MALARIA ELIMINATION IMPOSSIBLE TO ACHIEVE WITHOUT AFRICAN ENTOMOLOGISTS

MALARIA ELIMINATION IMPOSSIBLE TO ACHIEVE WITHOUT AFRICAN ENTOMOLOGISTS

MIM2013 Pan African Malaria Conference, Durban, South Africa – 16:30 pm 10 October 2013

pamca logoMajor success in the fight against malaria has largely been due to efforts aimed at killing mosquitoes. The targeted attack has involved deployment of bed nets and indoor sprays that include insecticides. But mosquitoes are developing resistance to these chemicals while at the same time global funds for their deployment are shrinking. In the push towards global elimination of malaria, we need to get smarter in the way we wage war against our six-legged enemy.

Entomologists are those intimately associated with the whereabouts and happenings of mosquitoes. They spend hundreds – if not thousands – of hours trekking through muddy villages, inspecting watery holes for young mosquito larvae, and collecting mosquitoes resting on walls of huts. Basic tests for the killing power of insecticides are performed in make-shift field laboratories in hotel rooms or even converted shipping containers. Essential information on mosquito behavior guides which anti-mosquito tools to use where, and at what time. It can be the difference between choosing a tool that will have high impact or no impact, decision which can amount to millions of dollars and thousands of lives. The expertise of entomologists is critical in guiding anti-malaria efforts.

Yet there is a dire shortage of entomologists worldwide and across Africa. Some high-burden African countries have less than a handful of expert entomologists. Very few African countries have entomology programmes at undergraduate university level. Specializing at a higher level is impossible without guidance from an experienced mentor, of which there are precious few.

The new Pan-African Mosquito Control Association brings together members of this elite yet endangered group from across the continent. As a united group, they will provide leadership and training to the next generation of entomologists. Efforts also focus on providing critical technical support as countries refine their malaria elimination strategies. Together they issue a sustained call for increased investment in this critical area.

The successful launch of PAMCA will be celebrated at the 6th Pan-African Malaria Conference held in Durban this week. The celebration will be graced by the Goodwill Ambassador for the Roll Back Malaria Partnership, Ms Yvonne Chaka Chaka. Over 50 renowned entomologists from Africa and beyond are expected to attend.

“This initiative is thoroughly welcome. We cannot relent in the fight against malaria – and African entomologist are our best weapon“, said Ms Chaka Chaka. “It will be impossible to say goodbye to malaria for good without their expert help”.

Those equally engaged in the fight against mosquitoes but unable to attend the launch celebrations are urged to join the cause via www.pamca.org.

For more information, please contact PAMCA Communications:
Tessa Knox
Tel:    +254 733 433 392
Email: tessaknox@hotmail.com
communications@pamca.org

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