Tropical Health Matters

Herbs, soil and hard scientific work have yielded Nobel Prizes in Medicine/Physiology for three scientists whose results now save millions of lives from death and disability due to malaria, onchocerciasis (river blindness) and filariasis (elephantiasis), according to the New York Times. Two of the winners, “Dr. Campbell and Dr. Omura, developed Avermectin, the parent of Ivermectin, a medicine that has nearly eradicated river blindness and radically reduced the incidence of filariasis.” Dr Tu Youyou, “inspired by Chinese traditional medicine in discovering Artemisinin, a drug that is now part of standard anti-malarial regimens and that has reduced death rates from the disease.”

Community Case Management of Malaria in Rwanda using Rapid Diagnostic Tests and ACTs

The development of these chemicals into human medicines was a long time coming, and in the case of artemisinin, over 2000 years. The Guardian quotes the Deputy Director of the Liverpool School of Tropical Medicine as saying that, “Artemisinin was discovered when fatalities from malaria were rocketing and the world was terrified we’d be looking at a post-chloroquine era. It has been a real game-changer.”

In fact artemisinin in combination with other medicines or artemisinin-based combination therapy (ACT) rescued many lives in the face of parasite resistance to earlier first line drugs like chloroquine and sulfadoxine-pyrimentamine (though artemisinin resistance is now growing). ACTs are also made freely available to populations in malaria endemic countries through such programs as the Global Fund to fight against AIDS, TB and Malaria (GFATM), the US President’s Malaria Initiative, the World Bank and others.

Avermectin began its medical role as a veterinary drug that killed parasites in livestock. Eventually research by Merck based on the similarities between animal and human filarial worms led to the testing and development of ivermectin to control onchocerciasis through annual doses that killed microfilariae.

Not only are both ACTs and ivermectin on WHO’s essential medicines list, but they form the basis of global efforts to eliminate disease. Once Merck determined that ivermectin was safe and effective in humans, it began donations of the drug to what has become the African Program for Onchocerciasis Control (APOC) and its counterpart that is working to eliminate the disease in the Americas. APOC and its national counterparts now reache people in over 200,000 endemic villages in 18 African countries with annual doses.

Community Directed Distribution of Ivermectin in Cameroon

While we celebrate the recognition that the drugs and their discoverers are receiving, we should not lose sight of the fact that without good delivery mechanisms these life saving medicines would not reach the poor, neglected, often remote populations who need them.

Beginning in 1995, APOC and the Tropical Disease Research Program of WHO and partners pioneered what has now become known as Community Directed Interventions (CDI) where the thousands of communities “beyond the end of the road” and their selected volunteers organize the annual ivermectin distributions. This community directed approach works for community case management of malaria, too.

Hopefully in the future, groups like APOC will receive Nobel Prize recognition for ensuring that those in need actually receive the medicines they require. In the meantime we encourage more countries to adopt the CDI approach to reduce malaria deaths and work toward the elimination of malaria, onchocerciasis and filariasis.

The African Health Initiative (AHI) will be presenting a second panel During the upcoming Third Global Symposium on Health Systems Research in Cape Town (30 September-3 October), entitled “Achieving People Centered Health Systems in Five African Countries: Lessons from the African Health Initiative.”

AHI was established in 2008 by the Doris Duke Charitable Foundation and seeks to catalyze significant advances in strengthening health systems by supporting partnerships that will design, implement and evaluate large-scale models of care that link implementation research and workforce training directly to the delivery of integrated primary healthcare in sub-Saharan Africa.

The five AHI country projects (Ghana, Mozambique, Rwanda, Tanzania and Zambia) will be sharing their experiences during the panel presentation. We will be tweeting at each panel presentation, and you can follow at: #HSG2014 and “Health  Systems Global” and “Bill Brieger Malaria“.

Highlights of the second panel follow:

Community health workers in Tanzania

It is a common claim that randomized controlled trials (RCT) are the ‘gold standard’ for scientific inference, with rigor derived from the imposition of stable interventions and statistically robust controls, and power derived from operational units as study observations. In health systems research, however, the ‘gold standard’ is more appropriately based on the relevance of research to decision-making. As a consequence, impact research is appropriately combined with implementation research, and units of observation are based on the way that systems function and decisions are made.

Mixed method complexity trials are indicated, with units of observation that integrate research with management processes. Presentations by scientists who are engaged in complexity trials in Ghana, Mozambique, Rwanda, Tanzania, and Zambia will highlight statistical designs that violate conventional standards of RCT, but derive rigor from mixed method research, hierarchical observation and modeling, and plausibility trials.

“Proof of utility” is derived from the operational adaptation of project implementation to local realities, monitoring process and outputs, testing impact, and revising strategies over time as needed. A learning process approach produces evidence-generating localities where operations serve as realistic models for large scale change in national systems.

Various terms used in the scientific literature to characterize this theme, such as ‘open systems theory’, the strategic approach, or participatory planning, each embracing the perspective that people centered service systems are essential to health systems strengthening. Practical examples of how to achieve people centered programming, however, are rare.

This panel presents five case studies that have confronted the challenge of developing, testing, and sustaining people-centered health systems in resource constrained settings of sub-Saharan Africa. These are outlined below.

– The Ghana Essential Health Interventions Programme tests the child survival impact system strengthening interventions. When monitoring identified perinatal health problems, priority was shifted to improving newborn and emergency referral services. Combined with political advocacy, changes increased access, improved quality, and expanded the range of services.

– The Mozambique project improves service quality by giving facility, district and provincial managers skills for identifying and fixing systems problems. Initial skills-building through training in leadership and management had only transitory effects. An evidence-driven redesign improved facility and district level operations and improved accountability.

– In Rwanda health-center-focused quality improvement data identified strategies for compensating health centers for reaching specific operational goals. Initial results show that the scheme has enhanced performance and fostered cross-center learning.

– The Tanzania Connect Project tests the survival impact of deploying community health workers. Connect monitoring showed that unmet need for family planning was inadequately addressed. Connect was redesigned to include comprehensive doorstep family planning services.

– Zambia’s Better Health Care Outcomes through Mentorship and Assessment project was developed from people centered lessons emerging from scaling up an HIV program. A 42 cluster stepped wedge tests the impact of improving outpatient care with training, structured forms, electronic data capture, and community engagement. In response to implementation challenges, volunteer density was increased and mortality and clinical data capture operations were reformed.

While the studies employ contrasting designs, the projects share an adaptive approach to implementation. A concluding session summarizes lessons learned and implications for health systems strengthening in Africa.

Kate Whitfield is sharing with us the following information about MESA‘s operational research …

New operational research projects in malaria elimination started in April 2014, after being selected for funding through MESA (the Malaria Eradication Scientific Alliance).

The MESA operational research portfolio includes: proof-of-concept of novel vector control and diagnostic tools, use of mapping technologies for surveillance and tailored response, and mobile phone applications for hard to reach populations. Urban, rural and forest settings are addressed. The projects are summarised below …

• Mopping up and getting to zero: mapping residual malaria transmission for targeted response in urban Lusaka, Zambia.
• Using voice]based technology to improve access to malaria care and treatment among high risk mobile population of forest goers in Cambodia.
• Applying novel nucleic acid surveillance to malaria elimination in South Cotabato Province, Mindanao, The Philippines.
• Efficacy and safety of high]dose ivermectin in reducing malaria transmission.

inety-one proposals were submitted to the call and after a thorough review process with an independent Peer Review Panel, 4 were selected for funding. The Peer Review Panel was composed of 12 experts from all over the globe. You can find a schematic of the review process through this link.

MESA (the Malaria Eradication Scientific Alliance) follows-up on the mal ERA agenda and provides a dedicated platform for the community in order to accelerate the translation of the science of malaria eradication for impact.

World AIDS Day coming up on Sunday 1 December 2013 is not just a time to think about progress and challenges of one infectious disease, but the interaction between HIV and other infections, especially Malaria.  Adu-Gyasi and colleagues express the relationship well in their article on malaria among HIV patients in Ghana: “Malaria is associated with an increase in HIV viral load and a fall in CD4-cell count. Conversely, HIV infection disrupts the acquired immune responses to malaria and the efficacy of antimalarial drugs.” Recent research provides continued insight that we must look at the two diseases as a joint problem in malaria endemic regions.

Research was conducted on mice that were infected with P. chabaudi malaria. The mice showed increased gut and genital mucosal T cell immune activation and HIV co-receptor expression. The implication of the findings was that malaria infection might enhance the sexual acquisition of HIV in humans, and the authors recommended further research to learn more.

In another study researchers looked at Malaria and HIV co-infection and their effect on haemoglobin levels from three health-care institutions in Lagos, Nigeria. The data showed that the total number of malaria infected patients were significantly higher in HIV sero-positive patients 47.7% (31/65) when compared with their HIV sero-negative counterparts 25.8% (262/1015) P = 0.047.  Not only was there a higher prevalence of malaria in HIV infected patients but also patients co-infected with malaria and HIV were more likely to be anaemic.

Both HIV and malaria in pregnancy present serious problems. Another recent study looked at Cotrimoxazole (CTX) prophylaxis versus mefloquine (MQ) intermittent preventive treatment (IPT) to prevent malaria in HIV-infected pregnant women. The study concluded that, “CTX alone provided adequate protection against malaria in HIV-infected pregnant women, although MQ-IPTp showed higher efficacy against placental infection. Although more frequently associated with dizziness and vomiting, MQ-IPTp may be an effective alternative given concerns about parasite resistance to CTX.”

Concern about malaria and HIV in pregnancy also focuses on the child. Research examined malaria diagnosis in pregnancy in relation with early perinatal mother-to-child transmission (MTCT) of HIV.   The authors reported that “HIV MTCT risk increased by 29% (95% CI 4-58%) per MIP episode. Infants of women with at least two vs. no MIP diagnoses were 2.1 times more likely to be HIV infected by 6 weeks old (95% CI 1.31-3.45).”

Finally since concurrent experience of both malaria and HIV infections means taking multiple drugs, researchers have also looked at the potential challenges of drug interaction. “An extensive literature search produced eight articles detailing n = 44 individual pharmacokinetic interactions.”  While various HIV medications either increased or decreased the exposure to malaria drug components including lumefantrine and artemisinin, artemether-lumefantrine or artesunate combinations generally had little effect on the pharmacokinetics of HIV-antivirals (with two exceptions).

It is difficult to say which disease is closer to reaching elimination goals, but unless both are understood from their mutual impacts on transmission and treatment of the other, both will continue to elude control efforts.

During 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

Sam 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.

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…

Twenty 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!

The 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.

There 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

The 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

These 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.

The Special Programme for Research and Training in Tropical Diseases (TDR – Unicef/UNDP/World Bank/WHO) seized the opportunity of the Multilateral Initiative on Malaria (MIM) 6th Pan-African Conference on Malaria in Durban 6?11 October to touch base with its ‘alumni’ who have received research and training grants over the almost 40 years since its inception.  A workshop was held discuss a new TDR alumni network platform and seek input on ideas for what that platform might look like and accomplish.

TDR has trained and supported thousands of researchers across the globe. We would like to assess how we can continue to support our alumni and their connections to people and institutions. This is a major new initiative that TDR will develop in 2014, and it wanted people who are familiar with TDR to provide feedback to initial plans for a new platform that will allow for better tracking of career progression and promotion, and to get ideas on how to increase opportunities for collaborations with other researchers and funders.

The idea of an alumni network was received enthusiastically by the more than 40 participants at the session, many of whom attested to the crucial role TDR played in their scientific careers either by supporting their doctoral studies or providing them grants that resulted in published work that help promote their careers.

Participants discussed various web based options where alumni profiles could be maintained and opportunities to share skills and solicit collaboration on research and training activities.  Other suggestions included an alumni newsletter and regular alumni meetings to coincide with international conferences that address the diseases of poverty.

TDR Director John Reeder said the organization was enthusiastic about receiving alumni input.  This participation will hopefully reinvigorate an organization that had been in a quiet transition over the past few years. The network will provide a good opportunity to learn how TDR investment in individuals and small teams has spawned further discoveries and disease control innovations.

On a personal basis, I can say that TDR grants to our team at the University of Ibadan beginning in 1981, helped us refine the concepts and capacities of volunteer community health workers (CHW) in tropical disease control including a contribution to guinea worm elimination in Nigeria, dissemination of pre-packaged anti-malarial drugs and refining the concept of the community directed distributor of ivermectin for onchocerciasis control and elimination.

These CHW principles have been worked into a new offering on Coursera, “Training and Learning Programs for Community Health Workers,” so that others can benefit from the lessons engendered through TDR support. Hopefully other alumni can use the network to share the benefits they have gained from TDR.

The World Health Report 2013 entitled Research for Universal Health Coverage has been released. Since universal coverage has been a central Roll Back Malaria target since 2009, we have included below some of the mentions of studies and activities around malaria service provision and scaling-up.

The case for investing in research is made, in part, by demonstrating that scientific investigations really do produce results that can be translated into accessible and affordable health services that provide benefits for health… In one (example) a systematic review of survey data from 22 African countries showed how the use of insecticide-treated mosquito nets was associated with fewer malaria infections and lower mortality in young children. This evidence underlines the value of scaling up and maintaining coverage of insecticide-treated nets in malaria-endemic areas. (page xiv)

(Environmental risk factors) also contribute to the transmission of vector-borne diseases: malaria is associated with policies and practices on land use, deforestation, water resource management, settlement siting and house design. (Page 41).

By killing or repelling mosquitoes, insecticide-treated bed nets protect the individuals sleeping under them from malaria. By killing mosquitoes, they should also reduce malaria transmission in the community. Randomized controlled trials conducted in sub-Saharan Africa in a range of malaria endemic settings have provided robust evidence of the efficacy of ITNs in reducing malaria parasite prevalence and incidence and all-cause child mortality. Such trials showed that ITNs can reduce Plasmodium falciparum prevalence among children younger than five years of age by 13% and malaria deaths by 18%. (page 61)

(More research is needed because) In contrast with the findings of controlled trials, ITNs may be less effective in routine use because the insecticidal effect wears off, or nets may be used inappropriately or become damaged. The impact of ITNs, as used routinely, on malaria and childhood mortality is therefore uncertain.  (page 62)

As we can see from the World Health Report, malaria research has made a major contribution to our understanding of factors and effects of scaling up programs to try to achieve universal coverage.  As WHO recommends, more funding for health service coverage is needed, and malaria countries countries themselves need to contribute their own share in supporting their own research institutions.

Tuberculosis is one of the big three receiving Global Fund support, and like HIV and malaria control efforts, the emphasis is on multiple interventions to ensure ultimate success. Compared to the other diseases, TB’s interventions have been mainly limited to immunization and directly observed treatment. Both of these interventions have recently met some major challenges that have also plagued the other big diseases.

Roger Bate and colleagues, who have focused on the problems of fake and substandard malaria drugs have turned their attention to TB. (see http://masetto.ingentaselect.co.uk/fstemp/a5829970064042ab6ec12023d514ef4f.pdf ). Their investigation at pharmacies in 19 Asian and African countries found around 9% of TB drugs were substandard/poor quality. The rate of fake medicines was 16% in Africa and 10% in Asia.

Governments in these countries were encouraged to give these issues greater attention including better regulation and collaboration with international policing efforts.

The need for new vaccines is a necessary development to maintain a strong disease control arsenal. For TB, “A new vaccine, modified Vaccinia Ankara virus expressing antigen 85A (MVA85A), was designed to enhance the protective efficacy of BCG.” (as reported in The Lancet http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960177-4/abstract )

As the BBC report on this study pointed out, “BCG is only partially effective against the bacterium that causes TB, which is why several international teams are working on new vaccines.” (see BBC at http://www.bbc.co.uk/news/health-21302518 )

While the new vaccine “… was well tolerated and induced modest cell-mediated immune responses. Reasons for the absence of MVA85A efficacy against tuberculosis or M tuberculosis infection in infants need exploration.” Fortunately research on other vaccine candidates is underway.

Continued control and eventual elimination of malaria and TB will require research that is both basic (vaccines) and applied (drug quality) in order to develop, maintain and implement effective strategies. Disease research budgets should not be compromised in the ever changing world of pathogen/parasite evolution.

The Nigerian Institute for Medical Research (NIMR) in Yaba, Lagos has been a major player in generating knowledge about malaria for national and international policy makers. Just a few days ago, one of its distinguished researchers Dr. P.U. Agomo (BSc Hons, MSc, PhD, AIMLS) retired after 32 years of service. He had attained the post of Director  of Research  (Biochemistry  and Nutrition) at NIMR. Below is the citation provided by NIMR on the occasion of his send-off party, 13 August 2012.

Dr Philip Agomo was born in August, 1947. He graduated from Greenwich University, London,  UK with  a BSc (Hons)  in  Biochemistry  (1973),  MSc in Applied Immunology from Brunel University, Uxbridge, Middlesex, England, UK (1977) and PhD from University of London, UK (1980).

Dr Agomo joined NIMR in 1980 as a research Fellow II and rose through the ranks of leadership to become the Director of Research (Biochemistry and Nutrition)  in 2008 and acting Director General of NIMR  from  July 2008 to May, 2010. Dr Agomo has also served the World health Organization (WHO) as an adviser on Antimalarial drug packaging for home management of malaria, appropriateness of childhood fever treatment in Africa, Health Sector Reform for Capacity Strengthening  and Malaria control in Africa and implementation  of community based management of Acute respiratory  infection  (ARI)  in Africa.

At the regional level, Dr. Agomo served West African Health Organization (WAHO) as an adviser on Health Research System Strengthening in the West African region. He also served as the Chairman of the Monitoring and evaluation sub-Committee of the National Malaria Control Committee (transformed  to NMCP in 2005) from 2001 to date.

Dr Agomo has also participated in many malaria control programmes at international,  regional, national and state levels as a Principal Investigator winning many  academic awards and research grants. Notable among these is the placement of NIMR as a training sub-recipient in the implementation  of global fund round 4 phase 2 (2008)  and round 8 (2010),  funded with about N150m Naira.

Dr. Agomo is well recognized not only for scholastic, administrative  and leadership qualities but also as a mentor of students and junior research scientists at NIMR, in Nigerian universities and outside the country. He has produced more than 10 PhD holders as a co-supervisor  in Malaria research (Pharmacokinetics,  Drug Resistance and Immunology),  Nutritional  Biochemistry  and Toxicology.  Dr. Agomo has to his credit over 80 scientific publications in peer-reviewed journals. He is happily married and blessed with two children. He is also a grandfather. 

Below are a few of Dr Agomo’s malaria-related publications that span his 30-year career:

• Prevalence of malaria in pregnant women in Lagos, South-West Nigeria. Agomo CO, Oyibo WA, Anorlu RI, Agomo PU. Korean J Parasitol. 2009 Jun;47(2):179-83. Epub 2009 May 27.
• Efficacy, safety and tolerability of artesunate-mefloquine in the treatment of uncomplicated Plasmodium falciparum malaria in four geographic zones of Nigeria. Agomo PU, Meremikwu MM, Watila IM, Omalu IJ, Odey FA, Oguche S, Ezeiru VI, Aina OO. Malar J. 2008 Sep 9;7:172.
• Treatment of childhood fevers and other illnesses in three rural Nigerian communities. Salako LA, Brieger WR, Afolabi BM, Umeh RE, Agomo PU, Asa S, Adeneye AK, Nwankwo BO, Akinlade CO. J Trop Pediatr. 2001 Aug;47(4):230-8.
• Analysis of human antibodies to erythrocyte binding antigen 175 of Plasmodium falciparum. Okenu DM, Riley EM, Bickle QD, Agomo PU, Barbosa A, Daugherty JR, Lanar DE, Conway DJ. Infect Immun. 2000 Oct;68(10):5559-66.
• Effect of chlorpheniramine on the pharmacokinetics of and response to chloroquine of Nigerian children with falciparum malaria. Okonkwo CA, Coker HA, Agomo PU, Ogunbanwo JA, Mafe AG, Agomo CO, Afolabi BM. Trans R Soc Trop Med Hyg. 1999 May-Jun;93(3):306-11.
• “Antimalarial” medicinal plants and their impact on cell populations in various organs of mice. Agomo PU, Idigo JC, Afolabi BM. Afr J Med Med Sci. 1992 Dec;21(2):39-46.
• Cell-mediated immunity in the liver of mice vaccinated against malaria. Playfair JH, De Souza JB, Dockrell HM, Agomo PU, Taverne J. Nature. 1979 Dec 13;282(5740):731-4.
• Development and suppression of a population of late-adhering macrophages in mouse malaria. Lelchuk R, Taverne J, Agomo PU, Playfair JH. Parasite Immunol. 1979 Spring;1(1):61-78.