the Malaria Institute at Macha

MIAM activities featured in NATURE, at http://www.nature.com/news/2008/080227/full/4511047a.html

MIAM's TB lab is up and running. Recently, two students of Erasmus MC of the Netherlands, supervised by Sue Penno and Janneke van Dijk, demonstrated the feasibility of such a lab even in Macha's remote resource-poor rural settings. Using only sputum smears, 20 out of 170 patients were AFB positive, while using MGIT culturing an extra number of 50 patients were positive. One problem faced was discriminating TB from nonTB. Therefore, Dick van Soolingen (Head of the Mycobacteria lab of the Institute for Health and the Enviroment [RIVM] in Bilthoven, The Netherlands) and his wife Patricia Buijtels visited Macha in September 2007 and successfully introduced Haynes lineblot PCR technology. Thus this TB lab in a rural hospital now uses liquid TB culturing as well as PCR based determination.

MIAM is part of the National Malaria Research Working Group, which meets quarterly and aims to align research agenda's and discuss local research needs. The following overview of MIAM's activities in the field of Malaria Research was presented at the 2nd Quarter meeting in July 2007.

The study was carried out in 2003 to determine the extent of anaemia that was responsive to iron therapy in the pediatric population living in the Macha area of southern Zambia. A simple protocol was designed whereby children in villages surrounding Macha Mission Hospital were screened for anemia at the end of the "malaria season" - those found to be anaemic were randomized to receive either daily ferrous sulphate or placebo for three months, followed by repeat determination of haemoglobin. Of the 402 children screened, 232 were enrolled with 4 subsequently disqualified upon re-calculation birth dates, and 198 completed the study. The mean increase in haemoglobin levels between the two groups (iron vs. placebo) over the three-month period was similar, 2.1 g/dl in the iron group, and 1.7 g/dl in the placebo group, with no statistically significant difference seen. We conclude that iron deficiency is not a major cause of anaemia in children in the Macha area of Zambia, and that recent malaria infection most likely contributes significantly to childhood anaemia in this population.

Published in the Medical Journal of Zambia 2007; 34:2 by J van Dijk, L Hachaambwa, M Mulenga, S Mharakurwa, P Thuma

Poster Presentation

EDTCP - European & Developing Countries Clinical Trials Partnership uses 2 Macha girls on their publications!

Authors: Aniset Kamanga, Harry Hamapumbu, Petros Moono, Janneke van Dijk, Sungano Mharakurwa, Phil Thuma, Timothy Shields, Gregory E. Glass,  Clive Shiff

Institution and Location: The Malaria Institute at Macha (MIAM), Choma, Zambia & Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Problem statement: Monitoring and tracking the progress of an endemic disease has always proved to be difficult especially in a situation where there is improper collection and management of data.

Objectives:
•    To establish a well documented geodatabase that will enable decision makers to choose the best options to combat an endemic disease.

A GCP training was held from December 13-15 at MIAM, facilitated by Dr. Biemba, executive director of CHAZ (Church Health Association Zambia). The course was very well attended and received by 42 participants, ranging from field workers, study nurses, doctors, lab personnel, school leavers, and other.

As a research institute, we would always encourage students to pursue a research mini-project while they are here - though one needs to be aware of several things; 1) Any research on humans carried out here has to be approved by an internationally recognized Ethics Committee, both in the country (we use the one at University of Zambia), as well as by the Ethics Committee (or Institutional Review Board) of the institution which would be sponsoring the student and the project. 2) The Ethics Committee in Lusaka takes usually 3 - 6 months to give approval, so we have to start this process very early! In addition, the submission fee is $300 plus it takes several trips to Lusaka, costing about another $350 each trip for transport costs.