Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.
The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.
The light at the end of the tunnel has never been so near. And for Africa, even before the targeted 2015, the RTS,S candidate vaccine is very likely to become a licensed drug protecting African children against malaria.
Studies have demonstrated that the vaccine is capable of inducing long-term protection against malaria for up to 45 months after initial vaccination.
Scientists anticipate preliminary results of the phase III trials could be released by 2013 and the final results expected by 2014.
Many have predicted that day to be the moment the universal spotlight stays on our continent for a long time. But even as the spotlight shines on Africa, we will remember that a proactive institution- Malaria Clinical Trials Alliance (MCTA) of the INDEPTH-Network worked tirelessly to build the capacity of African Scientists to lead the process. Five years ago, it would have been deemed impossible that African scientists can lead the search for a malaria vaccine.
The MCTA, a program, funded by the Bill & Melinda Gate’s Foundation, provided the milieu that enabled many African countries to carry out the RTS,S trials on a large scale in seven countries namely, Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique, and Tanzania.
The training of skilled research personnel and the recruiting of field workers and trial participants, was a herculean task in view of the novelty and the sheer size of the research- involving16,000 children across the trial sites in 2010 alone .
The Picture Before
Inadequate staff, congested laboratories, poor infrastructure and unskilled manpower were common features at the various research centers before the MCTA came on the scene.
Old congested laboratory in Kintampo
before the MCTA started.
Old Medical Research Unit, Albert
Schweitzer Hospital , Gabon
The run-down laboratories in Kintampo, Ghana and Lambarene in Gabon, as seen here, reflect the state of laboratories across research sites in Africa before the MCTA gave them a Midas touch.
Patients with serious infections like tuberculosis, for whom X-ray is critical, were usually referred to provincial general hospitals, situated many miles away.
A lot was taking place in the world of research with several promising drugs and vaccines being developed. But Africa with her malaria problem was left out. So also were their scientists. It became increasingly necessary therefore to build African capacity to conduct large-scale trials of appropriate drugs and vaccines.
This was the situation Africa found itself in, prior to the birth of the MCTA.
The MCTA story
MCTA was established in 2006 as a new initiative by the INDEPTH Network to help conduct clinical trials of new drugs and vaccines to fight malaria, a disease that kills 3000 African children every day. Without the MCTA, many countries involved in the malaria vaccine trials would have no opportunity, infrastructure and the human capacity to partake in the project.
MCTA has been working in partnership with the Gates Foundation grantees, Malaria Vaccine Initiative (MVI) and the Medicines for Malaria Venture (MMV), to train personnel and improve facilities and infrastructure to ensure the successful execution of clinical trials in 10 countries across Africa (Mozambique, Gabon, Tanzania, Nigeria, Malawi, Burkina Faso, Ghana, The Gambia, Kenya and Senegal) where trial sites have been identified for participation.
The RTS,S trials are running in eleven sites in 7 countries:
The research sites in the various countries of the trials were given tailor-made human and infrastructural capacity development to face the task ahead:
10 sites on the MCTA platform received support for infrastructural development in 2009:
Agogo Malaria Vaccine Trial Centre, Ghana, is part of the Kumasi Centre for Collaborative Research, KCCR
Modern laboratory equipment like these have been replicated at various sites doing the trials.
Research centre provided by MCTA in Kintampo, Ghana
Bagamoyo Research and Training Center, Tanzania
KEMRI/CDC, Siaya Site, Kenya
Kilifi clinical trial facility, Kenya
Fundação Manhiça- Moçambique
Medical Research Unit of Albert Schweitzer Hospital – Gabon
LILONGWE Clinical Trial Facility Malawi
The joy MCTA has brought into peoples’ lives is manifold.
Healthy baby, a participant
in RTS,S vaccine trials
The many job and learning opportunities provided by the sites is a positive development that has benefited workers and residents at the various sites, thanks to the ongoing research work.
Five students from Nanoro, Agogo, Bagamoyo, Lilongwe and Kisumu were sponsored to undertake MSc Clinical Trials at the University of Ghana.
Facilities at the Agogo Health Centre are so upgraded it is now rubbing shoulders with the Komfo Anokye Teaching Hospital in Ghana in terms of infrastructure.
In Kenya for example, digital X-Ray machines are available only at the MCTA study sites in Kombewa, Siaya district hospital and Kilifi . Most diseases, in the past, were treated based on clinical signs and symptoms.
MSc in clinical trials with The School of Public Health, University of Ghana
From left: Tapiwa Tembo, Sulley Malik, Ben Andagalu, Dr Alex Dodoo (Lecturer, behind), Kpoda Herve, Yakoub Achulo (at back), Michael Mihayo, Naana W. Brobby, Dr Priscilla Nortey (Lecturer)
Today, the equipments provided by the MCTA have increased diagnostic accuracy. Now the district hospital offers all the X-ray services to all patients and earns thousands of shillings in revenue.
Pictures produced by the X-ray equipment can be sent electronically anywhere in the world and results obtained as soon as possible.
Vehicles used by the researchers at the centers have on many occasions been deployed to convey accident victims to hospitals, in order to save lives.
The hospitals working with the MCTA have in some cases quadrupled the number of pediatric consultants. There is always a pediatrician on call. Kombewa, just like Agogo and other centers in the trials, has four pediatricians who combine work on the vaccine trials with seeing to patients with other complications.
Parents of trial participants confess that the children are healthier than those who did not receive any vaccine.
Seeing that diseases like polio have been controlled with vaccines, some communities present more children than the project requires. Those unable to participate in the trials, resort to bed nets to enjoy the benefits of a malaria-free life.
Mentorship and Exchange programmes
To ensure that its effort to build a critical mass of scientists in Africa is sustained, MCTA used a combination of approaches including exchange programmes by providing short term fellowship to research scientists to visit other sites. The aim was learn about different clinical trials and laboratory techniques of colleagues in other sites and to share experiences that could be useful to conduct research work at their sites. Another innovative idea is the mentorship programme that sought to pair senior scientists with experience in site development with sites development and implementation of the sites’ strategic plan over a period of time. Hopefully these initiatives will be sustained after MCTA folds up.
Even as we wait for the results of the vaccine trails, the scientists are already speaking of a reduction in the number of malaria cases at the out-patient department, due to the constant presence of doctors, required as part of the trial, thanks for the MCTA project.
There are already positive results from efforts of MCTA to link African scientists to universities in Africa to generate reliable scientific data for development and have made such sites credible research centers.
The Bill and Melinda Gates Foundation is happy with the improvement capacity and infrastructure and at the various sites that are now centers of excellence and is considering how to take the project further into the next phase.
RTS,S, was developed by GlaxoSmithKline Biological in collaboration with the Walter Reed Army Institute of Research. It is the only vaccine candidate shown in field trials to prevent malaria and, in one instance, to limit disease severity. The trials have been successful and the future is bright with a vaccine about only 3 years away.
Researchers hope that if licensed and subsequently approved, the vaccine would be an important addition to the current tools available to fight malaria. It is expected to be included in the Expanded Programme on Immunisation, EPI.
A philosopher once observed that history is the only laboratory we have in which to test the consequences of thought. Well, the MCTA put a great thought into reality, carving a niche for itself deep in the caverns of African history. The future is bright indeed for Africa.