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    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.


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.


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INDEPTH Network's contribution to research and policies on malaria is a glowing example of a vision becoming a reality. A malaria expert, renowned research scientist and brain behind the establishment of the Network, Professor Fred  Newton  Binka,  in  an  interview  with  the  African  Media  and  Malaria  Research  Network  (AMMREN), Correspondent, Theresa Owusu Ako, stressed that malaria can be eradicated with political commitment.

AMMREN:How did the INDEPTH Network story begin?
A: INDEPTH Network began with meetings which brought partners together early in 1998 in London, then Bellagio in Italy. We met finally in Dar es- Salaam, Tanzania in October that same year where  17 HDSS sites came together and signed the declaration to form the INDEPTH Network.

AMMREN: Why was it established?
A: It was established to do continuous follow up of people to understand their needs to help improve their lives.

AMMREN: What was the situation at the time?
A: Many groups were doing cross-sectional studies such as demographic and health surveys (DHS).   Once every five years, they administe red questionnaires and took snapshots of what existed in a place and went away. At the Navrongo Health Research Centre(NHRC), for example, we started developing the DSS in 1993 so this year is 20 years of continuous follow up of people who were  in the study. Children who were born into the  study at the time we started the study are twenty years old and we have been visiting them for the  last 20 years, which gives us better knowledge of the people and their health needs.

AMMREN: What  was  your  key  objective,  because INDEPTH has sort of concentrated a bit more on malaria?
A: Malaria is completely different from place to place, so if you sit in one corner and you find your results, the findings may not be applicable to all areas because of many factors. INDEPTH Network formed a great platform and it  convinced donors that the results of the Network will be much more  informative.  Take  the  example  of  the  INDEPTH effectiveness and safety studies of antimalarials (INESS) we are  doing  in  Mozambique,  Tanzania,  Burkina  Faso  and Ghana. When we see the results they look different and we need to know why the difference.

AMMREN: Any specific examples?
A: Yes. We  started with Ghana using artesunate-amodiaquine  (A SAQ)  and  Tanzania  using  artemether- lumefantrine (ALU), so already you have created a variation that will help you to measure performance. We saw that ALU  seemed  to  do  better  than  ASAQ.  We  expected  it because Ghanaians did not like the ASAQ anyway and it was imposed on them.

AMMREN: What will you consider as key malaria studies conducted by INDEPTH?
A: We covered a broad spectrum. We began  with  the epidemiology  and  for  the  first  time  it  was  tied  to  the demography. We published the paper, which WHO uses to determine  the  proportions  of  death  by  age  group.  We looked at causes of death at the INDEPTH sites which took about three years to put the data together. That was not funded by anybody, but because the DSS was there we could get data from all the sites on the number of people who have died. Because people were doing verbal autopsy we could assign the cause of death.

AMMREN: What were your findings?
We were able to show the distribution of the  causes of deaths  within  the  INDEPTH sites  and  malaria  was  a prominent cause of death.

We  also did an evaluation of the malaria control programmes. In Ghana, Navrongo, Kintampo and Dodowa actually assessed the state of control within our country. It was done the same way in Tanzania and Burkina Faso. Those were small studies. The real big ones were some that were there before INDEPTH came.   The  bed net  trials  were  done  in  places  with demographic surveillance systems, because we  wanted to measure deaths and the system provided the opportunity to  measure  deaths  because  everybody has  been  followed.  The  bed  net  trials were done in Ghana, The Gambia, Kenya and Tanzania.

AMMREN:  What  about  the  vaccine trials?
A:  Yes,  the  third  area,  which  we  have worked in is vaccine, because we already had a large population that allowed large-scale interventions to be undertaken.

The Malaria Clinical Trials Alliance (MCTA),  was  another  major  project meant to strengthen clinical trials capacity,  share  results  of  real,  on-the-ground trial activities and to codify best practices. It  was a  one-off  initiative which will never happen again.

A:  Because donors do not like to  fund 'brick  and  mortar,'  such  as  buildings.MCTA was meant to build structures to strengthen  health  research  sites  and build capacity of African scientists to carry out malaria research. So it took a while and a lot of pressure on donors to fund it, but it happened. The donor will  usually ask  “you are a scientist… what do  you know  about  buildings  and  developing sites?” So MCTA was a one-of-a-kind. We were lucky and successful and I do  not think there will be another project  like that for a long time to come.

AMMREN: What has been  INDEPTH's contribution to the generation of malaria data for policy?
A: There are a number of success stories that  could  be  attributed  to  INDEPTH. First and foremost, INDEPTH has made a case for the  need to measure. Malaria control  programmes  do  not  measure what they do.  If you do not measure you have not done it. When you  measure, then you can say, “look, I was there and I got here.” But generally our programmes are not designed that way.

This is one of the biggest contributions that INDEPTH has  made.   INDEPTH has been able to determine the cause of death in communities and has good estimates of the causes of death by transmission area. The other  contribution is being able to investigate any new large-scale  trials  of malaria tools.

AMMREN: What about other studies?
A: Under the INESS project, INDEPTH is looking at the system-related factors that will  reduce very efficacious drugs and make them less effective.

AMMREN: How are these relevant  for planning and policy formulation?
A: On the local network you may not see this much because most of the  African countries are very  dependent on WHO guidelines and not information generated from other platforms. For example we did a  bed  net  study  here,  but  the  Ghana government did not start using bed nets until WHO said that the bednets should be used.    However, a network such as INDEPTH, collects  data  from  several countries and the chances of influencing policy in various countries are higher. As a network, INDEPTH has been able to to  influence  policy  more  at  the  multi-country level than at the  national level, with data collected from several countries.

AMMREN: What are the  challenges  of the Network?
A: Apart from funding, one of the challenge has got to do with getting the Africans to be in charge of research. Our northern  partners  established  most research sites. In Navrongo for example, the British came to do the Vitamin A trials there.  It was only when they left that Ghana took advantage and established a health research centre.   In Kenya, it was the Americans who set up what is now the Kenya Medical Research Institute (KEMRI). Most of the sites there are run by  the American Centre for Disease Control  (CDC).  The  research  sites  in Mozambique  are  being run  by  the Spanish.  The  challenge  then  was  that anytime we try to take a decision, these institutions have to go back and consult with  their partners. So invariably, we struggled to start.

AMMREN: In your estimation, what will it take to move Ghana and other African countries closer to  malaria elimination and eventual eradication?
A: The answer is political commitment.
AMMREN: So are we on the right course or we are not?
A. We are not. Honestly how much is the government of Ghana contributing to the malaria control programme? No scientist can  ever  eradicate malaria. It is the politicians  who  would  say  it's  time  to eradicate  malaria. In the history of eradication politicians have always led. If we have a strong political leadership we will get there.

AMMREN: Any further comments?
A: In my own reflection, I think we need more networks such as INDEPTH Network to promote experience sharing and learning. It is easier for scientists to learn from  each other than to learn it from elsewhere. Today you are in Ghana running the programme and can  easily call  someone  in  Tanzania  for  support. Networking  has  worked  for  the  developed  world.  If  African  scientists  and researchers are able to create the environment for networking, they  will make great strides in the field of research.

Secondly, emphasis must be placed  on measuring in research. Everything we do must be measured. If we do not measure we  are  wasting  our  time.  And  people should not see the results of the measurement as something that is personal but as a way of  finding where things are working well and where things are not working well so that we can find appropriate solutions. This is very important.