tamanewsletter - MRC Unit The Gambia

TAMANEWSLETTER
Medical Research Council Unit, The Gambia
TAMA: Wolof. n. a talking drum
VOL: 10 ISSUE: 01 / JAN - FEB 2011
Leading Disease Control
& Elimination
Professor Umberto d’Alessandro,
the new Theme Leader: Disease
Control & Elimination, arrived in
The Gambia in January 2011. A
clinical epidemiologist from Italy,
Umberto is married to Annette, also
a clinical epidemiologist, and has
grown up children.
next page
Strengthening Paediatric
Research, Care and
Training in The Gambia
In early March 2011, Dr Kalifa Bojang (MRC (UK)
The Gambia) was seconded to the University of
The Gambia. He is taking up post as the Head of
the Paediatrics Department, Royal Victoria Teaching
Hospital, Banjul in a bid to build capacity in research,
healthcare and training.
From left: Dr Kalifa Bojang, Professor Muhammadou M O Kah
(Vice Chancellor – University of The Gambia), Professor Tumani
Corrah (Unit Director – MRC (UK) The Gambia), Professor
Ousman Nyan – University of The Gambia)
continued on 03
CONTENTS
04
WANETAM: Building bench capacity in Africa to fi ght TB
06
Fajikunda Health Centre receives signifi cant boost
07
Sibanor Studies Feedback Day
08
PROLIFICA consortium holds fi rst meeting in The Gambia
09
ICEMR West Africa kicks off in Senegal
10
News from Caio
11
Recent Unit Publications
13
The Clinical Research Laboratories – A Success Story
14
News from HR
17
BAES students learn about malaria
18
Environment Watch
Leading Disease Control & Elimination
Umberto d’Alessandro – continued from page 1
Umberto’s background
I graduated as a medical doctor in Pisa in 1982, where I also did my
specialisation in public health. After my diploma I went to Benin for two
years to work as a doctor in a medical centre [in lieu of military service
in Italy]. Not long after returning to Italy, I went to Kenya with an NGO
where I spent three years in a rural hospital on the border with Ethiopia
- and my son was born there.
On completing my MSc in community health in developing countries
in London I came to The Gambia as an epidemiologist in 1990. I led
the evaluation of the national bed net programme, based in Farafenni
for 3 years, and for one year I ran the clinical trial of the malaria SPf66
vaccine in Basse.
From there I joined the Institute of Tropical Medicine’s Department
of Parasitology in Antwerp, where I was made a permanent member
of staff in 1999. I set up the Unit of Epidemiology and Control of
Parasitic Diseases at the Institute: there we work only on malaria with
a multidisciplinary approach (molecular biology, epidemiology and
anthropology).
Coming back to The Gambia
It took a lot of thought before I decided to take up this post, because
my group in Antwerp is firmly established and running well. But I
wanted to go a bit closer to the field, and I felt that at this stage of my
career I could make a good contribution [by coming here]: I’ve spent
time not only in The Gambia, but also in East and other parts of West
Africa, South East Asia (Vietnam) and Latin America. I thought it was
time to put The Gambia into perspective – and to come back to the
‘real world’.
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My new post is demanding, but I am happy [with my decision]. It’s a
five-year secondment in principle: [currently] the unit in Antwerp is
being run by my wife Annette, but we are looking to recruit a leader so
that she will be able to come to The Gambia. It wasn’t planned like this
but we decided it would be better in terms of continuity.
Disease Control & Elimination: dreams for the new
Theme
I’d like to create a really multidisciplinary team as I did in Antwerp,
where we had the whole spectrum from basic lab science to social
science, and also to do research that is going to have an impact on
practices in The Gambia, the region and beyond. I work mainly on
malaria, so my first thinking is going to be on malaria research. Because
The Gambia has done so well, the research is going to be focused on
obstacles to malaria control/elimination and also on understanding
what’s happening at the national/regional level when you apply
interventions that reduce malaria substantially but not eliminate it
completely.
I hope the integration of MRC with the Government’s activities will
work very well. It’s very important that all the different actors –
including the NGOs - work synergistically and not in isolation. I would
like to contribute towards making these activities as complementary as
possible.
My remit as Theme Leader includes Hepatitis and Trachoma. I’ve met
with the Hepatitis group and I am happy to facilitate and help with their
activities. I am also preparing for discussions with the Trachoma group and there may be some interaction between the two areas of research,
for example on the Bijagos Islands (Guinea Bissau) where we may try
and do some studies at the same time.
Strengthening Paediatric Research, Care and Training in The Gambia
continued from page 1
A new chapter in this relationship has commenced with the secondment of Dr Kalifa Bojang (a paediatrician, clinical scientist and malaria expert)
from the MRC to the University. This is the second MRC secondment to the University: in 2003 Professor Ousman Nyan joined the School of
Medicine and Allied Health Sciences. Today, he is the Provost of the Medical School, one of the University’s Deputy Vice Chancellors and Chief
Medical Director of the Royal Victoria Teaching Hospital in Banjul.
At the signing ceremony, Professor Tumani Corrah, MRC (UK) The Gambia’s Unit Director said ‘Kalifa is a well trained paediatrician and an
excellent research scientist. His tasks will include developing a cadre of young Gambian paediatricians, strengthening the postgraduate training of
the University and introducing a culture of research into the Department of Paediatrics. We are quite aware that Kalifa will not be able to do this
alone, so we are also seconding another paediatrician – Dr Uduak Okomo – to support this capacity building initiative.’
Citing the MRC’s donation of Farafenni Field Site to the University in 2010, Professor Muhammadou Kah, Vice Chancellor of The University of The
Gambia commented ‘Yet again, the MRC has intervened in the capacity and competency needs of the University as they relate specifically to our
School of Medicine and Allied Health Sciences. On behalf of the Chairman and the Governing Council and more importantly our Chancellor, we
thank the MRC.’
The School of Medicine and Allied Health Sciences has graduated almost sixty clinicians who are now practicing in various health facilities around
The Gambia. Professor Kah added ‘Our vision is not only to service the health infrastructure here but also to serve in other countries, especially in
the region. We cannot do this alone: we need partners like the MRC.’
Dr Kalifa Bojang started his working life at the Paediatric Department of RVTH and has worked at the MRC for the past fifteen years. Commenting
on his return to RVTH he said ‘I hope that I can strengthen the Department through service provision, research work and the teaching of the young
doctors coming up. As Principal Investigator of a recent trial that was conducted at RVTH, Dr Bojang knows the benefits that research can bring to
the Paediatric Department. He said ‘the trial showed that artesunate (which is used for treating severe malaria) is actually better than the quinine
we are currently using. We hope that the use of artesunate will become common practice throughout Africa.’
In his closing remarks, Professor Corrah said ‘I will be very excited when we begin to see young Gambian doctors joining the MRC in various
capacities. The continuous development of those who will look after us and lead research in the near future is one of our key goals.’
Dr Kalifa Bojang joins The University of The Gambia to strengthen research, healthcare and training at the Royal Victoria Teaching Hospital and the
School of Medicine & Allied Health Sciences. From left: Dr Omar Jah (UTG), Dr Kalifa Bojang, Professor Muhammadou Kah (Vice Chancellor –
UTG), Professor Tumani Corrah (MRC (UK) The Gambia) and Professor Ousman Nyan (Provost – School of Medicine; Deputy Vice Chancellor
and Chief Medical Director – RVTH)
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WANETAM is boosting the region’s TB case detection capabilities, through the training of laboratory technicians from the West African
Sub-Region. Funded by EDCTP, WANETAM aims to develop lab training to a level where clinical studies in TB, HIV and malaria can be
performed to GCP standard.’
WANETAM: Building bench capacity in Africa to fight TB
MRC (UK) the Gambia recently hosted a one month TB diagnostics training programme attended by laboratory technicians from all
over West Africa. The programme was funded by the West Africa Networks of Excellence for TB, AIDS and Malaria (WANETAM)
under the auspices of the EDCTP.
The training package focused on Good Clinical Laboratory Practice (GCLP); Acid-Fast Bacilli (AFB) microscopy; Bacteria culture and
Identification; Drug Susceptibility Testing; Quality Control and Molecular Diagnosis.
At the opening of the training programme, Professor Tumani Corrah (Unit Director – MRC (UK) The Gambia said ‘WANETAM is the
realisation of a dream initiated by the EDCTP’s Developing Country’s Coordinating Committee. The aim of this month-long session in The
Gambia is to develop laboratory capacity to a level where TB clinical studies can be performed to GCP standards, and WANETAM provides
opportunities for sister institutions to benefit from centres with greater expertise, such as the MRC.’
In his words to the training programme participants, Dr Makie Taal, Director of the National Public Health Laboratories (The Gambia)
reiterated the regional importance of the training. He exhorted the participants to ‘go back to your countries and implement what you have
learned’.
At the end of the programme, the participants were keen to give feedback and expressed the desire to put their newly-acquired skills into
practice. Commenting on the significance of the training, Dr Martin Antonio (MRC and WANETAM co-coordinator in The Gambia) said
‘One of the cornerstones of fighting TB, not only in the West African Sub-Region but worldwide is to improve capacity on the bench. I am
really glad that MRC through our Director is doing that, and I am grateful for the opportunity to interact with all the participants – we also
learned from their expertise.’
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About WANETAM
WANETAM builds capacity to prepare West African sites for clinical trials on HIV, TB and malaria. The network is funded by EDCTP
which supports multicentre projects that combine clinical trials, capacity building and networking to ensure that the developed
capacity is utilised to successfully conduct the clinical trials in a sustainable way.
MRC (UK) The Gambia is the coordinating site for WANETAM’s TB package, led by Unit Director Professor Tumani Corrah and Dr
Martin Antonio.
WANETAM started its activities on 31st July 2009 and is coordinated by Professor Souleymane Mboup (Cheikh Anta Diop
University, Dakar). The WANETAM consortium has brought together institutions in West Africa that collaborate on the basis of
their individual strengths (e.g. GCP, GLP, data management and laboratory techniques).
Participants were keen to give feedback on the
value and future application of the skills they
had acquired in The Gambia. WANETAM
training participant Ms Nneka Onyejepu
(Nigerian Institute of Medical Research, Lagos)
expressed the sentiments of many when
she said ‘The training has been insightful and
thought provoking. I went back every evening
thinking of what needs to be done and what
could be changed. I am happy this project
has specific objectives and that we also have
site objectives - I know we will achieve these.
I’ve been fortunate to meet colleagues from
other West African countries and it will be
an honour to continue to work with them.’
Right: Nneka Onyejepu and Dr Martin Antonio
at the closing ceremony of the WANETAM
programme.
WANETAM partner institutions include:
 Laboratoire de Bactériologie-Virologie du Centre Hospitalier Universitaire Aristide Le Dantec, Senegal
 National Health Laboratory Service, Royal Victoria Teaching Hospital, The Gambia
 Centre Muraz, Burkina Faso
 Korle-bu Teaching Hospital/ University of Ghana Medical School, College of Health, Ghana
 National Public Health Reference Laboratory, Ghana
 Bandim Health Project, Guinea-Bissau
 College of Medicine, University of Ibadan, Nigeria
 Nigerian Institute of Medical Research
 Centre National de Recherche et de Formation sur le Paludisme, Burkina Faso
 Malaria Research and Training Center (MRTC)/Department of Epidemiology of Parasitic Diseases (DEAP)/Faculty of Medicine,
Pharmacy and Dentistry (FMPOS), the University of Bamako, Mali
 Pasteur Institute, Senegal.
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Fajikunda Health Centre receives significant boost
Dr Martin Ota and Team
A new phase II pneumococcal protein vaccine trial commenced recently at Fajikunda Health Centre. The trial,
which is being led by Dr Martin Ota in The Gambia, is funded by the Program for Appropriate Technology in
Health (PATH) and GSK, in collaboration with MRC (UK) The Gambia. It is hoped that the vaccine may be
a future – more effective - alternative to the pneumococcal conjugate vaccines that are currently included in
Expanded Programmes on Immunisation.
The MRC provided funds for the erection of a building at the Health
Centre to house the trial. Following approval from the Ministry of
Health, the first stone of the building was laid at the end of April 2010,
and work was complete in August 2010.
The new building, named the ‘Jula Jaiteh Block’ in honour of the late
Sister-in-Charge of Fajikunda Health Centre, was officially opened by the
Permanent Secretary – Ministry of Health & Social Welfare, Mrs Matilda
Eunson Boye on Thursday 27th January 2011. The opening ceremony
was attended by officials from GSK, PATH, LSHTM, MRC, the Ministry
of Health, Regional Health Team, the Mayor of Kanifing Municipal
Council, the Alkalos and residents from the vicinity.
Dr Martin Ota assured the community that a well-thought out trial that
will impact positively on their health and that of the nation had been
brought to their doorstep. In her address, Dr Dorota Borys, speaking
on behalf of GSK Biologicals, commended The Gambia for being one of
the few African countries using PCV and assured everyone that GSK is
committed to providing better and safe vaccines against diseases.
Professor Tumani Corrah, Unit Director (MRC (UK) The Gambia
reiterated the country’s status as having one of the best Expanded
Programmes on Immunisation in Africa. The Gambia’s EPI includes
hepatitis B, Haemophilus influenzae type b and PCV vaccines, made
possible through research carried out by the MRC in collaboration with
the Government and people of The Gambia.
MRC also donated a sterilizing machine, two computers and sanitary
ware to the Health Centre. Lamin Marong, Nurse-in-Charge of the
Fajikunda Health Centre thanked the MRC, especially the research
clinicians who have been a tremendous help in providing clinical care
at the Health Centre. The Alkalo of Fajikunda, speaking on behalf of
the other Alkalos, also thanked the MRC and commended the Unit’s
mothers and their children converge on Fajikunda Health Centre
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Prinicipal Investigator: Pneumococcal Protein Vaccine – Dr Martin Ota;
Dr Dorota Borys – GSK Biologicals, Belgium
contribution to the community. The Permanent Secretary commended
the cordial relationship between the MRC and The Gambia Government
and its impact on capacity-building and general public health, adding that
she hoped this was a relationship that would continue to grow.
Dr Ota wishes to acknowledge the large Trial team which includes 4
clinicians (Drs Simi Odutola, Ezra Ogundare, Muyiwa Owolabi and Bukky
Idoko), nurses, project administrators, fieldworkers, drivers, laboratory
scientists and technicians
Jula Jaiteh Block – named after the former Nurse in Charge of Fajikunda
Health Centre who passed away in 2010.
Sibanor Studies Feedback Day
On Thursday 17th February, the Sibanor Vaccine Trial team,
including Study Coordinator, Dr Anna Roca, Research Clinician
- Dr Uzo Egere, PhD fellow - Brenda Kwambana and Field
Coordinator - Ma Ansu Kinteh met with dignitaries and community
members in Sibanor to share their study findings.
Cross sectional studies
Feedback was given on how vaccination affects overall pneumococcal carriage at a
community level among subjects from 2 years of age onwards. Data was presented on
the indirect effect of vaccination among non-vaccinated and replacement (increase in
prevalence of pneumococcal serotypes not included in the vaccine after vaccination). The
indirect effect of PCV has not been shown in Africa yet.
Longitudinal studies of newborns
Researchers explained the effect of vaccinating the population on rates of carriage in
infants before reaching the age of vaccination. The results from the longitudinal studies
of infants also show how pneumococcal vaccination affects rates of carriage of other
bacterial pathogens.
The results of other ancillary studies of the trial are not available yet (antibody responses
to vaccination and whether vaccination has modified the time of pneumococcal carriage
among carriers and other potential molecular studies).
The Sibanor communities were happy because, comments Anna Roca ‘The MRC went
back to them to explain the results of the study. They felt they had contributed to an
important research study that will turn into important data for their country, the region
and beyond. The results of the study are better than expected – and we’ll be trying to
get external funding to maintain the work in Sibanor.’
Explaining the studies to the communities
Pneumococcal carriage: Many people in The Gambia have a bug called
pneumococcus in their noses. This bug is not causing any harm in most of these
people. However, they might spread the bug to others and this might cause
disease in some of them. If we could eliminate the pneumococcal bug from the
nose and throat, we would be able to block the transmission from people to
people and decrease the overall disease associated with this bug (pneumonia and
meningitis). Pneumococcus presents itself with more than 90 ‘hats’. The current
vaccine recognizes only 7 of these hats and therefore, it does not act against other
bugs carrying a different ‘hat’.
By vaccinating your children, you protect them from becoming carriers of the
pneumococcus bug carrying one of these 7 ‘hats’, and at the same time you
protect your family, yourself and the community because these children will not
spread the bug to others.
Soon The Gambia will replace the current pneumococcal vaccine with one that has
more ‘hats’ and we expect that the effect will be wider.
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Prolifica’s participants have been brought together from institutions and governments in the West African Sub-Region and Europe. From left:
Professor Souleymane Mboup (Cheikh Anta Diop University, Dakar), Hon Fatou Lamin-Faye (Minister of Basic & Secondary Education, The Gambia),
Professor Tumani Corrah (Unit Director, MRC (UK) The Gambia), Dr Edith Okeke (University of Jos Teaching Hospital, Nigeria), Dr Chris Wild
(Director – International Agency for Research on Cancer)
PROLIFICA consortium holds first meeting in The Gambia
Partners in the Prevention of Liver Fibrosis and Cancer in Africa consortium – Prolifica - met in The Gambia recently for
a two day kick off meeting. Funded by the European Commission, Prolifica has brought together investigators from The
Gambia , Senegal, Nigeria, the UK, Italy and France. The project has been established to identify causes of liver cancer in
West African populations and to show that it can be prevented by effective treatment of hepatitis B infection.
Hepatitis B and liver disease: a big burden on Africa
The Gambia: a long history of Hepatitis B studies
Hepatitis B is a major cause of morbidity and mortality in Africa. WHO
estimates there are 350 million people chronically infected with the
Hepatitis B virus (HBV). The majority of these individuals live in South
East Asia, China and Sub-Saharan Africa. Each year approximately
600,000 to 800,000 people die as a result of chronic hepatitis B
infection.
Research into Hepatitis B infection has been ongoing in The Gambia
for over three decades thanks to the partnership between the Gambia
Government and the MRC. The successful introduction of Hepatitis
B vaccination has almost eliminated chronic carriage in Gambians
under the age of 25. However, chronic carriage of the virus, which
may progress to chronic liver disease and liver cancer, remains high in
Gambians over 25 years.
Liver cancer and liver failure from liver cirrhosis are common causes
of death from chronic hepatitis infection. Liver cancer is among the 10
most common causes of cancer World-wide. In The Gambia as in other
developing countries, liver cancer is the most common cancer in males
and second only to cervical cancers in females.
The PROLIFICA consortium is led by Professor Mark Thursz (Imperial College London). PROLIFICA aims to address the
issues of liver fibrosis prevention and cancer by:
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identifying new risk factors for liver cancer
demonstrating that treatment of chronic hepatitis B infection is feasible and that it is an effective method of reducing the
incidence of liver cancer in the adult population
developing tests which identify patients with liver cancer at an early stage when treatment of the cancer might be
successful.
MRC TAMA - VOL: 10 ISSUE: 01 / JAN - FEB 2011
ICEMR West Africa kicks off in Senegal
Eniyou Oriero and Tisbeh Faye-Joof
America. Currently, there are 8 ICEMRs supported by the NIH for
a period of seven years and it basically rests on two themes: 1] a
population-based approach that links malaria research and control
through the cyclical changes in genetic diversity produced by the
parasite life cycle, and 2] a long-term commitment to development of
investigators from malaria-endemic areas.
Professor Don Krogstad (Tulane University and ICEMR partner)
during a recent visit to MRC Fajara
The International Centre of Excellence for Malaria Research, West
Africa (ICEMRWAF) held its first regional meeting in Dakar,
Senegal from the 27th – 31st January 2011. ICEMRWAF is a unique
collaboration of northern partners from Tulane University, Harvard
School of Public Health, Broad Institute MIT, Boston College, the
National Institute of Allergy and Infectious Diseases and the London
School of Hygiene and Tropical Medicine. Southern host country
investigators have come together from Cheikh Anta Diop University
(Dakar), the University of Bamako (Mali) and MRC (UK) The Gambia.
Contributions from the collaborators range from epidemiology and
entomology to genetics, molecular biology and immunology.
The ICEMR concept is a new funding initiative by NIH to merge
laboratory research with disease control. The ICEMR programme
establishes a global network of independent research centres in
malaria-endemic settings to provide knowledge, tools, and evidencebased strategies to support researchers working in a variety of settings,
especially within governments and healthcare institutions. The new
global ICEMR network includes West and Central Africa, East Africa,
Southern Africa, South Asia, Southeast Asia, Latin America and South
The scientific aim of ICEMRWAF is to perform prospective studies
of the epidemiology and entomology (transmission) of malaria at
field sites in the endemic area to characterize and understand: a] the
heterogeneity of malaria infection and disease and its transmission, b]
the effects of control strategies on its transmission and pathogenesis,
and c] the major obstacles to improving malaria control and its potential
elimination, including drug and insecticide resistance. These goals will
be accomplished by performing field and laboratory studies of the
epidemiology, entomology (transmission), immunology and pathogenesis
of malaria, and of antimalarial and insecticide resistance - organised into
three projects:
1 ] Epidemiologic Studies which aim to define the epidemiology
of malaria and the effects of malaria control at field sites in The
Gambia (rural field site - Basse); Senegal (urban malaria site Thies); and two rural sites in Mali (with transmission based on
microhabitats in Kenieroba and the massive inland delta region of
the Niger River at Dioro).
2 ] Immunology and Pathogenesis (Project 2).
3 ] Antimalarial Resistance (Project 3).
The meeting in Dakar consisted of daily sessions of presentations, and
panel discussions on the various projects based on the initial hypotheses,
priorities, protocols, feasibility and statistical issues. Participants also
welcomed the sessions on career development and mentorship for
young investigators in the southern sites, which included input from
some of the senior academics in the partnership.
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News from Caio
Tim Vincent
Directors tour Guinea Bissau
21st February 2011 saw the official inauguration of INASA – Instituta Nacional de Saúde Pública (Institute of
Public Health), in the capital of Bissau. Professor Tumani Corrah and Peter Noble attended as representatives
of one of INASA’s many collaborators. During their visit, the MRC Directors met with Dr Amabelia Rodrigues
- the President of INASA; Augustu Paulo – Guinea Bissau’s Secretary of State for Health and many other
members of the country’s scientific community.
On Wednesday 23rd February, Professor Corrah and Peter Noble travelled to Canchungo to visit the Regional Hospital. They were received by Dr
Kumba Bispo Yalá Insumbarem, the Director of the Hospital. They also met with Dr Paulo Pereira, who manages the health care of the Caio cohort
patients in Canchungo. The MRC Directors were given a tour of
the hospital facilities which have been recently refurbished by the
Chinese. Whilst the hospital itself is in reasonable repair and well
laid out, Prof Corrah and Peter Noble were able to see firsthand
the problems facing not just Canchungo but the country in general.
Most of the technical machinery, FACS, X-ray, incubators etc lay idle
because of the lack of trained technicians to maintain them. A visit
to the laboratory also presented them with antiquated machinery
and the ability to do just the very basics of routine clinical analysis.
From Canchungo they travelled the remaining 28 km to Caio to
visit the MRC Field Station. This was Peter Noble’s first visit to Caio
and the first visit made by Professor Corrah in many years. A brief
meeting was held with the staff in Caio. Prof Corrah outlined the
changes at MRC during these tough financial times, indicating that
Caio, as primarily an HIV research site, now fell into all three of the
new Thematic areas of research. He also indicated that they would
be looking into ways to expand the research in Caio beyond HIV
and that he would return as soon as possible with Dr Assan Jaye
(who was unable to come on this trip due to commitments in the
UK).
Prof Corrah and Peter Noble visited the local state authorities,
followed by a visit to the health centre in Caio. The health centre is
in need of repairs to the roof, ceiling and sanitary facilities and there
is an ongoing issue with a lack of water supply from a borehole that
was provided 3 years ago. The Caio Field Station will assist with
these repairs as much as possible over the coming months.
A brief ceremony was carried out at the site of the late Dr Andrew
Wilkins’ statue. Prof Corrah said a few words and poured wine
to ensure the success of the Field Site. Lunch was laid on and was
attended by all the staff. The Directors made a quick visit to a
member of staff who had lost her mother the previous day, before
they returned to Bissau.
The following day in Bissau was given over to presentations by
members of The Bandim Health Project, highlighting their work
over the years and the research currently taking place. The Bandim
Project has been in Bissau for 30 years; all the full-time workers
from Caio were invited to attend and a big party was held at the
end of the day to celebrate.
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I would like to thank Prof Corrah and Peter Noble for their visit
to Caio and the encouragement and feedback given to the staff
after this somewhat unsettled period. I hope that Caio continues
to grow, in terms of research, under the guidance of Dr Assan Jaye
and the West Africa HIV network which he now heads. We look
forward to seeing Dr Jaye and other researchers in Caio soon.
New nurse for Caio
In January the new state nurse in Caio was officially presented at the
Field Station. She is Beatriz Caetano a nurse and midwife who has
now joined the nursing team at the local Health Centre. Welcome
Beatriz!
Increased responsibilities for Field Site clinician
Dr Mavinga Saraiva, who is stationed at the Field Site, has recently been named as responsible for health in the Caio Sector (which includes the
islands of Jeta and Pecixe). Dr Saraiva is a state doctor who was seconded to the project in Caio in February 2010. As well as his responsibilities
coordinating health issues in the sector he also runs the anti-retroviral treatment programme in Caio and manages the health care of our cohort
patients.
Recent Unit Publications
Summaries: PubMed
Preventive treatment together with bed nets gives children better protection against malaria
Two separate studies – carried out in Burkina Faso and Mali– have found that combining intermittent preventive treatment of malaria in
children (IPTc) with insecticide-treated bednets (ITNs) can substantially reduce the incidence of severe and uncomplicated malaria. A third
study carried out in The Gambia supported the findings, reporting that IPTc treatment was not only easily administered by village health
workers, but could also significantly reduce the incidence of malaria among children.
All three studies, published in the journal PLoS Med, will further strengthen the evidence to support the integration of IPTc into malaria
control strategies in areas of seasonal malaria transmission.
The Gambian study set out how to determine how IPTc could be delivered most effectively in a rural community. The catchment
populations of 26 Reproductive and Child Health trekking teams in the eastern part of the Gambia were randomised to receive IPTc on
three occasions during the malaria transmission season from either the trekking team or from village-based community volunteers (VHWs).
Delivery by VHWs achieved a higher coverage rate for three courses of IPTc than delivery by the trekking teams (74% vs 48%) and there
were fewer cases of malaria in children in the communities served by the VHWs than in those served by the tekking teams (21 vs 49). The
incidence of malaria in both sets of communities where IPTc was given was much lower than in neighbouring communities.
In a further study conducted in The Gambia and published recently in the Malaria Journal investigators from the Gambia and LSHTM showed
that VHW could effectively combine administration of IPTc with treatment of any patients who did develop malaria.
No serious side effects attributable to use of sulphadoxine/pyrimethamine and amodiaquine for IPTc in each of these three studies were
observed.
Dr Kalifa Bojang, Senior Clinical Scientist (MRC (UK) The Gambia) and Principal Investigator of the trial carried out in The Gambia said ‘
These findings indicate that IPTc is a potentially valuable tool for the control of malaria in areas with seasonal transmission which can easily
be administered by village health workers in a cost-effective manner.
MRC TAMA - VOL: 10 ISSUE: 01 / JAN - FEB 2011
11
Recent Publications
Trial of a vaccine for chronic Hepatitis B infection
Chronic Hepatitis B (HBV) infects 350 million people causing cancer and liver failure. The investigators aimed to assess the safety and efficacy of
plasmid DNA (pSG2.HBs) vaccine, followed by recombinant modified vaccinia virus Ankara (MVA.HBs), encoding the surface antigen of HBV as
therapy for chronic HBV. A secondary goal was to characterize the immune responses.
Mild local and systemic adverse events were observed following the vaccines. A small shiny scar was observed in some cases after MVA.HBs.
There were no significant changes in AST or ALT. HBeAg was lost in one participant in the higher-dose group. As expected, the 3TC therapy
reduced viraemia levels during therapy, but the prime-boost vaccine regimen did not reduce the viraemia. The immune responses were variable.
The majority of IFN- was made by antigen non-specific CD16(+) cells (both CD3(+) and CD3(-)).
The conclusions were that the vaccines were well tolerated but did not control HBV infection
Partially Randomized, Non-Blinded Trial of DNA and MVA Therapeutic Vaccines Based on Hepatitis B Virus Surface Protein for Chronic
HBV Infection. Cavenaugh JS, Awi D, Mendy M, Hill AV, Whittle H, McConkey SJ. PLoS One. 2011 Feb 15;6(2):e14626.
Safe limits for blood sampling in children
A literature review was performed to search for evidence concerning the adverse effects of blood sampling in children and for guidelines
on sampling volume in paediatric research. The search included Medline, EMBASE, other web-based and non-web-based sources and the
bibliographies of the sources identified. Experts were also consulted.
Five studies and nine guidelines were identified. Existing guidelines specify paediatric blood sample volume limits ranging from 1% to 5% of total
blood volume (TBV) over 24 hours and up to 10% of TBV over 8 weeks. The evidence available is limited and includes findings from nonrandomized studies showing a minimal risk with one-off sampling of up to 5% of TBV.
The evidence available is consistent with the conclusion that all identified guidelines are within the limits of "minimal risk." However, more and
better evidence is required to draw firmer conclusions. Researchers and institutional review boards need to take into account the total sampling
volume needed for both clinical care and research rather than for each alone. The child's general state of health should be considered and extra
caution should be observed particularly with children whose illness can deplete blood volume or haemoglobin or hinder their replenishment.
Local policies must also address the appropriateness and local acceptability of collection procedures and of the blood volumes drawn.
Blood sample volumes in child health research: review of safe limits. Howie SR. Bull World Health Organ. 2011 Jan 1;89(1):46-53.
The effect of freezing on samples
Frozen storage often precedes metagenomic analysis of biological samples; however, the freezing process can have adverse effects on microbial
composition. The effect of freezing on the detection of bacteria inhabiting the infant nasopharynx, a major reservoir of bacterial pathogens, was
investigated.
The conclusions from this study are that although frozen storage of biological samples is often necessary for archiving and logistic purposes, the
potential effects on the number of taxa (composition) detected in microbial community studies are significant and should not be overlooked.
Moreover, genetic factors such as sex may influence the integrity of nucleic acids during the freezing process.
Differential effects of frozen storage on the molecular detection of bacterial taxa that inhabit the nasopharynx. Kwambana BA, Mohammed
NI, Jeffries D, Barer M, Adegbola RA, Antonio M. BMC Clin Pathol. 2011 Jan 24;11:2.
12
MRC TAMA - VOL: 10 ISSUE: 01 / JAN - FEB 2011
The Clinical Research Laboratories – A Success Story
Yailouise Ndure-Bensouda
2011 started on the right note for the clinical research laboratories and the Unit as a whole. Tim Stiles of Qualogy Ltd., who is also one of the
authors of the Good Clinical Laboratory Practice (GCLP) Guideline, came to the Unit in January and assessed the current level of compliance with
the requirements of GCLP within the clinical research labs and their support services. At the end of his assessment, Tim wrote in his report
“The facilities within the Clinical Laboratories at MRC Fajara are appropriate and suitably equipped for the clinical work being performed. Many
of the procedures and systems required to be followed in the conduct of laboratory work have also been introduced and tested to ensure their
appropriateness and fitness for purpose. I believe the Clinical Laboratory has implemented the systems and procedures required for GCLP
compliance.”
Excellent news for the Unit and the Quality Department. Here Quality Manager - Emma Hancox explains the challenges along the way
How long did it take you and the lab team
to get to where you are now?
We started talking about GCLP in March
2009. However I feel that the behavioral
change came about in Summer 2010.
What did you find most challenging about
initiating and implementing GCLP in the
labs?
There were two main challenges: I think
we underestimated the kind of resources
needed. For example, with documentation,
this involves writing, approving and
implementing. It involved all the lab staff in
addition to the Quality Department and
even the Biomed team. Everybody involved
had to find time outside their regular daily
activities for the documentation process.
Another challenge was changing the mindset
and behavior of people. It required a lot of
following-up with everybody who was part
of the process. Saying that, now that there is
a greater understanding of what needs to be
done, so it may not take as long for the next
area that plans to implement GCLP.
What would you tell a department
manager who is thinking about initiating
GCLP implementation?
You have to be committed, to really
understand the benefits from it. Personally,
I think the key person in implementing
the standard is the department manager
because this individual takes up the overall
responsibility. Managers have to be genuinely
committed rather than implementing it
because they are asked to.
If you could do it all over again, would you
change anything?
Yes, we would like to allocate more time
and resources to ensure the task is done.
We would need adequate planning with
clear, short-term objectives. We would also
hold regular meetings with smaller actions.
These meetings should be across the whole
team as opposed to just the department
manager. During the process, we assigned
roles to lab staff: we would have spread the
roles a little more by being more consistent
with meeting with the role members where
tasks and actions are discussed.
Moving forward, do you have any last
words for the Unit?
I would like to thank everyone who helped
with the implementation - Ignatius and
his entire lab team, the Quality team, the
Biomed Department, the Clinical Trials
Support Office, Archives and the Ward.
This is a great achievement for the clinical
laboratories and the Unit. Bravo once again
to the entire clinical labs staff and the support
departments for their commitment and hard
work throughout the process
Please contact the Quality Management
Department if you would like access to
Tim Stiles’s assessment report.
Back row (from left to right):
Malang Camara, Lamin Bojang,
Ebrima Bojang, Tim Stiles, Buntung
Ceesay, Boto Jaiteh
Front row (from left to right):
Ignatius Baldeh, Jainaba BadjieJallow, Emma Hancox, YaiLouise
Ndure-Bensouda, Kemo Sidibeh,
Ida Jallow-Manneh, Gibril Bah (not
in the picture).
MRC TAMA - VOL: 10 ISSUE: 01 / JAN - FEB 2011
13
HR
Kalilu Dibba
New staff
Elina Martha Cole – Senior Project Administrator, Global Fund Round
9 TB Projects
‘I joined the MRC in December 2010 as Senior Project Administrator, Global Fund Round 9
TB Projects. I was scared of MRC’s size at the beginning but glad that colleagues from different
departments have been very receptive and helpful. My gratitude goes to all I have been in
contact with so far. I hope to meet more people as time goes by.
My work experience for the past 12 years has been centred around volunteer management,
partnership development and project management/administration, the latter being my motivation
for applying for this position. The Global Fund TB Project is an exciting one and I am looking
forward to learning as well as contributing positively to its success. My major challenge is getting
used to the different operational systems at MRC compared to the smaller organisations I am
coming from.’
Dr Ireneh Akwara – Medical Officer, MRC Fajara
My background: I did all my education in Nigeria, graduating in Medicine from the College of
Health Sciences - University of Benin. I am currently doing a Diploma in Dermatology from
Cardiff University. Prior to joining the MRC, I worked as a Senior Medical Officer at Lagos
General Hospital in the Department of Internal Medicine - Dermatology Unit - for 5 years.
I am really interested in health record systems that work and the use of IT in modern medicine
as a way of influencing policy and public health. I am also interested in anthropology, especially
the history of medicine.
Extracurricular interests: Football – the Nigerian national team the Super Eagles, and at the
club level – Arsenal and Barcelona. I also enjoy reading – everything from fiction to a wellwritten science paper - as long as it makes sense…I enjoy travelling and have been to a few
continents – it’s interesting how different societies share the same values. And I like music anything that has rhythm - after all I am African.
Goals: I intend to expand my knowledge base of medicine and learn new skills. While here at
MRC The Gambia I particularly hope to learn a bit about research methodology. I intend to
get along well with the members of staff and hope to satisfy my patients – after all, they are the
reason I was employed!
Dr Jayani Pathirana - Research Clinician, Pneumococcal Surveillance
Project
About Jayani: I grew up in Malawi though I am from Sri Lanka originally. I did all my schooling
in Malawi. Choosing Medicine happened during my last 2 years of High School. My sister was
studying medicine and she was always smuggling home bones during holidays which I found
fascinating and I would enjoy looking through her textbooks. As my interest grew and I was also
studying the sciences for A Levels, I decided to pursue medicine at the University of Malawi,
College of Medicine.
Joining MRC The Gambia: I found out about the MRC through one of my Professors in
Paediatrics. I did my research on the MRC and thought: “I would like to work there,” and I also
wanted to experience research ‘hands on’. The opportunity to live in a different country, learn
about new cultures and practices was also appealing.
Early impressions: The Gambia (the coast) so far has been a pleasant surprise. The people are
very friendly and willing to help. Most things are available and there are quite a few places to
visit and explore. Talking to different people from the MRC community has been inspiring and
14
MRC TAMA - VOL: 10 ISSUE: 01 / JAN - FEB 2011
News from HR
provided me with so much useful information. As for Basse – donkeys and dust! I wanted to experience living in a rural town and I got what I asked
for, though it’s not as rural as I expected. Everyone in Basse has been very supportive and helpful and I feel well looked after.
Joining PSP: The cycle of research where you start with an unsolved problem then find a solution to it through well planned steps to (hopefully)
solve the initial problem is satisfying. Moreover clinical research is about being pro-active and interacting with people which I enjoy. As the president
of a British pharmaceutical company is reputed to have said: "You can't ask mice if they've got headaches."
I didn’t choose pneumonia in particular, but I was happy to join PSP with an opportunity to contribute to finding a long term solution, as pneumonia
is so common in Africa.
Finally: I’d just like to say thanks to everyone at the MRC who have made me feel welcome and helped me settle in.
Starters: January/February 2011
Lamin Fatty – Cook (Basse Bantaba)
Lamin Saidykhan – Laboratory Technician Grade 1 (Global Fund TB)
Tombong Badjie – Assistant Cook (Basse Bantaba)
Ensa Gitteh – Laboratory Technician Grade 1 (Global Fund TB)
Kadijatou Manneh – Cleaner (Basse Bantaba)
Magnus Ochoge – Staff Medical Officer (Clinical Services)
Tomaring Jadama – Projects Assistant (PSP)
Alpha Badjan – Electrician/Labourer (Electrical)
Baboucarr Joof - Temp Handyman (Facilities)
Muhammed Manneh – Field Assistant (Gates Diarrhoea Project – Basse DSS)
Augustin Fombah – Research Clinician (PSP)
Lamin T Cham – Field Assistant (Nutrition Group)
Ndofen Njie – Cleaner (Facilities)
Lucy Kangakan – Nurse Auxiliary (Clinical Services)
Amara Jah – Laboratory Technician Grade 1 (Pneumomoccal Protein Vaccine
Trial-PPVT)
Kemo Jammeh – Handyman (Facilities)
Mamadou Lamin Bajo – Laboratory Technician Grade 1 (PPVT)
Bakary L Camara – Field Assistant (PSP)
Elizabeth Stanley-Batchilly – Senior Project Administrator (PPVT)
Lamin Jatta – Field Assistant (Nutrition Group)
Fatoumatta Kanuteh – Laboratory Technician Grade 1 (TB Diagnostics)
Ousubie Jawla – Field Assistant (Nutrition Group)
Njowene Grey-Johnson – Laboratory Technician Grade 1 (PPVT)
Wally Camara – Field Assistant (Nutrition Group)
Aji Awa Konteh – Laboratory Technician Grade 1 (PPVT)
Kassa Kora – Field Assistant (Nutrition Group)
Basil Sambou – Laboratory Technician Grade 1 (TB Diagnostics)
Fakebba Camara – Field Assistant (Nutrition Group)
Elina Martha Cole – Senior Project Administrator (Global Fund TB)
Salieu Darboe – Field Assistant (Nutrition Group)
Khadiatou Fadera – Field Assistant (Global Fund TB)
Ansumana Bajo – Field Assistant (Nutrition Group)
Sidu Sibi – Field Assistant (Global Fund TB)
Isatou Bah – Laboratory Technician Grade 1 (Infant HIV EDCTP)
Ansumana Darboe – X Ray Assistant (PSP)
Ireneh Akwara – Medical Officer (GSK TB Vaccine Trial)
Abdoullah Nyassi – Data Entry Clerk Level 1 (PSP)
Jayani Pathirana – Research Clinician (PSP)
Catherine Bi Okoi – Scientific Officer (TB Diagnostics)
Yankuba Camara – Junior Finance Clerk (Procurement and Logistics)
Peggy Estelle Tientcheu – Scientific Officer (Microbiology)
Malang Tamba – Data Entry Clerk/Clinical Records Clerk (Nutrition Group)
Bakary Malang – Field Assistant (PSP)
Modou Manka – Stock Controller (Facilities)
Alison Sanneh – Clinical Trial Manager (GSK TB Vaccine Trial)
Fabakary Cham – Main Store Assistant (Procurement & Logistics)
Lamin N Sanneh – Field Assistant (Global Fund TB)
Abdoulie Jallow – Supplement Centre Assistant (Nutrition Group)
Fatoumatta Jarju – Community Health Nurse (PSP)
Jalika Mbowe – Field Assistant (Global Fund TB)
Amie Kamara – Field Assistant (Gates Diarrhoea Project – Basse DSS)
Ebou Bah – Nurse/Field Assistant (PPVT)
Cherno Ebrima Barry – Field Assistant (Gates Diarrhoea Project – Basse DSS)
Fatou Jallow – Field Assistant (PPVT)
Omar Sabally – Field Assistant (Gates Diarrhoea Project – Basse DSS)
Lamin Sanneh – Field Coordinator (Global Fund TB)
Aji Fatou Dibba – Laboratory Technician Grade 1 (Global Fund TB)
Musukoi Jammeh – Field Assistant (Global Fund TB)
Lamin Jammeh – Laboratory Technician Grade 1 (Global Fund TB)
Ismaila Jallow – Assistant Biomedical Engineering Technologist (PSP)
Amadou Mballow – Field Assistant (Gates Diarrhoea Project – Basse DSS)
MRC TAMA - VOL: 10 ISSUE: 01 / JAN - FEB 2011
15
Leavers: January/February 2011
Alhaji Bojang – Labourer (Refrigeration)
Mariama Ceesay – Laboratory Technician Grade 2 (Malaria Vaccine Project)
David Ameh – Research Clinician (PSP)
Haddy Faal – Laboratory Technician Grade 1 (Diarrhoea Project)
Kitabou Suwareh – Data Entry Clerk Level 3 (Diarrhoea Project)
Momodou Musa Bah – Laboratory Technician Grade 1 (Research
Microbiology)
Jemanti Sise – Watchman
Tijan Janneh – Translator (Viral Diseases)
Peter Aka – Senior Scientific Officer (Molecular Diagnostics)
Omar Jallow – Lab Technician Grade 1 (Diarrhoea Project)
Haddy Khan – SRN Staff Nurse (Clinical Services)
Lamin Kebbeh – Nurse SEN (Hib Initiative)
Momodou 1 Darboe – Field Supervisor (Nutrition Group)
Bubacarr Kanyi – Laboratory Technician Grade 1 (Zinc Trial)
Lamin Saidykhan – Laboratory Technician Grade 1 (Microbiology)
Borry Bass – Laboratory Technician Grade 1 (Infant Immunology)
Fatou Demba – Cleaner (Estates)
Jalamang Suwaneh – Senior Ward Attendant (Clinical Services)
Kebba Jobe – Nurse SEN (Severe Malaria)
Jahidul Anup Hasan – Database Developer/Data Manager (Keneba)
Abdoulie Jaiteh – Senior Records Clerk (Clinical Services)
Karalang Jobarteh – Purchasing & Stores Officer (Procurement)
Baboucarr Joof – Handyman (Facilities)
Oyedeji Oladele Adeyemi – Research Clinician (PSP)
Training success
Congratulations to Drs Rasaq Olaosebikan, Uduak Okomo and Joseph Okebe (also
Dr Khalifa Mohammed – not in the picture) at the London School of Hygiene &
Tropical Medicine on MSc Epidemiology graduation day recently.
Congratulations to Ramatoulie Janha who defended her PhD in London recently.
Her thesis title was ‘Effects of inactive CYP2C19/CYP2C9 alleles on chlorproguanil
pharmacokinetics in adults and treatment outcome in children with uncomplicated
malaria following Lapdap treatment'. Ramatoulie was examined at Queen Mary College
- University of London, Barts and The London School of Hygiene & Tropical Medicine.
Her supervisors were Prof Robert Walton (Director of Studies), Dr Fatoumatta SisayJoof (Immediate Supervisor), Prof David Conway (Internal Supervisor) and Prof Munir
Pirmohammed (External Supervisor).
16
MRC TAMA - VOL: 10 ISSUE: 01 / JAN - FEB 2011
Congratulations to Adetokunbo Bashorun
on the conferment of her MSc in IT
Professional (Networking) from Sheffield
Hallam University
BAES students learn about malaria
The Grade 7 and 8 Science class at Banjul American Embassy School has been studying “Disease” this
semester. As part of this course they arranged to visit the MRC malaria research laboratory in order to
see malaria parasites under the microscope.
Six students, and their science teacher, Mr Jain, visited
the Whittle laboratory at MRC Fajara. Simon Correa
and Aubrey Cunnington gave the students a brief
introductory talk about malaria and the life cycle of
the Plasmodium parasite, and then the students were
invited to examine some blood films from patients with
malaria and from parasites grown in the lab. Simon
helped the students to find the malaria parasites in
the blood films and explained the appearances of the
different stages visible in blood. The students enjoyed
this opportunity to see clearly the microscopic parasites
which cause malaria, still a common disease in The
Gambia. They also enjoyed having the opportunity to
ask “the experts” lots of questions about malaria and
its transmission. Overall the reaction was very positive,
and we hope similar visits will be possible in the future,
strengthening the MRC’s commitment to improving
public understanding of science.
Dr Aubrey Cunnington and Simon Correa taking the students through their paces in the
malaria research laboratory
Gowns, microscopes and malaria parasites – BAES students coming to grips with life in the lab
MRC TAMA - VOL: 10 ISSUE: 01 / JAN - FEB 2011
17
News from HR
ENVIRONMENT WATCH
Pa Tamba Ngom and Momodou W. Jallow
The impact of cattle on the environment
Cows, do they think they own our roads!
Despite the benefits of cattle rearing – income generation for farmers
from dairy, meat and other products - cattle are one of the major
destroyers of the environment. According to a report from the United
Nation’s (UN) Food and Agricultural Organization (FAO) in 2006,
livestock including cattle cause some of the world’s most pressing
environment problems, including global warming, air and water pollution,
land degradation and loss of biodiversity. The UN has identified cattle as
the major destroyer of the environment, responsible for 18% of the total
green house gases – that’s more than cars, planes and all other forms of
transport put together.
The statistics are alarming:
1.
Cattle generate 65 % of human-related nitrous oxide, which has 296 times the Global Warming Potential (GWP) of CO2. Most of this comes
from manure.
2.
Cattle account for 37 % of all human-induced methane which warms 23 times faster than as CO2; largely produced by the digestive system of
ruminants, and 64% of ammonia, which contributes significantly to acid rain.
3.
Livestock now use 30 % of the earth’s entire land surface, mostly permanent pasture but also including 33 % of the global arable land used to
producing feed for livestock. As forests are cleared to create new pastures, it is a major driver of deforestation. In Latin America, for example,
some 70 % of former forests in the Amazon have been turned over to grazing.
4.
Herds cause wide-scale land degradation, with approximately 20 % of pastures degraded through overgrazing, compaction and erosion
5.
The livestock trade endangers the earth’s increasingly scarce water resources. It takes a staggering 990 litres of water to produce one litre of
milk.
6.
Waste from feedlots and fertilisers used to grow their feed overnourish water, causing weeds to choke all other life. Pesticides, antibiotics and
hormones used to treat cattle get into drinking water and endanger human health.
What you can do: EAT LESS BEEF…
Goats: an environmentally friendly option…? Find out in the next TAMA…
References:
1.
Lean, G. (2006) Cow 'emissions' more damaging to planet than CO2 from cars. Available at: http://www.independent.co.uk/
environment/climate-change/cow-emissions-more-damaging-to-planet-than-cosub2sub-from-cars-427843.html
2.
Searle, G. (2006) electricfrog.com. Available at: http://www.electricfrog.com/ev.php?URL_ID=1486&URL_DO=do_root&URL_
SECTION=201&reload=1166020891
3.
UN News Centre (2006) Rearing cattle produces more greenhouse gases than driving cars, UN report warns. Available at: http://
www.un.org/apps/news/story.asp?newsID=20772&CR1=warning
Your Feedback Please!
Tama – the Newsletter of MRC (UK)
The Gambia – is for everyone who
is interested in our work and our
community.
We are keen to receive feedback and
suggestions for new features from our
readers. So if you have any comments,
please let us know.
Email: tama@mrc.gm
TAMA EDITORIAL BOARD
Alison Offong
Pa Tamba Ngom
Yailouise Ndure
Kalilu Dibba
Tisbeh Faye-Joof
Fanding P Njie
TAMANEWSLETTER
VOL: 10 ISSUE: 01 / JAN - FEB 2011
Medical Research Council Unit, The Gambia
Atlantic Road, Fajara
P. O. Box 273 Banjul
The Gambia
Communications
Tel: 4495 442 Ext. 2306
Email: communications@mrc.gm
Web: www.mrc.gm
© Medical Research Council 2011