Category: African research

BIOTOPE (BIOmarkers TO diagnose PnEumonia)

By Dr John O’Donoghue, Senior Lecturer in eHealth & Deputy Director of Imperial’s Global eHealth Unit

Mr Masters Chisale (Mzuzu Central Hospital) and Dr Chris Watson (Queens Universty Belfast) preparing the samples in Mzuzu Central Hospital.
Mr Masters Chisale (Mzuzu Central Hospital) and Dr Chris Watson (Queens Universty Belfast) preparing the samples in Mzuzu Central Hospital.

The last week has been very busy in Mzuzu, northern Malawi.  Scientists there have been packing blood and urine samples collected from 506 children with pneumonia in preparation for shipment to Dublin, Ireland.  These samples will travel 12,000km at -80oC with constant monitoring of their temperature and dry ice being packed around them at stops along the journey to ensure they remain frozen in the warm heat of Africa as they travel across the African and European continents.

Over the past twelve months the researchers from the gHealth Research group based in University College Dublin, Queens University Belfast & Imperial College London have been working with colleagues in Malawi to collect these samples.  The BIOTOPE (BIOmarkers TO diagnose PnEumonia) project is an innovative project which received funding from the Gates Foundation Grand Challenges Exploration Fund to investigate new ways to diagnose bacterial and severe pneumonia in the community. 506 children have participated in the research and as part of this, blood and urine samples have been collected and are now being shipped to Ireland for detailed analysis along with novel data from sensors and mobile phone applications monitoring the children’s health.  With this approach, new ways to help stop the million children dying each year from pneumonia are being developed along with approaches that will help reduce antibiotic resistance both in Africa and internationally.

Pneumonia continues to be the number one infectious killer of children under the age of 5 years worldwide – more than HIV, TB, Zika, Ebola and malaria combined.

People of any age in any country are at risk of contracting pneumonia but the vast majority (>90%) of childhood deaths from pneumonia occur in poor countries.

Antibiotic resistance is present in every country in the world and as recently as the 21st September 2016 the UN held a general assembly on antibiotic resistance.  This was only the fourth such General Assembly high-level event in the history of the UN to focus on a health issue highlighting the serious nature of this problem.  (more…)

The impact of Neglected Tropical Diseases on Universal Eye Health

By Professor Alan Fenwick of Imperial’s Schistosomiasis Control Initiative (SCI)

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‘Oncho blind’ – 60 years ago blind older people were led by children

There are five neglected tropical diseases (NTDs) which are the scourge of Africa, the Indian sub-continent, the Far East and South America.  Onchocerciasis is one of these 5 and until the late 20th century caused millions of people to gradually lose their sight and eventually go blind. The parasite is spread by infected Simulium blackflies which when they bite a human, transfer microscopic larvae to the human host, where they develop into adult worms and females produce millions of new larvae during their lifetime. It is these larvae that are the cause of irreversible blindness in as many as 25% of the adult population in several countries in Africa. Onchocerciases was also prevalent in some countries in South America.

Another cause of blindness in the poorest populations globally is the NTD trachoma. Caused by certain subtypes of the Chlamydia infection, it is spread through contact with discharge from the eyes or nose of an infected person. In developing countries, eye-seeking flies are a major cause of transmission, particularly in areas where water to wash is in short supply.

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‘Trachoma flies’ – After conjunctivitis eyelashes scratch the cornea causing blindness.

The remaining three major NTDs, schistosomiasis, lymphatic filariasis and soil-transmitted helminths do not directly affect eye health but overlap geographically with onchocerciasis and trachoma and debilitate in other harmful ways.

All 5 of these NTDs can be controlled by the annual administration of safe oral medications. Onchocerciasis, and the resulting blindness and itching caused by the larvae are controlled by an annual dose of Mectizan (Ivermectin). Trachoma is controlled by an annual does of Zithromax, and schistosomiasis is controlled by an annual dose of praziquantel. Albendazole treats both lymphatic filariasis and soil-transmitted helminths. All four medications are generously donated by the pharmaceutical companies which manufacture them (Merck Sharp Dom, Pfizer, E.Merck and GSK respectively). In 2015 almost 1 billion individuals globally have benefitted from treatment directly resulting from these donations. (more…)

FEAST – five years on

By Professor Kathryn Maitland, Director of the IGHI Centre of African Research and Engagement. 

First published by the Hippocratic Post on 22/8/16.

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Professor Kathryn Maitland

‘Back in 2011, my research team published the results of the largest trial of critically ill children ever undertaken in Africa (FEAST trial), a trial that examined fluid resuscitation strategies in children with severe febrile illnesses (including malaria and bacterial sepsis). Contrary to expectation, the trial showed that fluid boluses were associated with an increased mortality compared to no-bolus (control), the greatest effect was in children with the most severe forms of shock. We were delighted when the FEAST trial won the prestigious 2011 BMJ Research Paper of the Year award and expected that doctors around the world would sit up and take notice – and guidelines for management of children suffering from shock due to sepsis would change.

However, five years on, I have to say that I am disappointed that the WHO guidelines in resource-poor settings are still largely unaltered. Although the humanitarian aid charity Medicins sans Frontieres changed its own procedures within nine months of our results becoming public, the directing and coordinating agency for international health of the United Nations has so far left existing guidelines in place. This is despite the fact that we found that the intervention of rapidly administering fluids was actually harmful to children in our study which was robust and based on sound scientific evidence. One statistician said it was the most consistent he had ever seen. (more…)

World Blood Donor Day 2016: Blood connects us all

By Professor Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases and Director of Centre of African Research and Engagement, Imperial College London. 

Each year, World Blood Donor Day highlights the importance of blood donations as the transfusion of blood is a life-saving intervention. In any health system, the provision of adequate supplies of safe blood for transfusion is an essential undertaking.

Slide1The World Health Organization (WHO) estimates the blood requirement for countries to be in the region of 10 – 20 units per 1000 population per year. Yet in many sub-Saharan African countries, donations are far lower, in some countries as low as 2 units/1000 population/year. The demand for blood transfusion is very high, especially in children (largely due to infection) where up to 15% of children admitted to hospitals are transfused, with most being given as emergency interventions.

Over the past decade, several countries in sub-Saharan Africa have made progress in achieving the goals defined by the WHO to improve both the supply and blood safety, which have been financed largely by international donors.  This has led to an increase in the number of total blood donations and the proportion from voluntary donors, and improved safety of blood; but this is expensive to maintain therefore concerns about the sustainability of systems requiring a high level of financial support in low-income countries when cost recovery is unlikely. (more…)

Towards Eliminating Schistosomiasis in Africa – A Multi-Disciplinary Effort

By Dr Michael Templeton, Reader in Public Health Engineering, Department of Civil and Environmental Engineering, Imperial College London

Wednesday, May 25th 2016 marks Africa Day, the 53rd anniversary of the founding of the Organisation of African Unity, the forerunner of the African Union. There have been so many wonderful developments in Africa in the last 53 years, but sadly the quality of life of many of the poorest people in Africa continues to be limited by the burden of a group of debilitating diseases known collectively as neglected tropical diseases (NTDs), which have afflicted millions of Africans since ancient times. Therefore, it is hugely exciting that in 2012 The World Health Assembly put forward an important resolution to not only control but completely eliminate one such NTD, schistosomiasis.

It has been estimated that 200 million people in developing countries, most of whom live in Africa, are infected with the parasite causing schistosomiasis, which manifests itself in a range of symptoms, including enlargement of the liver and spleen, anaemia, increased risk of bladder cancer, exacerbation of the transmission of HIV and its progression to AIDS, and in extreme cases seizures. The parasite lives within infected people, with aquatic snails acting as intermediate hosts and releasing cercariae (the larval form of the parasite) into water bodies, which then penetrate the skin of other people who come in contact with the contaminated water. Preventing people from coming into contact with contaminated water and preventing urine and faeces from passing into water bodies should stop this cycle, however most endemic countries lack adequate water and sanitation provision. Achieving the WHA’s ambitious elimination goal will therefore require a coordinated, multi-disciplinary strategy, involving mass preventive chemotherapy with the drug praziquantel but also improving access to water, sanitation and hygiene (WASH).   (more…)

On this Africa Day, we need to talk about nutrition

By Alice Marks, Agriculture for Impact, Imperial College London

Credit Ag4Impact - women farmers in mozambiqueAs we celebrate Africa Day 2016, it’s time to reflect on the state of nutrition in Africa and the weighty effect malnutrition has on the continent’s ability to prosper. Progress has been made over the past decades, for example through the Millennium Development Goals (MDGs), to reduce extreme hunger and starvation. However, it is the quality of food that people consume and a lack of variety that is of increasing concern. A few weeks ago, Roger Thurow, a Senior Fellow at the Chicago Council on Global Affairs, released a new book, The First 1,000 Days: A Crucial Time for Mothers and Children—And the World. The book lays out that nutrition, or lack thereof, in the first 1,000 days of life – from conception to the age of two – has a profound and lasting influence on a child’s ability to grow, learn, develop and work.

Stunting is a measurable impact of malnutrition, but the height of a child doesn’t tell the full story. The development of the child’s brain is also affected, so stunted children are more likely to fall behind in school, fail to achieve decent incomes, and perpetuate the cycle of poverty for the next generation. The cumulative effect of widespread malnutrition in a group of people can therefore directly impact, and limit, a society’s ability to develop and prosper. Thurow’s book highlights Uganda in particular, where half of women of childbearing age are anaemic and about 35% of children suffer stunting due to malnourishment. Indeed, a staggering 40% of all under-five deaths in Uganda are caused by malnutrition. Tragically, Uganda is not an isolated case in sub-Saharan Africa, where 40% of all children under the age of five are stunted. (more…)

World Malaria Day 2016: Africa, children and malaria

By Professor Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases and Director of IGHI’s new Centre for African Research and Engagement (ICCARE).

5050015921_99fda97f5c_oAcross large parts of sub-Saharan Africa the major rains have got underway; which typically means that in a few weeks, hospitals will witness a seasonal upsurge of admissions into the children’s wards. Most of these will be children suffering a new bout of malaria, with around ten percent of these malaria admissions having life-threatening complications such a coma (cerebral malaria), severe anaemia (requiring urgent life-saving transfusion) and rapid breathing (to try to compensate for the build up of acids in their bodies). Outcome remains poor. Despite implementation of the new fast-acting effective antimalarial drugs, in-patient mortality remains unacceptably high (~10%).

In many parts of the world, including several sub-Saharan African (sSA) countries, the scale-up of control efforts has led to substantial reductions in the burden of malaria since 2000.  The World Health Organization estimated that severe malaria killed up to 500,000 African children in 2013. Whilst the last decade has witnessed a transformation in the epidemiological landscape of malaria, with many areas reporting substantially less malaria. However, this has not occurred equally within or across countries in Africa. In parts of the continent, where the pattern of transmission has not changed appreciably, malaria continues to contribute most to the global disease burden (e.g. Nigeria, DRC, Uganda, Mozambique). Early optimism that the most promising malaria vaccine candidate developed to date (RTS,S) would reduce the burden of severe and fatal malaria has proved premature with the recent publication of long term follow up data reporting a waning vaccine efficacy after 20 months. There seems little prospect for further reducing the substantial mortality burden from severe malaria within the foreseeable future hospitalized with malaria serves as a “barometer” of how well local, national and regional malaria control is performing.   (more…)

A video memoir: Our gap year experience in the Gambia

By James Frater, Amos Bursary student

As part of my gap year, with the help of the Amos Bursary and Imperial College London, I was given the opportunity to spend 3 months in The Gambia. I assisted the PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa) project, where I was able to experience various laboratory procedures and resource-poor healthcare services.

I was given a thorough induction on laboratory etiquette and different laboratory practices, as well as training on how to handle laboratory equipment and the various biomedical samples. This meant I was confidently able to work in and navigate my way around the laboratory with a relatively good level of competence.

The majority of my time was spent in the lab collecting, processing and storing blood samples from the clinic into plasma, serum, EDTA and buffy coat. I was also able to learn how to perform other techniques such as HBsAg rapid tests, ELISAs and extracting DNA from serum to use in PCR. (more…)

World Mosquito Day 2015: The burden of Malaria today

By Alison Reynolds and Dr Thomas Churcher from Imperial’s Malaria Modelling Research Group

World Mosquito Day (20th August) commemorates the discovery that mosquitoes transmit the parasite that causes malaria, made in 1897 by British doctor Ronald Ross.

Mosquito-Infographic_Updated-13-08-2015A hundred and eighteen years later this transmission still continues, to some extent unabated. There have been huge successes in malaria control, most notably in recent years, though a child still dies every minute[1] from a disease which continues to ravage large swathes of Africa and Asia. Importantly these deaths are completely avoidable, as we have effective tools to treat malaria and stop people dying.

This is clearly illustrated by the wonderful work of French scientist Jean-Francois Trape, of Institut de Recherche pour le Developpement, Senegal. He, along with his team, has lived and worked in the community of Dielmo, Senegal for the last twenty years providing diagnosis and treatment for malaria whilst conducting research. Malaria was a huge killer in this village but since they arrived only three people have died of the disease and these deaths can be ascribed to older drugs not being as effective as those we have today.

The village of Dielmo, Senegal, courtesy of Jean Francois Trape.

(more…)

A Pre-Medical Gap Year Experience in The Gambia

By soon to be Imperial medical student, Hannah Lewis

photo with crocI will start my medical course at Imperial in October 2015 and I was lucky enough to spend 5 months in Gambia at the beginning of the year, gaining insight into medical research in resource-poor settings. It is the smallest country in West Africa, and it is where the British Medical Research Council (MRC) has a big research unit. I worked closely with the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) group, who are looking at the link between hepatitis B and liver cancer.

Initially, I was concerned that, with no previous medical training, I would not be able to learn as much from the experience as fully-fledged medical students. Security was also a concern, if more for my parents than for myself. Although Gambia was unaffected directly by the Ebola outbreak, we still had concerns about it. Despite this, I was excited for the chance to travel there. After a brief training period at St. Mary’s Hospital, it was with great excitement and some trepidation that I travelled to Gambia.

Hannah in labUpon arrival, I had thorough training in laboratory practice at MRC Gambia and I developed my skills in handling laboratory equipment and biomedical samples. I became more dexterous and efficient in many laboratory techniques. These could then be put into practice to aid the PROLIFICA study. (more…)