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Column: The next generation of malaria researchers in Africa - by Jenni Lawton

October 30, 2014 - 19:42 -- Ingeborg van Schayk
The column below was contributed by Jenni Lawton.
 
Now in the ninth month since this alarming Ebola outbreak began, it shows no signs of slowing and could be beginning to spread worldwide. It has been harrowing to see how the healthcare workers putting their own lives at risk to treat and protect affected communities have also faced threats, violence and worse. [1, 2]
 
Probably the best way to counter such mistrust is to help communities feel integrated with the medics and scientists who are trying to help them. Poignantly, the countries worst affected to date have been those with the poorest infrastructure and some of the fewest doctors per population in the world. Increasing this provision with locally trained staff has been a longstanding goal for the medical profession in many sub-Saharan African countries. In Malawi for example, the College of Medicine has increased capacity from ~10 students to ~60 per year in the twenty years since it was established, and now have an impressive 67% of Malawian faculty members. [3]
 
But what about the scientists whose research supports the treatments medics are able to prescribe?
As the value of basic research becomes more recognized in sub-Saharan Africa, it is hoped that the current few centres of excellence will expand to provide a stable research tradition where ‘home-grown’ scientists are no longer lost in the ‘brain drain’ to other parts of the world.
 

Two researchers who have studied in the UK and are now helping to train the next generation of African scientists have kindly given their thoughts on how basic lab research, and malaria research in particular, are viewed in their institutions and beyond into the local communities.

Dr Bismarck Dinko from Ghana, trained in London, UK. Bismarck is now a lecturer & acting head of the department of Biomedical Sciences at UHAS (University of Health and Allied Sciences), Ho, Ghana. UHAS is a new University, established in 2011.

 

Dr Janet Storm from The Netherlands, has worked in both Oxford & Glasgow, UK. Janet is now a post-doctoral scientist at MLW (Malawi Liverpool Wellcome Trust), Blantyre, Malawi.

 

Are attitudes to research different in the European and African institutions where you’ve worked?
 
MLW has been a research centre since 1995, with a malaria research programme since its inception, and aims to conduct high quality research relevant to health in sub-Saharan Africa.
Janet: “Most of the research is clinical or epidemiological, there is little lab-based research. The lab research is mostly immunology and genomics, but that seems based on a few techniques, such as flow cytometry or sequencing”.
 
Compared to the UK, this is a more focussed approach to lab work making use of the technologies currently available at MLW, and of the opportunities to study at the population level. As a basic scientist though, this means that certain experimental approaches require external collaboration, at least until further technological investments are made. As the profile of research in Africa increases, it may be possible for further investment that will support and sustain emerging expertise.
 
Bismarck nicely summarized it from his experience; “Basic lab research in [Western] labs is seen as the fundamental piece of every scientific discovery and development and research support is provided accordingly. However, the importance of basic research is now dawning on labs in some Sub-Saharan countries which previously had a different view.”
 
How is malaria research viewed in endemic countries?
 
Janet: "Malaria research was much more prominent in MLW a couple of years ago. But lately it is picking up again. It is taken seriously, but we are a much smaller research group than for example the microbes/vaccine and HIV/TB research groups. In the wider community, people think it's important to research malaria, as everyone is affected by it."
 
Bismarck: "Yes, malaria research is taken quite seriously and as a head of department, I work on malaria and continue to encourage those with interest in the field to keep the focus. In general, the community of scientists here in Ghana take malaria research seriously too."
 
So how does it feel to work in these different environments?
 
I have certainly felt isolated and frustrated at times when my project has hit a tough obstacle, despite being in a large institution with plenty of expertise all around. When there is a technical research hurdle to climb, it can be difficult to solve on your own. This surely must be exaggerated when working in smaller centres with few other researchers to discuss with?
 
Janet: “Most clinical researchers have not much interest in lab research and have no idea what I do. That is frustrating and most of the input I get is from people outside the institute.” Clearly it is important to make use of colleagues outwith your department, whose knowledge and ideas can help solve such challenges, this is difficult when it may only be possible to contact those colleagues by phone or email.

Collaborating is a crucial part of research, and Bismarck believes the “opportunity to spend time in collaborators’ laboratories” is fundamental to his ability to 'carry out high quality research on malaria' whilst settling in to a new department at his university.
 
One advantage of working in an endemic area could be the chance to work with patient samples that have direct relevance to disease.
 
However, this might depend on the type of samples and demand for access! Bismarck has not struggled to access parasites from adult patients for his studies of the sexual/transmission stages: gametocytes. On the other hand, working with parasite isolates from children with cerebral malaria has numerous difficulties: only small blood samples may be taken and these would be useful to answer many research questions.
 
Accordingly, Janet has not found it easy to access samples for several reasons: “First, there are less children with cerebral malaria this season, which is wonderful of course, but means less participants for the studies. We are also part of a bigger research study and this year not every recruited child was available for our study. This has an impact, as we generate not as much data as we anticipated.”
 
The focus of research is also important. Whilst in the UK, “people work on parasites and do often have not enough knowledge about the disease and the patients”, Janet is heartened that in Malawi “the disease/illness and patients are the heart of each research study. All the research has clinical relevance and is also providing data which changes policy-making”.
 
So what do you think are some of the most outstanding questions for malaria research?
 
Janet: "How does severe malaria develop (major cause of malaria death) and why do certain people, but not everyone, develop severe malaria?"
 
Bismarck: "Understanding of the host-parasite interactions on the sexual stages concentrating on parasite factors which facilitate their development and transmission."

Janet: "How to control asymptomatic malaria (a source of transmission). Can it be controlled? (Mass drug administration?)"
 
Janet: "How to combat drug resistance?"
 
Janet & Bismarck: :Development of new anti-malarials that target all stages of the parasite including the sexual stages."

I would like to say an enormous thank you to Bismarck & Janet for their contributions here! Wishing them all the best for their current and future research.
 
References
 


Jenni Lawton is a post-doctoral researcher at the University of Glasgow, UK. Her research interests focus on the interactions between Plasmodium infected red blood cells (iRBCs) and the host; dynamic processes which are still incompletely understood. The behaviour of iRBCs may have important implications both in generating effective immune responses and in the escalation of some malaria infections towards severe complications. This will be her first foray into communications and she hopes to provide some interesting perspectives from the lab to the Malaria World community!