Lessons learned from Zambia: Discuss with Dr. Phil Thuma
Phil Thuma, MD, is Senior Scientific Advisor and founder of the Macha Research Trust (MRT), doing business as the Malaria Institute at Macha (MIAM) in Zambia. The institute is a collaborative effort to develop a regional center of excellence for research and education on malaria and other major public health problems in rural Zambia that will carry out state-of-the-art malaria research - including molecular biology, entomology, epidemiology and clinical studies. MIAM partners are the Johns Hopkins Bloomberg School of Public Health; Macha Malaria Research Institute, which is a US-based nonprofit organization; Macha Mission Hospital in southern Zambia; and the Zambian government through its Ministry of Health.
In 2003, when the MIAM collaboration was established, the hospital admitted 270 children each month for malaria treatment during the disease’s five-month peak season; since 2008 that number has been less than 10, and by 2011 the malaria cases almost disappeared, with 1 – 4 per month. This dramatic decrease has been sustained to date. Ask Dr. Thuma and he will credit this to the cooperation with the local community and the ownership by the community of the work. Now Dr. Thuma wants to “take what we’ve learned and expand” beyond Macha.
This week, from Monday, January 7 to Friday, January 11, Dr. Thuma will be answering questions and sharing his experience with us. To kick-off the discussion, he shared some updates from Macha.
Feel free to start asking questions and sharing thoughts today.
Question: Can you give us a brief update on ongoing work at the MIAM?
Answer: We have several projects and programs running at present. Our malaria work includes an epidemiological study in the Macha community, which includes both longitudinal and cross sectional field sampling. Samples obtained from this study are also tested in our molecular biology lab for molecular characteristics of P falciparum, and we also carry out serological longitudinal studies on those exposed to malaria in the past. In addition, our local insectary with a long-standing colony of A arabiensis is used for insecticide resistance testing, amongst other things.
Our work in HIV/AIDS includes a longitudinal cohort study of children with HIV infection, as well as a large program to increase the availability of HIV testing in the Macha area in an effort to decrease the transmission of Mother to Child HIV infection. We also are just completing a 5 year study on learning disabilities in school children in the Macha area.
Question: What would you say are the essential elements to reproducing the success met at the MIAM?
Answer: We have been fortunate to see a marked decrease (98%) in malaria case load in the Macha area over the past 10 years. While it is impossible to name one particular project or program that made this happen, we believe that the involvement of people at the community level has made a significant impact. More specifically, in addition to wide spread ITN distribution and treatment of malaria cases with ACT, we embarked on a community education and mass screening project to discover asymptomatic malaria cases, with treatment of the latter. Subsequent to that effort is when we saw the dramatic decrease in malaria cases in the area. That is why we feel community based efforts with mass screening and treatment of asymptomatic malaria cases may be a key to reproducing what we have seen in Macha.
Question: What are the key elements of vector control at the MIAM and in the community?
Answer: To be honest, our vector control efforts have been minimal, since we did not have resources for anything other than ITN distribution. That has thus been the main strategy used for vector control, such as it is. IRS has not been used in this rural community and larviciding was only used on a research basis, but the heavy intermittent rains were found to be very disruptive to any systematic larvidicing efforts.
Question: What are your hopes and goals for 2013 and beyond?
Answer: I hope to continue to use the Macha community to demonstrate that malaria control can really happen in rural Africa, and that the “Macha model” can be used in other areas to bring down malaria incidence and thus eventually lead to elimination of this disease. I doubt that will happen in 2013, but we have come a long way in the past 10 years – probably further than any of us imagined – and so who knows what the next 10 years might bring?