Resistance to anti-malarial drugs
is probably the most serious problem facing control programs in West Africa.
Patterns of drug failure due to genetically determined parasite resistance,
which initially emerged in East Africa, are now appearing in Mali and all
of West Africa. It may be possible to extend the life of currently used, inexpensive
drugs, but a better understanding of the pattern of the prevalence and spread
of resistant parasites is needed. The NIH in cooperation with Malian scientists
has developed a battery of extraordinarily sensitive, rapid, molecular probes,
which can detect the presence of resistant parasites from a single drop of
blood collected and dried on filter paper. This system will allow the conduct
of broad based surveys to determine where and how anti-malarial drugs should
be deployed in a given region. Such a program could make a significant contribution
to the national malaria control effort. The MRTC is the only site in Africa
where such technologies are currently available and it has been suggested
that the MRTC serve as a regional training center for the deployment of such
technologies. - Dr. Abdoulaye Djimde is heading this program at the MRTC.
Dr. Djimde, while a fellow in the LPD also completed a PhD in Molecular Biology
at the University of Maryland. Dr. Djimde’s recent publication of work completed
as a fellow in the LPD is an indication of the quality of the scientists working
at the MRTC.
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Studies by a joint MRTC/NIH/U.
Maryland team in Bandiagara have developed interventions, which can save many
of the children brought to the clinic suffering from severe or complicated
malaria. This strategy coupled with a program that trains mothers to recognize
and respond to the early signs of malaria have significantly reduced both
mortality and morbidity in pilot programs in Bancoumana and Bandiagara. The
MRTC hopes to work with the Ministry of Health of Mali to expand this training
to mothers and health workers throughout the country. Community-based case
management in Bancoumana has reduced mortality and occurrence of severe malaria
by 15-30%.
Predictive models
for malaria risk and planning
In cooperation with NASA, NOAA, the NIH, Columbia University and the National Meteorological Service of Mali, the MRTC has initiated a major program to develop models for predicting outbreaks of malaria. The program brings to bear the tools of climate prediction, remote sensing, and ground-based Epidemiology and vector ecology merged into a Geographic Information System (GIS) for the construction of models for malaria risk assessment. The MRTC is the West African center for MARA, the South Africa-based program for developing risks assessments for malaria in Africa. MRTC staffs have been trained in South Africa, at the NASA Ames research Center in California and the International Research Institute (IRI) of the Lamont-Doherty Earth Observatory of Columbia University. In March 1999, IRI coordinated a workshop for participants from 12 African countries on “Climate and Health” with an emphasis on malaria. Faculty included representatives from NASA, NOAA, the CDC and several US and European universities. ORSTOM (now IRD) sent staff and participants.
Insecticides for bednet and curtain impregnation
The MRTC has long been recognized
as a center for research on the use of impregnated bednets and curtains for
malaria control. Dr. Yeya Toure for several years chaired the WHO Bednet Taskforce
and was responsible for monitoring and evaluating all bednet trials in Africa.
The MRTC has also conducted for WHO to monitor the emergence of insecticide
resistance in mosquitoes to insecticides currently in use in bednets impregnation
programs and in evaluating the efficacy of new candidate insecticides for
the bednet impregnation program.