Annual report highlights, 2005/6 - Malaria Research Lead Programme

Achievements in scientific research
The Lubombo Spacial Development Initiative (LSDI) is the only regional project to receive funding from the Global Fund for AIDS, TB and Malaria; and was successful in receiving another three years of funding. Furthermore, an additional amount of US$21.5 million has been awarded to the LSDI to expand their operations in southern Mozambique over a five-year period.

The high incidence of malaria within the LSDI region was assessed to be one of the major stumbling blocks in developing the region into a competitive economic area. To this end, the LSDI set up a malaria control programme comprising two arms: vector control by indoor residual
spraying and parasite control by definitive diagnosis and effective treatment. Definitive diagnosis has been improved through the introduction of rapid disgnostic tests at all health facilities within the 3 August, 2012mmendation that artemisinin-based combination therapy (ACT) replace the more commonly used monotherapies like chloroquine and sulphadoxinepyrimethamine (SP), the ACT artesunate-SP (AS-SP), was introduced as the first choice antimalarial in zone 1 on 2004. Unfortunately, ACT implementation in Africa has not been as successful as in South East Asia. This may be due to higher malaria endemicity and/or the
inclusion of an inadequate partner drug. The latter can be monitored using molecular markers. Studies have shown that the presence of point mutations at positions 51, 59 and 108 of the dihydrofolate reductase gene and 437 and 540 of the dihydropteroate synthase gene are
strongly correlated with SP clinical failure. Assessmentof the prevalence of these five mutations was conducted on P. falciparum isolates obtained prior to and following ACT introduction in Zone 1. Our results show a dramatic increase in the prevalence of all five point mutations following the introduction of ACTs. This increase is an early indictor of both an increased risk of SP clinical
failure and a potential decrease in ACT efficacy. Close monitoring of mutational prevalence and clinical efficacy is essential to ensure effective antimalarials are being used.

Capacity development
The foundation of a successful, efficient and effective programme is optimally trained staff at every level. Within the LSDI, appropriate expertise at all levels was lacking in Mozambique; training was therefore a key priority before a spraying programme could be introduced. To ensure the smooth functioning of the LSDI programme, training of field staff was conducted and to date 320 people have been trained as spray operators. Training of supervisors and spray persons has taken place each year. Training was extended to include intervention assessment. In this regard, window-trap caught mosquitoes were morphologically identified in Mozambique and residual efficacy bio-assays carried out. Training has been undertaken to equip field entomologists with the necessary research techniques and to train field staff to use global positioning system (GPS) receiver hand-held units. Office staff were trained in the use of the management information system (MIS) and insectary staff in Maputo were taught to rear mosquitoes. A strong emphasis was placed on entomological training and drug management. To fully implement the MIS, information officers have been trained and put in place in all three malaria-affected provinces in South Africa, as well as in Mozambique and Swaziland. The malaria control programmes in South Africa have also been strengthened by recruiting, training and seconding entomologists to the provincial malaria control programmes. International funding was obtained for the funding of doctoral students. Money was obtained from the Swiss Tropical Institute (STI), LSHTM, WHO, National Institute of Health, Liverpool School of Tropical Medicine (LSTM) and the Gates Foundation. The lead programme has three South African Master's students, five South African PhD students and one PhD student each from Mozambique and Malawi. The lead programme director has negotiated for four staff members to do their PhDs internationally with full funding: two at the Swiss Tropical Institute, one at Liverpool School of Tropical Medicine and one at the London School of Hygiene and Tropical Medicine

Collaboration and research strengthening
The Malaria Research Lead Programme has strong links with national and international agencies, universities, research organisations and funding agencies.