Innovative Malaria Research in Southeast Asia: a UCI GHREAT Initiative (Video Review)

by Niniola Soleye

The University of California, Irvine (UC Irvine) recently released the first video in their four-part series showcasing the success of their Global Health Research, Education and Translation (GHREAT) Initiative. The initiative is headed by IH section member Dr. Brandon Brown. The goal of the video series is to demonstrate how GHREAT projects are enhancing health and saving lives all over the world. This first video was shot in Thailand and focuses on malaria research in Southeast Asia.

Myanmar has the largest number of malaria cases in Asia. Due to the poor economic conditions in the country, people immigrate to neighboring countries, including Thailand, to look for employment opportunities. Additionally, there has been an increase in drug-resistant malaria and an influx of counterfeit drugs. That, coupled with poverty and people not having funds to travel to the hospital or buy medicine, has resulted in malaria becoming a major public health problem in the region.

UC Irvine faculty, staff, and students partnered with the ministry of health, hospital workers, local health workers, and academic researchers in China, Myanmar, and Thailand to study malaria control in the border regions, and develop solutions for containing the malaria outbreak.

The video shows the UC Irvine team observing local health workers as they perform diagnostic blood-tests for malaria in Thai villages. Their observations led them to focus their efforts for this project on developing an innovative, non-invasive diagnostic test using saliva instead of blood.

Untreated, malaria can lead to death two to three weeks after infection, so early diagnosis and treatment are key. Blood testing requires workers to send samples away daily, delaying the start of treatment. Using saliva would allow for a fast, portable, low-cost diagnostic tool, all critical factors in a developing country setting.

One scene that stood out showed a young child getting tested for malaria. She was crying because she didn’t want to get her finger pricked, and also because she was afraid of the health worker. In situations like that, the new test would be quite beneficial.

Overall, the video does a good job of emphasizing how direct, firsthand experiences and observations are important when trying to innovate and solve problems in global health. I would have liked to hear more about the technique behind the saliva test, their border control efforts, how they plan to deal with the counterfeit drug problem, and how they’ll address drug-resistant malaria but the video doesn’t go into detail on those topics.

Click here to watch the video.

Global Health News Last Week (plus interest in a new working group!)

Attention IH Section Members: Dr. Kaja Abbas, MPH student at the University of Rochester, is gauging interest in forming a working group focused on using system science to improve global health, similar to the intitiaves being promoted by NIH. Her interests are in conducting system science research on global health policy by modeling population and disease dynamics and economic evaluation of public health interventions and systems, with a focus on HIV and TB. Dr. Malcolm Bryant, our section chair, has encouraged the expansion of our section’s activities in areas of technical expertise, and Dr. Abbas is enthusiastic about a working group within the section that promotes system science methodologies for global health solutions. She welcomes your thoughts and suggestions at kaja [dot] abbas [at] gmail [dot] com.

Global Health Delivery online’s HIV prevention community is hosting a “virtual expert panel” March 7-11 to continue the dialogue around PrEP as a novel approach to prevention. Panelists from Uganda, South Africa and the United States will lead the online discussion, highlighting various barriers and opportunities to implementing PrEP in clinical settings; how to encourage long-term adherence; and what additional research questions need to be answered. Panelists include (1) Douglas Krakower, MD, a fellow in Infectious Diseases at Beth Israel Deaconess Medical Center/Harvard Medical School, (2)Andrew Mujugira, MBChB, MSc, the East Africa regional medical director for the Partners PrEP study, and (3) Vivek Naranbhai, PhD, who was involved in CAPRISA microbicide gel study. All GHDonline members can participate in this online discussion. You can sign up here if you are not currently a member.

POLICY

  • Paramount Chief Mpezeni of the Ngoni people in the Eastern Province of Zambia has urged his subjects to get circumcised in order to reduce the chances of spreading HIV/AIDS and other communicable diseases in his land.
  • Britain is threatening to pull out of the Food and Agriculture Organization due to “patchy” performance.
  • Due to uncertainty in past estimates, the Indian government has formed a 16-member expert group to determine the annual death rate caused by malaria in the country each year.
  • The breakdown of the air conditioning in the plenary hall of the Philippines’ House of Representatives stalled the heated debate of a controversial reproductive health bill. The bill is vehemently opposed by the Catholic Church and pro-life groups and has caused a stir in the largely Catholic country.
  • A massive demonstration rally was held in New Delhi to protest a free trade agreement between India and Europe, which many fear may threaten the production of low-cost generic drugs, particularly HIV medicines.

RESEARCH

PROGRAMS

DISEASES

Mama Drama: The Value of Traditional Birth Attendants

I often seem to have babies on the brain these days, most likely because many of my college friends who got married a year or two ago are beginning to have children. For my generation, this of course means that pictures of a now-pregnant friends or new babies wrapped tightly in blankets are constantly popping up on my Facebook feed. One particular friend’s experience caught my eye, however, because she impressed (or shocked) most of us by delivering her first child, a baby girl named Evelyn, at home. While thinking about it, it struck me that while home births are so unusual (and often frowned upon) in the U.S., they are much more supported in Europe – and they are often the only option for mothers in developing countries.

According to the WHO, skilled attendance at births is considered to be the single most important intervention for ensuring safe motherhood – this means both the presence of a accredited health professional (doctor, nurse, or midwife) and an environment that allows for access to emergency obstetric care. Increasing the number of births with skilled attendance is crucial to reducing the 536,000 maternal deaths and 3.7 million newborn deaths that occur globally each year. Unfortunately, only about 62% of births in the developing world are attended by a skilled practitioner; in some countries, this figure is less than 20%. Additionally, there are regional disparities: while improvement in the proportion of assisted births has increased worldwide, sub-Saharan Africa and southern Asia lag behind other areas, and rural and impoverished women are less likely to receive skilled care.

Many of communities in rural or resource-poor areas already have traditional birth attendants who, though they have no formal medical training, are respected by the residents. While some countries, such as Kenya, have banned these women from practicing to try to encourage women to go to the hospital, others argue that this will only marginalize women who cannot afford medical care (or the transportation to get there). A more constructive approach, utilized by the MOM Project (mobile obstetric medics) on the Thai-Burma border, mobilized the traditional birth attendants in the area to improve health outcomes and could serve as a model for other resource-poor areas. Burma (Myanmar), which spends about 50 cents per capita (about 3% of its budget) on healthcare, has some of the worst health indicators in the world, and the ethnic groups along the borders are even worse off than the rest of the country. This intervention, designed by researchers at Johns Hopkins, incorporated traditional birth attendants into a three-tiered provider network designed to improve access to skilled care. Traditional birth attendants improved antenatal care services, health workers provided supplies and worked to prevent post-birth complications, and maternal health workers provided oversight, training, and emergency care. The intervention increased prenatal care and postnatal visits within seven days, malaria testing and ITN use, de-worming, and vitamin use. Other studies have shown similar improvements in mortality and referral rates after training traditional birth attendants. This underscores the importance of mobilizing traditional birth attendants to improve maternal and newborn health, particularly in areas where medical facilities and trained personnel may not become available any time soon.

MDG 5, which focuses on maternal health, aims to reduce maternal mortality rates by 75%. As countries strive toward this goal, traditional birth attendants could serve as a valuable resource to bridge the gap to skilled maternal care until the capacity of health systems can be built up to provide skilled attendance for every birth.