Scientists in West Africa Tackle Malaria and Schistosomiasis
Dr Mamy Andrianirina Rakotondratsara (centre) distributing antimalarials in rural Madagascar.

Malaria has long been at the heart of public health efforts in Africa. As a preventable but potentially fatal disease, it is caused by a parasite transmitted by mosquitoes. In 2022, the WHO African Region accounted for about 94% of cases globally. WHO says 78% of deaths in the region are among children under 5 years of age.

That’s why Dr Mamy Andrianirina Rakotondratsara, a medical doctor and research technician for Madagascar’s National Institute of Public and Community Health (INSPC), wanted to dedicate his TDR-supported studies for a Masters in Public Health to malaria research.

Originally from an endemic region in eastern Madagascar, Rakotondratsara has been personally affected by malaria as he lost his older brother to the disease. 

“I lost someone close and beloved to me from this disease,” he told Health Policy Watch in an interview. That reinforced his determination to address the disease in the course of his studies. 

Dr Mamy Andrianirina Rakotondratsara lost his brother to malaria and is passionate about addressing the disease.

In 2021, during the course of his Masters studies at the Cheikh Anta Diop University of Dakar (UCAD), Rakotondratsara  also completed TDR’s Massive Open Online Course (MOOC) on implementation research. 

As part of this course, he designed a study around the relationship between the frequency of malaria episodes and mosquito bed net coverage, working with other researchers and doctors that specialize in malaria. This research is still ongoing and specifically targets the rural population of Madagascar’s Anosibe An’Ala district. 

Although results are still pending, designing such a study has laid the foundations for Rakotondratsara to put the research findings into practice in his home region and disease context, complementing his prior work on malnutrition

Sub-regional training centre for Francophone Africa

Students engaged in a field training in participatory epidemiology organised by the  National Institute of Public and Community Health Madagascar.

Rakotondratsara was able to undertake this research thanks to TDR’s global postgraduate training scheme – which focuses on building students’ skills to do interdisciplinary forms of research that look at barriers and opportunities for better uptake of available preventative and treatment methods.

For physicians, researchers and other professionals interested in local public health, the fellowships supported by TDR – the global research programme on diseases of poverty co-sponsored by UNICEF, UNDP, WHO and the World Bank – provides essential skills for health programme management and implementation. It is particularly important for addressing infectious diseases affecting vulnerable and underserved populations and promoting engagement in research from the local to global levels.

UCAD is one of the two universities in French-speaking West Africa to collaborate with TDR in the programme. It has been hosting students since 2021, to conduct research into how to control infectious diseases found across the region. In 2022, University of Sciences, Techniques and Technologies in Bamako, Mali, joined the programme with the support of Germany’s Deutsche Gesellschaft für Technische Zusammenarbeit.

“The TDR training allowed us to have a new vision of the health system,” Rakotondratsara  observes.  It changed my way of asking questions when faced with poor health indicators. Regarding my Master’s thesis, it gave me an idea of issues to be explored in the mosquito net distribution process, starting with the quantification of needs to end point use.”

He strives to integrate such lessons learnt into his current role with the INSPC. And he is also planning to pursue a PhD with a specialization in implementation research.  

“The INSPC is a public health training and research institution attached to the Ministry of Public Health,” he explains. “Given that it is a research institution, in collaboration with funding bodies, we are often called upon to carry out expert appraisals on their behalf. As a research technician, I accompany this research and bring my contributions to it,” he says.

“Based on my experience, it’s my intention to ensure that implementation research finds an important place both in the research and the teaching context.” 

Towards better management of Schistosomiasis

Although less well known, schistosomiasis, also known as bilharzia, is the second most prevalent disease after malaria both in Senegal and much of the rest of sub-Saharan Africa.

Its most common form – urogenital schistosomiasis – can result in damage to the bladder, urethra, and kidneys. It is a parasitic disease that occurs in tropical and subtropical regions where there is limited access to clean water, particularly in the Senegal River Basin, a hyper-endemic region for several species of the parasite that causes the disease. 

The different variants of the disease are classified by WHO according to the NTD principles for which a greater global response is needed, making it an important research target in the TDR program.

Oumy Kaltome Boh, a physician originally from Dakar, has been interested in the burden of NTDs in Senegal since her formative years, and hopes to see their eradication by 2030.

Dr Oumy Kaltome Boh

“Faced with the impact of these diseases on the health of the population,” she says, her main objective is to contribute to their management “through the implementation of innovative interventions.” 

This is what led Boh to undertake a Masters degree in management of health programmes at UCAD, as well as an International Inter-University Diploma in emerging infections.  

Benefiting from a TDR grant in December 2020, Boh was able to conduct a study examining the day-to-day lifestyle practices and environmental factors that make schistosomiasis transmission more likely in endemic areas of her home country.

As part of this study, done in collaboration with Senegal’s national bilharziasis programme, she also aimed to verify the effectiveness of schistosomiasis treatment with praziquantel, the only available treatment option currently. A total of 287 children were followed over the course of three weeks, with ‘Day Zero’ representing the date of administration of a single praziquantel dose. Between days 14 and 21, both the effects of the drug on disease progression were assessed and a favourable efficacy profile was found, with a 98% reduction in parasite eggs by day 21.

Today, Boh holds the position of deputy chief medical officer in the health district of Saint-Louis, Senegal, and is mainly involved in care and prevention activities for people living with HIV or tuberculosis.

Recruited into this position by the Ministry of Health, she stresses that it was through the support of the TDR postgraduate training scheme that she acquired the skills she needed to manage the public health challenges in this district. In particular, learning about community-based approaches allowed her to better “understand the specific needs and problems” of the districts. 

New research and management approaches

As a key aspect of disease control, students supported by TDR can learn to apply new health research and management approaches previously unknown in Senegal, Boh says.

Among these is the One Health approach, which aims to assess how diseases emerge from a holistic and ecosystem-oriented perspective, taking into account the reciprocal role of humans, animals, plants, and microorganisms such as the aforementioned pests.

By combining scientific, strategic, and rigorous implementation training, the TDR grants offered through UCAD enable their recipients to evaluate and propose improvements to health interventions against poverty-related infectious diseases. 

These opportunities are game-changers for both UCAD students and the future of implementation research in French-speaking Africa. With the help of TDR grants, Boh emphasises, students can gain exposure to critical health programmes and “pool their skills in order to end the neglect of poverty-related diseases and to achieve the Sustainable Development Goals.”

This is the second article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions.

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