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Handbook
The Malaria Institute at Macha (MIAM) is a malaria research field station and training center established in 2003 with the signing of a collaborative Memorandum of Understanding between four partners—the Johns Hopkins Bloomberg School of Public Health and its Malaria Research Institute, the Zambian government, the Macha Mission Hospital and the Macha Malaria Research Institute. With major sponsorship from the Johns Hopkins Malaria Research Institute (JHMRI), MIAM greatly expanded the existing infrastructure available to host visiting scientists and students at Macha. MIAM opened officially in January 2005.
Basic descriptions of the site, the community, facilities and resources are included here, with links to the most current information and fee schedules. While priority is given to malaria research, MIAM will host investigations in other diseases if space and resources are available.
Please use the following contacts if you have questions about the Malaria Institute at Macha, or if you are interested in conducting or collaborating in research at the site.
MIAM | JHMRI |
admin@machamalaria.org | 410-502-3377 |
Macha Hospital was established in 1957 as a mission hospital under the Brethren in Christ Church of North America, and has functioned within the program of the Ministry of Health of the Zambian government since that time. Since 1990 the hospital has been administered by the Zambian Brethren in Christ Church. Now a 208-bed facility, it is considered a district-level hospital by the Zambian government.
Malaria research has been conducted at the hospital since 1989. In 1994, a malaria research institute was formally registered as an independent institute with the Zambian government under the name of Macha Hospital Malaria Research Institute (MHMRI). The Institute was registered for the purpose of continuing research on various aspects of malaria, including drug trials, as well as efforts to control and prevent malaria. In 1997, a legally separate organization, the Macha Malaria Research Institute (MMRI), was incorporated as a non-profit organization in the U.S. state of Pennsylvania, and under this organization further grants were obtained and projects carried out at Macha Hospital.
Over 20 privately and publicly funded studies have been carried out at Macha by MHMRI and MMRI investigators, including those on malaria transmission, diagnosis, drug evaluation and treatment, resulting in 21 publications by 2004 in peer-reviewed scientific journals.
The activities of the MHMRI and the MMRI are now incorporated into the Malaria Institute at Macha.
Philip Thuma, MD - Executive and Administrative Director
Dr. Thuma was the founding director of both the MHMRI and the MMRI. He is a Johns Hopkins Hospital-trained, American board-certified pediatrician with more than twenty years experience working in Zambia on the treatment and study of malaria. On-site nine months of the year.
Sungano Mharakurwa, PhD - Scientific Director
Dr. Mharakurwa received his academic training from the University of Zimbabwe and Oxford University. He has studied the epidemiology of malaria and the effects of interventions on the development of drug-resistant molecular markers in the malaria parasite. On-site 12 months of the year.
Gertjan van Stam - Technical Director
Mr. van Stam has extensive experience in information technology and is an expert in radio-based communication. On-site 12 months of the year.
Clive Shiff, PhD - Principal Investigator, JHMRI MIAM Project
Dr. Shiff, associate professor of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, is principal investigator for the JHMRI-funded project to develop MIAM into a center of excellence. He has over 30 years experience with malaria-control operations in Zimbabwe and Zambia. Based in Baltimore, Maryland, USA.
Macha is located in the Southern province of Zambia, 80 km from the nearest town of Choma and 300 km by road (or a 55 minute flight) from the capital city of Lusaka. The area provides a relatively pristine research environment. The rural population has not applied insecticides or employed bed nets to any degree, circumstances that provide a variety of opportunities not available in settings with a higher level of management.
The topography of the area is somewhat undulating, primarily open savanna woodland averaging 900 meters above sea level. The climate is tropical with a rainy season that runs approximately November to June.
By Road
MIAM is 80 km from the nearest town of Choma, accesible year-round by an all-weather gravel road.
By Air
MIAM is served by a government-licensed gravel-based aerodrome named ABFA-MACHA. For information, contact Gertjan Van Stam, gertjan.vanstam@macha.org.zm
The Macha area is populated by traditional villagers, primarily members of the Batonga tribe, living in small scattered homesteads usually consisting of one extended family. There are no commercial farmers or industries in this area. The primary livelihood is subsistence farming with maize being the main crop. The staple diet is cooked maize-meal supplemented with peanuts, sweet potatoes and leafy green vegetables. While much of the population is stable, younger adults tend to move to and from the urban areas of the country.
There is an estimated population of 128,000 (c. 2000) within an approximately 35 km radius of the Institute. Macha Hospital serves as a referral hospital for a number of smaller hospitals and rural health centers, bringing patients in from an 80 km radius.
Overall population density in this area is 25 per square kilometer and 50 percent of the population is under 12 years of age. Other specific data for the local population are not reliable, but country-wide the crude birth rate is 49.5 per 1,000 population with an infant mortality of 107 per 1,000 live births. Average life expectancy at birth is 48.3 years.
The southern province of Zambia, including the area around Macha Hospital, has endemic P. falciparum malaria with cases existing year round, although there is peak incidence during the rainy season (November through June). P. ovale and P. malariae are also present in the country but are relatively rare, being found in less than 5 percent of positive blood smears. The hospital outpatient department sees over 5,000 cases of malaria each year, the majority of them confirmed by a positive malaria smear. The pediatric ward admits 700–1,000 children annually with slide-confirmed malaria, including 50–60 children with cerebral and 160–195 children with severe malaria anemia. Malaria has been the foremost discharge diagnosis and most common cause of child mortality for many years at the hospital, and accounts for 35 percent of pediatric discharges.
Relatively little is known regarding the medical entomology of the Macha catchment region. Malaria is the most important arthropod-borne infection in the region and is primarily transmitted or "vectored" by Anopheles arabiensis and An. funestus. Studies to determine the geographic and seasonal distributions of these mosquitoes and the relative importance of each species to Plasmodium transmission are currently underway at the MIAM. Anopheles gambiae has been identified in the Zambezi valley to the south, but has not been identified in Macha. Although no other vector-borne diseases are frequently documented in the region, numerous other potential vectors are present. Several species of culicine mosquitoes, including Culex pipiens quinquefasciatus and Mansonia uniformis, are abundant and frequent man-biters. Sand flies, ticks (both hard and soft), bed bugs, lice and filth flies are also common in rural households.
Livestock infested with various ectoparasites are closely associated with people in the region, occasionally sharing the same living space. Such an association creates the potential for cross-species transfer of arthropods with opportunistic feeding habits and the pathogens they may carry. The involvement of these arthropods in the biological or mechanical transmission of human or animal pathogens in the Macha catchment region is unknown. MIAM offers the unique opportunity to make novel entomological observations important to public health in an area where little is known about the arthropods present and their role in the spread of infectious disease.
Current Investigations
Entomological studies at the MIAM were initiated in March 2004. Two major investigations are currently underway in the Macha catchment area, with expected completion in 2006. Both involve the study of the primary malaria vectors in the region, Anopheles arabiensis and An. funestus, and will determine their temporal and spatial distribution in the region.
- Study 1
This study is focused on determining the relative contribution of each of these mosquito species to human malaria transmission. This contribution may vary from site to site as the relative densities of the two species fluctuate with available habitat and climate conditions through time. This study will also investigate the efficiency of parasite transmission (vectorial capacity) by An. arabiensis, a species whose involvement in the transmission of human malaria is complicated by a zoophilic feeding behavior, a willingness to feed on blood of both human and non-human hosts. - Study 2
This study examines the spatial structure of these same vector populations. This investigation has a geographic information system (GIS) component that will help provide ecological clues to the relative distribution of these important vector species in the Macha region.
The combined effort of these two investigations will provide a solid foundation for future studies on malaria entomology. In addition, data on the vectorial capacity of An. arabiensis and each species' role in Plasmodium transmission will not only provide important information on the biology of these mosquito species, but will also provide data relevant to the implementation of effective malaria control interventions.
FACILITIES
The site has 24-hour electric service from the national grid, with generator back up. Communication is available by a radio link with Choma, a reliable satellite-based system including full broad-band Internet connectivity and VOIP telephony, which allows for voice communication to and from regular phone numbers, using the broadband satellite connection.
The pediatric ward, where most malaria cases are admitted, is a 45-bed unit made up of seven separate care units, although the census often reaches 75 during peak malaria season. A pediatric ICU, as such, does not exist. However, severely ill patients are cared for in a 13-bed room with more direct observation by the nursing staff. The building includes a treatment room where procedures such as lumbar punctures, intravenous cannula insertion, etc., can be performed.
Clinical Laboratory: Clinical laboratory facilities were upgraded in 2000, with the completion of a new laboratory building housing hematology, parasitology/microbiology and biochemistry sections.
Research Laboratory/Insectary: A 285-square-meter laboratory and insectary dedicated to malaria research was completed in 2005.
Office: The hospital and malaria research offices have copying equipment as well as a number of computers, including recent Pentium models with up-to-date word processing, spreadsheet and statistical software. A Local Area Network (LAN) has been established with both direct and wireless connections.
Housing: Visiting scientists and students coming to MIAM will be accommodated in single-bed apartments located on the MIAM campus. These are built as duplex units sharing a kitchen, with each side having a living/dining area and large bedroom with a self-contained bathroom. Twenty-four-hour water and electricity are usually available. Bed linens, mosquito nets, towels and laundry service are included in the daily charge. Electricity in Zambia is 240 volt 50 cycle, so appropriate transformers and adaptors (UK outlets), should be brought by guests, if required.
RESOURCES
Patient Care Equipment
- Oxygen concentrators
- Oxygen saturation monitor
- Intravenous pumps
- Whirlpool for wound and burn care
- Static and portable x-ray machines
- Ultrasonography
- Electrocardiography
- Audiometry
Clinical Laboratory Equipment
- Automated cell counter
- Cobas-Micros, Roche Diagnostics
- Spectrophotometer
- Spectronics 20D
- Automated dry chemistry analyzers
- Reflotron and Vitros DT60
- Binocular microscopes
Equipment for:
- Routine bacterial cultures
- Blood banking
- Slide staining
- Basic ELISA testing methods
Freezers
- Minus 20º C
- Minus 70º C
- Liquid nitrogen
Research Laboratory Capabilities
- PCR
- Gel electrophoresis
- Parasitology
- Malaria microscopy
- Mosquito dissection and identification
Insectary
Computerized, digital databases of environmental and social conditions in Macha are maintained in spatially explicit map formats for research purposes. Data are available over the Web and can be downloaded into several popular GIS software formats. Very large databases can be provided for downloading from an ftp site. Data layers on the distribution of houses, population centers, and linked census data are being updated. Physical features, such as topography, landcover, road networks, hydrology, soils and meteorological conditions, are also available. Assistance with spatial modeling is available from the core facility at the Hopkins Malaria Research Institute.
The GIS Core Facility of the JHMRI maintains a website that provides data and maps for the African continent.
GIS Core
Layers specifically for the Macha region may be obtained from Tim Shields
MIAM staff members have many years of experience conducting malaria studies under Good Clinical Practice (GCP). Apart from the executive director, the scientific director and the technical director, full- and part-time staff are available to conduct or coordinate clinical, laboratory and field trials include:
Macha Hospital staff physicians
Hospital Laboratory Director
Hospital Pharmacy Director
Laboratory technicians, project managers, field workers, study assistants, data entry staff
SENIOR STAFF & CONSULTANTS
Godfrey Biemba, MBChB, DTM&H, currently general secretary of the Churches Hospital Association of Zambia (CHAZ), serves as a consultant for many malaria research projects.
Lottie Hachaambwa, MBChB, staff physician at Macha Hospital, assists with projects and has committed 15 percent of his time for malaria research.
Kelvin Moomba, MBChB, staff physician at Macha Hospital, assists with clinical care of study patients.
Janneke van Dijk, MD, full-time physician employed by the Malaria Research Institute, serves as project manager for clinical studies.
Stenford Zulu, senior clinical officer, is manager for clinical care at the hospital and on-site manager for individual clinical research studies.
Gracious Simwanza, BSc, lab scientist, is director of the hospital clinical laboratory and coordinator of the lab-related aspects of malaria research studies.
Johnson Chola, senior lab technologist, assists with malaria research studies.
Rogers Moono, lab technician, assists with malaria research studies.
Abraham M'hango, MSc (Honors), pharmacist and director of the hospital pharmacy, assists with malaria research studies.
Marjorie Hamahuwa is manager of the research office and coordinator of data entry and accounting.
Any scientist or student interested in conducting research at MIAM should first contact the administrative or scientific director, to receive up-to-date information on the site. If it is determined that the proposed project is appropriate and feasible for the Macha site, MIAM administration will work with the investigator in establishing the best way to move the project forward. This will include assistance in obtaining Zambian national ethics approval, as well as arranging for use of vehicles, Internet access, personnel, lab space and equipment that may be needed. Fees for all services will be agreed upon before the project begins, and arrangements made for timely payment to MIAM for services rendered.
FEE SCHEDULE Please contact MIAM for current prices.
Transportation
- Toyota Hilux double-cab pick-up truck
- Toyota Condor 4-wheel drive
- Mitsubishi Pajero 4-wheel drive
- Honda motorcycle
- Bicycle use
Labor
- Field worker or study assistant
- Data entry
- Technical staff
Accommodation
- Room and board
Office Use/Fees
- Copying
- Printing
- Typing/data entry
Internet/Email
- Individual Internet/email use
- Project Internet usage
Lab Use/Bench Fees
- Full service (with use of equipment)
- Partial service (no local equipment use)
- Reagents/disposables
- Project laboratory usage
Other Charges
- Supplies bought locally (cost + handling fee)
Macha Hospital and MMRI are registered with the U.S. Office for Research Protection, and protocols involving human studies must receive ethical approval by a Zambian body serving as an Ethics and Research Committee. The two currently registered Institutional Review Boards in Zambia are based at the University of Zambia in Lusaka, and at the Tropical Diseases Research Centre in Ndola.
In addition, for each study, the Institutional Review Board at the institutional base of the principal investigator, must review and approve all projects in which he or she is involved as an investigator.
Protocols are discussed with local chiefs and headmen for their approval before beginning studies, especially if they involve extensive work in the community and surrounding villages.
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