Can you tell us a bit about the malaria situation in Sri Lanka and how it has changed?
When I joined the University of Colombo as a Lecturer in 1989, malaria was a major problem with around 400,000 cases per year. But there’s been a drastic reduction since 2000 with no evidence of local transmission in Sri Lanka since 2012. So, according to the World Health Organization criteria, Sri Lanka has fulfilled the requirements to be certified as a malaria-free country.
Korogwe site is where we at the National Institute for Medical Research are undertaking one of our Consortial Project 2 studies. In 2003 two neighbouring villages (about 25km apart) located at different altitudes, and therefore with different malaria transmission intensities, agreed to participate in various studies of the epidemiology and immunity of malaria. In all these studies community involvement and joint ownership have been recognised as critical components of the projects. Since 2003 the study has expanded to include more villages.
In Sri Lanka, our study site at Kataragama is 288Km away from our main lab in University of Colombo, Faculty of Medicine. For our Consortial Project 2 study we were planning to collect more than 1500 blood samples from people who resided in the area 15 years ago. Though the number of malaria cases in this area has declined remarkably it was considered a malaria endemic area before 2003 when as many as 40-50 patients were diagnosed as malaria positive per day.
Within the MalariaGEN Consortial Project 2 project at the Institut Pasteur de Dakar we are working in 2 villages in the south-east of Senegal: Dielmo and Ndiop. With Dr Adama Tall, the investigator of the project, in November 2006 we carried out the collection of informed consent forms of both populations. This process enabled two extremely important advances in our ethics review and informed consent processes.
At the Papua New Guinea Institute for Medical Research we are contributing archived and new matched cases and controls for Consortial Project 1 and family trios for Consortial Project 3. We are based in the Entomology Unit in Madang and work closely with the Modilon General Hospital where the patients are recruited and samples are collected. We have faced many challenges during the project including setting up the necessary infrastructure, obtaining informed consent and even reaching rural clinics.
In Blantyre, Malawi we have been collecting DNA samples from children with severe malaria admitted to the Malawi-Liverpool-Wellcome Trust and Blantyre Malaria Project research ward since 1997. These datasets were contributed to MalariaGEN's Consortial Project 1. One of the challenges we have had to overcome with the project is a lack of ethnicity data for some of these retrospective cases.
Field activities started at my site, the Navrongo Health Research Centre, in June 2007. We aimed to recruit 300 new cases and controls for Consortial Project 1 and 30 child-mother-father trios for Consortial Project 3. One important aspect of the project was to explain and discuss the study with all the relevant stakeholders especially community leaders and research participants.
Working with the Noguchi Memorial Institute for Medical Research and the Navrongo Health Research Centre we planned to recruit 200 cases of severe malaria during our high transmission season spanning Aug-Nov 2007. We based this on the numbers of cases we had experienced in previous seasons. However, for a number of reasons we struggled to recruit even 60 cases during the same period.
At the Medical Research Centre in The Gambia we have been working on the best way to add to our collection of controls samples. The aim is to maximize the potential of the severe malaria cases that we are contributing to the MalariaGEN Consortial Project 1.
To match the severe malaria cases we needed to increase the number of controls in our collection by approximately 2000. Having carefully considered the ethical issues associated with collecting such samples from healthy children we decided to use cord bloods.