THE PRESENT STATUS OF MALARIA VACCINE

By Mazhar Shahen – Art in Tanzania internship

In Tanzania over 90% of the population live in areas where there is risk of malaria. In Africa, Tanzania is the third largest population at risk of malaria. Most of the victims of the disease are children, with around 80,000 death annually caused by malaria. In Tanzania, the Kagera Region on the western shore of Lake Victoria has the highest risk of contracting the disease. The Arusha Region is a lower risk area. However due to climate change and people migration caused an increase in the migration of mosquitoes and caused areas that are malaria free to be exposed to the disease. 

MALARIA

Malaria is a life-threatening disease caused by the transmission through an infected female Anopheles mosquito. The infected mosquito is a carrier of Plasmodium parasite. The parasite is released into the human bloodstream through the mosquito bite. The parasite survives in tropical and subtropical climates. After the parasite enters the human bloodstream it travels to the liver to mature. Maturity of the parasite takes several days, then the parasite goes back to the bloodstream to travel to the red blood cells this time. Once the red blood cells are infected, the parasite starts multiplying withing 2-3 days, causing the infected red blood cells to burst. 

Malaria is an acute febrile disease, which means it shows signs of fever when infected. Symptoms appear in a non-immune person 10-15 days after the infection has occurred. Early symptoms are mild fever, chills, and headache. Since it is mild, it makes the malaria disease harder to detect early on. If not treated the plasmodium parasite can progress to severe illness, usually leading to death.

Severe malaria in children could lead to severe anaemia, respiratory distress, and/or cerebral malaria. Adults are at risk of multi-organ failure. 

In 2019 the World Health Organization (WHO) reported that half of the world’s population is at risk of malaria. With most of the cases and deaths are in the sub-Saharan Africa. This indicates that African community is in need of a malaria vaccine as soon as possible. Malaria control has been better, with the number of cases dropping significantly over the last decade, with the number of children dying from malaria being halved. 

MALARIA VACCINE

Vaccines are a hot topic in the world we live in. Vaccines help us strengthen our immune system against specific disease which protects us from that illness. Vaccines are usually needle injections but can also be given by mouth or sprayed into the nose.

WHO claims that the malaria vaccine is capable of reducing malaria cases by 75% and put us on goal of the eradication of the illness. Malaria is responsible for 219 million cases each year with an estimated 660,000 deaths of the illness.

Tanzania has the third largest population that is at risk of the illness in Africa, with 90% of the population at risk of contracting malaria. Tanzania has 10 to 12 million cases of malaria annually, with most of them being children. The number of cases has been controlled a lot better of the decade leading to significant decrease, and number of children dying from malaria halved. However, due to climate change and the migration of people malaria cases are rising in areas that were considered low risk in the past. This is complicating the fight against malaria. 

Vaccine RTS,S acts on Plasmodium falciparum, the most deadly malaria parasite in the world and specifically in Africa. The vaccine is the first and only successful vaccine for malaria, which helped in reduction of children death in Africa. This vaccination is part of the Malaria Vaccine Implementation Progamme (MVIP), this program is established by WHO to deliver the vaccine in selected areas of Africa with the help of each country’s governments. The 3 African countries that are currently in pilot introduction are Ghana, Malawi and Kenya. The goal is to supply the whole region by 2023. Vaccine RTS,S is considered a safe vaccine, and no proven direct side effects are there. The pharmaceutical giant GSK will be conducting a number of Phase 4 studies in the 3 African countries chosen for pilot. 

In 1987 the discovery of a synthetic peptide polymer (SPf66) in Columbia enabled the development of the first vaccine candidate. Tanzania was the second country after Columbia to participate the clinical trials of SPf66. This indicates that historically Tanzania has an advantage as researchers will have a deeper pool of information in Tanzania compared to other African countries. Researcher George M Bwire states in his article that the inclusion of Tanzania in the Malaria Vaccine Implementation Program for the current RTS, S vaccine is crucial.

REFERENCES

  1. Agnandji, S. T., Agnandji, S. T., Asante, K. P., Lyimo, J., Vekemans, J., Soulanoudjingar, S. S., . . . Abdulla, S. (2010). Evaluation of the Safety and Immunogenicity of the RTS,S/AS01E Malaria Candidate Vaccine When Integrated in the Expanded Program of Immunization. The Journal of Infectious Diseases, 202(7), 1076-1087. Retrieved 2 11, 2021, from https://academic.oup.com/jid/article-abstract/202/7/1076/837083
  2. Bwire, George & Sanga, Anna. (2019). Malaria control in Tanzania: Current status and future prospects. 2664-8490..
  3. Dimala, C. A., Kika, B. T., Kadia, B. M., & Blencowe, H. (2018). Current challenges and proposed solutions to the effective implementation of the RTS, S/AS01 Malaria Vaccine Program in sub-Saharan Africa: A systematic review. PLOS ONE, 13(12). Retrieved 2 11, 2021, from https://ncbi.nlm.nih.gov/pubmed/30596732
  4. Galactionova, K., Tediosi, F., Camponovo, F., Smith, T., Gething, P. W., & Penny, M. A. (2017). Country specific predictions of the cost-effectiveness of malaria vaccine RTS,S/AS01 in endemic Africa. Vaccine, 35(1), 53-60. Retrieved 2 11, 2021, from https://sciencedirect.com/science/article/pii/s0264410x16311033
  5. Malaria vaccine implementation PROGRAMME (MVIP). (n.d.). Retrieved February 12, 2021, from https://www.who.int/news-room/q-a-detail/malaria-vaccine-implementation-programme
  6. Malaria in Tanzania. (n.d.). Retrieved February 12, 2021, from https://malariaspot.org/en/eduspot/malaria-in-tanzania/
  7. White, N. J. (2011). A vaccine for malaria. The New England Journal of Medicine, 365(20), 1926-1927. Retrieved 2 11, 2021, from https://nejm.org/doi/full/10.1056/nejme1111777

Tips for medical volunteers

Art in Tanzania works with numerous health care facilities in Tanzania, varying from big hospitals to small community clinics. Medical volunteering or interning in Tanzania is an eye-opening and educational experience for both current and future medical professionals. One of our professional medical volunteers listed some useful tips for future volunteers based on her experiences:

Medical volunteer in Tanzania

  • The roles at hospitals are the same as in the Western world, but the resources are very different. High respect for the local medical staff and their good job despite the limited resources!
  • You will see and experience a lot of things which at home you could only read from books. You will be having a hard time seeing people die of simple diseases that in Western countries could be cured with just better nutrition and hygiene. It’s very educational to realize that you can only do a small fraction and not save the whole world.
  • You will be able to participate in the hospital’s/clinic’s daily life in many ways. Depending on your level of studies and profession, one day you’ll be assisting in a surgery and the next folding bandages with nurses.
  • Patient records are kept in paper files. Therefore there is no excess paperwork or endless sitting in front of computer screen, so there will be more time left for actual work with the patients.
  • The work days involve a lot of waiting and long lunch breaks that can sometimes feel frustrating and inefficient, but that’s the way things are done here and it’s just something you will have to get used to.
  • Thoughts about a Westerner coming here to tell how things should be done should be thrown in the dustbin. The work is done together, learning from each other. What works in Western countries doesn’t necessarily work here. The most important thing is to abandon your prejudices and “everything’s better at home”-attitude and try to be open-minded towards the new culture!
  • Before your trip it’s good to determine your motives and goals, as that way it’s easier to help and learn.Medical volunteer at Mbweni hospital
  • Keep your eyes open, make observations and ask lots of questions.
  • After all, health care is always about people and their wellbeing. As a health care professional you donate the patients part of your time, knowledge and skills regardless to where in the world you are. Despite the limited resources there’s always something you can do -listen, learn and support!
  • It’s a good idea to study the basics of the local language beforehand, and you will learn more in the work.
  • If you wish to get involved in making diagnosis and treatment decisions, it’s a good idea to do research on at least the most common diseases; malaria, diarrhea etc., and also on tropical diseases in general.
  • Bring your own scrubs to wear, and if possible, bring with you disposable gloves, facemasks or other healthcare equipment to donate.

Mawenzi Regional Hospital, Tanzania – supporting many with few resources

By Saara Kanula

Mawenzi Regional Hospital is a busy hospital which attends to over 300 outpatients daily and has around 300 beds in its wards but the number of patients can easily rise to almost 500. In the paediatric ward, sometimes up to four kids sleep in one bed.

Art in Tanzania is organizing donations for Mawenzi hospital in order to support its staff to continue their work supporting the people of the Kilimanjaro region in northern Tanzania.

Mawenzi Hospital - Moshi

Building of the new theatre started at 2010.

In Mawenzi you will find all of the usual medical facilities including: paediatric, physiotherapy, gynaecological and prenatal, a HIV-unit, tuberculosis clinic, X-ray unit and laboratory. Besides the in-patients, more than 300 out-patients come to the hospital each day. 

Art in Tanzania has been co-operating with Mawenzi Regional Hospital for several years. They have great opportunities for medical students to undertake internships and they are constantly looking for volunteers to share their professional skills with the hospital staff.

The staff in the hospital do their very best but have few resources and outdated equipment. As a public hospital Mawenzi offers medical care to the majority of the population in the Kilimanjaro region, especially those who can’t afford private healthcare. Lack of basic equipment puts patients at risk and makes it difficult for the doctors to do their work.

Mawenzi Hospital - Moshi

Dr. Nkini

Mawenzi Regional Hospital is located in Moshi and serves a population of around 1.7 million. It was established prior to 1920 as a small military dispensary for German soldiers. In 1956 it became a hospital and has been growing ever since. Mawenzi hospital is funded by the government but since KCMC (Kilimanjaro Christian Medical Centre, a big university hospital) was opened in the 1970’s support and funds have been scarce.

Many of the hospital’s buildings are inadequate for modern medicine. There is a great need for renovation of old facilities and construction of new ones. The hospital is making efforts to find private investors to co-operate with and improve the quality of its facilities. Its management team has great plans for the future but it is desperately in need of support.

Mawenzi Hospital - Moshi

Building of the new Maternity clinic was suspended in 2009 because the government couldn’t fund the construction anymore.

Slow progress

Inside the hospital compound you can see lots of small buildings surrounded by flourishing gardens. Most of the buildings are over 90 years old and in need of renovation. The wards are quite modest inside.

Mawenzi Hospital - Moshi

Most of the buildings inside the hospital compound are from the 1920’s and in need of renovation.

Mawenzi Hospital - Moshi

Doctors office in the eye clinic is quite modest with only few basic equipment.

After walking pass different wards and through small paths you see a brand new white building which Dr Nkini (my host) points out to me. It is the new theatre building. Inside the building there are three theatres that have wash and sluice rooms, as well as facilities for the surgical staff. You can easily picture the building full of nurses and doctors, and patients waiting for surgery. However, at this point there are only empty rooms. The hospital has been waiting a long time for government funds for new surgical equipment.

Theatre two 2

The hospital has been waiting a long time for government funds for new surgical equipment.

Before the old theatre was closed in 2010 there were seven to twelve operations being performed daily—mainly C-sections, laparotomies and hernia repairs. Now the hospital send patients elsewhere, even for minor surgery. The Hospital’s administrators worry about loosing its specialists to the other hospitals because they are not using their surgical skills.  By the end of July the new theatre building should be finished and the hospital is working to obtain new surgical equipment little by little.

 Behind the new theatre there is another building under construction. Dr Nkini explains that it is to be the new maternity clinic. Building started in 2004 but was suspended in 2009 because the government couldn’t fund both the theatre and maternity clinic construction at the same time.  Now it is uncertain when the building will be completed.

Dr Nkini also took me to the dental clinic. It has just been renovated and the practice is about to be shifted from the old department. The clinic is busy, attending 30 to 60 patients per day and has three specialists to take care of them. More up-to-date equipment is needed as they only have few basic equipment.

Mawenzi Hospital - Moshi

The old theatre was closed at the end of 2010 by the Ministry of Health because it didn’t conclude the standards anymore.

Donations from Finland and the UK

At the moment Art in Tanzania is collecting donations in Finland destined to  different locations  within Tanzania. If you can donate medical equipment it will be very much appreciated.  Please contact Sari Vilen for a list of equipment that the hospital needs.

Also other kinds of donations are needed such as eyeglasses, school supplies, second hand computers, tools, sport equipment etc. Contact: sari@artintanzania.org.

Art in Tanzania is also planning to collect donations in the UK and other countries. If you are in the UK and want to make a donation, please contact Andy McKeegan – andy@artintanzania.org

Medical volunteering with Art in Tanzania

By Katie O’Reilly-Boyles (Originally Published on Sep 26, 2013)

We interviewed Rosie, from the UK, about her experience as she worked on the medical project in Dar es Salaam. Here are her views:

Volunteers help to diagnose one of the patients on the female ward

Volunteers help to diagnose one of the patients on the female ward

As your project draws to a close, what have you most enjoyed about medical volunteering?

“I like it because it differs from place to place, and it’s also good to see how a hospital is run here compared to the system in the UK. I saw a very undeveloped clinic before coming to this [Mbweni] hospital, for example, and although it was upsetting –doctors had no soap to wash their hands with – the doctor was clearly amazing and the experience really had a big impact on me. Now I want to send over books, laptops and equipment in general from the UK, because that’s really what they need. I’ve also enjoyed the responsibility, particularly at the clinic, as I was sometimes allowed to treat patients.”

 How do you think you have helped?

“We shadow the doctor here at the hospital which means we sometimes assist him, but in the clinic the doctor would sometimes leave me with some patients (who could speak English). I was allowed to diagnose and prescribe medicines, and it was very exciting when I got it right! Again, I think it would be really useful, when I get home, to set up funds so that we can send them over equipment such as an ultrasound machine, and even simple things like some papers to write patients’ records on.”

Rosie takes the blood pressure of an outpatient

Rosie takes the blood pressure of an outpatient

We also interviewed Dr Daniel Muganyizi of Mbweni hospital who our medical volunteers have been shadowing.

How do you feel that the Volunteers help you in the hospital?

“I believe it is important to develop a field of medicine for the junior medics among us, and provide opportunities for them. The volunteers come from different parts of the world bringing with them different knowledge which they can exchange among themselves. With the medical profession, you don’t just learn things and consider it is done – you continuously gain more medical knowledge and skills throughout your career, for the benefit of the people you are saving and the volunteers.

Dr Daniel Muganyizi, Mbweni hospital

Dr Daniel Muganyizi, Mbweni hospital

My best memory of volunteers and how they have helped us at the hospital is when some groups performed an X-ray and prepared instruments for operations, and they did it very well! All the staff at Mbweni Hospital, including the nurses, clinical assistants and porters really appreciate the volunteers and what they do.”Justyna, from Poland, performs a Malaria test on a patient at Mbweni Hospital

Justyna, from Poland, performs a Malaria test on a patient at Mbweni Hospital