TAMANEWSLETTER
Medical Research Council (UK) The Gambia
TAMA: Wolof. n. a talking drum
VOL: 09 ISSUE: 02 / Mar - Apr 2010
New vaccines showcased at Sukuta
On Thursday 29th April 2010, Sukuta
Health Centre opened its doors to the
community and other key stakeholders
in a programme themed ‘Working
Together with the Community: Novel
Vaccine Studies’.
The programme was part of the efforts
of the MRC field site in Sukuta to
disseminate the findings of the various
studies that have taken place at the site.
The people, leaders of the community
and MRC were brought together to
foster a stronger relationship on ways
of achieving better health through
meaningful participation in future
studies.
Next page
Communicating MRC’s vaccine studies in Sukuta: Saihou Bobb (field assistant); Dr
Katie Flanagan, Head of Infant Immunology Team, MRC (UK) The Gambia
WAPHIR: paving the way for a sub-regional
HIV research network Story page 04
06
PneumoWAR
Assessing the tools to fight meningitis
188
In conversation with Professor Brigid Heywood, OU Pro Vice Chancellor
20
MRC The Gambia: Centre of Excellence for PhD training
08
News from Caio
11
News from Keneba
13
News from Basse
15
Recent Unit Publications
26
HR News
» Youngee Choi’s diary
» Going to Caio: be prepared
» Training: a Keneba initiative
» SANTE: Spraying And Nets Towards malaria Elimination
»
»
»
»
»
Appraisals
GEM and Team Awards
Restructuring
New staff & leavers
Clinical Services staff say farewell
New vaccines showcased at Sukuta
Continued from page 1
The Open Day programme attracted more than 200 participants from within and outside The Gambia. The forum
featured feedback from MRC scientists on various vaccine studies that have either taken place or are ongoing in
Sukuta, or are planned for the near future:
MVA85A: a new vaccine against TB
The conventional vaccine against tuberculosis - BCG – is known to have limitations, particularly in this setting.
This has led to the search for a new vaccine to reduce the burden of disease and death cause by TB. MRC (UK)
The Gambia has successfully conducted a phase I study of a new TB vaccine called MVA85A. The vaccine was
developed by researchers based in Oxford, and the work is being led by Dr Martin Ota and his team at MRC (UK)
The Gambia. The findings showed that the new TB vaccine is safe and produces immune responses in Sukuta
children, and does not interfere with responses to other vaccines also given in early infancy. These results provide
important information required for further testing of this vaccine for efficacy in protecting against tuberculosis.
Prevention of mother-to-child transmission of HIV
An ongoing study is investigating how the human body responds to a novel HIV vaccine (MVA.HIVA) that aims
to prevent transmission of HIV from mother-to-child during breastfeeding. This study, led in The Gambia by Dr
Katie Flanagan and her team, is the first phase in the evaluation of this vaccine in healthy under-1 year old children
from Sukuta. Similar studies are also being carried out in Nairobi, Kenya. The group that developed the vaccine,
led by Professor Tomas Hanke, is based at Oxford University and was present at the Sukuta Open Day. This study
is funded by the EU-European Developing Countries Clinical Trials Partnership, and includes capacity building
elements such as staff training and the renovation of Sukuta Health Centre which took place in 2009.
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
The search for a malaria vaccine
A novel malaria vaccine trial is soon to
commence at Sukuta Health Centre. Malaria
is responsible for more than 1 million deaths
and between 300 and 500 million clinical cases
each year, affecting mainly women and children
in Sub-Saharan Africa. Presently, there is no
effective vaccine against the malaria parasite,
and this trial aims to test the safety and immune
response to this candidate vaccine in adults,
children and infants. The trial is being led by
Dr Kalifa Bojang and his team at Sukuta Health
Centre. The work is being funded by the
EDCTP and the developers of the vaccine are
based at Oxford University.
Students of Sukuta Upper and Lower Basic Schools attending the
Open Day programme
MRC wishes to acknowledge the value and
importance of the Sukuta community, the local
government hospital staff, especially Ms Sally
Savage – Principal Nursing Officer at Sukuta
Health Centre and the Ministry of Health in
working together in order to carry out these
important vaccine trials. This is part of the
overall global effort to develop safe and effective
vaccines against the 3 major killer diseases,
malaria, TB and HIV which will save millions of
children’s lives.
Professor Tumani Corrah officially opens the new EDCTP-funded
building at Sukuta Health
Paramount Chief, Alhaji
Demba Sanyang
Dr Kalifa Bojang,
Principal Investigator,
Sukuta malaria vaccine
trial
Ms Sally Savage (Aunty Sally), Principal Nursing
Officer, Sukuta Health Centre remains a vital and
active supporter of MRC’s studies at the Health
Centre.
Presenters at Sukuta Open Day: From left: Dr Muhammed Afolabi, Ms Jainaba Njie-Jobe, Dr Sarah Burl, Dr Adesina Owolabi
and Dr Jane Adetifa
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
03
WAPHIR: paving the way for a sub-regional HIV
research network
Recently, Dr Assan Jaye received the welcome news that he, together with colleagues from Dakar and Bissau, won
a 1.8 million Canadian dollar capacity building grant from the Global Health Research Initiative, Canada. The West
African bid was one of four that won funding; the other winners were from Uganda, Kenya and South Africa. The
award comes into effect in July 2010, and as Dr Jaye explains here, it will enhance MRC The Gambia’s plans to build a
robust network of sub-regional partners.
Building a shared resource
‘The grant is a four-year consortium award for the
development of capacity in HIV clinical trials in Africa.’
Explains Dr Jaye.
‘Working with partners from Dakar, Bissau, Denmark,
Oxford, Toronto and Montreal, we plan to amalgamate our
regional cohorts and resources, with Dakar as the centre.’
‘This West African Platform for HIV Intervention Research
(WAPHIR) will develop partners’ biobank capabilities,
expand population cohorts and pool shared resources.
The partners are bringing a lot of expertise to the table:
MRC has long been a hub for laboratory and other training
Canadian
Group
in the sub-region; the Bacteriology and Virology groups at
Cheikh Anta Diop University (Dakar) manage the large sex
workers cohort and HIV laboratory platform; and Professor
Pap Salif Sowe’s research and training centre of tropical
infectious diseases in Dakar has extensive experience on
clinical management of an ambulatory cohort. With the
addition of the Caio cohort biobank resources and the
Bissau cohort, we are poised to create an HIV network,
by pooling resources and preparing the ground for vaccine
trials and other research.’
‘We intend to develop each site’s biobank resources. Each
will retain their own biobanks, but we’ll be amalgamating
the data at one source (Dakar). Access to data will be
UCAD
Senegal
Laboratory
Platforms
Oxford
Clinical Trials
Support
HIV cohorts
bio-resources
& Unified Database
MRC
Gambia
BHP
Guinea Bissau
Tecnical Leadership
Training & Research
Danish
Group
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
West African Platform for HIV Intervention
Research (WAPHIR)
A model for capacity strengthening
WAPHIR: paving the way for a sub-regional HIV research network
shared, with requests being made through a steering
committee and our own ethics committee.’
Capacity
‘The grant includes capacity building components in
laboratory management, clinical trials management,
biobank and biomedical engineering management. We
need to make sure that each of the sites has the ability
to contribute on an equal footing. For example, Guinea
Bissau is not as advanced as Dakar in terms of research
expertise and infrastructure, so this proposal will really help
them to participate fully in joint regional research initiatives.’
Towards improved laboratories
‘The grant will enable us to develop certain laboratory
platforms for clinical trials such as cellular immunology.
We’ll also be focusing on the quality processing of samples,
good laboratory practice and quality management in
general. We intend to transfer some basic technologies
such as HLA typing, and we’ll be working on the
development of Dakar’s virology platform as the centre for
this. We also intend to share our successful biobank and
biomedical engineering models with Dakar.’
Training
‘The award’s staff development component includes
training to master’s level in areas such as clinical trials,
immunology and virology. There are also PhD and post
doc opportunities.’
A timely award
‘MRC UK has endorsed the setting up of a West African
research network in principle. However, it would have
been a massive challenge to start off without this grant,
which will do so much to develop sub-regional research
capacity.
I hope that we will be able to achieve a lot in the next four
years. I am very proud of this proposal and our success
in winning this funding. And I’d like to end by thanking
Professor Tumani Corrah for all his encouragement and
support. He kept on urging me to be persistent and not to
give up!’
Sub-regional partners fine tuning their vision for an HIV 2 network. From left: Ms Astou Cissé (Finance Manager, UCAD), Mr
Abdulaziz Hane (Programme Officer, UCAD), Professor Souleymane Mboup (UCAD), Professor Tumani Corrah and Dr Assan Jaye
(MRC The Gambia)
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
05
PneumoWAR: assessing the tools to fight
meningitis
Martin Antonio, Sheikh Jarju and Jacob Otu
In April 2010 a team headed by Dr Martin Antonio made a site assessment visit to the Royal Victoria Teaching
Hospital, Banjul, where they met Mr Pa Momodou C Jaye (Laboratory Manager), Ms Nelly Lloyd Evans
(outgoing Head of Microbiology), Mr Baba K Fofana (new Head of Microbiology) and key hospital personnel
who have a direct role in the PneumoWAR disease surveillance project.
The purpose of the visit included an assessment of
the hospital’s capacity to isolate and identify the three
pathogens in question (S. pneumoniae, H. influenzae b
and N. meningitidis). Sensitisation meetings with other
stakeholders within this PneumoWAR site were also
held.
RVTH was given a questionnaire for the site assessment,
which included questions on the use of standard
operating procedures, and the visiting team was pleased
to note that an SOP document was in place for the
laboratories.
Basic requirements, supplies and equipment were
another area included in the questionnaire, and RVTH
was found to have most of the essential reagents
needed for the isolation and identification of the
pathogens of PneumoWAR.
The MRC team was received by Dr Tamsir Mbowe, the
Chief Medical Director of the hospital. Dr Antonio
gave Dr Mbowe a breakdown of PneumoWAR’s
objectives and activities in the sub-region and its
anticipated benefits to the community.
The MRC Regional Reference Laboratory team has
shared the recommendations arising from this visit with
the RVTH team, and will continue to offer appropriate
support and advice going forward.
Jacob Otu (MRC TB group) shown above demonstrating laboratory techniques to sub-regional participants at the
PneumoWAR workshop held at MRC The Gambia, February 2010
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
The Paediatric Bacterial Meningitis (PBM)
Network is a sentinel based surveillance in
selected countries that was established in 2001
with the support of WHO.
The specific objectives of this network are to:
•
•
•
•
Dr Martin Antonio, Unit Microbiologist and Principal
Investigator, Pneumowar
Provide evidence of Hib and
Pneumococcal disease burden
Generate data on S. pneumoniae serotypes
circulating in the AFR region
Support advocacy for the introduction of
Hib and Pneumococcal vaccines
Provide a framework to evaluate the
impact following vaccine introduction
WHO and partners are supporting a subregional reference laboratory (RRL) at the
MRC (UK) The Gambia as part of regional
efforts to strengthen pneumococcal surveillance
in the West African region. The Regional
Reference Laboratory (RRL) is working closely
with the Ministries of Heath involved in WHOsupported PBM Network in 22 countries
(selected on the basis of performance over the
past three years, as well as likelihood of early
uptake of new Pneumococcal vaccine).
Ms Nelly Lloyd-Evans (outgoing Head of Microbiology, RVTH)
and PneumoWAR workshop trainer.
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
07
News from Caio
Tim Vincent
Youngee Choi’s diary
Youngee Choi is a 4th year medical student from Washington University in St Louis (USA) who came to Caio last
autumn for a research project. Here she shares her experience.
Coming to Caio was my first time in Africa. I came to
investigate the neurologic sequelae of HIV-2 by conducting
clinical neurologic exams. However, my two months in
Caio provided me with so much more – experience in
handling primary care issues as well as learning about rural
Guinean life and culture. The latter is what I think will stick
with me for years to come. Below are some highlights from
my two months there.
Settling in. Caio field site was set up in the late 1980s,
after a French doctor working with commercial sex
workers in a nearby town noticed that a high prevalence of
HIV-2 women originated from Caio. A complete survey of
Caio from 1988-89 showed that it has one of the highest
rates of HIV-2 in the world; this is the reason why it was
the perfect site for my research project.
The local MRC staff are lots of fun, and they proved very
adept at evaluating our study participants. In particular, I got
to know Moises, one of the staff who plays the guitar. He
and I had several flute-guitar jam sessions, and I also taught
Moises the basics of playing the flute!
October. From mid-October to November, traditional
fighting takes place between fighters of Caio’s ten zones.
It looks very much like wrestling, the
goal being to put one’s opponent on
his back. The fight takes place in a
temporary enclosure made of wooden
poles interlaced with string to form
a ring. Drummers set up on one end
of the ring, while referees go running
around the periphery and blowing plastic
whistles to excite the crowd. Little boys
have their own fights at the edge of the
ring, and are thwacked away by the refs
with branches every so often. There
isn’t really one clear winner. People
take turns at fighting without any sort
of elimination. First the men have their
rounds of fights, followed by the women.
There is no way I would want to end up
fighting any of the women in Caio – they
are quite buff!
November. In Caio it has become tradition to have a
dinner at the end of a study to thank the staff. Seeing as
Thanksgiving fell on my last few days there, we decided
to use this occasion as the thank you dinner. So we – a
Brit (Tim Vincent), Korean (a US permanent resident), 20
Guineans and two guests from Scotland and Holland – sat
down to an American Thanksgiving dinner! We feasted on
baked chicken, mashed potatoes, baked squash, peanut
butter cookies, doughnuts and a traditional Guinean dish of
fish and rice!
December 1. We celebrated World AIDS Day in Caio.
Local schools put on plays about HIV, and health officials
gave speeches emphasizing the availability of free HIV
testing and counseling. There was also traditional dancing,
a poetry contest, a condom demonstration and tug-of-war.
A cow was slaughtered in honour of AIDS Day to feed all
the schools and guests. The day ended with a party with
the staff and their families.
It was a wonderful way to spend my last evening in Caio. I
really grew to love Caio and my coworkers, and I hope to
be able to return one day.
Youngee guiding Moises Gomez on the flute
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
News from Caio
Going to Caio: be prepared
To maximize visitors’ enjoyment of Caio, Tim Vincent and Carla van Tienen have provided a checklist to help you
plan your stay.
What’s in the visitors’ accommodation?
Three separate bedrooms, each with two beds. Lighting
is by generator during the day and there is solar powered
light at night (no appliances at night). Sheets, pillows, pillow
cases and soap are provided.
One bathroom serves the three rooms with a toilet, hand
basin and shower with hot and cold running water.
There’s a kitchen with basic pots and pans, cutlery and
crockery. There’s a gas cooker and a gas powered fridge/
freezer which is very efficient and very cold: the freezer
section will hold about 10kg of frozen produce.
Outside there’s a seating area with a dining table and
chairs, plus armchairs and sofas for lounging.
We’ve also got two or three bicycles for those who wish
to explore
What must you bring?
Food supplies, insect repellent, a hand torch, books to
read and walking shoes. You can get basic items such as
oil, sugar, powdered milk, onions, chillies, bread, a few
in-season vegetables, biscuits and beer/soft drinks in the
village. Fish is available most days but often only the local
cat fish. You should aim to bring meat, fresh fruit and
vegetables, cereals, juices etc with you.
What medicines should you pack?
Obviously for visitors requiring treatment we have a good
supply of essential medicines at the field station. There
are also a couple of small pharmacies in the village with
the basics. One thing we don't have is loperamide 2mg
(imodium), and it’s always a good idea to travel with this.
Also, we don't currently have a supply of coartem for
malaria. We have chloraquine, fansidar and quinine but in
the unfortunate event that you get malaria you might want
to have an emergency treatment pack with you.
Is the water drinkable from the tap?
The water at the field station is from a sealed borehole
on the site and is pumped up into a tank. The borehole
is serviced regularly (every 5 years) and we have a good
supply of clean drinking water direct from the tap (though
it might be a bit warm).
What’s the currency?
Guinea-Bissau is in the CFA zone along with Senegal,
Mali and others. The current exchange (as at 1/04/2010)
is about 725 FCFA to the pound and about 250 dalasi to
5,000 FCFA. Of course this constantly changes but this has
been the average over the last 6 months or so.
What can visitors bring for the project or the village?
The staff are always pleased to receive anything to do with
the MRC, such as pens, pencils, T-shirts etc. So, if you're
here doing a study and you have any 'give-aways' they
would be very much appreciated. In terms of the village,
just be prepared to join in with any activities going on, such
as village meetings or ceremonies. It's always very much
appreciated by the locals when visitors take part in, and
take an interest in the culture.
When is the best time to visit Caio?
Any time is good to visit Caio, though if you're worried
about road conditions, it’s probably best to stay away in
the rainy season, July/August/September being the worst
months. The best months temperature-wise are probably
pretty much the same as The Gambia. From November
through to March the humidity is low, the sun is shining
and the nights are cool.
Can you eat out in Caio?
There are currently three establishments in the village
which provide food, situated near the Bush Taxi stop/
mobile phone antenna. All will provide a rice dish and it
depends on the availability what you get with it - chicken,
fish, bush meat etc. Usually these dishes are 500 FCFA a
plate. At this time of year you may also be lucky to get
salad as well.
Are there any cultural/behavioural rules you should be
aware of?
People generally don't like strangers taking their photos
without asking. Always greet people when out and
about. If you're introduced to a group, greet everyone
by shaking their hand. If you're sharing food from a bowl,
remember only use your right hand and never pass food to
anyone with your left (pretty much as in The Gambia and
elsewhere in West Africa). Unlike The Gambia drinking
alcohol is a way of life here and you will most likely be
offered local wine at some point. Even if you don't want
to drink it's polite to take the drink and spill a little on the
ground (for the spirits) before passing it on.
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
09
News from Caio
Joaquim da Silva (Djoca) - Laboratory Technician/
nurse, HIV pre and post-test counsellor, ARV
counsellor
Second row:
Antonio Pina Gouveia (Pina) - Mechanic
Claudette Mendes - Domestic staff
Third row:
Aliu Sanha - Maintenance
Julio Mendes (Mpas) - Ground staff
Silvina da Silva - Fieldworker (Children and
pregnancies)
Ana Mendes - Domestic staff
Fourth row:
Fernando Camara - Fuel depot
Charles Djata - Driver
Front row:
Tim Vincent - Station Head
Alberto Salinha (Jordao) - Staff supervisor, data
entry
Elsa Fereira - Fieldworker (children and
pregnancies)
Luis Cubaba (vega) - Stores and communications
Eva Mauricio - Domestic staff
Kneeling:
Nino da Costa - Ground staff
Caio Staff.
Back row:
Alfredo da Costa (Djipan) - Fieldworker (census), HIV pre and post-test
counsellor, ARV counsellor and fieldworker
Justiano Gomes - Fieldworker (census)
Carla and Tim on the benefits of conducting research in
Caio
•
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•
•
•
•
It’s small scale so you can arrange and delegate all
your work directly without loads of paperwork and
bureaucracy
It has a very dedicated and enthusiastic team
The field site has a very good relationship with the
village and the village elderly
There’s an excellent database with up to date census
data of the whole village that can easily be linked to
the census data from the capital and all past studies.
Caio has produced more than 25 papers in
international peer reviewed journals
You’ll be made to feel at home immediately, giving you
an unforgettable experience.
Caio’s uniqueness
The community cohort of HIV patients (primarily HIV-2)
has been followed for over 20 years. In addition, due to
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
the close ties with the Bandim Health Project in Bissau,
there is a very thorough demographic system which is
continually updated by the team of fieldworkers, with
census data, vaccination and health status of children, and
follow-up of pregnant women.
The best equipped laboratory in Guinea Bissau
The lab is equipped with a biohazard cabinet, 2 centrifuges,
mixer and roller, CO2 incubator, 2 gas powered fridge/
freezers (freezer to -20C), 2 solar powered chest freezers
to -20C, 1 small freezer to -70C, 1 microscope, and 1
partec flow cytometer for CD4 counts and percentages.
A separate laboratory has been built for clinical analyses,
but needs equipment.
Connected to the outside world
The office can provide computing facilities with printers
and access to the internet via the local mobile GPRS
system.
News from Keneba
Yankuba Sawo
Training: a Keneba initiative
The Keneba local training committee came into existence in June 2009. This was in response to requests for an
independent body that would meet periodically to discuss staff training needs and consider applications. In addition,
the committee offers career development advice to staff, helping them to identify courses that are both relevant to
the unit’s research interests and at the same time contribute to the individual’s career progression.
The membership of the committee cuts across
all grades and sections of staff, and includes
union representation. The committee meets
quarterly to consider training applications. Ad
hoc meetings are also held, should the need
arise.
Since the committee’s inception, there has
been a great deal of interest in pursuing a
variety of training opportunities. During the
last financial year, the committee received
10 applications and approved sponsorship
for 8 candidates. The majority of the courses
approved were distance learning programmes;
2 short courses overseas were also sponsored.
In addition, the committee approved a group
IT training programme for various categories
of staff and English proficiency classes for the
non-literate staff.
The Keneba Training Committee
Here we meet two recent recipient’s of Keneba’s training funds.
Bakary Sarr
‘A nurse by profession, I started working with MRC Keneba
in June 2003. I am responsible for the nursing care of TB
patients at our field station and I also attend the quarterly
meetings of the National TB programme where we
present and discuss the TB data from all the TB diagnostic
centres in the country.
Currently I am doing a Modular Diploma on Tuberculosis
through an institute called Education for Health in the UK.
I feel that this course will help me to improve the nursing
care that I provide. In addition, The Nutrition group
collaborates closely with various sectors including the
Ministry of Health by providing primary health care services
at the station, including TB diagnosis and care. Through
this collaboration, the station was recently opened as an
official TB diagnostics centre. This is a very big benefit for
the station, because it will enable us to send our TB data
directly to the National TB Programme and, through them,
to international organizations. Through such international
exposure, we could one day benefit from TB/nutrition
projects.
One day I hope to be a high calibre research nurse and
conduct my own research, so this course is definitely
relevant and useful.
I have 100% confidence in the local training committee,
because the members were selected by us and every
section in the field station is represented. The committee
is open to dialogue any time you need them and I admire
that.
Mustapha Ceesay
‘I joined the MRC in 1990 as a field assistant. I worked with
short projects before joining the Calcium, Vitamin D and
Bone Health Group. Because of my key involvement in
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
11
News from Keneba
projects I was promoted to senior field assistant and then
supervisor. I am now a research assistant in the Calcium
Group. My main area is operating sophisticated bone
imaging equipment (DXA, pQCT, X-ray and more recently
the jumping mechanography). This equipment performs
different but complimentary measurements, including bone,
muscle and body composition measurements at different
skeletal sites.
I am currently studying for the Advanced Anatomy and
Physiology level 3 Diploma by distance learning with
Essential Training Solutions. This course is directly linked
to my bone imaging work. A better understanding of
the body parts and how they function will enable me
to appreciate what we are doing as a research group.
The course will also enable me to contribute to the data
interpretation and discussions on new project areas.
As a Bone Health Research Assistant, I feel this course will
benefit myself and the Nutrition group by helping me to
understand and carry out my work more effectively and
efficiently and therefore contribute to the overall success
of the project. I will be able to train other colleagues and
help them do their work well. Also, the knowledge gained
from this course will help me explain better to study
participants what we are trying to do and the importance
of our work to their health and global health in general.
I aim to complete this course successfully and proceed to
do the advanced level and possibly a master’s degree.
What I like most about the committee is their
encouragement and motivation for staff to take up courses
and develop themselves. They want everyone to benefit
from this training, without exception. And that’s important
because good science cannot be achieved without well
trained staff.
To give a balanced perspective, we asked an applicant for
training funds who was not successful on this occasion to
give his opinion on the workings of the committee.
Three of the recent beneficiaries of
Keneba’s training fund. From left:
Bakary Sarr, Yankuba Sawo, Michael
Mendy
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
Lamin Sanyang
‘I have worked with the MRC since October 1988. I
started as a field worker and I am now a senior field
worker. I have worked in many projects, collecting data,
administering supplements, collecting biological samples,
recruiting subjects etc.
I submitted an application for project management
training. I felt this was very relevant to my job, as project
management is all about organizing work activities and
making sure the work is implemented as planned by the
principal investigator. Project management also looks
at working with and managing staff and other people,
skills that I feel are relevant to me, as my ambition is
to be a project manager, working closely with principal
investigators.
Even though I wasn’t successful, I am satisfied with the way
selections were made. The committee has been helpful
and given me sound advice. I realize that I had a problem
in identifying the appropriate level of project management
training and that was why the committee did not approve
my application. So now I am searching for an appropriate
course from the internet and I intend to apply to the
committee again.’
News from Basse
Dr Margaret Pinder
SANTE: Spraying And Nets Towards malaria Elimination
Can Indoor Residual Spraying provide additional protection against clinical malaria over current best practice? That’s
the question being posed by a new study headed by Professor Steve Lindsay (Disease Control & Vector Biology Unit,
LSHTM), and led in The Gambia by Dr Margaret Pinder (Epidemiologist). The field work, which commenced recently, is
based in Basse and the surrounding villages spread over the Upper River Region.
Margaret is responsible for liaising with the National
Malaria Control Programme and local communities,
developing SOPs, management of field teams, dayto-day management of the research clinician and
data collection, including PCR, data cleaning, analysis
and manuscript preparation. Here she explains
the potential contribution of SANTE to MRC The
Gambia’s disease control and elimination research
efforts.
The study questions whether current ‘best
practice’ is indeed best.
Yes. The current WHO recommendations for best
practice for malaria control are that everyone at risk
of getting malaria should sleep under an insecticide
treated bed net (LLIN) and that they should have
access to prompt effective treatment if sick with
malaria.
Courtesy call at the office of URR Commissioner Omar Khan. From
left: Pa Cheboh Saine, Dr Margaret Pinder, Musa Jawara and Kebba
Keita.
Bed nets prevent mosquito bites only while one
is in bed. However, spraying the inside walls of
houses with insecticide (indoor residual spraying,
IRS) also reduces mosquito bites before bedtime.
In addition, it may have an extra effect at reducing
malaria mosquito populations, and Musa Jawara (Unit
Entomologist) is looking at this aspect in the study.
DDT was used for vector control in the tropics
fifty years ago. Why didn’t it succeed then
in eradicating malaria – and why is it being
resuscitated as a control measure now?
Lamin Jarju (standing left) is on secondment to the project (6 months)
DTT was very effective at eliminating malaria in
from the National Malaria Control Programme.
some areas with low levels of infection, and IRS has
been effective at maintaining low malaria levels in
it combines with our current tools.
other countries such as South Africa. But in most cases
DDT was stopped before malaria was eliminated, and then
Resistance to DDT has been noted in the countries
it tends to return rapidly. Eradication means that a disease
bordering The Gambia. How does SANTE address this?
is no longer present in the world; elimination that it is no
We will be monitoring resistance to DDT, pyrethroids
longer present in an area, such as a country. We need to
(used on bed nets) and other insecticides during the
aim for the latter and IRS is becoming popular as it is a
study
and compare these with measurements made by
proven malaria control tool, and countries are adding it to
their anti-malaria “arsenal”. Data is needed to see how well the Malaria Programme three years ago. We will test an
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
13
News from Basse
alternative insecticide to DDT in a small scale pilot study.
Together these results will help advise on the future choice
of insecticide.
What are the health economics components of the
study?
The main result from the study will be the number of cases
of malaria stopped by IRS with DDT against a background
of complete coverage with LLIN. The economic
component will collect data on material and labour costs
to calculate the cost of malaria cases stopped by the
addition of IRS.
What capacity building initiatives does the project
include?
Lamin Jarju, an NMCP Vector Control Officer, has joined
the study to oversee the distribution of LLIN and IRS
both years and he will gain in-depth training on IRS, the
development of vector control management systems and
insecticide resistance monitoring strategies, and application
of the results. Together with Regional Health Teams, study
nurses will provide refresher and on-the-job training for
village health workers in the study area. The study also has
a limited budget to train a local government employee(s),
for example at the University of The Gambia, in Health
Promotion Planning.
How will the outcome of the study benefit decision
makers?
The results should influence decisions on malaria control
policy by providing accurate measures of the additional
benefits of using IRS with DDT together with current best
practice, the cost of malaria cases stopped by this added
intervention, up-to-date data on insecticide resistance
in URR and the comparison of DDT with an alternative
insecticide to guide its future use.
14
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
Study Manager Dr Margaret Pinder ‘the results should
influence decisions on policy by providing accurate
measures of the additional benefits of using IRS with
DDT together with current best practice.’
Recent Unit Publications
Summary by Dr Margaret Pinder
Social perceptions of research: findings
from the Larval Control Project
This paper describes a malaria research project
in The Gambia to provoke thinking on the
social value of transnational research. The Larval
Control Project (LCP) examined how effective a
microbial insecticide was at reducing the density
of malaria-transmitting mosquitoes and clinical
malaria in Gambian children. To track cases of
malaria the study involved the Village Health
Workers (VHWs) who were supported by project
nurses. In the current article we combine insights
from ethnographic fieldwork conducted at the
Medical Research Council (MRC) Laboratories
in Farafenni from 2005 to 2009, open-ended
interviews with project nurses,
nurses and eight focus
group discussions held with participant mothers in
October 2007, to consider the social impact of the
LCP's investigative method against the backdrop
of several years of research activity. We found
that while participants associated the LCP with
the clinical care it provided, they also regarded
the collaboration between the nurses and VHWs
added additional benefits. Organised around the
operational functions of the trial, these small-scale
collaborations provided the platform from which
to build local capacity. While ethical guidelines for
medical research emphasise the considerations
that must be added to experimental endeavour
in southern countries (e.g. elaborating processes
of informed consent, developing strategies of
community engagement or providing therapeutic
access to participants after the trial concludes),
these findings suggest that shifting attention from
supplementing ethical protocols to the everyday
work of research -embedding ethics through
scientific activity - may provide a sounder basis to
reinforce the relationship between scientific rigour
and social value.
'Like sugar and honey': The embedded ethics of a
larval control project in The Gambia. Kelly AH,
Ameh D, Majambere S, Lindsay S, Pinder M. Soc
Sci Med. 2010 Mar 9.
Summaries from PubMed
Understanding TB in HIV infected people:
vaccine development clues
Tuberccul
Tube
u ossiss kills
ls 2 m
milililliliion p
peo
e pl
eo
p e pe
p r year
ar and
infe
in
fect
ctio
ionn wi
io
with
thh H
HIV
IV iiss th
the mo
m st potten
e t kn
know
ow
wn
riiskk fac
risk
facto
torr fo
forr pr
prog
ogre
ress
ssio
ionn to aact
ctiv
ivee TB
iv
TB. An
An
understand
dingg of tthe
he iimm
mm
mun
u e re
resp
sponse
spo
onse tto
TB Ags in HIV-infeect
cted
ed p
pat
atie
ient
ntss is required to
develop optimal TB vaccines and diagnostics.
The investigators assessed polyfunctional (IFNgamma(+)IL-2(+)TNF-alpha(+)) T cell responses
to TB Ags in three groups of HIV-1-infected
patients dependent on their TB status, CD4
counts, and anti-retroviral exposure. They found
that although the proportion of IFN-gamma cells
in response to TB Ags was higher in patients with
low CD4 counts, the responding cells changed
from a polyfunctional CD4(+) to a monofunctional
CD8(+) response. The overall polyfunctionality
of the cells was restored by 12 months of antiretroviral therapy and primarily involved CD4(+)
T cells with an effector memory phenotype. These
findings have major implications for diagnosis of
TB and in vaccine development strategies for TB in
HIV-1-infected patients.
Polyfunctional CD4+ and CD8+ T Cell
Responses to Tuberculosis Antigens in HIV-1Infected Patients before and after Anti-Retroviral
Treatment. Sutherland JS, Young JM, Peterson
KL, Sanneh B, Whittle HC, Rowland-Jones SL,
Adegbola RA, Jaye A, Ota MO. J Immunol. 2010
Apr 30.
Studying pneumococcal carriage
To prepare for national introduction of a
pneumococcal vaccine of restricted valency, the
investigators studied the pattern of nasopharyngeal
carriage of Streptococcus pneumoniae and
its transmission in Gambian villages over time.
Nasopharyngeal swab specimens were collected
every 2 weeks from 158 villagers in 19 households
in 2 villages over one year. The investigators
studied the prevalence and duration of S.
pneumoniae carriage, the effect of household size
and composition on carriage, and sequence typespecific carriage within and between households.
It was found that 97% of children and 85% of
adults carried S. pneumoniae at some time. Fiftythree serotypes were represented among 1522
isolates. Carriage was more common among
children than adults for all serotypes studied
except 9V. There was an overall trend toward
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
15
Recent Unit Publications
shorter carriage with increa
easi
assiiing
ng age
ng
ge (P = .0
043
43) an
a d
significant differences in carrri
r agge du
durraatition
ionn beetttwe
ween
ween
we
e
serotypes. For most serotype
pes,
s thhee o
odd
dds off beeiingg a
dd
carrier were greater if theree were
weeree other
therr car
th
arri
rieerrs inn
ri
rier
the household. The prevalence of
of car
arri
riaag
ri
age va
vaari
ried
ri
ied
e
by serotype. Most notably, serotyp
y e 5 caarr
rria
iaaggee
occurred in only 1 village and was transientt.
Multilocus sequence typing of serotype 6B isolates
from 1 village revealed 8 different sequence types
and strong evidence of nonrandom distribution
among households (P < .001). Study by sequence
type suggested household spread starting most
commonly in children, followed by spread to
adults.
This longitudinal carriage study in Gambian
villages provides unique information on the
pattern of spread of S. pneumoniae in rural Africa
and a baseline for evaluatingg the impact
p of the
introduction of pneumococcal conjugate vaccine
into the region.
Transmission of Streptococcus pneumoniae in
rural Gambian villages: a longitudinal study. Hill
PC, Townend J, Antonio M, Akisanya B, Ebruke
C, Lahai G, Greenwood BM, Adegbola RA. Clin
Infect Dis. 2010 Jun 1;50(11): 1468-76.
Immune system: ‘remembering’
malaria infection
Longitudinal cohort studies are important to
describe the dynamics of naturally acquired
antibody response profiles to defined Plasmodium
falciparum malaria antigens relative to clinical
malaria episodes. In children under 7 years of
age in The Gambia, serum IgG responses were
measured to P. falciparum merozoite antigens
AMA1, EBA175, MSP1(19), MSP2 and crude
schizont extract, over a 10-month period.
Persistence of antibody responses was measured
in 152 children during the dry season when there
was virtually no malaria transmission, and 103
children were monitored for new episodes of
clinical malaria during the subsequent wet season
when transmission occurred. Children who
experienced clinical malaria had lower antibody
levels at the start of the study than those who
remained free from malaria. Associations between
dry season antibody persistence and subsequent
wet season antibody levels suggested robust
16
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
immu
im
muno
n lo
logi
ggiicaal m
meemory
mo
ory
ry res
espo
pons
po
ons
nses
es. Me
es.
Mean
an annttibod
ib
bod
dy
leevveels
elss to al
alll an
anttiiggeens
n wer
ere eellev
ere
e at
ated
ed by th
ed
thee end
off the
o
he wett seaason
so
on in
in chiild
ldre
ren who exxperiennced
ced
ce
clliinnic
clin
ical
al mal
alaarriaa; ea
each
each
ch of tthhes
e e chhildr
illd
drren
en had a
bo
b
oos
ostteed anntit bo
body
dy res
espo
ons
n e to
o at
at le
leas
astt on
as
one an
antittiigen.
I alll chi
In
hildre
ld
dren,
n ant
n,
ntibod
ib
bod
odyy avid
vid
dittiees w
weere llow
o er aga
ow
gaainnst
MSP2
MS
P tha
hann ot
othe
her an
antitige
geenss, a di
d ffer
errence
ence that did no
n t
change throughout the study period or in relation
to clinical malaria episodes
Boosting antibody responses to Plasmodium
falciparum merozoite antigens in children
with highly seasonal exposure to infection.
Akpogheneta OJ, Dunyo S, Pinder M, Conway
DJ. Parasite Immunol. 2010 Apr;32(4):296-304.
Regulation of severe malaria: more
genetic signposts
With the functional demonstration of a role in
erythrocyte invasion by Plasmodium falciparum
parasites, implications in the aetiology of
common conditions that prevail in individuals of
African origin, and a wealth of pharmacological
knowledge, the stimulatory G protein (Gs)
signal transduction pathway presents an exciting
target for anti-malarial drug intervention. Having
previously demonstrated a role for the G-alpha-s
gene, GNAS, in severe malaria disease, the
investigators sought to identify other important
components of the Gs pathway. Using metaanalysis across case-control and family trio
(affected child and parental controls) studies of
severe malaria from The Gambia and Malawi,
the investigators sought evidence of association
in six Gs pathway candidate genes: adenosine
receptor 2A (ADORA2A) and 2B (ADORA2B),
beta-adrenergic receptor kinase 1 (ADRBK1),
adenylyl cyclase 9 (ADCY9), G protein beta
subunit 3 (GNB3), and regulator of G protein
signalling 2 (RGS2). The study amassed a total
of 2278 cases and 2364 controls. Allele-based
models of association were investigated in
all genes, and genotype and haplotype-based
models were investigated where significant
allelic associations were identified. Although no
significant associations were observed in the other
genes, several were identified in ADORA2A.
The most significant association was observed
at the rs9624472 locus, where the G allele
(approximately 20% frequency) appeared to
confer enhanced risk to severe malaria [OR = 1.22
(1.09-1.37); P = 0.001]. Further investigation of
Recent Unit Publications
t e AD
th
ADOR
ORA
A2
2A ge
gennee reg
egio
io
on iss rreq
equi
eq
uire
reed
d to
to val
alid
alid
idat
atee
thee as
assso
ociiat
atiio
onnss iide
dent
de
ntifi
nt
ifified hheere
re,, annd to
to iide
dent
ntififyy
annd fuunncctition
onal
a lyy chhaara
al
ract
cter
errizze th
eriz
the re
r sp
pon
onsi
sibl
b e ca
c us
u al
a
vaari
ria t(s). Thhe re
rian
resuults
ltts pr
prov
ovid
idee furt
furt
rthe
herr ev
he
e id
iden
ence
cee
suupp
p orrttiing
n a rol
ole of the Gs signnal ttra
rans
nsdu
duct
ctio
tionn
p thhwa
pa
w y in the regulation of severe malaria, and
request further exploration of this pathway in
future studies.
Further evidence supporting a role for gs signal
transduction in severe malaria pathogenesis.
Auburn S, Fry AE, Clark TG, Campino S, Diakite
M, Green A, Richardson A, Jallow M, Sisay-Joof
F, Pinder M, Molyneux ME, Taylor TE, Haldar K,
Rockett KA, Kwiatkowski DP. PLoS One. 2010
Apr 1;5(4):e10017.
a bir
at
irth
th.. Fl
Flan
nag
agan
an KL, Halliday A, Burl S, Landgraf
K JJag
K,
agne
ne YJ,J,J Noh
oho-Konteh F, Townend J, Miles
DJ,, vaan de
DJ
derr San
Sande
nd M, Whittle H, Rowland-Jones S
Placental malaria: its effects on babies’
health
Placental malaria (PM), a frequent infection of
pregnancy, provides an ideal opportunity to
investigate the impact on immune development of
exposure of the foetal immune system to foreign
Ag. The investigators looked at the effect of PM
on the regulatory phenotype and function of
cord blood cells from healthy Gambian newborns
and peripheral blood cells from their mothers,
and analyzed for effects on the balance between
regulatory and effector responses. Using the gold
standard for classifying PM, the researchers further
distinguished
between resolved infection and acute or chronic
PM active at the time of delivery. They show that
exposure to malarial Ag in utero results in the
expansion of malaria-specifi c FOXP3(+) Treg
and more generalized FOXP3(+) CD4(+) Treg in
chronic
and resolved PM, alongside increased Th1
proinflflflfl ammatory responses (IFN-gamma,
TNF-alpha,IFN-gamma:IL-10) in resolved PM
infection only. These observations demonstrate a
clear effect of exposure to malarial Ag in foetal life
on the immune
environment at birth, with a regulatory response
dominating in the newborns with ongoing chronic
PM, while those with resolved infection produce
both regulatory and infl ammatory responses. The
findings
might explain some of the adverse effects on the
health of babies born to women with PM.
The effect of placental malaria infection on cord
blood and maternal immunoregulatory responses
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
17
In conversation with Professor Brigid Heywood
Brigid Heywood is the Pro-Vice Chancellor (Research) of the Open University, UK. In March she made a site visit to
MRC The Gambia. Here Brigid introduces herself and gives her assessment of the unit.
My background
I am a scientist. I started out in life sciences and medicine;
I completed a first degree in chemistry, I then went on
to study human biology for my PhD at Liverpool Medical
School. I gradually migrated through a career of materials
chemistry, but with an interface directly into medicine.
My research area is the growth of crystals. I have a lot less
time than I would like so research is now something that I
probably do in the small bits of spare time I can muster. I
used to have a very large group of over thirty people, and I
finished my last full time PhD student last year. So for the
first time in 25 years I am not surrounded by PhD students
associated with my research group, but I remain at heart an
academic.
My expertise as a senior officer of a university is in the
procurement and management of research at large scale.
I think it’s important for my connection with my role to
retain my research interests. So I keep them as much
out of personal interest as I do out of showing that I have
professionally relevant skills.
18
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
My university
The OU has 4,500 staff and we are located in a seventy
two acre campus in Milton Keynes, 50 minutes north of
London. The OU is unique in the UK for two things: it’s
the largest university by a significant margin; we currently
have just under a quarter of a million registered students
(the next largest would be Manchester which has about
45,000). Secondly we were the first university to commit
to providing higher education to anybody who wished it,
regardless of their qualifications. So there are no entry
qualifications into the institution and the majority of our
teaching – 98% - is provided through a model which is
called open supported learning - all educational provision
is provided through a distance education model. Each
student has an assigned tutor that they can contact on line
at any time they want. And for some courses they meet
their tutors physically once a month and meet their tutor
peer group as well.
Visiting The Gambia
In my role as Pro-Vice Chancellor, I am responsible for
all doctoral training for the OU. We have just over a
thousand registered PhD students, 300 of whom belong
In conversation with Professor Brigid Heywood
to affiliated research centres. MRC The Gambia is one
of our connected, affiliated research centres. We have
another one in Kenya, some in SE Asia, America and we
have a whole series scattered across Europe and the
UK. They are mainly elite research centres that focus
almost exclusively on conducting research. So they are
not typical of academic university based institutions where
they have a teaching responsibility. But they have a large
commitment to high quality, focused research so most of
them are medical research centres, and most of them have
a commitment to capacity building and succession planning
- succession both in terms of the skills for a particular
discipline or technical area and also in terms of capacity
building within a country. We support that as part of the
mission of the university and my responsibility here is to do
reviews, which is the equivalent of a quality assurance audit,
to make sure that the approach you take to your doctoral
training on site meets with our quality assurance standards.
Currently, I am visiting all 30 odd centres round the world.
I am trying to make sure we help the sharing of best
practices in terms of how you support and develop your
doctoral candidates. One of the exciting things has been to
put something that I’ve read quite a lot about into a human
picture of what the centre looks like and why your model
works for you in a particular way.
Doing well
MRC The Gambia gets a ‘gold star’ for the quality of the
doctoral students’ experience. From my perspective the
unit’s got excellent completion rates – one of the best of
any affiliated research centre we have. I now understand
why: MRC The Gambia has an incredibly robust, critical
way of selecting suitable candidates. So it’s the sheer
effort you put in to make sure those you recruit are fit
for purpose in the sense of being candidates who will be
suitable for doctoral training and will make it worthwhile
that you should invest so much resource – human and
financial.
Could do better
The world of research is very competitive and what
it requires is an evidence base. Funders want to see
evidence of due diligence on the quality of the research
environment. That includes the physical environment:
equipment that’s fit for purpose, effective investment
of money; a very robust research environment that
acknowledges what good quality research is. I suspect
MRC The Gambia knows all of this like the oxygen that
you breathe, but how do you prove it? You have built up
a language, culture where everything is done in a certain
way, but you couldn’t evidence that to someone outside
the four walls of your compound. So you must be able to
narrate and connect with a framework for articulating your
research environment – and that includes training.
Word of mouth is 20th century. You need a framework
that is documented and evidence based. This is not
only because the OU will demand it, but also because
increasingly, research funders require the different points of
evidence to be there.
All this will be seen as a criticism but it isn’t quite. It was
clear when I met staff that they could articulate what they
were doing and why. They’ve got most of that information
in some form or another. Unfortunately too much of that
is in their heads or transpires as part of ‘water cooler’
conversations. So one of my recommendations is that you
need to put a system of guidance documents in place, and
the staff community needs to participate in creating these
guidance documents, so that everyone will have a sense of
‘ownership’ over them.
Final thoughts
It’s been a really enjoyable, inspirational experience,
but quite humbling to see a little part of my university
contributing in a small way to a very successful centre.
And underlying that is a training environment of the very
highest quality. Many of the technical staff I talked to
while walking around the campus were able to explain
very clearly what they were doing, why they were doing it
and what their role in the process was. So that speaks to
anyone who’s spent 30 odd years in education.
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
19
MRC The Gambia: Centre of Excellence for PhD training
MRC The Gambia has trained many PhDs over the years from all over the world. Here we feature three recent
success stories: from Cameroon, Kenya and the United Kingdom
Meet Louis
University.
Marie Yindom who recently defended his PhD sucessfully at Oxford
Mrs. Mireille Kwekam Yindom, Mr. Georges Kenko Yindom, Mr. Nathan Fozeu Yindom, Ms Claire Sussussi Yindom, and Dr. LM
Yindom
Louis’s journey
I came to The Gambia in February 2001 armed with a Fellow of the Institute of Biomedical
Sciences of Nigeria after my studies at the University of Jos, Plateau State, Nigeria [I am from
Cameroon originally]. I worked with RVTH for six months, and was ready to go to Ireland to do
an MSc when I got the job of managing the MRC’s HLA typing laboratory from October 1st 2001.
Fortunately Ulster University agreed that I could do my MSc by distance learning instead, which I
did and finished successfully in 2003.
Introducing new methods at the unit
In 2005, I visited Professor Mary Carrington’s lab at the National Cancer Institute, Maryland to
learn new techniques for HLA typing by sequencing. We’d been doing HLA typing by PCRSSP (sequence specific priming) for a number of years, which involved the use of huge amounts
of synthesised primers to identify the different HLA alleles. And since HLA is one of the most
polymorphic regions of the human genome, we were using close to 500 different primers to
HLA type each DNA sample, a huge amount of work. When I returned to The Gambia from
Prof Carrington’s lab, Professor Sarah Rowland-Jones and I discussed the possibility of introducing
this technology (HLA typing by the Sequence-based method) at the unit. Around that same
time, EDCTP launched a call for two PhD Fellowships and I was encouraged to apply. I wrote a
proposal and submitted in November 2005.
In March 2006 I was selected for one of two EDCTP PhD fellowships under the supervision
of Professor Rowland-Jones, Professor Carrington and Professor Robert Walton (then head of
20
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
MRC The Gambia: Centre of Excellence for PhD training
MRC’s Genetics group). I was then registered with the Open University in the UK for my PhD
from October 2006. My proposal focused around sequencing highly polymorphic regions of the
human genome and relating them to susceptibility to HIV 2 infection and disease progression. This
became one of the main drivers for the acquisition of a sequencing facility which is a state-of-theart technology in this unit.
Caio
The title of my PhD project was ‘Human Leukocyte Antigens (HLA) and Killer Immunoglobulinlike Receptors (KIR) in HIV-2 infection’. I chose HIV 2 - and Caio as my focal point - because a
lot was known already about HLA and KIR in HIV 1 (although most of what we knew came from
developed world), but virtually nothing about HIV 2. The Caio HIV cohort is one of the best
resources that this Unit has and second to none in the world with regards to HIV 2 research. As
there were no ‘high tech’ facilities in Caio, we collected blood samples and shipped them to Fajara
for DNA extraction, quantification and storage in the Unit’s Biobank. We subsequently used
those DNAs for immunogenetics and other studies looking at variations in the human genome
that could influence the way people respond to infection or progression to disease (AIDS) when
infection is established.
HIV Long term non-progression: looking for clues
Genetic typing is used to determine the genetic makeup of individuals with the aim to understand
whether certain genotypes predispose people to, or protect them against certain infections, e.g.
HIV. It can also provide a clue as to who is likely to progress with the disease faster or slower.
Looking specifically at the HLA genes on human chromosome 6, we were interested in variations
in that portion of the human DNA in a homogenous population to see whether we could relate
specific variations to the outcome of HIV infection or disease progression.
Studies from this unit and elsewhere have shown that a significant number of individuals
infected with HIV 2 do not progress to full blown AIDS at the same rate as their HIV 1 infected
counterparts and they have been called long-term non-progressors (LTNP). We still do not
understand fully why this group of people accommodate the HIV 2 virus for a very long time
(15-20 years) without coming down with the disease (AIDS). The HIV 2 and 1 viruses are closely
related: they share between 30-60% similarities in many of their genes and both target the same
cell for destruction, so you’d expect that they’d behave the same way while in their host. But
we’ve realised that there are people in Caio that have been infected with HIV 2 for well over
two decades and are still going about their businesses comfortably. This scenario is very rare
in HIV-1. So we are trying to find out if the genetic makeup of these LTNPs could explain to
some extend why their immune system can successfully manage the virus for that long time. We
do this by studying the HLA loci in chromosome 6, with particular reference to HLA class I loci
(HLA-A, HLA-B, and HLA-C), which have long been associated with how the body functions
immunologically to protect itself from infections. This formed the first part of my PhD work.
Natural killers
The second part of my thesis was the study of Killer Immunoglobulin-like Receptors (KIR) in
relation to susceptibility to HIV 2 infection and progression to AIDS. These are specialized
receptors that are found on the surfaces of Natural Killer (NK) cells. NK cells are a sub set of
white blood cells which are specialised in protecting the body from infection. They are the soldiers
of the body and are among the first cells to come in contact with any foreign substance, be it a
bacterium, a virus or a parasite, that crosses the skin or mucus membrane and gain access into the
body. We now know that these special types of white blood cells have several receptors, which
help them distinguish between normal body cells (“self”) and foreign substances (also referred
to as “non-self”). NK cells identify anything in our body that wasn’t there originally and try to
mop it up and destroy it with the help of other body’s immune machineries. They are also able
to distinguish between healthy/normal body cells and those that are aged or dying or becoming
cancerous and help the immune system get rid of those aged or cancerous cells. In doing this,
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
21
MRC The Gambia: Centre of Excellence for PhD training
they use the receptors on their cell surfaces as sensors to sense other body cells looking for their
ligands which happen to be HLA class I molecules. The presence or absence of these ligands
(molecules) leads to a cascade of signals in the NK cell which will either hinder that NK cell from
killing the target (ie the other cell) or stimulate the NK cell to attack and kill that target. For our
study, we were interested in identifying genes that encode (make) KIR receptors. Those genes
are located on human chromosome 19, within a highly polymorphic region called the Leukocyte
Receptor Complex (LRC). We looked for the presence or absence of 15 KIR genes in infected
and uninfected individuals, trying to relate their gene profiles to susceptibility to HIV 2 and/or
protection against disease progression.
Contributing towards vaccine and drug development
We used HIV 2 as a conduit to understanding the main destroyer which is HIV 1. HIV 1 and 2
are essentially very similar although they behave differently before the onset of AIDS. So if we find
something informative in our HIV 2 model of LTNPs by identifying what protect them from rapid
progression to AIDS, it could be very helpful in curtailing the spread of HIV-1. Such information
could also inform vaccine and pharmaceutical companies to develop interventions that will save
people from both HIV 1 and HIV 2.
Looking forward
I’d love to continue HIV research and fortunately I can do my work using archived samples. But
essentially my work in immunogenetics is cross cutting and I can apply it in any field irrespective
of disease or pathogen. These days I am busy writing grant applications to attract some funds to
continue with my line of research. My interest is in host immunogenetics of infectious diseases
and not limited to HIV alone.
My future direction will depend upon what’s good for my family and not just me. My wife and kids
have been very supportive for the past three and half years of my PhD work, travelling from one
place to another and I think their welfare is now a priority to me, particularly with regards to the
line of studies they will like to follow.
I’d like to thank the MRC, without whom I wouldn’t have had this opportunity to do my PhD.
I’d also like to thank the EDCTP for sponsoring my research; they’ve been very supportive – I
can’t recall anything request from me that they’ve turned down. And of course the study
participants: without them this work would not have been possible. Currently, I am writing papers
for publication and I do get back to Caio from time to time to give feedback to the community
through the Caio field staff.
So many people at the unit have been supportive with ideas and prayers and I remain grateful to
them. So I definitely will never regret coming to the MRC.
Sarah Burl was awarded her PhD in mid 2009.
After seven years in The Gambia she is
leaving in June to pursue postdoc opportunities in the UK.
About Sarah
My background is both academic and professional - both in the UK and Canada. I came out
of science and worked in the biotechnology industry as a consultant for three years in London
working with start up companies. During that time I met my partner Martin Holland who then
came out to The Gambia. At that time the company I was working in was being disbanded, so I
came to The Gambia intending to stay for just a few months, and ended up staying seven years. In
fact, I got a job with the TB group a week after my arrival.
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MRC The Gambia: Centre of Excellence for PhD training
Finding a research passion in the
Gambia
[Once I’d started working with the
TB group], I realised that this area of
research was incredibly interesting,
so I ended up doing a PhD. I had
considered doing a PhD before but
I’d never felt like I was working on
something I was so interested in I’d
want to spend the rest of my life
studying it.
Vaccination and the environment
My PhD was based on BCG
vaccination in early life, looking at the
immunogenicity of the vaccine. We
wanted to know why the vaccine is
not very effective in this environment.
One of the theories is that the BCG
vaccine is masked by your immune
Dr Sarah Burl taking time out from a conference in Turkey
responses to other things, particularly
the environment. Environmental
mycobacteria induce an immune response and the mycobacteria have very similar profiles to the
BCG vaccine itself, so if you are exposed to these first before receiving BCG, the response to the
vaccine may be reduced.
We vaccinated a group of children at birth and delayed the vaccine in the other group to four and
a half months. I’d like to reiterate that the vaccine is recommended to be taken within the first
year of life, so it was within the recommended time frame. Children vaccinated at 4 and a half
months would have been exposed to environmental mycobacteria, which we found by looking at
their in vitro responses to mycobacteria at that age. Their responses were different from those
vaccinated with BCG at birth. When we compared the two groups at the same time point post
vaccination (i.e. 4½ months), we found reduced interferon gamma, IL17 and IL6 responses in the
group vaccinated at 4 and a half months. We can’t say that protection is reduced, but the lack of
IFNg and its receptor has been associated with reduced protection in humans. However when we
compared the groups at 9 months of age the responses were similar. This may also be due to a
waning of the response 9 months post vaccination in those vaccinated at birth. Also, responses to
mycobacteria prior to vaccination were observed, so it would suggest that there could be some
interaction, explaining why the responses in the delayed group were reduced.
A PhD at MRC The Gambia: pros and cons
You have the expertise and the interest of people here in the same subject area you wish to work
on. You also have all the material you need to work on here – the samples and technology. You
can do everything in one spot and that’s been the major advantage for a subject area of this type.
However, it can feel a bit isolated here which makes going to conferences essential to discuss your
work with others around the world in your own field of interest. In a big university in a large city
you would have the opportunity to mix with more people and attend many more seminars from
internal and external scientists although the interest of those around you may be much broader.
Looking forward
I am planning to move to London, UK in June. There may be future opportunities to continue
collaborating with MRC The Gambia which I would really like to do. I’ve been doing work on tolllike receptors and I’d like to continue doing that. I’ve just completed a pilot study since my PhD
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
23
MRC The Gambia: Centre of Excellence for PhD training
so I’d quite like to continue with a larger study and maybe write a fellowship for my own funding
to do that here but based in London, although nothing is final for me at the moment.
London is probably not somewhere I’d end up long term but I think it will be a good opportunity
for work at this stage of my career. I am not looking forward to the long commute (at least 3
h daily); that’s an advantage of being here – a five minute cycle to work and fewer distractions
so you can work very hard more easily here and still have a nice lifestyle. And I am not looking
forward to having to wear socks every day…
I’ll miss…
The light and the weather. And the interactions with people working in similar fields.
I’ve had quite a lot of independence here. I’ve been able to be involved in different areas such as
managing the labs and training including tutoring some of the BSc and Foundation degree students.
Here there are a lot of other aspects of the academic world than just sitting in the lab doing
bench work. It’s a lot more applicable to real life. It’s been great having the opportunity to be in
an academic area and utilise other skills as well.
I will miss many people who I have met and/ or worked with over the years in The Gambia but
hope to stay in touch and continue with possible collaborations in the future.
Clayton Onyango defended his PhD in early May.
He joined MRC The Gambia in 2005
as a scientific officer and went on to win an MRC doctoral fellowship in 2006. Clayton left
the MRC on 30th March with his family to take up a new appointment back home with the
Wellcome Trust at Kilifi, Kenya, but before he left he told us his story.
Clayton’s background
I have a Masters degree in biotechnology from Kenyatta University, where I did my thesis on the
molecular virology of yellow fever. I was working as a research assistant on viral hemorrhagic
fevers, when I got the job with Dr Abraham Alabi at MRC The Gambia. He’d won an EDCTP
senior career fellowship award to develop an HIV viral load assay.
After a year, Abraham and I were successful in getting the viral load assay up and running; initially
we thought it would take us two years but we were able to work much faster.
Along the way came Dr. Matthew Cotten with whom we wrote a proposal and secured my
MRC PhD studentship. So in 2006, I registered with the OU and I’ve just finished; I am doing my
viva on 10th May in The Gambia.
HIV 2
The topic of my PhD is the characterisation of variations in TRIM5alpha HIV-2 pathway that
associate with disease progression. In simple terms, we were interested in any changes in the
HIV-2 capsid (p26) protein that would account of the varied disease outcome observed in HIV-2.
The study identified a variety of p26 that associate with viral load. And because we know viral
load plays an important role in HIV disease we were able to pinpoint this to changes to p26 that
actually attributed to either increased or low viraemia in infected persons.
Answers from a ‘weaker’ infection
For a long time, HIV researchers have been trying to understand exactly how HIV can be
contained by the body and how research can lead to vaccines that will help contain the virus.
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
MRC The Gambia: Centre of Excellence for PhD training
pandemic. We think the lessons we’ve
learnt from studying HIV-2 (that seems
to be a weaker infection than HIV1) can be used to help design better
studies on HIV 1.
Moving on
I’ve got a three year appointment
with the Wellcome Trust in Kilifi. I
am moving away from HIV research
for the meantime and I’ll be working
on respiratory viruses especially those
infecting children. KEMRI-Kilifi has a
large cohort of children and mothers.
Well established studies in the Kilifi
cohorts include epidemiology of
different diseases, but we seek to boost
the virology arm over the period of my
stay in Kilifi.
Dr Clayton Onyango: From time to time we’d like to come back and show Mercy
The Gambia: a peaceful home
where she was born
We’ll miss The Gambia. It’s been a
hospitable place for my family and we
are going back to Kenya where life is fast paced. You have to behave like a Kenyan to survive in
Kenya.
Gambians really love people – they love each other and they love foreigners. In fact, my last
daughter Mercy was born in The Gambia; she has a Gambian birth certificate and a Kenyan
passport, so from time to time we’d like to come back and show her where she was born and
how life is here.
Farewell and final thoughts
Recently, there have been many structural challenges that have affected us all at MRC The
Gambia. Currently we don’t have a clear picture of the future of HIV research at the unit and
this has been a particular issue for me and my lab team. However, I hope that in spite of all the
changes, the good things and the warmth will continue. I am proud to say that I am a product of
MRC The Gambia; undoubtedly, MRC has contributed a lot towards my career. I want to thank
Prof Corrah for offering the enabling environment for me to do my PhD, because it was quite a
challenge being a member of staff and taking up a studentship. And I’d like to thank Drs Assan
Jaye and Matthew Cotten, Professors Sarah Rowland Jones and Hilton Whittle. They encouraged
and supported me through tough times; I will never forget them and I thank them very much -I
hope in future we can still work together. I must thank my wife Consolata who has been there for
me throughout…And my children for putting up with my late homecoming and travelling while I
was studying. Jerre Jeff to you all.
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
25
HR NEWS
Kalilu Dibba & Kathy Hill
Appraisals
The appraisal documents have been sent out to Appraisers and Senior Reviewers. The performance review period is
from March 2009 to February 2010. The exercise will be in two phases:
A2 – C3 staff – 08/04/2010 to 10/05/2010
D1 – E2 staff – 11/05/2010 to 10/06/2010
HR is appealing to all Appraisers and Senior Reviewers to adhere to the above schedule. If this is not possible due
to staff being absent from the Unit could you please inform Kalilu Dibba, Assistant HR Manager so he note this in our
records.
GEM and Team Awards
The deadline for submission of nominations has been extended to 31st May 2010. All nominations must reach the HR
office on or before this date.
Restructuring
The restructuring exercise has now been completed and all staff have been notified of their status.
HR would like to thank staff for their patience and understanding during this difficult period.
Following the restructuring exercise organograms are now being developed for each department/section to reflect the
new structure.
New Staff
Isatou Ndow
Data Entry Clerk Level 1
Maudo Samba Jallow
Data Entry Clerk Level 1
Anta Gibba
Data Entry Clerk Level 1
Mansour H.B Njie
Data Entry Clerk Level 1
Bintou Jobe
Data Entry Clerk Level 1
Deyda Njie
Data Entry Clerk Level 1
Ismaila Kanteh
Data Entry Clerk Level 1
Abdoulie Gibba
Data Entry Clerk Level 1
Ousman Ceesay
Data Entry Clerk Level 1
Sariba Jammeh
Data Entry Clerk Level 1
Safiatou Bah
Data Entry Clerk Level 1
Lawrence Gibba
Data Entry Clerk Level 1
Abdul Khalie Muhammad
Trainee Data Manager/Statistician
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
HR News
Shola Able-Thomas
Laboratory Technician Grade 1
Sainey Senghore
Laboratory Technician Grade 1
Haddy Faal
Laboratory Technician Grade 1
Gilleh Thomas
Data Manager
Abdoulie Jatta
Assistant Data Manager
Ramatoulie Jobe
State Enrolled Nurse
Modou O Cham
Data Entry Clerk Level 1
Abdoulie Bandeh
Field Assistant
Leavers
Ebou Manneh
Driver
Ebou Senghore
Yard Attendant
Bedy Baldeh
Yard Attendant
Anna Colley
Cleaner
Saikou Dumbuya
Field Supervisor
Ousman Ceesay
Data Entry Clerk Level 1
Biram Saidybah
Field Assistant
Kebba Dibba
Field Station Projects Officer
Mohammed Bandeh
Senior Field Assistant
Bunja Kebbeh
Nurse Field Work Coordinator
Zainab Kalokoh
Laboratory Technician Grade 1
Sanie Sesay
Research Clinician
The following long serving staff members officially retired on 31st March 2010 after many years distinguished service at
the Unit;
Lamin Fatty
Electrician
Adama Sidebeh
Auxiliary Nurse
Abdou Colley
Auxiliary Nurse
Sally Ann Clements
Cook
Emelia Gomez
Housekeeper
We wish them a happy and restful retirement.
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
27
HR News
Clinical Services staff say farewell
On 31st March, four long-standing members of staff of the Clinical Services Department retired – Ms Sally Ann Clements
(Cook), Mrs Emilia Gomez (Housekeeper), Mr Abdou Colley and Ms Adama Sidebeh (Auxiliary Nurses). Here are some
images from their tearful send-off party.
Ms Sally Ann Clements receiving her parting gift
from Sister Isatou Marenah
Adama with Mamina
Bojang (SRN nurse)
Deputy Matron Ilene Carayol drying the tears of Mrs
Emelia Gomez
Professor Hilton Whittle and Ms Adama Sidibeh
Mrs Gomez and Musa Sawaneh
(Acting Transport Manager)
Sally Ann with colleagues
Mr Abdou Colley
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MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
HR News
Meet Abdoulie Jadama, who joined the MRC in March 2010 as a
Project Manager (External Grants).
‘I am a Certified Project Management Professional (PMP) born in
Gimansari Bah, Upper Badibou District, North Bank Region, The
Gambia.
I started my early academic and professional career in Agriculture
and Rural Development. I did my Higher Diploma in Agriculture
and Rural Sociology at the Gambia College. Upon completion
in 1997, I joined the Department of Agricultural Services (DAS)
as Senior Agricultural Officer. Later that year I was seconded
to support the Decentralised Rural Development Programme
funded by the European Union at Kerewan Area Council as
Project Support Officer-Agriculture and Natural Resources
Management. Prior to leaving (SRDR), in 2003 I joined the
Management Development Institute to pursue my Diploma in
Management Studies.
In 2004 I returned to (DAS) under the Soil Management Unit
attached to the Lowland Agricultural Development Programme (LADEP) as Programme
Specialist Conservation.
In September 2007 I went to the University of Bedfordshire (UK) to do my MBA. I later
worked with Action for Employment in the UK as a Programme Support Officer/ Coordinator.
From January 2009 to September 2009 I registered with the Project Management Institute in
United States of America for my Certified Project Management Professional (PMP) qualification.’
Welcome, Abdoulie. We wish you a productive and successful time in a department that is scheduled
to become much busier over the coming years.
Obituary
Mr Silaba Drammeh passed away on 5th April 2010 at the
MRC ward at Fajara after a long illness. He was laid to rest
on 6th April 2010 at Wellingara. A large number of MRC
staff led by the Matron of Clinical Services turned out to
pay their last respects to Mr Drammeh.
Silaba Drammeh joined the Unit on 25th July 1978 and
worked continuously until his death. Several speakers
at the funeral described his admirable personality and
piety. Colleagues at MRC will remember his gentility and
diligence.
May his soul rest in perfect peace.
MRC TAMA - VOL: 09 ISSUE: 02 / Mar - Apr 2010
29
Your Feedback Please!
Tama – the Newsletter of MRC (UK)
The Gambia – is for everyone who
is interested in our work and our
community.
We are keen to receive feedback and
suggestions for new features from our
readers. So if you have any comments,
please let us know.
Email: tama@mrc.gm
TAMA EDITORIAL BOARD
Alison Offong
Maimuna Mendy
Bouke de Jong
Kathy Hill
Pa Tamba Ngom
Fanding P Njie
TAMANEWSLETTER
VOL: 09 ISSUE: 02 / Mar - Apr 2010
Medical Research Council (UK) The Gambia
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P. O. Box 273 Banjul
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Communications
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Email: communications@mrc.gm
Web: www.mrc.gm
© Medical Research Council 2010