Improving malaria diagnosis in Africa, one lab at a time
June 4, 2010
OYUGIS, Kenya - Inside Rachuonyo district hospital, Simba Mobagi peers through his laboratory's only microscope at a sick woman's blood sample.
The 33-year-old laboratory technologist's goal - rapidly identifying malaria parasites.
Dozens more samples await his eyes. Each represents a patient suffering outside on wooden benches.
Mogabi takes little time to ponder his workload. He quickly finds malaria parasites, marks his findings on a pink patient record and moves to the next slide. Much to his surprise, a U.S. Army officer arrives, removes his black beret and sets down a large box.
Inside Maj. Eric Wagar's box is a new microscope - a small gesture within U.S. Army Medical Research Unit-Kenya's larger efforts to improve malaria diagnostics in Africa.
For more than 40 years, USAMRU-K - known locally as the Walter Reed Project - has studied diseases in East Africa through a partnership with the Kenya Medical Research Institute.
Wagar heads USAMRU-K's Malaria Diagnostics and Control Center of Excellence in Kisumu, a unique establishment begun in 2004 that's since trained more than 650 laboratory specialist to better their malaria microscopy skills.
"Working with the Walter Reed Project is so good for the community, as it benefits the patient," Mobagi said, who is looking forward to attending the center's malaria diagnostics course. "Plus, having a new microscope improves our work environment. Work will be easier and we will have better outcomes."
Back in Kisumu, wall maps mark the center's success, with hundreds of trained lab technicians from more than a dozen countries across the African continent. International students have come from Ireland, the U.S. and Thailand.
Many students are sponsored through U.S. government aid programs aimed at reducing disease in Africa or by nongovernmental organizations. Most of the center's $450,000 annual budget comes from the U.S. President's Malaria Initiative. Other funding is from the U.S. Defense Department, NGOs and pharmaceutical companies.
For students to practice malaria identification, five Kenyan lab technicians work tirelessly to create a variety of blood specimens. Slides may show one or more of malaria's several species - others are free of parasites. The majority of malaria cases are the falciparum species, but many people are co-infected with other species and it's important for students to recognize that, Wagar said.
"At our course, lab students learn skills and habits that increase their ability to accurately detect malaria on blood slides. Yet, when they return to their local laboratories, they face the challenge of changing habits and procedures," Wagar said. "Changing behavior is hard to do."
In late-April, Wagar accompanied Jew Ochola, 28, the center's daily operations manager to Oyugis, the district center of Rachuonyo that lies roughly 30 miles south of Kisumu in Kenya's Nyanza province.
"First I do an assessment of the hospital's lab, what procedures they have, the number of people on staff and the equipment they use," Ochola said. "By partnering with laboratory managers, we hope to increase standards and improve efficient and effective diagnosis.
The goal is to lessen the burden of malaria on the local people."
To mark progress, lab staffs must collect 20 slides each month that show properly handled blood samples. Monthly visits will mark performance improvement.
Through quality malaria diagnosis, USAMRU-K is part of a larger public health effort to reduce malaria's impacts on Kenyan's lives. Illness means paying for treatment and less wages earned, creating an impact on the economy.
"By mitigating a public health burden, people should have more time to grow food and have money for things other than medical care," Wagar said. "We can't expect to see change right away, but hopefully things will be a little bit better every month."
Working with the Djibouti-based Combined Joint Task Force - Horn of Africa and other DoD agencies, the center recently offered microscopy courses through U.S. military partnership events in Ghana, Nigeria and Tanzania. The effort supports U.S. Army Africa's strategic engagement goal of increasing capabilities and strengthening capacity with the militaries of African nations, Wagar said.
"To date, that includes eight Kenyan military lab techs, 17 from the Tanzania People's Defense Force and 30 Nigerians," Wagar said.
Accurate diagnosis is also a key factor for military readiness, Wagar said. For example, a Kenyan soldier stationed in Nairobi - where malaria is less prevalent - is susceptible to the disease if posted elsewhere in the country.
"Improving malaria diagnosis within African military laboratories sets conditions for healthier troops," Wagar said. "When forces are healthy, they are more capable to support their government and regional security."