UP and French researchers intensify malaria research programme in Limpopo

Approximately half of the world's population is at risk of contracting malaria, but 90% of malaria cases and deaths occur in Sub-Saharan Africa. Around 78% of these deaths occur among children under the age of five.

With these numbers in mind, the University of Pretoria Institute for Sustainable Malaria Control (UP ISMC) is contributing towards malaria elimination in the country through research and awareness projects. A group of researchers from UP ISMC and Aix-Marseille University, France, recently visited two villages in the Limpopo River Valley (LRV) region, in the Vhembe District of Limpopo, to research the human behaviour contribution towards the high incidence of malaria in the region.

About 1 000 community members will benefit from the cutting-edge research that aims to ultimately solve the problem of malaria in the area. Professor Riana Bornman, one of the lead researchers in the LRV region, said a “knowledge, attitude and practice (KAP) survey is being done in the two villages that appear to have the highest malaria case numbers in the area”.  

Prof Bornman said the number of malaria cases in the area was of concern. “If Masisi is the clinic with the highest number of malaria cases, there must be something going on,” she said. Masisi Clinic, approximately 20km away, is where most of the residents of these two villages go when they get sick.

In order to ensure accurate and useful results, researchers often use the services of local, mostly female, VhaVenda community members who have been trained to collect quality data through the use of questionnaires as part of KAP surveys.  This overcomes language barrier issues and makes locals more comfortable with the process of the research.

This project is one of several in the Remote Sensing for Malaria Control in Africa (ReSMaCA) programme that UP ISMC and the Aix-Marseille University researchers are involved in.

The team has been making trips to the LRV region since 2016. The programme is dedicated to researching sustainable, safer and innovative ways to help combat the disease, explained Dr Taneshka Kruger, Project Manager of the UP ISMC. She said malaria was prevalent in the northeastern parts of Limpopo, Mpumalanga and KwaZulu-Natal, “close to the borders with our neighbouring countries”.

“Limpopo has the highest incidence, specifically in the LRV region of Vhembe. Regardless of the high incidence, there is very limited data about malaria in the area and many unknowns exist that need to be answered [in connection with] why the prevalence is so high.”

According to Professor Tiaan de Jager, UP ISMC’s Director, the aim of the ReSMaCA programme is to develop an understanding, through research, of why the LRV region has a high incidence of malaria. “We suspect a lot of factors are involved in the high malaria incidence in the area and we have anecdotal evidence of the social and environmental contribution. However, a systematic assessment of these factors must occur and that is what we aim to do by using satellite technology.”  

Prof De Jager said the ReSMaCA programme addresses factors such as climate change; the mosquito vector (habitats and habits); the parasite (habits, parasatemia); human movement across borders; land usage; vegetation; using a more integrated approach. The aim is to address all the social and environmental contributing factors.

An important tool in the programme is the use of satellite technology. According to Prof De Jager, remote sensing forms a major part of the research. “The French National Space Agency is involved and we value the partnership to assist us to reach the malaria elimination target by 2023,” he said.

Meanwhile, Professor Jean Gaudart, Biostatistician and Public Health Specialist at Aix-Marseille University, said: “Mosquitoes breed in water and require vegetation to survive. So when we see vegetation using remote sensing technology, it will guide us to find the hotspots – the most at-risk areas for malaria.” He is also a co-supervisor on the new study focusing on the two villages, which will make use of remote sensing to determine some of these factors.

Prof De Jager said the main challenge of any project was consistent funding. “It takes money to do research and in the case of the ReSMaCA programme, most of the projects take place in the field in Vhembe District, which means travelling and accommodation expenses, and this really adds up. Other challenges include the language barrier, and building and keeping trust between us and the community.”   

He expressed gratitude for the support the collaboration has received and hoped the project would contribute towards the overall goals of ResMaCA.

“Aix Marseille University and the French Research Institute for Development (IRD) have been very supportive from the start towards this collaboration. We hope to be able to identify malaria hotspots, develop early warning systems and design effective control strategies in the area.”

Researchers

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  Professor Riana Bornman

  Professor Riana Borman’s research seeks to understand the effects of endocrine-disrupting chemicals (EDCs) on human and environmental health, with a special focus on male reproduction. Most of her research is carried out in the rural areas of the Vhembe District in Limpopo, in communities where insecticide is sprayed to control malaria-carrying mosquitoes.
  She began her career in the Department of Urology at the University of Pretoria (UP) in 1980 and had a research topic to explore within the first week, which triggered a career-long curiosity. “I am still researching the role of EDCs on human health today,” she says.
  
  Prof Bornman, who obtained an MBChB at UP, says her research focus developed from her experiences in managing patients in clinical settings. “As a clinical physician, I realised that human and environmental health was intricately affected by environmental pollution, especially exposure to EDCs. Being a clinician at UP has created unique opportunities to conduct research in the Limpopo province.”
  
  Her field of research addresses the unintentional health consequences of annual indoor residual spraying of insecticides to control malaria-carrying mosquitoes. In the Vhembe District, dichlorodiphenyltrichloroethane (DDT) is sprayed to control these mosquitoes and reduce cases of malaria and death. While DDT is largely a banned chemical, according to the Stockholm Convention on Persistent Organic Pollutants, it is allowed in some countries, including South Africa, for malaria vector control.
  But there is growing concern around the adverse health effects associated with DDT. Scientific evidence from South Africa is crucial and contributes to the body of evidence that is calling for safer alternatives to DDT for malaria vector control.
  
  The chemical is effective for about six months and needs to be sprayed every year. Prof Bornman’s research shows that annual spraying has negative, long-term consequences for pregnant women and young children. “We are seeing these consequences in children, possibly persisting into future generations, suggesting long-term health effects. Our research collects important irrefutable scientific evidence of the health impacts of EDCs in communities exposed to insecticides.”
  
  Prof Bornman is the co-principal investigator for the Venda Health Examination of Mothers, Babies and the Environment (VHEMBE) study, which is being conducted in collaboration with Prof Brenda Eskenazi of the University of California, Berkeley in the US and Dr Jonathan Chevrier of McGill University, Canada. The VHEMBE study is the first birth cohort from a population that is currently exposed to DDT via annual spraying and is the biggest longitudinal birth cohort from Africa. The study group recruited and enrolled 752 mother-child pairs at Tshilidzini Hospital in Thohoyandou and have monitored the children up to eight and a half years of age for various possible health impacts.
  
  She hopes to continue doing research that contributes to improving the health of those whose voices are not often heard.
  
  She is also co-principal investigator and clinical leader of the South African Prostate Cancer Study, which is investigating the genomics of prostate cancer in African men; this is being done in partnership with Prof Vanessa Hayes, Scientific Director of the Garvan Institute of Medical Research in Sydney, Australia. A recent highlight in their research work has been funding awards from major international bodies to investigate the development of aggressive prostate cancer in black African men. “We are extremely motivated to continue with this research,” says Prof Bornman. “Successful awards reflect that the scientific leaders in our field support our approach.”
  
  Over the past 18 months, the prostrate cancer study group began a new project that focuses on the mutational signatures of DDT and the possible role of this EDC on prostate cancer aetiology. Prof Bornman is also the study leader for a new study on knowledge, attitudes and practices of traditional healers, primary healthcare service providers and men in the rural Vhembe District.
  
  She says in her research work she was inspired by Prof Dion du Plessis, former Head of Urology and Dean of the Faculty of Health Sciences at UP, who taught her to think beyond the obvious, to dream big and to just DO it!
  Her academic role model was Prof Carl Franz, former Head of Surgery at UP. He was a prime example of how to integrate laboratory and clinical medicine in an academic career, she says.
  
  Her message to school learners or undergraduates who are interested in her field is: “Every one of us, irrespective of our discipline, can make a difference in the lives of people. My research aims to improve the lives of people living with the constant threat of malaria under unforgiving environmental and socio-economic conditions. We can all do research that makes a difference. One just has to care enough about people.”
  
  Her hobbies are photography and travel.
  
  
  

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  Dr Taneshka Kruger

  Dr Taneshka Kruger has been doing research at the University of Pretoria (UP) since 2012, which was when she did her postdoctoral fellowship on an innovative malaria mosquito vector control method. She joined the UP Institute for Sustainable Malaria Control (ISMC) as project manager and coordinator in the same year. Dr Kruger is also responsible for marketing the institute, and her research focus contributes to this.
  
  Her research focus is innovative and novel malaria education and health promotion as proactive malaria transmission prevention methods and strategies. A large proportion of malaria deaths occur annually in children under five years of age. Dr Kruger’s research and communication initiatives often have her working directly with malaria-endemic communities, especially with young children of primary school age, in the rural Vhembe District in northeast Limpopo. The aim is to raise malaria awareness and to teach children how to prevent contracting the disease.
  
  Malaria is still a major public health concern, with hundreds of thousands of people dying annually from the disease, despite it being both preventable and treatable. Dr Kruger says her research matters because it contributes towards proactive malaria prevention strategies, specifically identifying novel education and health promotion interventions that have the potential to contribute towards malaria elimination.
  
  Dr Kruger is part of a cross-faculty research team at UP. In her capacity as project manager and coordinator at the UP ISMC, she works with a variety of researchers that specialise in many interesting fields and with a focus on malaria elimination. She recently collaborated with Dr Megan Riddin – of UP’s School of Health Systems and Public Health, and medical entomologist at UP ISMC – on mosquito vector biology and innovative control; Professor Walter Focke, of the Department of Chemical Engineering, on innovative malaria/mosquito repellents and control methods; and Prof Irma Eloff, of the Department of Education Psychology, on the use of culturally and age-appropriate songs to educate children about malaria.
  
  A recent research highlight for her was determining the most effective malaria intervention education method in primary schools. This research will be expanded further in the following year.
  
  Dr Kruger regards Prof Riana Bornman, senior research professor in the School of Health Systems and Public Health, as an inspiration because she is so devoted to what she does, which includes working with rural malaria-endemic communities. Dr Kruger adds that Prof Tiaan de Jager, director of the UP ISMC and Dean of the Faculty of Health Sciences, is her academic role model because of his vision to establish the transdisciplinary research entity that has brought together researchers from various disciplines working towards the elimination of malaria.
  
  Her advice to school learners or undergraduates who are interested in her field is to identify the one thing about this field, or any research field, that generates excitement for them, because that makes the hard work and challenges worth the while. She adds that by focusing on the one thing that brings joy, the rest will fall in place.
  
  In her spare time, Dr Kruger enjoys scuba diving.
  

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  UP and French researchers intensify malaria research programme in Limpopo