Views from the London School of Hygiene & Tropical Medicine

Tanzania award for pioneering work on vector control  

By JMuheza award JoLines1o Lines, Reader in Malaria Control and Vector Biology

 

It was great to receive an email the other day from my former colleague Abraham Mnzava at the WHO, with news that our Muheza Team from 30 years ago was honoured with an innovation award in health from the government of Tanzania in recognition to our pioneering work on the use of treated nets for malaria control. The trophy was presented to Steve Magesa, now director of vector control operations at RTI, by Vice President Mohamed Gharib Bilal on 22 April, World Malaria Day. These were all my colleagues in 1983-91, when I worked in Tanzania as a Postdoc with Chris Curtis.  We were all the same age learning how to do fieldwork.  It was a wonderful reminder of that time, that team and that research…

The story starts in 1983. As a team, we were all young and new and starting out in a small field station on the edge of a small town in Northern Tanzania. As well as Steve, there was Edith Lyimo, Jasper Ijumba, Abraham Mnzava, Kato Njunwa and myself.   I was happy because I was allowed to drive the bright red Land Rover, which we had imported unaware of local superstitions about vampires, blood collection and malaria research.

We started learning the basic skills, including such practical necessities as how to catch female mosquitoes alive as they bite your leg, how to spot them resting in a thatched roof in a dark house, and how to dissect their salivary glands to see if they are carrying the malaria parasite. The experienced elder technicians taught us these skills: they were supposedly working for us, but really they looked after us.  I was impressed because in the 60s, several of these older guys had worked with heroes from the malaria hall of fame: David Clyde, Garrett-Jones and Bagster-Wilson.

In mid-1984, Chris Curtis sent us a bottle of permethrin insecticide, and a WHO report on tests of permethrin-impregnated mosquito-nets in Burkina Faso. We bought some nets, treated them, and tried them out for ourselves. A few weeks later, I wrote back to Chris: “please send another bottle of permethrin, we need to do more, this could turn out to be something big”.

Over the next few yebednets-distribution-300_155146ars, we worked out how mosquitoes are affected by insecticide-treated nets (ITNs), including the fact that use of ITNs by some people in a community can confer indirect protection to unprotected people sleeping nearby. Later, other colleagues (including Mwele Malecela) joined the team and made important contributions, and my own place as the participant from LSHTM was taken over by the irrepressible Tony Wilkes, and later still by the legendary Caroline Maxwell.

Our early entomological work was only one tiny step, but what it helped to start did indeed turn out to be “something big”:

  • large-scale epidemiological field-trials, carried out in The Gambia and elsewhere in the mid 1990s, showing that ITNs were as cost-effective as measles vaccine as a means of improving child survival in Africa;
  • a renewed sense of opportunity and obligation about the role of malaria control in public health … contributing to the creation of the Roll Back Malaria movement (1998), as well as…
  • the inclusion of malaria as one of the Global Fund’s three target diseases — since its launch in 2002, the Global Fund has spent more than USD 7 billion on malaria control, with treated nets as the largest single item of expenditure;
  • 3.3 million deaths prevented by combined anti-malaria interventions since the year 2000, according to WHO; the majority of these deaths being prevented by increased treated-net coverage.

Collaborative entomological research involving LSHTM staff is still going on in Tanzania, not only in Muheza but also now in Moshi and Muleba, on the west side of Lake Victoria, This research is led on the School’s side by Mark Rowland, and one of the key aims of the work is to develop and test nets and other forms of vector control using new and alternative insecticides, in response to the pyrethroid resistance now spreading through the country. This work is critical to ensure the sustainability of the malaria-control achievements of the last decade.

For Mark and myself, and for all the colleagues we have worked with in Tanzania over the years, there is one person who stands out as having made this happy story possible: Professor Chris Curtis. He was responsible for the birth of the team in the 1980s, and he continued to guide us until he died in 2008.  His achievements and his influence continue to be celebrated by his students and colleagues all over the world.

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