Multi-Institutional Collaboration at its best

Multi-Institutional Collaboration at its best

The Epidemiology Ecology and Social-Economics of Disease emergence in Nairobi (ESEI) project has hosted a variety of studies each with different study designs since its conception. MSc students, Mercy Gichuyia, James Macharia and I had the opportunity to work within an aspect of this wider project which involved a cross-sectional study among livestock keeping house-holds in Korogocho and Viwandani informal settlements of Nairobi. We sampled blood and faeces from humans and different livestock species kept in the area and from the faecal samples, identified the prevalence and antimicrobial susceptibility patterns of Salmonella, Campylobacter and E.coli. This article will focus on the interaction with the different team members and partners during our field sample collection. The science we undertook is currently being prepared for publication.

msc-students

MSc Students, James Macharia Mercy Gichuyia and Maurine Chepkwony

I had the opportunity to work with a large and robust multi-institutional team that was well coordinated and that gave me the best introduction anyone could hope for in how a collaborative project functions. Our typical field day began at 6am where we would be picked from the University of Nairobi, College of Agriculture and Veterinary Sciences by Fredrick Amanya, Lorren Alumasa or James Akoko (all from ILRI).  Our voyage would get us to the heart of the informal settlements where we would meet with a team from the African Population and Health Research Centre (APHRC): Sophie and Jacky, as well as three residents from each area who acted as our security guides and who are known to the chief, elders and the APHRC. These two groups of people were crucial in creating rapport with the households as well as locating the randomly selected households and also acted as guides while navigating the otherwise complex neighbour-hoods.

Lorren and Amanya (both Clinical officers based at ILRI) would give clinical feedback to household members whose laboratory findings required some form of clinical feedback. This acted as community feedback, one of the many community benefits from the project. After a morning of questionnaire administration, collecting human feacal samples (with the help of Fredrick and Lorren) and livestock sampling with the help of Akoko (project field coordinator), we (Mercy, Macharia and I) would then head to the University of Nairobi (UoN) for laboratory isolation and analysis of the livestock samples  while the human samples were transported to the KEMRI-CMR laboratory.

The fatigue from the morning physical work notwithstanding, laboratory work was very exciting owing to the very dedicated and motivating University of Nairobi Laboratory team led by Mr. Nduhiu Gitahi and comprising of Mr. Masinde, Mrs. Mungai, Ms. Wandia, Mrs. Gateri, Mr. Wambaru among others who offered us a lot of guidance and encouragement. The KEMRI –CMR laboratory team was also a huge part of our work and from my standing, a great resource to my work. I learnt several skills from this team particularly antimicrobial susceptibility testing using the agar dilution method from Mr. Ngetich and how to run a PCR as well as analysing of sequence data from Mr. Samuel Njoroge. The two institutional laboratories have very distinct tasks in the project, but the linkages of these activities and support from the Labora-tory coordinator, Dr. John Kiiru, gave me an excellent opportunity to accomplish different aspects of my project as a student since I was able to work in both laboratories with a lot of ease. The contribution of Dr. John Kiiru from KEMRI cannot be overstated especially in the facilitation of this inter-laboratory collaboration ob-served.

Now I understand that it takes a village to make a successful project. Even with the above mentioned activities, a lot went on in the background. The whole urban zoo team was very efficient in the coordinating of activities including field work, and laboratory equipment and reagent acquisitions.  Dr. Victoria Kyallo and Mr. James Akoko were very effective, including Maurice Karani and Patrick Muinde (research technicians based at ILRI) were also instrumental in the project implementation. We were lucky to have supervisors: Prof. Kang’ethe (UoN) and Prof. Fevre (University of Liverpool/ILRI) who were always available and ready to support and guide us whenever we needed assistance in solving problems. I also interacted with Dr. Gemma Wattret from the University of Liverpool who was of great assistance in my Campylobacter research and especially so, in the molecular analysis and Laura Made of University of Liverpool in the study design. I cannot forget Dr. Annie Cook who taught us the ropes of rodent trapping and handling.

Although  this article reports on a successful multi institutional interaction during my experience in the urban zoo project, it is actually an acknowledgement from Mercy, Macharia and myself to the project and, institutions and all the individuals mentioned and not mentioned in this article that were involved in making our Master of Science research projects a success. Working with the urban zoo team was without a doubt a very exciting experience as well as an opportunity for growth both personally and profession-ally. We are very grateful for all your input.

This article has been written by  Maurine  Chepkwony (An MSc student under the Urban Zoo Project, based jointly between University of Nairobi  and International Livestock Research Institute (ILRI) in Kenya). 

 

Urban Zoo Team-Breaking the barriers

Urban Zoo Team-Breaking the barriers

Managing a large multidisciplinary research team is a challenging task, especially when the teams are based in different organisations that are far apart from each other. This is the situation that Urban Zoonoses project is currently in. The 99 Household Study involves sampling 99 different households in different parts of Nairobi. Primary data and samples are collected by both veterinarians and medics based at ILRI, after which samples are sent to University of Nairobi, ILRI and the Kenya Medical Research Institute laboratories. Isolates from these laboratories are then sent  to Universities of Edinburgh, Oxford, Liverpool for further analysis and full genomic sequencing.

journal-club-presentation

The urban zoo team during a journal club presentation

Proper planning and efficient communication has been the key to ensuring that everything is well coordinated. Team leaders (management or PI’s) from all the collaborating institutions hold fort-nightly teleconferences to update, consult and agree on a unified way of moving forward. It is a common practice for staff to communicate through emails, phone calls, skype and one on one talks with each other. The group has a “WhatsApp group chat” that is used to share updates/progress including photos of both the labs and fieldwork. It is also the easiest and simplest way of sharing information with the entire group. Our active website www.zoonotic-diseases.org and the quarterly newsletters, publications and scientific conference presentations are some of the effective means used to ensure that the public is informed of the projects progress and findings.

Staff development and mentoring of young talents, is an area where the project has excelled with several Kenyan staff having either completed or ongoing with their Masters studies in the different collaborating Universities; University of Edinburgh, University of Liverpool, Royal Veterinary College at the University of London. In addition, five MSc students from the University of Nairobi, and six from Moi University through the Field Epidemiology Training program have been supported to undertake their research projects. The project has also attracted a number of European, American and Asian graduate fellows who joined to either gain experience or undertake research projects.

team-building-session

The urban zoo field team on a team building session

Team building sessions, write-shops, journal clubs and support to present scientific findings in both National and International Conferences coupled with inspiration and guidance from our dedicated Project Investigators, post-doctoral fellows and management are some of the ways that have helped in forming a united and dedicated team. Looking back, we all feel like one family, really privileged to be part of this big success!

Article written by  James Akoko and Victoria Kyallo  (Field Coordinator and Project Manager, respectively)

Endemic infectious diseases: the next 15 years

Endemic infectious diseases: the next 15 years

I have recently returned from the International AIDS Conference in Durban, South Africa. It was, as many have noted, a landmark event: a chance to celebrate the remarkable success of the HIV response over the past 15 years.

But it was also a stark wake-up call. Despite the tangible results – which include millions of lives saved – it is increasingly clear that to achieve the goal of ending the AIDS epidemic as a public health threat by 2030, the world needs to take the fight several steps further.

Accelerating progress across all infectious diseases

Dr Ren Minghui, Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases WHO

Dr Ren Minghui, Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases
WHO

The Sustainable Development Goals (SDGs), agreed last September at the United Nations in New York, offer an ample opportunity to accelerate progress across all infectious diseases. The focus on equity, health systems strengthening, universal health coverage, and multi-sectoral action will transform the way we tackle these diseases.

The SDGs build on the momentum generated during the Millennium Development Goals era, and on lessons learned during the first 15 years of this century. And they recognize that while the global response has significantly reduced the infectious disease burden and saved over 50 million lives, much more needs to be done.

In 2000, who would have thought that by 2015 the world could get 17 million people in low- and middle-income countries on antiretroviral treatment, reduce malaria mortality rates by 60% and cut tuberculosis (TB) deaths by 47%? Who would have predicted that, within the space of 15 years, it could bring down the number of guinea worm infections from over 75 000 to just 22? But it did.

What we have to do now is maintain our resolve and further intensify our efforts.

“More than anything, the next 5 years should be about creating solid foundations for ending the infectious disease epidemics everywhere. This is not a moment to lift our foot off the accelerator. These diseases are known for returning with a vengeance, if we ever slow down.”

Dr Ren Minghui, WHO Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases

Infectious diseases continue to have far-reaching impacts on people’s lives. In some of the poorest countries of the world, they continue to devastate economies and cripple health systems. Progress remains uneven and millions are not being reached with prevention measures and treatment.

From the outset, the fight against infectious diseases has been dogged by social, legal and economic barriers, and funding gaps have been significant. These are a major reason why HIV, TB, malaria, viral hepatitis and neglected tropical diseases (NTDs) still kill more than 4 million people every year.

Globally, 480 000 people develop multi-drug resistant TB each year, and drug resistance is starting to complicate the fight against HIV and malaria, as well. A coordinated effort to tackle this challenge – under the umbrella of the WHO global action plan on antimicrobial resistance – will be critical to success.

Global strategies on infectious diseases

To help countries deliver on their pledge to ‘end the epidemics’ by 2030, the World Health Assembly has adopted global strategies on HIV, TB, and malaria. This year, it passed the world’s first-ever global hepatitis strategy and set the first global hepatitis targets. Since 2012, a WHO roadmap has been available to guide global efforts on NTDs which affect over a billion people.

The strategies are backed up by a set of evidence-based guidance documents to help countries design and implement their own plans. They emphasize opportunities to maximize the impact of prevention, treatment and care services, and to mitigate the impact of biological challenges, such as drug and insecticide resistance, and climate change.

At the same time, WHO is working to help countries move closer to universal health coverage, by ensuring that all people have access to the health services they need, without being thrown into poverty as a result.

As well as establishing robust health financing systems, this means building up a qualified workforce and investing in efforts to improve the quality of treatments, diagnostics and prevention tools. It means assuring adequate supplies of affordable, safe and effective health products and putting an end to stock-outs. And it means joining up the dots: a greater integration of services, as we are already seeing in many places.

More than anything, the next 5 years should be about creating solid foundations for ending the infectious disease epidemics everywhere. This is not a moment to lift our foot off the accelerator. These diseases are known for returning with a vengeance, if we ever slow down.

This post was authored by Dr. Ren Mingui (WHO Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases) originally appeared as a commentary on the World Health Organisation website on 17th August 2016. Available at: http://www.who.int/mediacentre/commentaries/2016/Endemic-infectious-diseases-next-15-years/en/

Sampling Kibera chickens-a look at urban farming in its most innovative form

Sampling Kibera chickens-a look at urban farming in its most innovative form

IMG_20160525_122708896Under the Urban Zoo umbrella, we have been sampling chicken farms as well as chicken    meat retailers in Kibera, Nairobi, in order to investigate the prevalence of a food-borne pathogen, Campylobacter. Kibera, said to be the largest urban slum in Africa, is a surprising, challenging and rewarding environment to work in. The constantly evolving environment illustrates urban farming in its most inventive form. Densely populated and very low-income, the urban landscape goes from shiny newly-built roads, public toilets and other community spaces, often sponsored by donors, to muddy alleyways with open sewers and precarious living spaces.

Livestock is part of everyday life. Goats roam everywhere – some even took a nap under our car – as well as chickens, ducks, and sometimes even camels. People are keen to discuss their farming arrangements and projects, or laugh at our interest for the local chickens (kienyeji kukus), which seem so uneventful to them. As sampling is ongoing, results for Campylobacter presence are not yet available. This bacteria, common in chickens, yet not harmful to them, can lead to severe diarrhoea in humans, especially children. Poultry in Kibera often sleep in houses; kids and chickens run alike in courtyards; we have found chicken-raising pens on a shelf, behind doors, above some roofs and in other unexpected places. With such a diverse interface between humans and chickens, it will be valuable to determine the presence of Campylobacter and better understand related public health risks.

Maud Carron

Article by Maud Carron

 

This blog entry is an article on our quarterly Urban Zoo Newsletter Volume 3 Issue 3 which can be accessed by clicking here.

Human, Food and Environmental data collection

Human, Food and Environmental data collection

WhatsApp-Image-20160607Human, food and environmental data are among the wide range of data collected within the 99 households. The data are often collected by Clinical Officers. Human sampling involves among others, individual consenting to participate, questionnaire interviews administration, general physical examination and anthropometric measurements, biological data collection and offering feedback and health education on the outcome of the laboratory based investigations. Two sets of structured questionnaires are administered; a general household and individual participant questionnaires. Biological data that is collected includes fecal samples and nasal swabs. Fecal samples are assessed for E. coli and campylobacter bacteria while nasal swabs are assessed for antimicrobial resistance. Collection and transportation of human samples from the field to laboratories involves sterile techniques.

Like human sampling, sterile steps are also observed during food and environmental data collection. Only livestock sourced foods are collected in the study. A sample of meat, milk and a wipe of egg shells if available, are collected. Sterile wipes of kitchen working surfaces such as chopping boards as well as kitchen door knobs are also collected. Environmental samples are collected using sterile boot socks. Normal saline-wet boot socks are worn and environmental samples collected by walking around the area surrounding the household as well as surfaces within livestock pens if available. Whirl pack bags are used in transportation of environmental samples. Water samples from water puddles, boreholes or storage water tanks are also collected as environmental samples. Subsamples of food and environmental samples are marked with a red dot to identify those going for whole genome sequencing and a blue dot on those being analyzed for campylobacter. All collected data are de-identified using barcode numbers to enhance participant and sample anonymity.

On completion of data collection, participants in the household are either given Albendazole or Mebendazole anthelminthic depending on age. Anyone found to be clinically ill is offered a prescription. If they are seriously ill a written referral letter to the nearest and most preferred health facility for further management is offered. Laboratory outcomes are communicated back to individual participants within two to three weeks of data collection. This is accompanied by health education with emphasis on how to maintain proper hygiene as well as interaction with livestock. Like many other community studies, our study is not devoid of challenges. Some of the challenges encountered involve heavy traffic. As investigators, we have to sometimes anticipate early morning starts. Participants which means rescheduling the day to collect data. Others include withdrawal from participation and inability to access household heads especially in high income settings.

Laureen AlumasaFredrick Amanya

 Article by Lorren Alumasa & Amanya Fredrick

This blog entry is an article on our quarterly Urban Zoo Newsletter Volume 3 Issue 3 which can be accessed by clicking here.

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