Hello from Blantyre, Malawi! I arrived on January 7th for a Fulbright US Student Research Award for six months during which time I will be researching malaria rapid diagnostic tests (mRDTs) with students and researchers in the Medical Laboratory Sciences department at Kamuzu University of Health Sciences (KUHeS). Our mentors hail from several institutions including KUHeS, the Blantyre Malaria Project (BMP), and the Liverpool School of Tropical Medicine (LSTM). We also have the approval of the National Malaria Control Programme at the Ministry of Health for our research and have been working with District Health Officers in each District in Malawi where we plan to collect data.
The first phase of our project is conducting surveillance screening for mutations in Plasmodium falciparum (P. falciparum) which threaten the effectiveness of mRDTs. These gene deletions cause parasites to no longer express the antigen detected by the most widely used mRDTs. This can cause false negative test results which disrupt malaria diagnosis and treatment, complicating control efforts and leading to increased morbidity and mortality.
In 2021, 262 million RDTs were distributed by National Malaria Programmes worldwide and over 13 million RDTs were used in Malawi. It is a frontline diagnostic tool for combatting the most important parasitic infection in humans which is endemic in Malawi and the seventh leading cause of death here. Surveying for these gene deletions has been identified by the World Health Organization as a priority in the fight against malaria for all endemic countries, particularly those in sub-Saharan Africa, like Malawi.
Working at 12 health centers in the Southern Region of Malawi, we aim to capture a picture of the prevalence of pfhrp2/3 gene deletions amongst P. falciparum parasites circulating in Malawi. This data may be useful in informing future public health decisions with respect to the use of HRP2-detecting mRDTs. We are also evaluating a method of parasite DNA extraction which has the potential to significantly expand the capacity for molecular testing for gene deletions within the existing public health framework. If successful, it could eliminate additional sample collection beyond the finger prick for mRDT, thereby preventing additional discomfort to patients and costs associated with biobanking.
We hope this project will provide a proof of concept for a standard operating procedure for routine surveillance for pfhrp2/3 gene deletions in Malawi without additional sample collection beyond the minimum necessary for malaria diagnosis. As global recommendations advise that surveillance screening for gene deletions should be performed every two years, this protocol, if successful, could be reused for future surveillance efforts in Malawi.
On a more personal note, I am looking forward to the adventure of living in Blantyre for six months! Working with a local tutor, I will be taking lessons in Chichewa, the main local language in Blantyre. I am excited to explore the beautiful countryside in Malawi on hikes and game drives and I look forward to continuing to learn more about Malawians and their culture while also sharing my perspective and experience as an American citizen!
Meredith in Malawi 