- Email: [email protected]
The Internet: a valuable tool for Roll Back Malaria
Research Update
TRENDS in Parasitology Vol.17 No.4 April 2001
159
Research News
The Internet: a valuable tool for Roll Back Malaria Jürg Utzinger, Marcel Tanner and Burton H. Singer Roll Back Malaria (RBM) will face a tremendous challenge in halving the current malaria burden by 2010. Thus, the initiative needs to explore novel and innovative approaches. The potential of the Internet to build a virtual community and to facilitate the training of a new generation of skilled personel for malaria diagnosis is discussed here. We also argue that investment in information technology is crucial to achieve the goal of RBM.
We thank Clive Shiff 1 for his Comment in Parasitology Today and share his appraisal that achieving the goal of the Roll Back Malaria (RBM) campaign – halving the burden of the disease by the year 2010 and again five years later – indeed represents a major challenge. Since the announcement of RBM in May 1998, the campaign has gained wide attention, and the current globally pledged support is approaching up to US$1 billion per year 2. The launching phase has been impressive, but it is now time to shift the emphasis from campaigning to implementing practicable malaria control measures3. Resources should be directed towards feasible and integrated control strategies of documented efficacy and effectiveness. A good example is the promotion and use of insecticide-treated bednets in Tanzania, where the upscaling of this proven tool from the project-based work from local4 to national level is under way. Early diagnosis and treatment
One of the mainstays of RBM is early diagnosis and treatment, thus reiterating the 1993 Global Conference on Malaria, where it was recommended to implement this strategy at the level of peripheral health services5. One way of promoting the strategy might be to sensitize the communities to classical biomedical descriptions of clinical signs and symptoms of malaria and to increase the availability of service. This approach is appealing because it recognizes the central role of the local community and households in malaria control. However in terms of implementation and
sustainability, the strategy is less successful6. Reasons for this are many, and differ from one setting to another, according to cultural, epidemiological and socio-economic features. A literature review on treatment seeking for malaria revealed three common characteristics: • most malaria episodes begin with self-treatment; • delays of 3–5 days before using antimalarial drugs are common; • under-dosing is extremely frequent7. A potentially greater problem is the fact that healthcare delivery and promotion systems in malarious countries have been structurally and functionally weakened over the past 30 years8. There is now a serious lack of skilled personnel and infrastructure necessary to design and implement adequate control measures. There is a prevailing belief that the present public health crisis is partly a result of the failure of the previous malaria eradication campaign (S. Litsios, Abstract*). Training
In view of these observations and recent recommendations made by Shiff 1, there is a need for identification, recruitment and training of personnel and the strengthening of healthcare facilities. Motivated people with adequate training, who operate from readily functioning healthcare facilities, are the essential prerequisites for promoting, implementing and sustaining the strategy of prompt diagnosis and treatment. A central feature of successful control attempts in the past and a key for their sustainability is local self-reliance9, as opposed to the expensive recruitment of consultants from abroad. Also, wellorganized and strong (colonial) community structures have shown success in the past, when there were skilled onsite personnel experienced in malaria control per se10,11. These structures have been lost; rebuilding them in the classical way is neither feasible nor desirable. Therefore, an innovative alternative is *Malaria control and the future of international public health. Presented at Contextual Determinants of Malaria,10–22 May 2000, Lausanne, Switzerland.
needed urgently so that RBM can reduce the burden of malaria. The Internet
With regard to malaria and its control, a comparative situation analysis between today and a few decades ago reveals two significant differences. First, there has been an enormous increase in the knowledge of malaria epidemiology, especially at the molecular level. Unfortunately, this progress has not sufficiently been translated into public health action. Second, an extremely powerful information technology has evolved with the culmination of the Internet. The Internet is based on the very simple concept of interconnecting computers. In the early 1990s, it was largely restricted to the developed world. However, it is now spreading throughout Africa12. It is estimated that 3.11 million people in Africa have Internet access, at least in the capital cities of all African countries (Box 1). The Leland initiative, a US$15 million commitment by the US Government, was launched in 1995 with the aim of increasing Internet access in at least 20 African countries. It has achieved considerable success in connecting even remote areas to each other (Box 1). The proceedings of the Durban conference further stress the importance of the Internet for the planning and implementation of malaria research and control measures (Box 1). Local researchers expressed their excitement about the Internet because it allows them immediate access to, and dissemination of, a diversity of information collected, processed and made available from all parts of the world. Most importantly, users can communicate with each other; the Internet has, therefore, become a platform for exchange of experience and expertise. Furthermore, it is a convenient way to build a network of people who share a common objective, thus creating among them a scientific community. The potential of a people’s network, for example in addressing cultural and social factors associated with diagnosis and treatment of tropical diseases13 or appropriate vector
http://parasites.trends.com 1471-4922/01/$ – see front matter © 2001 Elsevier Science Ltd. All rights reserved. PII: S1471-4922(00)01878-X
160
Research Update
TRENDS in Parasitology Vol.17 No.4 April 2001
Box 1. Websites of interest How many people are online? http://www.nua.ie/surveys/how_many_online/index.html US Agency for International Development: USAID Leland Initiative: African Global Information Infrastructure Project http://www.usaid.gov/leland/indext.html Multilateral Initiative on Malaria (MIM): Proceedings of the MIM African Malaria Conference. 14–19 March 1999, Durban, South Africa http://mim.nih.gov/english/news/index.html Mapping Malaria Risk in Africa: an International Collaboration http://www.mara.org.za/ The Royal Perth Hospital. Malaria: an online resource http://www.rph.wa.gov.au/labs/haem/malaria/ Roll Back Malaria: a Global Partnership http://www.rbm.who.int/ The Global Health Network Supercourse: Epidemiology, the Internet and Global Health http://www.pitt.edu/~super1/ Africa Energy Policy Research Network http://www.afrepren.org/
control14, has been demonstrated even before the era of the Internet. The additional features of the Internet, effective storage and accessing data for malaria control on a global scale, have been demonstrated repeatedly15 (Box 1). Just connect
Our suggestion is that RBM should take advantage of the Internet as a vehicle to create a virtual community with the aim of training personnel to be skilled in the diagnosis and treatment of malaria. Searching the Web clearly reveals that a diversity of websites already exists that could easily be adapted to serve as resources for training. For example, the Royal Perth Hospital in Western Australia made a start and provides an interactive online resource on malaria diagnosis based on the preparation and examination of thick and thin blood films (Box 1). Following the training manual, the students learn the diagnostic features of the four Plasmodium species, and they can self-evaluate their new skills by a special test module with a series of case studies. Under the auspices of WHO, and in close collaboration with the local public health authorities, RBM could establish and adapt training modules to local needs (Box 1). http://parasites.trends.com
These would facilitate the teaching of problem-solving skills, and could be available on CDs or as free online resources with built-in interactive features and hyperlinks to all other relevant sites, analogous with the ‘Global Health Network Supercourse’ (Box 1). After setting up the manuals, RBM could facilitate the validation of the training through a system of quality control and through providing feedback. Initially, this could be done in situ by experienced microscopists. In the future, this could be facilitated by a store and forward process, inviting the trainees to send digital images of thick and thin blood films as e-mail attachments, together with their assessment of malaria parasitemia, so that RBM can do performance ratings and adaptively assist in improving the skills of a new generation of health workers. This approach has already shown success in Ghana where clinicians make digital images of X-ray films. The images are then sent to doctors in the US who provide medical advice12. Challenges
Computer penetration, connectivity, illiteracy, costs and lack of appreciation of the potential benefits of Internet access remain big challenges in Africa, especially in
remote areas. The exponential increase in the number of computers, their rapid decline in cost and the current progress in satellite connection and wireless networking are important developments in overcoming some of these challenges. Another crucial point is the necessity of creating a panel of experts to assure the accuracy of malaria diagnosis16. RBM, together with local health authorities, could form such a panel, analogous to the X-ray example12. Finally, there is a need for a stable energy supply to facilitate distance learning through the Internet. An interesting African energy network with more then ten years of experience, bringing together researchers from 18 African countries with the goal of strengthening local initiatives, is promoting the use and development of renewable energy technology (Box 1). We believe that information technology is an avenue through which RBM should direct substantial financial resources. We are convinced that young people across subSaharan Africa will be highly motivated to learn the necessary computer skills and they will rapidly acquire the technical skills that are vital for accurate malaria diagnosis. RBM also requires the involvement of social scientists for dissemination of the availability of improved malaria diagnosis at local health facilities and promotion of treatment seeking, for example by community health workers4 or radio advertising. We conclude that investing in computing and information technology – with renewable energy as a tool for sustaining these developments – might pay off rapidly. It will play a crucial role in bridging research and control and it is quite likely that besides reducing the malaria burden, the entire public health system will benefit from such a strategy. Acknowledgements
J.U. acknowledges financial support from the Swiss National Science Foundation. References 1 Shiff, C.J. (2000) Can roll back malaria achieve its goal? A challenge. Parasitol. Today 16, 271–272 2 Dove, A. (2000) New economic analysis draws big money to malaria. Nat. Med. 6, 612 3 Lancet (2000) Donor responsibilities in rolling back malaria. Lancet 356, 521 4 Armstrong Schellenberg, J.R.M. et al. (1999) KINET: a social marketing programme of treated nets and net treatment for malaria control in Tanzania, with evaluation of child health and long-term survival. Trans. R. Soc. Trop. Med. Hyg. 93, 225–231 5 WHO (1993) Implementation of the Global Malaria Control Strategy. Report of a WHO Study
Research Update
6
7
8 9
10
Group on the Implementation of the Global Plan of Action for Malaria Control 1993–2000. WHO Technical Report Series No. 839 Tanner, M. and Vlassoff, C. (1998) Treatmentseeking behaviour for malaria: a typology based on endemicity and gender. Soc. Sci. Med. 46, 523–532 McCombie, S.C. (1996) Treatment seeking for malaria: a review of recent research. Soc. Sci. Med. 43, 933–945 WHO (2000) The World Health Report 2000. Health Systems: Improving Performance. Singer, B. (1989) Social science and the improvement of tropical disease control programs. Ann. New York Acad. Sci. 569, 275–287 Watson, M. (1921) The Prevention of Malaria in the Federated Malay States. John Murray, London
TRENDS in Parasitology Vol.17 No.4 April 2001
11 Watson, M. (1953) African Highway: the Battle for Health in Central Africa. John Murray, London 12 Fraser, H.S.F. and McGrath, S.J.D. (2000) Information technology and telemedicine in sub-Saharan Africa. Br. Med. J. 321, 465–466 13 Briceño-León, R. (1994) Setting up a scientific community by means of a small grants program: the Latin American experience. Acta Trop. 57, 201–209 14 Gillett, J.D. (1990) Vector control through radio and television: appropriate technology for the future. In Appropriate Technology in Vector Control (Curtis, C.F., ed.), pp. 214–219, CRC Press 15 Hay, S.I. et al. (2000) Annual Plasmodium falciparum entomological inoculation rates (EIR) across Africa: literature survey, Internet access
161
and review. Trans. R. Soc. Trop. Med. Hyg. 94, 113–127 16 Yamey, G. (2000) Global health agencies are accused of incompetence. Br. Med. J. 321, 787
Jürg Utzinger* Burton H. Singer Office of Population Research, Princeton University, Princeton, NJ 08544, USA. *e-mail: [email protected] Marcel Tanner Swiss Tropical Institute, CH-4002 Basel, Switzerland.
The Internet: a valuable tool for Roll Back Malaria Response from Clive Shiff Trends in Parasitology is performing an important role in providing a forum for the presentation of ideas and guidance to the Roll Back Malaria (RBM) initiative. The RBM initiative is crucially important to all nations beset with increasing problems of malaria, and the initiative can benefit from such constructive discourse. The points made by Utzinger et al. are highly pertinent, especially the role of the Internet as a tool for interchange of ideas, dissemination of information and strengthening of local networks. This vehicle penetrates to most institutions concerned with public health and, in my experience, it is already well represented in Africa. Every effort should be made to ensure that it is maintained and extended where necessary. However, as stressed by Utzinger et al., the main weakness in our current efforts to develop local programmes for the control of malaria lies in the shortage of skilled personnel who live and work in the endemic areas. These are the people who can provide local expertise and guidance to governments and authorities responsible for national public health. However, we are all aware of the brain-drain from Africa. The issue we face is how to provide career opportunities to local scientists interested in malaria, especially in situations where such opportunities are rare and poorly remunerated in many of the endemic countries. The goal is to help such people to sustain their careers at home by encouraging their research and to provide additional salary support through research grants. In many instances there
is no avenue to do this effectively and transparently. In Zimbabwe, we have established a locally registered non-government organization in Harare, the Biomedical Research and Training Institute (www.brti.co.zw). It is fully independent of government and the universities, and provides a vehicle to manage research grants and training programmes both locally and in the Southern African Development Community region. We encourage and manage collaborative research programmes between locally employed scientists and international collaborators with the aim of sustaining local career opportunities. Our goal is to support local expertise because if these
people are able to live and work in the endemic areas and earn a reasonable wage for their efforts, not only will they contribute to the basic knowledge necessary for the development of sustainable local disease control interventions, but they will be available to provide consultative support to underserviced Ministries of Health on an ‘as needed’ basis and thus help develop and supervise locally sustainable health interventions. Clive Shiff School of Hygiene and Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA. e-mail: [email protected]
Articles of interest in other Trends journals A mitochondrial perspective on cell death, by P. Bernardi, V. Petronilli, F. Di Lisa and M. Forte (2001) Trends in Biochemical Sciences 26, 112–117 Disease model: dissecting the pathogenesis of measles virus, by J.B. Patterson, M. Manchester and M.B.A. Oldstone (2001) Trends in Molecular Medicine (formerly Molecular Medicine Today) 7, 85–88 Nitric oxide and the regulation of gene expression, by C. Bogdan (2001) Trends in Cell Biology 11, 66–75 The role of molecules that mediate apoptosis in T-cell selection, by O. Williams and H.J.M. Brady (2001) Trends in Immunology (formerly Immunology Today) 22,107–111 A centuries-long epidemic of scrapie in British sheep? by M.E.J. Woolhouse et al. (2001) Trends in Microbiology 9, 67–70
http://parasites.trends.com 1471-4922/01/$ – see front matter © 2001 Elsevier Science Ltd. All rights reserved.
TRENDS in Parasitology Vol.17 No.4 April 2001
159
Research News
The Internet: a valuable tool for Roll Back Malaria Jürg Utzinger, Marcel Tanner and Burton H. Singer Roll Back Malaria (RBM) will face a tremendous challenge in halving the current malaria burden by 2010. Thus, the initiative needs to explore novel and innovative approaches. The potential of the Internet to build a virtual community and to facilitate the training of a new generation of skilled personel for malaria diagnosis is discussed here. We also argue that investment in information technology is crucial to achieve the goal of RBM.
We thank Clive Shiff 1 for his Comment in Parasitology Today and share his appraisal that achieving the goal of the Roll Back Malaria (RBM) campaign – halving the burden of the disease by the year 2010 and again five years later – indeed represents a major challenge. Since the announcement of RBM in May 1998, the campaign has gained wide attention, and the current globally pledged support is approaching up to US$1 billion per year 2. The launching phase has been impressive, but it is now time to shift the emphasis from campaigning to implementing practicable malaria control measures3. Resources should be directed towards feasible and integrated control strategies of documented efficacy and effectiveness. A good example is the promotion and use of insecticide-treated bednets in Tanzania, where the upscaling of this proven tool from the project-based work from local4 to national level is under way. Early diagnosis and treatment
One of the mainstays of RBM is early diagnosis and treatment, thus reiterating the 1993 Global Conference on Malaria, where it was recommended to implement this strategy at the level of peripheral health services5. One way of promoting the strategy might be to sensitize the communities to classical biomedical descriptions of clinical signs and symptoms of malaria and to increase the availability of service. This approach is appealing because it recognizes the central role of the local community and households in malaria control. However in terms of implementation and
sustainability, the strategy is less successful6. Reasons for this are many, and differ from one setting to another, according to cultural, epidemiological and socio-economic features. A literature review on treatment seeking for malaria revealed three common characteristics: • most malaria episodes begin with self-treatment; • delays of 3–5 days before using antimalarial drugs are common; • under-dosing is extremely frequent7. A potentially greater problem is the fact that healthcare delivery and promotion systems in malarious countries have been structurally and functionally weakened over the past 30 years8. There is now a serious lack of skilled personnel and infrastructure necessary to design and implement adequate control measures. There is a prevailing belief that the present public health crisis is partly a result of the failure of the previous malaria eradication campaign (S. Litsios, Abstract*). Training
In view of these observations and recent recommendations made by Shiff 1, there is a need for identification, recruitment and training of personnel and the strengthening of healthcare facilities. Motivated people with adequate training, who operate from readily functioning healthcare facilities, are the essential prerequisites for promoting, implementing and sustaining the strategy of prompt diagnosis and treatment. A central feature of successful control attempts in the past and a key for their sustainability is local self-reliance9, as opposed to the expensive recruitment of consultants from abroad. Also, wellorganized and strong (colonial) community structures have shown success in the past, when there were skilled onsite personnel experienced in malaria control per se10,11. These structures have been lost; rebuilding them in the classical way is neither feasible nor desirable. Therefore, an innovative alternative is *Malaria control and the future of international public health. Presented at Contextual Determinants of Malaria,10–22 May 2000, Lausanne, Switzerland.
needed urgently so that RBM can reduce the burden of malaria. The Internet
With regard to malaria and its control, a comparative situation analysis between today and a few decades ago reveals two significant differences. First, there has been an enormous increase in the knowledge of malaria epidemiology, especially at the molecular level. Unfortunately, this progress has not sufficiently been translated into public health action. Second, an extremely powerful information technology has evolved with the culmination of the Internet. The Internet is based on the very simple concept of interconnecting computers. In the early 1990s, it was largely restricted to the developed world. However, it is now spreading throughout Africa12. It is estimated that 3.11 million people in Africa have Internet access, at least in the capital cities of all African countries (Box 1). The Leland initiative, a US$15 million commitment by the US Government, was launched in 1995 with the aim of increasing Internet access in at least 20 African countries. It has achieved considerable success in connecting even remote areas to each other (Box 1). The proceedings of the Durban conference further stress the importance of the Internet for the planning and implementation of malaria research and control measures (Box 1). Local researchers expressed their excitement about the Internet because it allows them immediate access to, and dissemination of, a diversity of information collected, processed and made available from all parts of the world. Most importantly, users can communicate with each other; the Internet has, therefore, become a platform for exchange of experience and expertise. Furthermore, it is a convenient way to build a network of people who share a common objective, thus creating among them a scientific community. The potential of a people’s network, for example in addressing cultural and social factors associated with diagnosis and treatment of tropical diseases13 or appropriate vector
http://parasites.trends.com 1471-4922/01/$ – see front matter © 2001 Elsevier Science Ltd. All rights reserved. PII: S1471-4922(00)01878-X
160
Research Update
TRENDS in Parasitology Vol.17 No.4 April 2001
Box 1. Websites of interest How many people are online? http://www.nua.ie/surveys/how_many_online/index.html US Agency for International Development: USAID Leland Initiative: African Global Information Infrastructure Project http://www.usaid.gov/leland/indext.html Multilateral Initiative on Malaria (MIM): Proceedings of the MIM African Malaria Conference. 14–19 March 1999, Durban, South Africa http://mim.nih.gov/english/news/index.html Mapping Malaria Risk in Africa: an International Collaboration http://www.mara.org.za/ The Royal Perth Hospital. Malaria: an online resource http://www.rph.wa.gov.au/labs/haem/malaria/ Roll Back Malaria: a Global Partnership http://www.rbm.who.int/ The Global Health Network Supercourse: Epidemiology, the Internet and Global Health http://www.pitt.edu/~super1/ Africa Energy Policy Research Network http://www.afrepren.org/
control14, has been demonstrated even before the era of the Internet. The additional features of the Internet, effective storage and accessing data for malaria control on a global scale, have been demonstrated repeatedly15 (Box 1). Just connect
Our suggestion is that RBM should take advantage of the Internet as a vehicle to create a virtual community with the aim of training personnel to be skilled in the diagnosis and treatment of malaria. Searching the Web clearly reveals that a diversity of websites already exists that could easily be adapted to serve as resources for training. For example, the Royal Perth Hospital in Western Australia made a start and provides an interactive online resource on malaria diagnosis based on the preparation and examination of thick and thin blood films (Box 1). Following the training manual, the students learn the diagnostic features of the four Plasmodium species, and they can self-evaluate their new skills by a special test module with a series of case studies. Under the auspices of WHO, and in close collaboration with the local public health authorities, RBM could establish and adapt training modules to local needs (Box 1). http://parasites.trends.com
These would facilitate the teaching of problem-solving skills, and could be available on CDs or as free online resources with built-in interactive features and hyperlinks to all other relevant sites, analogous with the ‘Global Health Network Supercourse’ (Box 1). After setting up the manuals, RBM could facilitate the validation of the training through a system of quality control and through providing feedback. Initially, this could be done in situ by experienced microscopists. In the future, this could be facilitated by a store and forward process, inviting the trainees to send digital images of thick and thin blood films as e-mail attachments, together with their assessment of malaria parasitemia, so that RBM can do performance ratings and adaptively assist in improving the skills of a new generation of health workers. This approach has already shown success in Ghana where clinicians make digital images of X-ray films. The images are then sent to doctors in the US who provide medical advice12. Challenges
Computer penetration, connectivity, illiteracy, costs and lack of appreciation of the potential benefits of Internet access remain big challenges in Africa, especially in
remote areas. The exponential increase in the number of computers, their rapid decline in cost and the current progress in satellite connection and wireless networking are important developments in overcoming some of these challenges. Another crucial point is the necessity of creating a panel of experts to assure the accuracy of malaria diagnosis16. RBM, together with local health authorities, could form such a panel, analogous to the X-ray example12. Finally, there is a need for a stable energy supply to facilitate distance learning through the Internet. An interesting African energy network with more then ten years of experience, bringing together researchers from 18 African countries with the goal of strengthening local initiatives, is promoting the use and development of renewable energy technology (Box 1). We believe that information technology is an avenue through which RBM should direct substantial financial resources. We are convinced that young people across subSaharan Africa will be highly motivated to learn the necessary computer skills and they will rapidly acquire the technical skills that are vital for accurate malaria diagnosis. RBM also requires the involvement of social scientists for dissemination of the availability of improved malaria diagnosis at local health facilities and promotion of treatment seeking, for example by community health workers4 or radio advertising. We conclude that investing in computing and information technology – with renewable energy as a tool for sustaining these developments – might pay off rapidly. It will play a crucial role in bridging research and control and it is quite likely that besides reducing the malaria burden, the entire public health system will benefit from such a strategy. Acknowledgements
J.U. acknowledges financial support from the Swiss National Science Foundation. References 1 Shiff, C.J. (2000) Can roll back malaria achieve its goal? A challenge. Parasitol. Today 16, 271–272 2 Dove, A. (2000) New economic analysis draws big money to malaria. Nat. Med. 6, 612 3 Lancet (2000) Donor responsibilities in rolling back malaria. Lancet 356, 521 4 Armstrong Schellenberg, J.R.M. et al. (1999) KINET: a social marketing programme of treated nets and net treatment for malaria control in Tanzania, with evaluation of child health and long-term survival. Trans. R. Soc. Trop. Med. Hyg. 93, 225–231 5 WHO (1993) Implementation of the Global Malaria Control Strategy. Report of a WHO Study
Research Update
6
7
8 9
10
Group on the Implementation of the Global Plan of Action for Malaria Control 1993–2000. WHO Technical Report Series No. 839 Tanner, M. and Vlassoff, C. (1998) Treatmentseeking behaviour for malaria: a typology based on endemicity and gender. Soc. Sci. Med. 46, 523–532 McCombie, S.C. (1996) Treatment seeking for malaria: a review of recent research. Soc. Sci. Med. 43, 933–945 WHO (2000) The World Health Report 2000. Health Systems: Improving Performance. Singer, B. (1989) Social science and the improvement of tropical disease control programs. Ann. New York Acad. Sci. 569, 275–287 Watson, M. (1921) The Prevention of Malaria in the Federated Malay States. John Murray, London
TRENDS in Parasitology Vol.17 No.4 April 2001
11 Watson, M. (1953) African Highway: the Battle for Health in Central Africa. John Murray, London 12 Fraser, H.S.F. and McGrath, S.J.D. (2000) Information technology and telemedicine in sub-Saharan Africa. Br. Med. J. 321, 465–466 13 Briceño-León, R. (1994) Setting up a scientific community by means of a small grants program: the Latin American experience. Acta Trop. 57, 201–209 14 Gillett, J.D. (1990) Vector control through radio and television: appropriate technology for the future. In Appropriate Technology in Vector Control (Curtis, C.F., ed.), pp. 214–219, CRC Press 15 Hay, S.I. et al. (2000) Annual Plasmodium falciparum entomological inoculation rates (EIR) across Africa: literature survey, Internet access
161
and review. Trans. R. Soc. Trop. Med. Hyg. 94, 113–127 16 Yamey, G. (2000) Global health agencies are accused of incompetence. Br. Med. J. 321, 787
Jürg Utzinger* Burton H. Singer Office of Population Research, Princeton University, Princeton, NJ 08544, USA. *e-mail: [email protected] Marcel Tanner Swiss Tropical Institute, CH-4002 Basel, Switzerland.
The Internet: a valuable tool for Roll Back Malaria Response from Clive Shiff Trends in Parasitology is performing an important role in providing a forum for the presentation of ideas and guidance to the Roll Back Malaria (RBM) initiative. The RBM initiative is crucially important to all nations beset with increasing problems of malaria, and the initiative can benefit from such constructive discourse. The points made by Utzinger et al. are highly pertinent, especially the role of the Internet as a tool for interchange of ideas, dissemination of information and strengthening of local networks. This vehicle penetrates to most institutions concerned with public health and, in my experience, it is already well represented in Africa. Every effort should be made to ensure that it is maintained and extended where necessary. However, as stressed by Utzinger et al., the main weakness in our current efforts to develop local programmes for the control of malaria lies in the shortage of skilled personnel who live and work in the endemic areas. These are the people who can provide local expertise and guidance to governments and authorities responsible for national public health. However, we are all aware of the brain-drain from Africa. The issue we face is how to provide career opportunities to local scientists interested in malaria, especially in situations where such opportunities are rare and poorly remunerated in many of the endemic countries. The goal is to help such people to sustain their careers at home by encouraging their research and to provide additional salary support through research grants. In many instances there
is no avenue to do this effectively and transparently. In Zimbabwe, we have established a locally registered non-government organization in Harare, the Biomedical Research and Training Institute (www.brti.co.zw). It is fully independent of government and the universities, and provides a vehicle to manage research grants and training programmes both locally and in the Southern African Development Community region. We encourage and manage collaborative research programmes between locally employed scientists and international collaborators with the aim of sustaining local career opportunities. Our goal is to support local expertise because if these
people are able to live and work in the endemic areas and earn a reasonable wage for their efforts, not only will they contribute to the basic knowledge necessary for the development of sustainable local disease control interventions, but they will be available to provide consultative support to underserviced Ministries of Health on an ‘as needed’ basis and thus help develop and supervise locally sustainable health interventions. Clive Shiff School of Hygiene and Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA. e-mail: [email protected]
Articles of interest in other Trends journals A mitochondrial perspective on cell death, by P. Bernardi, V. Petronilli, F. Di Lisa and M. Forte (2001) Trends in Biochemical Sciences 26, 112–117 Disease model: dissecting the pathogenesis of measles virus, by J.B. Patterson, M. Manchester and M.B.A. Oldstone (2001) Trends in Molecular Medicine (formerly Molecular Medicine Today) 7, 85–88 Nitric oxide and the regulation of gene expression, by C. Bogdan (2001) Trends in Cell Biology 11, 66–75 The role of molecules that mediate apoptosis in T-cell selection, by O. Williams and H.J.M. Brady (2001) Trends in Immunology (formerly Immunology Today) 22,107–111 A centuries-long epidemic of scrapie in British sheep? by M.E.J. Woolhouse et al. (2001) Trends in Microbiology 9, 67–70
http://parasites.trends.com 1471-4922/01/$ – see front matter © 2001 Elsevier Science Ltd. All rights reserved.