medical research council unit, the gambia

MVVC2: A truly South-South collaboration

In a truly South-South collaboration, scientists from MRC Unit, The Gambia and the University of Dakar, UCAD Senegal, are conducting a joint trial to determine the safety and interference of the malaria vectored vaccines when given together with EPI vaccines to young Gambian infants, funded through the Malaria Vectored Vaccine Consortium 2 (MVVC2).

Success story for Meningitis Vaccine Project

Introduction of the meningococcal A conjugate vaccine 10 short years after development is a public health success story and is already showing promise of significant impact. Following the end of the Meningitis Vaccine Project in December 2014, we celebrate MRC Unit, The Gambia’s role in the project, working in partnership with the Gambian Government and the people of The Gambia.

MEDICAL RESEARCH COUNCIL UNIT, THE GAMBIA

www.mrc.gm/tama

TAMA: Wolof. n. a talking drum

2014/15

VOL 13ISSUE 03

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CONTENTS NEWS

VACCINOLOGY

DISEASE CONTROL & ELIMINATION

CHILD SURVIVAL

NUTRITION

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NEWS FROM BASSE

RECENT UNIT PUBLICATIONS

RECENT UNIT SEMINARS

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Success story for Meningitis Vaccine Project

Studies performed at MRC Unit, The Gambia, and other African sites, including CVD-Mali, Navrongo Health Research Center in Ghana and Institut de Recherche pour le Développement in Senegal, have resulted in the successful development of a vaccine to the highest scientific, professional, and ethical standards for the public health of people across Africa.

“This affordable vaccine has been developed and tested in record time to combat meningitis A, one of the most threatening infectious diseases, which periodically affects people living within the “meningitis belt”, said Professor Beate Kampmann, Principal Investigator of the trial at MRC Unit, The Gambia.

“When meningitis A comes along, it has a devastating impact on people of all ages and causes death and disability. It shows that big goals can be achieved when funders, developers and sites pull together.

“We are proud to have played an important role in the study. We are also delighted that this vaccine now protects people in The Gambia, as it was introduced here swiftly by the Government of The Gambia into its vaccination program.”

INTRODUCTION OF THE VACCINEThanks to the Meningitis Vaccine Project, more than 200 million people have now been vaccinated with the meningococcal A conjugate vaccine, MenAfriVac, and are protected against meningitis A. The mass vaccination campaign was launched first in Burkina, and soon after in Mali and Niger, in 2010. The vaccine was introduced in The Gambia a year ago resulting in almost complete national coverage in a mass vaccination campaign.

Some initial trials for the vaccine and an antibody persistence trial were held at MRC Unit, The Gambia’s Basse Field Station. This included two safety and immunogenicity trials in one to 29 year old Gambians and later a study which investigated antibody persistence up to five years after initial vaccination with MenAfriVac; this is important in order to know how often the vaccine has to be given.

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This affordable vaccine has been

developed and tested in record time to combat meningitis A, one of the most threatening infectious diseases, which periodically affects people living within the “meningitis belt"

Professor Beate Kampmann Principal Investigator of the trial at MRC Unit, The Gambia.

Dr Olubukola Idoko, Study Clinician on the initial trials and Trial Coordinator/Local PI for the persistence project, and some members of her team

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EFFECTIVE AND AFFORDABLEThis vaccine has proven to be both effective and affordable and has the added advantage of being able to travel outside the cold chain. MenAfriVac induces better immune responses than the previously available vaccines and achieves antibody persistence at five years post-vaccination. The vaccine offers herd protection and, although still in the early days, the impact of vaccination has already been observed within the African meningitis belt.

Dr Olubukola Idoko, Study Clinician on the initial trials and Trial Coordinator/Local PI for the persistence project at MRC Unit, The Gambia, said: “It was a real joy to be able to see the vaccine introduced into the region and here in The Gambia in particular. The introduction in The Gambia was accelerated by the fact that the country participated in the original trials. This is further testimony to the unique role of the Unit.

“The region has suffered these devastating epidemics of meningitis periodically and in the short time that the vaccine has been introduced there's already significant impact. Another notable highlight for me was seeing the significant indirect impact our studies can have. Entire communities were educated on the use of locally available items to prepare healthy weaning meals, in response to a clustering of malnutrition among study participants. Following this, malnutrition rates in our study population dropped significantly.”

NEXT STEPSThe definition of success for the Meningitis Vaccine Project is the elimination of epidemic meningitis in sub-Saharan countries that introduce the meningococcal A conjugate vaccine. MRC Unit, The Gambia is supporting the evaluation plan by assessing the impact of the introduction of MenAfriVac in The Gambia.

Monitoring is being carried out, in collaboration with the London School of Hygiene and Tropical Medicine, through a series of carriage studies to evaluate the impact of the vaccine on the transmission of meningococcal infection. MenAfriCar (the African Meningococcal Carriage Consortium) is a global research effort to study how meningococcal meningitis is spread in Africa, and to document the impact of a new meningitis vaccine on meningococcal carriage and meningitis.

About the Meningitis Vaccine Project

The Meningitis Vaccine Project was born from a partnership between WHO and Program for Appropriate Technology in Health (PATH) with funding from the Bill and Melinda Gates Foundation in 2001. The goal of the project was the elimination of epidemic meningitis in sub-Saharan Africa where it was posing a great public health crisis. This was to be done through development, testing and licensure of a conjugate meningococcal vaccine.

Some of the Meningitis Vaccine Project team ready for action during the study

Find out more at www.meningvax.org

Read about the Meningitis Vaccine Project community feedback event on page 11

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MVVC2: A truly South-South collaboration

Dr Muhammed Afolabi and Dr Ebrima K Kanteh

Malaria remains a leading cause of childhood illness and death, predominantly in Africa, despite the implementation of extensive control measures. An effective vaccine is a key complementary strategy to achieve the Roll Back Malaria initiative and Millennium Development Goals.

Leading researchers from The Jenner Institute, University of Oxford have therefore been working to develop an effective malaria vaccine using a unique heterologous approach involving delivery of a potent liver and sporozoite stage antigen, called ME-TRAP, through the use of two special agents that are given sequentially, eight weeks apart.

Under the auspices of the Malaria Vectored Vaccine Consortium, a number of vaccine trials funded by European and Developing Countries Clinical Trials Partnership (EDCTP) and coordinated by European Vaccine Initiative Germany took place in the four partner sites including MRC Unit, The Gambia, UCAD Senegal, CNRFP Burkina Faso and KEMRI Kilifi. The Unit successfully conducted the early phase of the vaccine trials in adults, children and infants while the efficacy trials took place in UCAD, KEMRI and CNFRP.

Consolidating on the success recorded in the first round of the trials at all partner sites, the Consortium applied for and won a competitive Strategic Primer Grant under the operational name Malaria Vectored Vaccine Consortium 2 (MVVC2).

The grant seeks to conduct a phase 1 trial to establish whether the candidate malaria vaccines would cause interference when co-administered with routine Expanded Programme on Immunisation (EPI)

vaccines in healthy Gambian infants aged 16 weeks, eight weeks and one week. The unique aspect of the trial is that scientists from MRC Unit, The Gambia and UCAD Senegal unanimously agreed to jointly conduct this important trial. This distinctive collaboration represents a paradigm shift from the usual North-South collaboration and fulfils the cardinal goal of the funder, EDCTP.

Like every other human endeavour, the trial is not without challenges, nevertheless the MRC and UCAD scientists are well motivated to overcome the challenges and achieve the objectives of the vaccine trial. At the time of writing this report, the team had successfully completed the enrolment of the 16 and eight-week-old infants and were preparing to start the last lap of the study involving one week old babies.

For the Senegalese collaborators who have relocated to live and work at the MRC Unit in The Gambia it has been an exciting and resourceful experience working in a multi-cultural world-class research institute in Africa. They are eager to consolidate their experience in the conduct of cutting-edge research. The MRC hosts are also making concerted efforts to nurture the partnership between two sites to develop the capacity of young West African scientists to lead translational research that saves lives and improve health across the developing world.

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Find out more about the MVVC in this short film produced by the European Vaccine Initiative, featuring Sukuta Health Centre in The Gambia: http://bit.ly/MVVCfilm

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Inspiring the next generation

Marie Rose Thorpe

From learning about field research in the communities of the Gambia, to grilling a panel of doctors, MRC Unit, The Gambia recently gave 32 final year medical students from the University of The Gambia a first-hand insight into career options available for graduates of medicine.

The visit, on 7th October, served to familiarise the students from the University of The Gambia’s School of Medicine and Allied Health Sciences, with undertaking field research in the communities of the Gambia. Unit Director, Professor Umberto D’Alessandro, welcomed the students, outlining the past achievements of the Unit as well as current research priorities and activities. His talk expanded on the collaborations between the Unit and the Gambia Government, which led to the introduction of insecticide-treated bed nets and other important achievements in the arena of public health.

Drs Bully Camara, Julia Mwesigwa, Gibril Ndow and Abdou Sillah and Wellcome Trust Fellow Modou Jobe, gave first-hand accounts of their journeys from medicine into research and outlines of the various research projects that they are currently undertaking. The session concluded with a question and answer session where Dr Kalifa Bojang, Senior Clinical Scientist and Consultant Paediatrician at the Edward Francis Small Teaching Hospital, also joined the panel of doctors to answer questions from the eager students.

Dr Ousman Secka then gave the group a tour of the various MRC laboratories. Pa Amadou Sohna, the University class representative, expressed appreciation on behalf of his fellow classmates for having been introduced to the work of the Unit and getting first-hand accounts from doctors that had made the transition from medicine into research.

Commissioning of School of Medicine academic complex

On 22nd October, Professor Umberto D’Alessandro attended the opening ceremony of the new School of Medicine and Allied Health Sciences academic building at the Edward Francis Small Teaching Hospital in Banjul.

Inaugurated by the Vice President and Women’s Affairs minister, the building represents a major milestone in the ongoing development of The University of The Gambia.

The new building is expected to give improved learning space for academic and clinical activities for the Medical and Allied Sciences students, faculty members and researchers.

Established in 1999, The University of The Gambia has been a close partner of the MRC Unit since the University’s inception. The Unit currently employs a number of graduates of the University.

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Enhancing learning facilities

A ceremony at the Edward Francis Small Teaching Hospital (EFSTH) in Banjul on 20th January celebrated the opening of refurbished facilities completed by MRC Unit, The Gambia, funded through The West African Network of Excellence for Tuberculosis (TB), AIDS and Malaria (WANETAM).

As part of MRC Unit, The Gambia and the WANETAM’s shared commitment to build capacity for West African scientists, the MRC has renovated the former neonatal ward of the Paediatric Unit at EFSTH into a conference room and library. The refurbishments include computers and an internet connection which will be funded for one year. The renovated area will be used by medical students in the department of paediatrics to support and enhance their studies.

Funded by the European and Developing Countries Clinical Trials Partnership, WANETAM’s mission is to build capacity at West African sites for clinical trials in HIV, TB and malaria. The WANETAM network consists of 20 institutions in 12 countries.

The subsequent WANETAM Plus grant continued to build on the strategic objective of capacity building for West African scientists by supporting a number of short-term training sessions.

Dr Martin Antonio, Senior Scientist and Unit Molecular Biologist at MRC Unit, The Gambia, leads the TB work package for the WANETAM consortium and Unit Director Professor Umberto D’Alessandro is a WANETAM collaborator.

The ceremony also included the official presentation of equipment donated to the Paediatric Unit by MRC Unit, The Gambia, including two oxygen concentrators, a photocopying machine and equipment in the SMAC lab such as haematology analysers, a colorimeter and microscopes.

Also present at the ceremony was Dr Kalifa Bojang, seconded to the EFSTH from the Unit in 2011 as Head of Paediatrics, who said: “The relationship between MRC Unit, The Gambia and the EFSTH has proved mutually beneficial, allowing the MRC to carry out research that addresses important public problems in The Gambia.

“The hospital benefits from the teaching and clinical services provided by skilled physicians and highly qualified nursing staff from the MRC. The renovation of the former neonatal ward into a meeting room and library will further enhance teaching and learning in the department of paediatrics.”

A computer room in the newly refurbished facilities

Unit Director Professor Umberto D’Alessandro and Chief Medical Director of the EFSTH Dr Muhammed Ammar Al-Jafari at the opening ceremony

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MRC presents equipment to the Gambian Government

In a ceremony attended by senior representatives of the Gambian Government, MRC Unit, The Gambia handed over equipment to the Ministry of Health and Social Welfare through the Global Fund Asset Transfer, on 23rd December 2014.

The Global Fund Nationwide Gambian Survey of TB prevalence (GAMSTEP) was done in collaboration with the Ministry of Health and Social Welfare and the MRC, through its agency, the National Leprosy and TB Programme. The project set out to determine the prevalence of TB in The Gambia.

WHO estimates of TB prevalence in The Gambia were 490 per 100,000 people but the survey showed overall national prevalence of all forms of TB to be 128 per 100,000 people, about four times lower than previously estimated.

100,678 Gambians in 138,857 households were invited, of which 55,831 were eligible to participate in the survey. The project involved symptom screening of all participants with prolonged cough via chest X-rays, and sputum testing.

As part of the project documentation and agreement, equipment used during the recruitment process was handed over to the Ministry of Health and Social Welfare as required by the Global Fund and Country Coordinating Mechanisms, for use within the health sector.

In the ceremony, MRC Unit, The Gambia handed over six motorcycles, a mini truck, three laptops and two sets of X-ray machines to the Ministry of Health and Social Welfare.

On presenting the equipment, Professor Umberto D’Alessandro said: “This project is a fantastic example of the collaboration existing between the Gambian Ministry of Health and MRC Unit, The Gambia. We are together in fighting diseases of major importance in The Gambia and Africa.

“We provide the Ministry of Health with information to better control infectious diseases. The TB prevalence project, which included about 50,000 participants aged over 15 years, found that The Gambia has already reached the Millennium Development Goal for TB.”

In appreciation, the Honourable Omar Sey, Minister of Health and Social Welfare, thanked the MRC for the continued partnership that exists between the MRC and the Ministry of Health and Social Welfare. He also expressed gratitude for MRC Unit, The Gambia’s involvement in the development of the Strategic Plan and thanked the MRC for providing Ebola prevention training to the National task force.

The Honourable Omar Sey, Minister of Health and Social Welfare and Professor Umberto D’Alessandro, Unit Director at the ceremony.

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Welcoming global collaboration

On the 2nd and 3rd of September, MRC Unit, The Gambia welcomed a team of seven researchers from the University of Cambridge to explore potential two-way collaborations in health research across a broad range of themes. Both the MRC and the University of Cambridge expressed an interest in developing a synergy using complementary resources. The two day visit was hosted by Professor Tumani Corrah and Dr Peter Dukes, Director and Assistant Director respectively, of the Africa Research Development Programme and the MRC Leadership Board.

The discussions included existing common research interests in infectious diseases and meeting the challenges of emerging and re-emerging diseases – such as respiratory infection and diarrhoea – and possible research collaborations in the intersection between non-communicable diseases, nutrition and malaria. The team experienced the Unit’s stimulating research environment first-hand by touring the MRC laboratories, Clinical Services Department and then onto the Sukuta Health Centre.

The University of Cambridge has a Cambridge-Africa Programme, which was initiated and led by Professor David Dunne, one of the visitors, that aims “to strengthen research capacity in Africa through the provision of training and mentorship to African researchers, and also through supporting Cambridge-Africa research collaborations in a range of disciplines including health.” This nature of this programme provided an invaluable opportunity to discuss capacity building, as well as a poster session that included early career scientists Brenda Kwambana, Jorjoh Ndure and Leopold Tientcheu.

The Cambridge delegation included Professor Nabeel Affara, Head of the Division of Cellular Molecular Pathology at University of Cambridge, the father of the MRC Unit’s own Dr Muna Affara.

Dr Pauline Essah, Coordinator of the Cambridge-Africa Programme and the Wellcome Trust-Cambridge Centre for Global Health Research, expressed her thanks: “I would like to say a big thank you to everyone we met, for their hospitality and participation in the discussions. We definitely found the meeting to be very worthwhile, and are convinced that there are potential opportunities for collaborations and training in the near future.”

I would like to say a big thank you to

everyone we met, for their hospitality and participation in the discussions. We definitely found the meeting to be very worthwhile, and are convinced that there are potential opportunities for collaborations and training in the near future

Dr Pauline Essah Coordinator of the Cambridge-Africa Programme and the Wellcome Trust-Cambridge Centre for Global Health Research

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Improving community health services through mutual partnershipDr Muhammed Afolabi

A community event held last year saw Dr Kalifa Bojang, Senior Scientist and Head of Paediatric Department at the Edward Francis Small Teaching Hospital, along with Dr Ed Clarke, Head of Infant Immunology, Vaccinology Theme, donate materials to help the smooth running of medical services and diagnostics at Sukuta Health Centre.

The event was attended by the representative of the Alkalo of Sukuta, the Village Development Committee, staff of the health centre and of the MRC Sukuta field site. It served to rekindle the spirit of mutual partnership that has long been entrenched between MRC Unit, The Gambia and the host community of Sukuta.

“What started in a ‘portacabin’ has grown to become an internationally recognised clinical trial site which has successfully conducted phase I-IV trials.” He also noted that these outstanding achievements would not have been possible without the understanding, support and co-operation of the good people of Sukuta and he encouraged them to put the items to good use.

Dr Ed Clarke in his address cherished the excellent relationship existing between the MRC and the Sukuta community. He donated a microscope to facilitate the diagnosis of common infectious diseases in the health centre.

The Acting Matron-in-charge Ms Mariama Jamba, thanked the team for the generous donations and promised to make good use of the items. The representative of the Alkalo also echoed the goodwill messages of the Alkalo and the Village Development Committee. He called on the staff of the MRC Unit and Sukuta to continue working together to improve the health of the people of Sukuta community, and The Gambia.

Dr Kalifa Bojang and Dr Ed Clarke donated office items and a microscope to Sukuta Health Centre

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MVP thanks the community in Dampha KundaNjilan Johnson

Born in 2001, the Meningitis Vaccine Project (MVP) came to a close in December. Earlier in 2014 the MVP team and partners joined Professor Beate Kampmann, Principal Investigator and Dr Olubukola Idoko, Clinical Trial Coordinator, to share the results of the vaccine trial and persistence studies with the communities around Basse who were involved in the trial, and to thank them for their support and participation.

The community feedback event was held in the market square of Dampha Kunda and attended by village elders, men, women and children, as well as representatives from the Ministry of Health and sections of local Government. Many of the women and their children were part of phase II/III and persistence trials of the MVP and got to know MRC staff members well during the trial.

Before the event started, a group of women began singing and dancing, getting the crowd excited as they watched and listened. This prompted another group of women to respond with their own musical interlude.

The programme began with introductions from the master of ceremonies, Pa Cheboh Saine, research project manager for Child Survival at MRC Basse, and Mustapha Darboe, data/ field coordinator for the MVP. The Imam of Dampha Kunda offered the prayers and the Alkalo of Dampha Kunda then welcomed everyone to the event.

Professor Beate Kampmann, theme leader for Vaccinology at MRC Unit, The Gambia, shared information about MVP with the community, while Dr. Olubukola Idoko, Clinical Trial Coordinator, elaborated on the role of the community in licensing MenAfriVac. Their talks covered the devastation caused by meningococcal epidemics, the amazing success story of getting the vaccine developed and introduced in 10 short years, and the impact already noted within the African meningitis belt.

Abdoulie Juum of the Regional Health Team discussed the importance of the relationship between the MRC and the Ministry of Health and the almost complete coverage attained during the introduction

of MenAfriVac the previous year. The Chief of Tumana and the representative of the URR Governor made a few remarks commending the MRC teams and stressing the importance of collaboration.

The MRC Drama group put on a phenomenal performance to emphasise the devastating effect that meningococcal A meningitis has had on families and the roles that the WHO, the MRC and other health organisations played to come up with this affordable vaccine that saved lives and built healthier and happier communities.

A question and answer session gave community members an opportunity to ask questions and voice their opinions. Key among the questions asked were the mode of spread of meningitis and how often MenAfriVac needed to be given. Dr Olubukola Idoko then delivered a vote of thanks and the day ended with the singing of the national anthem.

Community members expressed appreciation for the community feedback event, giving them an opportunity to hear about the results of the research and ask questions. For staff who had worked on the project it was an opportunity to show the members of the community that the visits to the MRC Basse Field Station and subsequent home visits were for an important purpose. The MVP has helped save lives and bring hope to many communities.

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Highlights of a productive year for the MDV teamDr Olubukolo Idoko

Following successful kick-off of the 13-valent Pneumococcal Conjugate Vaccine Multidose vial trial in January 2014, our team has recorded multiple accomplishments, including the adoption of electronic data collection methods – a first for a trial undertaken at the Unit – producing excellent results.

The trial aims to test the safety and immunogenicity of the 13-valent Pneumococcal Conjugate Vaccine (PCV13) Multidose vial preparation (MDV) which contains four doses of PCV13, compared to the single dose format which is currently routinely used as part of the immunisation program in The Gambia.

The single dose pneumococcal vaccine has proven efficacy in protecting children from pneumococcal pneumonia and other pneumococcal presentations such as meningitis and ear infections. It is provided in The Gambia and other African countries with the support from the Global Alliance for Vaccine Initiative (GAVI).

The major difference between the two formulations is the addition of a preservative in the MDV preparation. The advantage of having four doses in the same vial instead of single vials (or syringes) means a reduction in the cold chain costs and overall delivery costs for an otherwise expensive vaccine. Reducing these costs may have significant implications for sustaining the supply of PCV13, particularly beyond the period of GAVI funding.

If the immunological response induced by the MDV formulation is not inferior to the current format for the 13 pneumococcal serotypes included in the two vaccines in our trial in The Gambia, the licensing process could start for the MDV formulation.

In terms of recruitment for the study, as has happened previously in other Unit trials, the 500 required participants were recruited into the study two weeks ahead of schedule. Vaccination visits were completed on 25th July and the last subject attended the last study visit on 1st September.

In a first for a trial at the Unit, electronic diaries for collecting participant follow up information were introduced. The new data collection method was implemented with great enthusiasm by the study team in spite of some network challenges that were quickly resolved with the support of our sponsor, Pfizer. The trial was intensively monitored (100%) and audited with excellent reports at all time-points. Study close-out is expected in January 2015 as a few out-of-study procedures continue to be carried out by the team.

At our recent end-of-study dinner, the team had a chance to unwind after what has been a truly busy year. The significant additional talents of the members of the trial team made the evening a very happy gathering. Highlights of the event included a skit put on by the field team comically entitled ‘On your own’, which included a farewell poem written by the poets within the group, as well as presentation of certificates and speeches from key members of the team.

We are grateful to have received praise from Pfizer for the conduct of the trial. We look forward to early results due in the first quarter of2015.

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Improving community care of mothers and infants

Kirsty Le Doare, MRCPCH, Dip PID Oxon, Wellcome Trust Clinical Research Training Fellow

The Infant Immunology Theme were delighted to host the first joint training course for midwives and nurses at MRC Fajara in August 2014.

The course, designed to help improve care of mothers and infants in our community, was the second in a series of regular ‘helping babies breathe’ newborn care clinical skills courses, established by the team, for MRC study staff and government health workers.

During the two day course, of intensive practical training in midwifery and neonatal emergencies and resuscitation skills, Professor Beate Kampmann, Dr Anna Battersby and Dr Kirsty Le Doare were joined by midwifery specialists Dr Beverley Donaldson and Mrs Maggie Welch from Imperial College London, and Dr Patrick Oboye, Obstetrician from Edward Francis Small Teaching Hospital (EFSTH). They were supported by Dr Kalifa Bojang, Senior Clinical Scientist and Consultant Paediatrician at the EFSTH.

Over 30 participants from government clinics and MRC field sites joined in the training. Midwifery skills run by midwifery trainers Dr Donaldson and Mrs Welch included the management of shoulder dystocia and postpartum haemorrhage. Neonatal skills run by Dr Battersby and Dr Le Doare included bag and mask ventilation and respiratory support.

The course is accredited by the American Society for Emergency Care and all participants passed the examination on the final day with flying colours. The training team are looking forward to running more successful courses in the future. The next course will be held in March 2015.

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Strengthening capacity across West Africa

Marie Rose Thorpe and Malick J Bah

As part of the West African Nodes of Excellence for TB, AIDS and Malaria (WANETAM) Plus project coordinated by the MRC, the Unit hosted 18 West African researchers for the fourth and final TB workshop on ‘Data Analysis and Write-up’ from 4th–8th August.

This latest workshop created the opportunity for senior researchers from Burkina Faso, Ghana, Guinea Bissau, Mali, Nigeria, Senegal, Togo and The Gambia (National Public Health Laboratories) to analyse data generated from the TB isolates and begin the initial stages of writing up results.

The workshop was led by Dr Martin Antonio, MRC Principal Investigator of the TB Nodes of Excellence. His team of facilitators was Florian Gehre, Jacob Otu, Kodjovi Mlaga and the TB team in this French-English, bilingual workshop. Dr Bouke de Jong, collaborator in the WANETAM Plus grant from the Institute of Tropical Medicine, Belgium, also facilitated the course.

In his welcoming address, Professor Umberto D’Alessandro, Unit Director, gave an overview of the MRC’s achievements across the sub-region and emphasised that the Unit will continue to lead research and collaboration in this area. He congratulated participants for the high quality of their contributions during the course of the workshop.

WHO representative, Dr Charles Sagoe, said: “WANETAM, which is funded by the European and Developing Countries Clinical Trials Partnership, has done a great job in coordinating research activities according to local and regional priorities in the field of TB, HIV and Malaria.”

He noted the importance of capacity building through training junior and senior West African scientists, as well as linking seven research institutions in West Africa (The Gambia, Senegal, Burkina Faso, Nigeria, Mali, Guinea Bissau and Ghana) through collaborative training packages and strengthening communication.

Dr Sagoe also cited the positive results of a recent survey on TB prevalence conducted by MOH, the MRC, WHO and GFATM showing that the overall prevalence of all forms of TB in The

Gambia is 128 per 100,000 of the population, 3.8 times lower than the 490 per 100,000 estimates in the 2013 Global TB Report.

Mr Ignatius Baldeh, Director of National Public Health laboratories at the Ministry of Health and Social Welfare, welcomed all visiting scientists from the sub-region to The Gambia, noting how the workshop will ensure excellence and quality research in data analysis. On behalf of the Gambian Government and Ministry of Health he congratulated the MRC for their training of local junior scientists.

Professor Tumani Corrah, Director of the Africa Research Development Programme, described the gathering as “a massive success”. He promised that the Unit will continue to support capacity development over the next three years, thanks to continued funding for WANETAM.

About WANETAM

The WANETAM grant, funded by the European and Developing Countries Clinical Trials Partnership (EDCTP), aimed to develop technical skills that will enable scientists in the West Africa sub-region to conduct clinical trials to international GCP standards.

The WANETAM network consists of 20 institutions in 12 countries.

During the five years of the WANETAM grant, TB isolates have been collected at the ‘sister’ Consortium sites with TB laboratory facilities.

The subsequent WANETAM Plus grant has continued to build on the strategic objective of capacity building for West African scientists by supporting a number of short-term training sessions.

Dr Martin Antonio, MRC Principal Investigator of the TB Nodes of Excellence

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Team Gambia at EDCTP Forum

Dr Muhammed Afolabi

A team of scientists represented MRC Unit, The Gambia in the international arena at the 2014 Seventh Forum of European and Developing Countries Clinical Trials Partnership (EDCTP).

Held at a prestigious hotel in the heart of Berlin in Germany, the meeting came at a perfect time to share the partnership story, being at the interface between the tail end of the first EDCTP programme and commencement of the second programme.

The Forum hosted 359 participants from more than 43 countries; 120 oral presentations were delivered, of which 90% were from EDCTP-funded projects.

The Unit was well represented by leading scientists who made excellent presentations of their study findings. These ranged from research support, novel TB diagnostic methods and TB molecular studies to bioethics.

The Forum also benefitted from the leadership skills of Professor Tumani Corrah and Professor Beate Kampmann who expertly chaired many plenary and parallel sessions.

Overall, the team gave an outstanding performance at the meeting, putting the Unit in a favourable position to attract more grants and

perform better in the next phase of EDCTP, which was officially launched on 2nd December 2014.

Visit the Seventh EDCTP Forum website to access the exciting presentations at: www.edctpforum.org/2014/index.php/programme-2/presentations

DISEASE CONTROL & ELIMINATION


CHILD SURVIVAL

A new malaria team memberKalilu Dibba

Dr Jane Achan joins the Disease Control and Elimination Theme as a Clinical Epidemiologist. While at MRC Unit, The Gambia, she will be involved in some of the already ongoing research activities within the malaria team and in development of additional areas of research targeting new approaches to achieve further reductions in malaria transmission.

What is your professional background?I am a medical doctor with a PhD in Biomedical Sciences from the University of Antwerp Belgium, a Master’s degree in Paediatrics and Child Health from Makerere University, Kampala, Uganda and Master’s training in clinical trials from the University of London, UK.

I have been actively involved in malaria and HIV clinical and operational research for the past 12 years with the Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration.

My professional interests and experience mainly include evaluations of chemotherapeutic interventions to guide policy, evaluation of health-related impact of interventions as well operational health systems research. I have also provided technical support for clinical research, public health and epidemiological strategies to health organisations focused on operational and clinical research activities.

I have been actively involved in the epidemiological surveillance of malaria morbidity and mortality trends as well as a provider of technical advice on case management policy issues in Uganda. I am a practicing paediatrician and was previously a lecturer at the Department of Paediatrics and Child Health at Makerere University College of Health Sciences.

Why medicine as a profession?I think medicine is a call to service and a really noble profession whose sole aim is to save lives. I was drawn to medicine mainly because of the burden of diseases we observe in resource-limited settings like Uganda and the need to contribute towards alleviating this suffering.

I hoped to contribute positively towards achieving improved quality of health care provided in these settings. The interest in research was generally driven by the need to provide evidence-based practices that feed back into improvements in better interventions that target disease prevention and treatment.

What is your research focus?The focus of my prior research work was generally driven by the need to provide evidence to guide policy and improve clinical practice. I have been involved in several antimalarial drug therapeutic trials in Uganda that have informed malaria case management practices in the country. We provided evidence of poor effectiveness of oral quinine for uncomplicated malaria and this led to a policy change of second-line therapy from oral quinine to dihydroartemisinin-piperaquine. In addition, we also documented sub-optimal treatment practices for severe malaria across health facilities in the country and used this information to guide training and support supervision approaches to improve on the quality of care provided.

I have also been involved in several studies evaluating the interactions between HIV and malaria, two diseases that cause significant morbidity and mortality in sub-Saharan Africa. Through this work we have been able to provide evidence of significant drug-drug interactions that have also led to policy changes at the international level. Our work on interactions between Lopinavir/ritonavir and artemether-lumefantrine led to a revision in the 2013 WHO treatment guidelines for HIV with a preference for Lopinavir/ritonavir based regimens for treatment of HIV-infected children in areas of high malaria transmission.

Why MRC Unit, The Gambia?What attracted me to MRC Unit, The Gambia

was its amazing track record of research and the public health impact this research has had internationally. Another attraction was the glaringly different epidemiology of malaria in The Gambia compared to Uganda which presented an opportunity for involvement in a completely scope and spectrum of research activities.

Do you have plans for a particular line of research in the Disease Control and Elimination Theme?I would like to pursue new approaches to achieve further reductions in malaria transmission especially in areas with relatively high transmission. My interest in this area stems from a few observations thus far that show opportunities for additional interventions over and above what the current guidelines provide for.

Impressions of the Unit and The Gambia so far?My early impression of the Unit is that it is an academically rich environment with very talented scientists and amazing research teams. I think the Gambia is a beautiful and calm country. I look forward to a fruitful stay and experience in the Unit and The Gambia.

DISEASE CONTROL & ELIMINATION CHILD SURVIVAL


Strengthening Hib surveillanceDr Akram Zaman

Is the burden of invasive Haemophilus influenzae type b (Hib) disease increasing in the Western Region of The Gambia? To help find out, the Hib Surveillance Project team ran a full day workshop on 19th November to train new medical graduates and lab scientists from eight major health centres and hospitals in the Western Region on the importance and methods of disease surveillance.

Hib is a bacteria responsible for causing severe pneumonia, meningitis and other invasive diseases in children, most of which occur in developing countries. It is transmitted through the respiratory tract from infected to susceptible individuals.

A successful trial of Hib conjugate vaccine was carried out in 42,848 infants in The Gambia by joint efforts between the Government of The Gambia and the MRC from 1993–1995. The Gambia was subsequently the first country in Africa to routinely vaccinate its children with conjugate Hib vaccine, beginning in 1997, using a primary series of three doses; these were scheduled for two, three, and four months of age, and no booster dose. We reported the virtual disappearance of invasive Hib disease from The Gambia by 2002, and its presence at a very low incidence thereafter.

However we are concerned that Hib vaccine effectiveness is waning in the second decade after introduction in the first African country to use the vaccine, and a key question is whether a booster is needed.

Between January 2011 and November 2013 formal surveillance of invasive Hib disease in Eastern Gambia – associated with pneumococcal conjugate vaccine introduction (August 2009) – detected 18 cases, having detected just one in the previous two years. This was accompanied by incidentally detected hospital cases in the Western Region where formal surveillance had stopped in 2010. Around half of the detected cases had received two or more doses of vaccine and half were over 12 months of age. Also, in 2011 a Hib antibody survey undertaken in the Eastern part of The Gambia, in a group of fully vaccinated older children and adults, showed that a substantial proportion had non-protective levels of Hib antibody.

We are now re-establishing Hib surveillance to answer the crucial question as to whether the burden of invasive Hib disease is increasing in the Western Region. This will allow the indications of a recent resurgence in Eastern Gambia to be understood better and the implications for vaccine policy to be assessed. We also plan to do a carriage study in selected age strata to detect potential reservoirs for increased transmission.

The specific aims and objectives of our workshop were to re-establish

Hib meningitis surveillance in the Western region, measure incidence of Hib disease, identify any emerging hyper-invasive clones and detect potential reservoirs for increased transmission by undertaking a carriage study.

The workshop provided training on the clinical and laboratory surveillance procedures necessary to carry out high quality surveillance, strengthen Paediatric Bacterial Meningitis Surveillance lead by the Public Health Laboratories, and also to train new medical graduates in clinical research.

Dr Samba Ceesay, Acting Director of Public Health at the Ministry of Health and Social Welfare, attended the workshop and in his inauguration remarks thanked the MRC for taking up the challenge. Representatives from the MRC and Mr Ignatius Baldeh, Director of the National Public Health Laboratories, were among the workshop presenters.

Dr Akram Zaman, Acting Theme Leader of Child Survival gave a talk on Public Health Surveillance, and Dr Steve Howie, presented on the past and present epidemiology of Hib diseases in The Gambia. With a remit to ensure quality management, Mr Ignatius Baldeh, spoke on the importance of Total Quality Management in research – a means of strengthening health systems. Dr Magnus Ochoge, Research Clinician from the Child Survival Theme, explained the new Hib Surveillance system and gave an overview of clinical procedures, and Dr Ousman Secka, Manager of Microbiology Laboratory Services, provided an overview of lab procedures at the MRC for the benefit of clinicians and lab scientists.

The workshop also served as a means of bringing together the expertise of clinicians and lab scientists to emphasise the importance of joint working to improve Hib disease surveillance and reduce child mortality.

NUTRITION


NUTRITION

Keneba research prominent at 10th GCGH Symposium

The Bill and Melinda Gates Foundation’s “Grand Challenges in Global Health” (GCGH) program aims to foster scientific and technological innovation to solve key health problems in the developing world.

Among other highlights, at the 10th GCGH Symposium in Seattle in 2014, Mr Bill Gates showed keen interest in Clare Elwell’s poster describing collaborative work with MRC Unit, The Gambia to validate functional near infra-red spectroscopy (fNIRS) to assess cognitive function in Gambian children. This work has now received Phase II funding.

Find out more at: http://gcgh.grandchallenges.org/Pages/Default.aspx

Tony Fulford seeks new pastures

After 15 years as the leader of databases and statistics at MRC Keneba Field Station, Tony Fulford has opted for early retirement in order to concentrate on his ornithological research. We owe a huge debt to Tony and wish him many discoveries and much satisfaction in his new career.

Congratulations to Sophie Moore

After sterling service as our Head of Station in Keneba we congratulate Sophie on her appointment as Group Leader in Maternal and Child Nutrition at our sister unit MRC Human Nutrition Research in Cambridge. Sophie will continue to lead our sub-theme on Early Growth and Development until we recruit her replacement and will be an integral part of MRC Unit, The Gambia’s work into the foreseeable future.

Neonatal Society’s Annual Lecture

The Neonatal Society’s Elsie Widdowson Annual Lecture was given by Professor Andrew Prentice Nutrition Theme Leader at the Institute of Child Health, London on 18th November. His topic was: Conceptions, pregnancies and neonates: Lessons from rural Africa.

Read more at: www.neonatalsociety.ac.uk/about/widdowsonlecture.shtml

NUTRITION NUTRITION


The Four Horsemen of the Apocalypse

The Royal Society of Medicine hosted a one day meeting on ‘The Four Horsemen of the Apocalypse’: Death, War, Pestilence and Famine. The meeting examined the roles of coroners and the pathology laboratory, a century of pathological activities within military services, global pandemics and the impact of famine on human health.

Addressed by experts within their fields, including Andrew Prentice who spoke about Famine, the meeting offered those attending a chance to hear presentations focusing on an exciting range of medical topics which brought together current and historical perspectives on death, war, pestilence and famine - from the battlefield to the laboratory.

Find out more at www.rsm.ac.uk/events/ptf01.aspx

Science Museum LATES

On the evening of the last Wednesday of each month London’s Science Museum holds a series of ‘LATES’ events for the public. At one such evening Andrew Prentice described the team’s breakthroughs in epigenetic research to the title of ‘Are you what your mother ate?‘

Find out more at: www.sciencemuseum.org.uk/visitmuseum_old/events/events_for_adults/lates.aspx

NEWS FROM BASSENEWS FROM KENEBA


A fresh face for Keneba Clinical Services

MRC Keneba Field Station has recently welcomed a new Head of Clinical Services, Dr Ian Head. Here, he discusses his experience, the qualities required of a good doctor and his goals for the clinic with Yaya Minteh.

Tell me about yourself.I’m originally from a small seaside town in the South of England. Since graduating from Medicine at Sheffield University in 2008, I have been working all around the UK. Outside of work I enjoy swimming, playing squash, and relaxing with a good book.

How did you get to the MRC Unit, The Gambia?I was working with infectious diseases in the UK and it has been an ambition of mine to work in an African country for some time; to experience the life here and to learn more about tropical medicine. A colleague put me in touch with the MRC team in Fajara, who told me about the job opportunity in Keneba, and here I am!

What do you feel are the most important qualities in being a medical doctor?Alongside good medical knowledge, the most important qualities in a good doctor are those which allow him or her to build a trusting and open relationship with the patient. Good medical doctors all share excellent communication skills, empathy and honesty.

Discuss your clinical experiencesSince qualification, I have worked in a variety of adult medicine specialities including cardiology, renal and emergency medicine. My main interest now is in infection and infectious diseases and I have been working both in the hospital ward and in the microbiology laboratory.

What are your major goals and priorities for the MRC Keneba Clinical Services?I want to continue the excellent work of my predecessor, Dr Helen Nabwera, in the MRC Keneba Clinic. The redevelopment of the whole clinic is underway, and this will be an exciting change for the site. I would like to take some of our diagnostic services forward to enable the clinical team to provide even better care for our patients. Ongoing training of the clinical team is a priority to ensure that we maintain our excellent care standards. The current Ebola threat has been a focus here for some months; one of my priorities is to ensure that we here are as prepared and safe as possible.

Recruiting talented faculty (clinicians and researchers) is a key part of your job. What do you see as the keys to success in this area?To ensure that we recruit the best talent to our team, we need to advertise widely and to take advice from those who have many years’ experience here in Keneba. Their expertise will be a great guide in recruiting the right person for the right job.

In what ways will your involvement in both the clinical and research areas benefit you in your role as Head of Clinical Services?One of the great things that I have seen in my short time so far here in Keneba is the way in which the clinical and research teams work alongside each other. We can learn so much from each other. I hope to continue to encourage this collaboration between the two areas.

What are your strengths?Oh dear! I’m organised at work, and love working within a team.

How do you feel about your stay in Keneba?A little nervous at first, but since arriving in Keneba everyone has been very welcoming. I’m slowly getting to know the village and I’m enjoying the peace and quiet of this beautiful place.

Do you have anything to tell your colleagues and friends?Thank you to everyone for giving both Helen (my partner) and I such a warm welcome since we arrived. We’re both so impressed by the hard-working staff here, and are excited to be a part of the team.

NEWS FROM BASSE


NEWS FROM KENEBA

A visit from the US Charge d’Affaires

MRC Basse Field Station was delighted to host Mr Richard T. Yoneoka, Charge d’Affaires of the Embassy of the United States of America in Banjul, in July 2014.

Mr Yoneoka and his delegation were accompanied by the Unit Head of Operations, Joan Vives Tomas. He had the opportunity to visit the Demographic Surveillance System (DSS) office, the lab and the insectary.

At the DSS, Mr Salifou Sambou and Golam Sarwar gave a brief outline of the activities of the DSS. At the main lab, Rasheed Salaudeen, deputising for Basse Lab Manager, gave a vivid account of the various activities of the lab, while Mr Camara gave an account of the works at the malaria lab and insectary.

The visit served as a first-hand insight for Mr Yoneoka into some of the operations of the field station, demonstrating the excellent facilities available at Basse Field Station to enable clinical trials, and the opportunity to measure the long-term impact of interventions in a meaningful way.

Accelerating translational scienceBasse Field Station recently welcomed Professor Andrew Prentice, Nutrition Theme Leader and Professor of International Nutrition at the London School of Hygiene and Tropical Medicine.

With a view to accelerate the Unit’s translational science building upon synergies between the four themes and MRC field stations, Andrew’s stay included a visit to the Demographic Surveillance System (DSS) office, the lab facilities and the new site at Mansajang. Andrew was accompanied on his visit by Pa Chebo Saine, Mr Felix Badji and clinicians based at Basse.

NEWS FROM BASSE

22

NEWS FROM BASSE


Investing in communities

As part of the process of giving back to the communities of the Upper River Region and Central River Region, Basse Field Station has donated six computers to three schools in Basse.

The beneficiary schools are St George’s Senior Secondary School, Nasir Ahmadiyya Senior Secondary School and St Mulumba’s Upper Basic School, and more donations are to follow in the not too distant future.

In her address to all present at the event, Gyasiwaa Amofa, previous Operations Manager of Basse Field Station, noted: “This donation is part of the MRC Unit’s overall efforts to give back to a very supportive community that has always been a part of the parcel of the MRC’s research initiatives. It is important for students to be computer literate as this is an aspect of any research initiative; the computer is a necessary prerequisite in any meaningful research activity.”

On a similar note she informed the students that there is an opportunity to work at the MRC as part of an attachment scheme to deserving students, again an effort to give back to the community. The opportunity will give the students a chance to gain work experience in various areas of interest including IT, science, administration and finance.

Since mid-October a group of six high performing students from the beneficiary schools have taken up roles in the areas of finance, administration, laboratory science and IT/data.

The head teachers of all of the schools seized the opportunity to the thank the MRC for what they all see as an appropriate gesture and promised to ensure that the computers will be put to good use for the benefit of the students.

Nashir Ahmadiyya Senior Secondary School

NEWS FROM BASSE NEWS FROM BASSE

23MRC TAMA | VOL: 13 | ISSUE: 03 | 2014/15

LEFT: St George’s Upper Basic and Senior Secondary Schools. RIGHT: St Mulumba’s Upper Basic School

From Basse to Fajara: the Odyssey of an administrator

To gain big, one has to start small. And that is precisely what Gyasiwaa Amofa has done, leaving her role as Operations Manager of Basse Field Station to pick up a new and challenging role as coordinator of Africa Research Development at MRC Fajara.

When she arrived in Basse over two years ago, people may have wondered who this small lady was, stepping into a leadership role as the new Head of Operations. Calm and focused, Gyasiwaa came to Basse with a determination to change the Field Station for the better.

Gyasiwaa made it clear that the old ways cannot endure if there has to be meaningful and progressive change in Basse. And in many respects she succeeded in streamlining the administration of Basse Field Station, although she concedes that there is still a lot to be done. As the world is a stage where every individual must play a role, she has played her role here and must now move on. We wish her all the best in her new role.




Antibodies against Haemophilus influenzae type b in The Gambia: investigating the extent of protection across age groups.

Following a landmark clinical trial, the vaccine against Haemophilus influenzae type b (Hib) was introduced in The Gambia in 1997. Whilst the immunogenicity of this vaccine is well established subsequent to the doses administered under the EPI schedule, little data exists assessing longevity of protection, using serology. Such data are needed however to predict the susceptibility to Hib at the population level.

To determine antibody persistence in 5-6 year old fully vaccinated Gambian children compared with older children, adolescents and young adults, 427 serum samples from healthy 5-37 year old participants were tested for Hib antibodies using VaccZyme Human Anti-Hib ELISA kits. 86% of the children who had received 3 doses of Hib vaccine in infancy had Hib antibody concentrations ≥0.15 mg/l at the age of 5-6 years. This proportion was 76% for adolescents who had also largely been vaccinated and 90% for adults who had never received Hib vaccine.

Although most participants had anti-Hib antibody above concentrations putatively defined as protective, significantly fewer had concentrations thought to confer long-term protection. This suggests a population with insufficient or waning antibody that may be susceptible to breakthrough disease and transmission.

Idoko OT, Roberts E, Cox M, Jafali J, Njie-Jobe J, Mackenzie G, Ota MO, Kampmann B. Vaccine. 2014;32(36):4620-4

Coverage and timing of children’s vaccination: an evaluation of the Expanded Programme on 1 Immunisation in The Gambia

The investigators aimed to evaluate the coverage and timeliness of the Expanded Programme on Immunisation (EPI) in The Gambia. Vaccination data were obtained between January 2005 and December 2012 from the Farafenni Health and Demographic Surveillance System (FHDSS), the Basse Health and Demographic Surveillance System (BHDSS), the Kiang West Demographic surveillance system (KWDSS), a cluster survey in the more urban Western Health Region (WR) and a cross sectional study in four clinics in the semi-urban Greater Banjul area of WR.

BCG vaccine uptake was over 95% in all regions. Coverage of DPT1 ranged from 93.2% in BHDSS to 99.8% in the WR. Coverage decreased with increasing number of DPT doses; DPT3 coverage ranged from 81.7% in BHDSS to 99.0% in WR. Measles vaccination coverage ranged from 83.3% in BHDSS to 97.0% in WR. DPT4 booster coverage was low and ranged from 43.9% in the WR to 82.8% in KWDSS.

The investigators found that The Gambia health system achieves high vaccine coverage in the first year of life. However, there continues to be a delay to vaccination which may impact on the introduction of new vaccines. Examples of effectively functioning EPI programmes such as The Gambia one may well be important models for other low income countries struggling to achieve high routine vaccination coverage.

Scott S, Odutola A, Mackenzie G, Fulford T, Afolabi MO, Jallow YL, Jasseh M, Jeffries D, Dondeh BL, Howie SRC, D'Alessandro U. PLOS ONE. 2014 September 18. doi: 10.1371/journal.pone.0107280

Olubukola Idoko

Susana Scott

RECENT UNIT PUBLICATIONS RECENT UNIT PUBLICATIONS


Targeting regulatory T cells to improve vaccine immunogenicity in early life

Human newborns and infants are bombarded with multiple pathogens on leaving the sterile intra-uterine environment, and yet have suboptimal innate immunity and limited immunological memory, thus leading to increased susceptibility to infections in early life.

They are thus the target age group for a host of vaccines against common bacterial and viral pathogens. However, neonatal and infant responses to many vaccines are suboptimal, and in the case of the polysaccharide vaccines, it has been necessary to develop the alternative conjugated formulations in order to induce immunity in early life. Immunoregulatory factors are an intrinsic component of natural immunity necessary to dampen or control immune responses, with the caveat that they may also decrease immunity to infections or lead to chronic infection.

This review explores the key immunoregulatory factors at play in early life, with a particular emphasis on regulatory T cells (Tregs). A deeper understanding of the role that Tregs play in limiting or controlling vaccine induced immunity would provide strategies to improve vaccine immunogenicity in this critical age group. New adjuvants and drugs are being developed that can transiently suppress Treg function, and their use as part of human vaccination strategies against infections is becoming a real prospect for the future.

Ndure J and Flanagan KL. Frontiers Microbiol. 2014;11;5:477.

Heterologous and sex differential effects of administering vitamin A supplementation with vaccines: a literature review

WHO recommends high-dose vitamin A supplementation (VAS) to children from 6 months to 5 years of age in low-income countries, in order to prevent and treat vitamin A deficiency-associated morbidity and mortality. The current policy does not discriminate this recommendation either by sex or vaccination status of the child.

There is accumulating evidence that the effects of VAS on morbidity, mortality and immunological parameters depend on concomitant vaccination status. Moreover, these interactions may manifest differently in males and females. Certain vaccines administered through the Expanded Program on Immunization (EPI) have been shown to alter all-cause mortality from infections other than the vaccine-targeted disease.

This review summarises the evidence from observational studies and randomized-controlled trials of the effects of VAS on these-so-called heterologous or non-specific effects of vaccines, with a focus on sex differences. In general, VAS seems to enhance the heterologous effects of vaccines, particularly for diphtheria-tetanus-pertussis (DTP) and live measles vaccines, where some studies, although not unanimously, show a stronger interaction between VAS and vaccination in females. The investigators suggest that vaccination status and sex should be considered when evaluating the effects of VAS in early life.

Jensen KJ and Ndure J, Plebanski M, Flanagan KL. Trans R Soc of Trop Med Hyg. 2014 December 3. doi: 10.1093/trstmh/tru184.

Jojo Ndure




Early Phase Clinical Trials with Human Immunodeficiency Virus-1 and Malaria Vectored Vaccines in The Gambia: Frontline Challenges in Study Design and Implementation

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and malaria are among the most important infectious diseases in developing countries. Existing control strategies are unlikely to curtail these diseases in the absence of efficacious vaccines. Testing of HIV and malaria vaccines candidates start with early phase trials that are increasingly being conducted in developing countries where the burden of the diseases is high. Unique challenges, which affect planning and implementation of vaccine trials according to internationally accepted standards have thus been identified.

In this review, the investigators highlight specific challenges encountered during two early phase trials of novel HIV-1 and malaria vectored vaccine candidates conducted in The Gambia and how some of these issues were pragmatically addressed. They hope their experience will be useful for key study personnel involved in day-to-day running of similar clinical trials. It may also guide future design and implementation of vaccine trials in resource constrained settings.

Afolabi MO, Adetifa JU, Imoukhuede EB, Viebig NK, Kampmann B, Bojang K. Am. J. Trop. Med. Hyg. 2014;90(5):908–914.

Correlates of protection against human rotavirus disease and the factors influencing protection in low income settings

Rotaviruses (RV) are the leading cause of gastroenteritis in infants and children worldwide and are associated with high mortality predominately in low-income settings. The virus is classified into G and P serotypes and further into P genotypes based on differences in the surface-exposed proteins VP7 and VP4, respectively.

Infection results in a variable level of protection from subsequent reinfection and disease. This protection is predominantly homotypic in some settings, whereas broader heterotypic protection is reported in other cohorts. Two antigenically distinct oral RV vaccines are licensed and are being rolled out widely, including in resource-poor setting, with funding provided by the GAVI alliance. The first is a monovalent vaccine derived from a live-attenuated human RV strain, whereas the second is a pentavalent bovine-human reassortment vaccine. Both vaccines are highly efficacious in high-income settings, but greatly reduced levels of protection are reported in low-income countries.

The authors consider the current challenges facing mucosal immunologists and vaccinologists aiming to define immunological correlates and to understand the variable levels of protection conferred by these vaccines in humans. Such understanding is critical to maximize the public health impact of the current vaccines and also to the development of the next generation of RV vaccines, which are needed.

ET Clarke, U Desselberger. Mucosal Immunol. 2014 December 3. doi:10.1038/mi.2014.114

Ed Clarke

Muhammed Afolabi

RECENT UNIT PUBLICATIONS RECENT UNIT PUBLICATIONS


Efficacy of indoor residual spraying with ichlorodiphenyltrichloroethane against malaria in Gambian communities with high usage of long-lasting insecticidal mosquito nets: a cluster-randomised controlled trial

BackgroundThe investigators aimed to assess whether the addition of indoor residual spraying to long-lasting insecticidal nets (LLINs) provided a significantly different level of protection against clinical malaria in children or against house entry by vector mosquitoes.

MethodsIn this two-arm cluster, randomised, controlled efficacy trial the investigators randomly allocated clusters of Gambian villages using a computerised algorithm to LLINs alone (n=35) or indoor residual spraying with dichlorodiphenyltrichloroethane plus LLINs (n=35).

In each cluster, 65–213 children, aged 6 months to 14 years, were surveyed at the start of the 2010 transmission season and followed in 2010 and 2011 by passive case detection for clinical malaria. Exposure to parasite transmission was assessed by collection of vector mosquitoes with both light and exit traps indoors. Primary endpoints were the incidence of clinical malaria assessed by passive case detection and number of Anopheles gambiae sensu lato mosquitoes collected per light trap per night.

FindingsIncidence of clinical malaria was 0.047 per child-month at risk in the LLIN group and 0.044 per child-month at risk in the indoor residual spraying plus LLIN group in 2010, and 0.032 per child-month at risk in the LLIN group and 0·034 per child-month at risk in the indoor residual spraying plus LLIN group in 2011. The incident rate ratio was 1.08 (95% CI 0.80–1.46) controlling for confounders and cluster by mixed-effect negative binomial regression on all malaria attacks for both years.

No significant difference was recorded in the density of vector mosquitoes caught in light traps in houses over the two transmission seasons; the mean number of A gambiae sensu lato mosquitoes per trap per night was 6.7 (4.0–10.1) in the LLIN group and 4.5 (2.4–7.4) in the indoor residual spraying plus LLIN group (p=0.281 in the random-effects linear regression model).

InterpretationThe investigators identified no significant difference in clinical malaria or vector density between study groups. In this area with high LLIN coverage, moderate seasonal transmission, and susceptible vectors, indoor residual spraying did not provide additional benefit.

Pinder M, Jawara M, Jarju LBS, Salami K, Jeffries D, Adiamoh M, Bojang K, Correa S, Kandeh B, Kaur H, Conway DJ, D'Alessandro U, Lindsay SW. The Lancet. 2014 December 9. doi:10.1016/S0140-6736(14)61007-2

Margaret Pinder



TITLE: Share and Share Alike: Why Open Access Matters

NAME: Caroline Lloyd, Head of Library & Archives Service, London School of Hygiene & Tropical Medicine

Caroline Lloyd visited the MRC Unit in The Gambia to discuss current practice in open access. Caroline’s presentation, based on the work of Gareth Knight, explored the barriers to data sharing in public health and practical steps that can be taken to address these issues. In particular, she identified the need to: Establish personal and professional benefits that can be gained by data sharing; Ensure study participants are aware of any intent to make data available and provide their consent; Perform a risk assessment to determine the likelihood that information will directly or indirectly identify a participant and take action to resolve problems; Identify a digital repository through which data can be made available and make key decisions on when, where and how access will be provided.

Following Caroline’s presentation, she invited the audience to discuss how the community could build data sharing capacity in The Gambia. This discussion highlighted the need for national and international collaboration, among other factors. The LSHTM’s library has been selected to contribute to the UK Medical Heritage Library digitisation project, joint funded by the Wellcome Library and JISC. The project aims to create high quality digital scans of 19th century medical books and pamphlets which will be available for everyone to use under a creative commons license.

Find out more here: http://blogs.lshtm.ac.uk/library/2014/06/25/wellcome-digitise-librarys-19th-century-literature

TITLE: Mycobacterium tuberculosis complex lineages diversity: Does it have an impact on anti-TB treatment response?

NAME: Dr Leopold D. Tientcheu, Senior Scientific Officer, Vaccinology Theme

The likely impact of Mycobacterium tuberculosis (Mtb) complex (MTBC) lineages on anti-tuberculosis (TB) treatment response is still understudied despite evidence of epidemiological differences in their virulence.

In The Gambia, TB patients infected with Mycobacterium africanum (Maf) are more likely to be older, HIV co-infected and/or severely malnourished. In addition, Maf-exposed contacts progress slower to active disease compared to Mtbexposed contact, suggesting that Maf might be the less virulent of the two prevalent strains. The complex interaction between the bacilli and their host requires an integrated approach that investigates both arms to better understand the response to treatment in TB patients.

We have shown that the proportions of activated MTBC-specific T-cells are similar between Maf- and Mtb-infected patients before treatment, but significantly higher post-treatment in Maf- compared to Mtb-infected patients. Post-treatment Mtb-infected patients recovered better than Maf-infected patients, despite similar degree of disease severity in both groups before treatment. Furthermore, analysis of sputum isolates from these patients revealed a drug tolerance phenotype for Maf that could not be detected using conventional drug susceptibility testing methods. Taken together, our results suggest differences in response to standard anti-TB drug treatment between Maf- and Mtbinfected patients and warrant further investigation of MTBC strain-specific treatment.

TITLE: A New Diagnostic Toolbox: Immuno-epidemiological approach to the Diagnosis of Tuberculosis in Children

NAME: Dr Toyin Togun, MRC Clinical Research Training Fellow, Vaccinology Theme

Despite the considerable morbidity and mortality caused by Tuberculosis (TB) in children in developing countries, there is very limited research and routine surveillance data on paediatric TB, principally due to the difficulties in making a diagnosis of TB in children. Our main objective is to improve diagnosis of childhood TB by developing a new diagnostic toolbox using an integrated approach that combines epidemiological data with host and pathogen signature among TB-exposed symptomatic children.

Our results so far confirm the poor specificity of the classical symptoms of TB in children and that interferon-gamma release does not add discriminatory value to our clinical prediction model. Importantly, the combination of ‘age <5yrs’ and ‘presence of lymphadenopathy’ on clinical examination, reliably classified at least 77% of active TB in the target population. We have identified candidate host-specific biomarkers with reasonable discriminatory accuracy for active TB which we will be exploring further, towards coming up with a unique bio signature for paediatric TB.

NEWS FROM QUALITY



Quality for All

Nana Tawiah, Yai Louise Ndure-Bensouda and William Dei-Alorse

In November, the Quality Department of MRC Unit, The Gambia joined the Global Quality Community yet again to celebrate World Quality Month, a platform for acknowledging the efforts and accomplishments of quality and all who work to make it happen. Here they provide an update on their ambitious plans.

Since 2012, the department has been working hard to keep quality at the forefront of the Unit’s work, in striving towards ISO 15189 accreditation. The Unit’s Quality Management System (QMS) has adopted a process-based approach, in accordance with the requirements of ISO 9001 – and in alignment with the ultimate goal: ISO 15189 (Medical Laboratories – Requirements for quality and compliance).

The ISO 15189 international standard recognises the significant role customers play in every QMS. In fact one of the metrics used in determining the success of any business/institution is measuring customer satisfaction based on their requirements. As a result, the process-based model aims to enhance customer satisfaction by meeting the customer requirements.

ISO 15189 standard is a combination of the requirements of ISO 9001 and 17025. Therefore it promotes the process approach by enabling organisations to effectively improve their quality management systems. This model efficiently allows interactions of the numerous linked activities between customers’ requirements or ‘inputs’, managing these through the organisation’s resources, and transforming the inputs into outputs. This transformation is considered as a process.

At the simplest level, our QMS process is based on a continual improvement cycle. We need to heed feedback from customers/clients and findings through audits or monitoring visits. To remain competitive, we need to feed back the output, results achieved, including mistakes learned, back into the way of working.

The concept behind this game was to use the principles of Plan Do Study Act (PDSA) to demonstrate:

� how to approach improving or changing a process, � how to test the changes and build on knowledge gained to design

subsequent changes � how having an objective and performing multiple testing cycles lead

to improvement

After playing the game, the participants understood the concept and were able to relate this to their process improvements.

World quality month (WQM) provided an opportunity to draw attention to the continual improvement process, encouraging everyone to work together to improve their working environments and enable high quality science with worldwide recognition. The highlight of the celebrations was the Tennis Ball game that participants played.

The Quality Management department wishes to thank everyone who joined them in celebrating Quality. They also want to thank those who took the annual WQM quiz. Congratulations to this year’s WQM winners: Fatou Lette-Jallow, Adam Drammeh, and Alpha Jawo. They were presented with their gifts at the Director’s Awards ceremony.

The Quality Management team with Alpha Jawo, one of the World Quality Month winners

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The MRC Workers Credit Union exists to help staff and complement the efforts of MRC Unit, The Gambia in staff development.

Workers Credit Union: “People Helping People”

Mr Abdoulie Cham, Community Relations Officer at MRC Unit, The Gambia, was elected Chairman of the MRC Worker’s Credit Union in 2014. On 20th November, he joined all cooperate credit unions and rural branches in The Gambia to represent the MRC Workers Credit Union at the International Credit Union day celebrations.

The National Association of Co-operative Credit Unions of The Gambia (NACCUG) commemorated International Credit Union day at the July 22nd Square in Banjul. NACCUG was established in Banjul in 1991 to act as the national trade association representing approximately 70 affiliated micro-financing member credit unions in the country.

At the celebrations the Board Chairman of NACCUG, wished all attendees a happy International Credit Union 2014 and outlined the importance of the celebration. This year’s theme was "Local Service, Global Good" which promotes the positive impact of credit unions in their communities and around the world. There is a powerful global network of 57,000 credit unions, with nearly 208 million members in 103 countries worldwide. Sharing challenges, experiences and solutions with one another can bring advantages to better serve members.

The MRC Workers Credit Union exists to help staff and complement the efforts of MRC Unit, The Gambia in staff development. It aims to help staff by offering loans at reduced interest rates when it can be difficult to get a loan from the bank and interest rates can be high.

Unlike banks, the credit union is owned and managed by its members. Members make decisions and have the final say as to how they want it to be run, including interest rates and dividends to be paid on returns. The credit union has helped many staff members, for example enabling payment of education for their children or themselves, or the purchase of land.

Abdoulie, who has served in different executive positions of NACCUG, said, “The aims of the commemoration were numerous as it brought together all cooperate credit unions and rural branches in The Gambia. The aim is to promote more advocacy and remind people of the important service credit union offers to it members.

“The MRC Workers Credit Union has a close relationship with the National Association of Co-operative Credit Unions which is the parent body of all credit unions in the country. I would like to call on Unit staff to come on board and join the union which is an initiative of cooperate helping co-operatives; the credit union interest rate is just 1% per month and 12% per year compared to up to 30% offered by banks.”

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2014 Director’s Awards

The 2014 MRC Unit, The Gambia Director’s Awards were presented at a reception in December. We would like to congratulate the winners, thank everyone who nominated staff for the awards and give a special thank you to the judges, Yai-Louise Ndure Bensouda (Quality Management Department), Dr Helen Nabwera (Nutrition Theme) and Dr Magnus Ochoge (Child Survival Theme). They had the unenviable job of sifting through the entries and coming to a consensus on the winners.

Category Winner Runner-up Nominations also received for:Inspirational Leader Dr Sarah Burr Professor Beate Kampmann Dr Anna Roca, Kalilu Dibba, Serign Jawo CeesayResearch Leader of Tomorrow Dr Alfred Ngwa Dr Olubukola Idoko Fatoumatta DarboeScience Support Ms Isatou Foon Mr Simon Donkor Ebrima Bah, Lamin Manneh, Njilan JohnsonG.E.M. Award (Going the Extra Mile) Mr Abdou Gibba Mrs Kathy Hill Ebrima CambiOutstanding Team Sukuta Platform Team Trachoma Research Team Facilities, Keneba Lab and Admin Team, Research Support Office,

Transport, TBCC Team, MDV team, PregnAnzi team, PRINOGAM team.

The Recognition Award

We were pleased to present two teams from the Unit with this award.

The MRC’s Worker’s Union was also presented the Recognition Award, by Professor Umberto D’Alessandro, Unit Director, in recognition of the collaboration and contribution of the MRC Worker’s Union to the overall success of the Unit.

The Honourable Minister of Health, Dr Omar Sey, kindly attended the evening and presented the first award to the Ebola Virus Disease (EVD) Preparedness Team, Clinical Services Department, in recognition and great appreciation of their contribution in Clinical Services in EVD preparedness.

We would like to recognise the hard work, dedication and bravery of all members of the team: Ed Green, Suzanne Anderson, Amie Bah, Binta Fatty, Fatou Sanneh, Nyima Ceesay, Fatou (Matty) Camara, Fatou Jatta, Ngendeh Touray, Isatou Trewally, Gibril Bass, Sheila Jarret, Mamina Bojang.

There are another 25 clinical services team members who are trained and ready to respond, as well as the Business Continuity team, Mr Ebrima Cambi, the Research Support Office, and Nana Tawiah and Aminatta Houma-Colin from the Quality Management Department, who have been working tirelessly in the efforts towards EVD preparedness.

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MRC CEO Award: Driving change

We would like to congratulate Dr Muhammed Afolabi, Principal Investigator at MRC Unit, The Gambia, who received a runner-up award in the MRC CEO Awards in the category of ‘Driving Change’.

The MRC CEO Award Scheme recognises contributions from employees for outstanding effort and commitment to both their work and the MRC as an organisation. For the third year running, a tremendous number of nominations were received from across the MRC.

The awards are a great achievement and recognition of the contribution made by staff to the overall success of the MRC. The award ceremony was held on 7th October at the London Head Office, where Professor Sir John Savill announced the category results and presented prizes to the winners and runners up.

The award recognises the significant contributions of Muhammed’s PhD study which focused on development and evaluation of a locally appropriate multimedia tool for delivery of consent information to low and non-literate research participants.

Muhammed also developed an audio digitised questionnaire to measure participant comprehension of informed consent. The tools have been shown to improve participant understanding of informed consent and consequently the ethical conduct of clinical trials in The Gambia.

Congratulating Muhammed on the receipt of his award, Professor Umberto D’Alessandro, Director of MRC Unit, The Gambia said: “Muhammed certainly deserves this recognition thanks to his commitment to research and his ability to overcome obstacles. I would like to congratulate him for this fantastic achievement and I wish him well for new exciting research projects.”

Dr Muhammed Afolabi was presented his award by MRC CEO, Professor Sir John Savill in London.

Muhammed certainly deserves this recognition thanks to his commitment to research and his ability to overcome obstacles. I would like to congratulate him for this fantastic achievement and I wish him well for new exciting research projects.

Professor Umberto D’Alessandro

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Leaving behind a legacy of good clinical practice

After almost a decade of service, during which she pioneered the implementation of high good clinical practice standards for the conduct of clinical trials, Dr Jenny Mueller retired from her role of Clinical Trials Support Manager at the Unit in August. Malick J Bah reports.

What has been the formula to your success?I think there are two main factors. Firstly I brought in the relevant experience to build up the Clinical Trials Support office, which I started when I arrived in January 2006. Secondly I had the support of management behind me and of course the willingness of staff to employ high standards of conduct in clinical trials. I think this has been a two-sided success story.

How do you feel about leaving the Unit?As usual you have a crying and a laughing eye. The crying eye is definitely to leave a job that I like and that I enjoy doing. And of course to leave behind many lovely people; it was a great experience for me.

The laughing eye is that I can now do what I want whenever I want, and get up in the morning when I want to. I don’t know exactly what this future will bring but that is how I see it.

What has been the impact of your work at the Unit?We succeeded in setting a standard that is comparable to international standards. We were confirmed by monitors and auditors verifying that we really have set an internationally competitive standard. This means the assurance that all clinical trials conducted here at MRC Unit, The Gambia, will follow the international quality standards of good clinical practice.

I also succeeded in building up a strong team. I started the Clinical Trials Support office alone in the first one and half years but I recruited one new member and expanded the team with another member later; we worked really well together as a team.

If you could take something with you from the MRC, what would it be?Probably the wonderful working environment. I worked mainly on clinical trials but was also

supporting other research projects. There was always willingness and respect from everyone involved, without which it would have been difficult. There were many changes in the last two years, which if you get a little bit older can be difficult to deal with – that was one reason to retire.

I go into such a different life now. However I will say I am proud of what I have achieved and even though I am retiring I would still like to collaborate and offer my services to the Unit as a consultant.

What are some of the challenges you have encountered during the course of your work?The main challenge was definitely last year. In the absence of a Senior Data Manager for the inactivated poliovirus vaccine trial we took all that additional responsibility as a sponsor. It was challenging but I am proud that when the second audit was conducted during the trial, there were no critical findings and we managed it well.

What has been your most enjoyable moment?I can’t say there was really one moment but it was rewarding to get the work we did here recognised. For example there were no major findings when trials were monitored or audited that could not be solved easily. To see the fruit of our work and how new researchers have progressed, some becoming principal investigators for example, was great.

What will be your final message to the Unit and the young scientists in particular?Be committed and be honest. Honesty is very important, particularly in research. If you make any mistakes in your research, which is normal, admit them and apply correcting measures. It has been a real pleasure to work with everyone here.

Be committed and be honest. Honesty is very important, particularly in research.


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Driving the Transport Department forward

Here we meet Mr Martin Sabin, who started coming to The Gambia as a tourist 13 years ago and fell in love with the country and its people. He joined the Unit in August as Fleet Technical Services Manager.

Tell us about yourselfI decided to emigrate to The Gambia in April 2007, initially working with Euromotor Services as a Garage Manager. After a while I moved on to work as Garage Manager with ‘AB Rent A Car’, maintaining a small fleet of rental vehicles, and initiating third party repair work, thus mitigating the cost of rental fleet maintenance.

I later worked at the British Embassy as Estates and Transport Manager. Unfortunately with British Government cut backs, my job was made redundant. I am now married here to Veronica and have a beautiful daughter Emily, who has just celebrated her third birthday.

Why MRC Unit, The Gambia?The redundancy at the British Embassy coincided with the day that the vacancy for Fleet Technical Services Manager was advertised locally. I applied for the post, partly because of the redundancy, but also because of the excellent reputation that the MRC has locally – both for services provided to the local population and their reputation as a fair and ethical employer.

Initial impressions?The Unit has lived up to all my expectations. All staff are friendly and always willing to share a greeting. The Transport Department in particular is staffed by knowledgeable and competent mechanics and managers. The range and quality of the work carried out is very good, and the facilities are excellent.

What are your plans to move the workshop forward?I plan to build on the good work already evident in the Transport Department. I would like to build a stronger team ethic, and to introduce systems to effectively monitor the progress of repairs from initial report to final sign-off.

I would also like to give all mechanics experience on all of the equipment we are responsible for, thus building a more capable and flexible team, and increasing job satisfaction. I am also trying to update vehicle and service records.

Final words?I have now been here for a few months and believe I am getting my ‘feet under the table’. I can see that this role is important to the Unit as a whole, ensuring that transport issues never interfere with the important work and research that is done here.

I have always run an ‘open door’ policy, so if any members of staff want to pop in for a chat they are more than welcome! I am always open to suggestions as to where we can improve our services, and I’m always ready to discuss them. After all, I probably don’t have ALL the answers!

The range and quality of the work carried out is very good, and the facilities are excellent.

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Meet the TAMA Editorial Board

Yai Louise Ndure-Bensouda is a Quality Assurance Auditor working in the Quality Management Department at MRC. She became a member of the Tama editorial board in 2010 and has contributed to the Quality section since.

Isabel Baker is Interim Head of Communications, Chair of the Tama Editorial Board and a Science Writer at MRC Head Office, UK. Seconded from the MRC (UK), she joined MRC Unit, The Gambia in August 2014 and has been splitting her time between The Gambia and the MRC (UK). With a first class degree in Biology and experience in the medical communications industry she enjoys writing about science for non-specialist audiences and is proud to be helping communicate the Unit’s world-class research.

Sulayman Janneh is the Theme Project Manager for Child Survival. He joined the Unit in 2011 as a PA/Project Support Officer. He has been a member of the TAMA Editorial Board for 3 years and takes particular interest in covering the Social Science Research as well as Child Survival activities. Sulayman has served in many groups but none is more gratifying than being a part of the TAMA Editorial Board family where stories are told of ordinary people doing extraordinary things at the MRC.

Kalilu Dibba joined MRC Unit, The Gambia’s HR Department in 2003. Currently he is the Senior Human Resources Advisor. Kalilu worked in Cooperative Development for over 8 years under the Ministry of Agriculture and received Cooperative training at the now Moshi University College of Cooperative and Business Studies in the United Republic of Tanzania. He currently holds a graduate membership of the Chartered Institute of Personnel and Development (UK)

Muhammed Afolabi is a Clinical Scientist with a medical degree from the University of Ibadan, Nigeria. He also has a Masters degree in Public Health from another leading university in Nigeria. Muhammed is a Fellow of the West African College of Physicians. He joined the MRC in 2009 as a Clinician and has coordinated the field and clinical aspects of HIV and malaria vaccine trials. He is the Principal Investigator on a malaria vaccine trial and successfully defended his PhD from the London School of Hygiene and Tropical Medicine, UK, in January

Joan Vives Tomas is the Unit Director of Operations, MRC Unit, The Gambia. Joan has a special interest in the history of medicine and the social impact of medical research in Africa. He has been living in The Gambia for the last 4 years, but as he says “ I feel as if I just arrived yesterday…”

Tisbeh Faye-Joof is the Serology Laboratory Services Manager at MRC Unit, The Gambia. She has twelve years of hands-on laboratory experience. Tisbeh is graduated with a first class degree in Biomedical Sciences from the University of Westminster, London. She is married and blessed with two sets of twin daughters.

Fanding P Njie joined the Unit’s Communications Team in 2006 as Digital and Print Communications Manager. He manages the Unit’s print production facility and pre-press requirements. A significant part of his job involves developing and maintaining the website and web applications. He is currently doing his MSc in IT by distance learning. He is a Certified Web Professional (CIW), Certified Ethical Hacker (CEH) and an active member of the British Computer Society.

Your Feedback Please!Tama – the Newsletter of MRC Unit, The Gambia – is for everyone who is interested in our work and our community.We are keen to receive feedback and suggestions for new features from our readers. So if you have any comments, please let us know.Email: [email protected]

Medical Research Council Unit, The GambiaAtlantic Road, FajaraP. O. Box 273 BanjulThe GambiaCommunicationsTel: 4495 442 Ext. 2306Email: [email protected]: www.mrc.gm

© Medical Research Council 2015

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