Thursday, March 27, 2008

What's grunt got to do with it?

I've been thinking a lot about grunting and flailing during March Madness.

In addition to the requisite athletic exertion by teams, there’s a veritable Olympics of the spectators – the hand waiving, gasping, forehead smacking, fist clenching, roar and grunting that comes with cheering a team on. It’s a lot of work.

And I can’t help but notice it doesn’t really GO anywhere, other than a vague feeling of gratitude that no one’s posting you and your gyrations on YouTube.

I’m kind of a spectator spectator when it comes to sports (I go to games to people watch. Sue me) but I do my own share of flailing without purpose. Today, my dog, who takes homeland security seriously, maimed a stray cat in my yard, and I had to have poor kitty put to sleep. Lots of mental gyrations here.

So I’m laying down a challenge for the armchair grunters and flailers – sports-induced or otherwise: How about after an exhilarating afternoon of athletic grunting and flailing, you channel those feelings -- be they celebration or despair -- by buying a net or two? 10 bucks, I argue, can buy a bit of mental peace. $20 may buy me back into heaven.

Even though I've already bought a fair amount of nets, I'm gonna go buy another one. For the poor kitty. Because my flailing isn't doing anybody any good. But buying a net will help a family in Africa that's got a lot more worries than I do.

This way, I can feel like I slam dunked something.

As I write this, we're 22 percent of the way to the goal. That's cool -- but it's still a ways from those nets.

Wednesday, March 26, 2008

World Malaria Day and an Update

World Malaria Day is Friday, April 25. Plans are in the works for some type of activites on the MSU campus. Check back for more details.

We're 22 percent of the way toward our goal! This means the MSU community has sent more than 220 bed nets to Africa. Which means lives have been saved. Give yourselves a pat on the back!

Thanks to Lorraine for posting the comment about the Jazz Benefit Concert for Bed Nets on March 30. For more information, click the link she posted.

Monday, March 24, 2008

Donation update

We moved up to 18 percent of our goal over the weekend. And the Spartan basketball team defeated Pittsburgh to move on to the Sweet 16 and No. 1 seed Memphis. A nice two days all the way around. Any predictions on next weekend's scores? Thanks again to all.

Friday, March 21, 2008

A Quick Thanks

Just a quick note to say thanks to Ned for posting very interesting and helpful information. Also thanks to all who have donated -- we're up to 16 percent of our goal. And congrats to the basketball team for beating Temple! On to the second round!

Wednesday, March 19, 2008

Response to Sandra's comment

I wanted to respond to Sandra's comment about the Nothing but Nets program too, as has Jamie. Sandra expressed concern in her comment that this program could undermine the local bed net economy, and she noted that bed nets in Malawi were cheaper by half than the $10 donation/bed net in the Nothing but Nets program. Thanks to Sandra for bringing these points of view to our attention.

RETAIL MARKETS AND BED NET DISTRIBUTION AND USE
There has been a lot of focus on how to get bed nets into communities of rural Africa, and it led to a pretty sharp debate that seemed to follow the political spectrum to a certain degree. On the one hand was a group of people who felt that retail market forces should drive purchasing decisions. However, it has been determined that under these conditions, when people could simply pay for their own nets in the retail market on the basis of an economic choice when a wide range of choices exists (buy food, a new bicycle tire, a battery for the radio, cell phone time, medicines), that bed net purchases fall behind and the number of bed net users in a community does not rise to a sufficiently high level to lower malaria transmission. Here, it is important to understand that bed nets are really best thought of as community protection tools, as opposed to personal protection devices. The goal is to get as many people using them as possible in a community, so that mosquitoes die and malaria goes away.

Given this observation, a series of "social marketing" programs were tried in several different countries, including Malawi. Traveling shows would put on music events and education programs, hand out hats and t shirts, and try in this way to market bed nets by raising social consciousness of them. Those programs didn't work well either. In both cases, people had to pay part or all of the price of the net and in the realm of choices, bed net purchases were down the list of priorities for people.

On the other end of the spectrum (and I'll admit this is where I fall) is to consider that bed nets are a public good, much like a vaccine, and that poor people should be given them through national roll out programs. But somebody, somewhere, still has to provide the funding to buy the nets. This is where the Nothing but Nets program, the President's Malaria Initiative, and others like it come in. National ministries of health have partnered with this idea.

I recently saw a graph of bed net use in Kenya surveyed from the late 1990s to 2007. Use rates very slowly went up with the initiation of retail sales, but stayed low overall. When the national rollout campaign began in 2006, use rates shot up rapidly to nearly 60%. This shows that the retail market system is inadequate to achieve the high use rates needed to have an impact.

TYPES OF NETS
Another comment is about the kind of nets. There are actually no bed net manufacturers in Africa. The companies that make them are typically "first world." Nets are mostly made in factories in India, Thailand, and Vietnam, and are imported. So, undermining the local economy is not really an issue. A single bed net factory in Tanzania has been constructed to produce Olyset Net, a brand owned by Sumitomo, but the quality of these nets has been variable. Many countries have agreed to eliminate import tariffs on nets to keep prices down.

The cheaper nets that Sandra refers to are an older formulation that need to be retreated with insecticide every 6 months or so, and that are not wash durable. They remain on the market under several brand names but are now being replaced by LLINs. The newer types of nets are so called Long Lasting Impregnated Nets or LLINs and these are wash durable, do not need to be retreated, and may last for up to 5 years depending upon the type of synthetic fiber used in them. These indeed are more expensive and are of the type that Nothing but Nets and other programs purchase for distribution. They are superior to the other non-wash durable types in all respects and in the long run are cheaper because they last so much longer. All of them are manufactured by "first world" companies, e.g., Vestergaard Frandsen of Denmark, Sumitomo of Japan.

ECONOMICS OF MALARIA
The idea that donating bed nets would undermine the local economies of rural Africa (which I think is highly unlikely given the above discussion) must be balanced by a discussion of the positive economic effects that alleviating the malaria burden has. When bed net use is high enough to reduce malaria transmission, there are healthier pregnancies, healthier newborns, fewer trips to clinics for malaria treatment, fewer medicine purchases, higher school attendance rates, and better growth and development of children. When the human population is alleviated from the malaria burden, there is a surplus of resources that otherwise would have gone to malaria prevention and malaria treatment; this surplus can then be used for other types of economic activities. All of these outcomes have clear, positive economic effects and could be viewed as part of a larger, socioeconomic and development context. I believe Jeffrey Sachs and the Earth Institute through its Millenium Village program is having a look at these economic benefits; certainly Dr. Sachs has written about it.

Bed net research in western Kenya

Notes from Ned:

I wanted to post some information here about my research on insecticide treated bed nets in Kenya, and to show how the research is related to the Michigan State Nothing but Nets Team. Interestingly, none of the research described below has a direct relationship to the Nothing but Nets program. The donations are not used for my research. I am not even sure that any of the nets obtained through the program will even end up in Kenya, vs. another country or setting, but that is fine. I asked the Nothing but Nets administrators if there was a way to steer the funds to western Kenya to identified villages as a philanthropic activity, but that is not the way the program operates and they were not able to support this idea. Rather, Nothing but Nets at the programmatic level interacts with the United Nations, the World Health Organization, the Global Fund, the Gates Foundation, and other groups to ensure that the bed nets purchased by donations arrive into users' hands in needy areas of a wide variety of countries. The distribution system, interestingly, is tied to measles vaccination programs in ante-natal medical clinics, so that pregnant women and women with newborns can learn about bed nets and have access to the bed nets when they come in for care and for vaccinations for their children.

The main thing is that we know that use of bed nets really helps to push malaria infection down wherever they are used in SubSaharan Africa, and that is a worthy philanthropic goal and participating in a program like this one is very unifying. It brings people together who otherwise would never interact with each other. My motivation is to think with my head and my heart as my technical studies of bed nets in Kenya go forward. Just doing the science alone, without trying to apply the results of the research to achieve a noble end such as alleviating the malaria problem, is not enough for me.

RESEARCH VENUE AND PARTNERSHIPS
My research engages two partner organizations: the Kenya Medical Research Institute and the US Centers for Disease Control. These two groups have themselves formed a partnership to conduct research on infectious diseases in western Kenya, including malaria. The governments of Kenya and the United States signed a cooperative agreement to work together in this way. They have constructed a laboratory complex in a village called Kisian, which is about 10 km west of the city of Kisumu. The research station is called the Centre for Global Health Research. Kisumu is the third largest city in Kenya, and is located on the shores of Lake Victoria. University researchers such as myself can bring forward projects to this research station, particularly if external funding is available (which we do have) and if the Kenyan and US staff scientists based at the station agree to collaborate (which they have). My main collaborators in Kenya are Dr. Nabie Bayoh, Dr. John Vulule, Dr. John Ayisi, Dr. Luna Kamau, Dr. Simon Kariuki, and Ms. Damaris Matoke. Two key staff members are Mr. George Olang and Mr. Maurice Ombok. On the US CDC side, my main collaborators are Dr. Mary Hamel, Dr. Kayla Laserson, Dr. Ya-Ping Shi, and Dr. John Gimnig. The other MSU scientist involved is Dr. Joe Messina. So you can see that this is really a team effort which I feel privileged to lead.

RESEARCH ACTIVITIES
Anopheles mosquitoes
The research itself builds upon several recent studies at this same site, including some of my own work, on how community-based implementation of insecticide treated bed nets affects the mosquito populations and the intensity of malaria transmission. We already know, based upon a set of randomized field trials conducted in this setting and in 4 other locations in SubSaharan Africa, that when most people in a community use bed nets nightly for an extended period, malaria transmission goes way down and the burden of malaria infection in children and pregnant women also goes down. What we don't know is how sustainable this kind of program is, and what the potential long term consequences are. My particular interest has to do with what we call the "population structure" of the mosquitoes and the malaria parasites. For the mosquito populations, we think that the widespread use of the bed nets causes a shift from a mostly human feeding form of Anopheles to a mostly cattle feeding form, with an overall reduction in density of the mosquitoes too. Those are both highly desirable outcomes. We will test this idea over a 5 year period, to see if such a desirable shift occurs and sustains itself. Secondly, we are concerned about the emergence of insecticide resistance in the mosquito populations, so we are establishing some long term studies on the kind of insecticide resistance (either "target site" resistance or "metabolic" resistance) and are putting into place some methods and procedures to analyze the frequency of these traits genetically in the mosquito populations. Thirdly, we are interested in the interactions of lowered mosquito density and the rate at which genes conferring insecticide resistance "flow" or move through populations, which obviously will affect its spread.

Malaria parasites
Our research on malaria parasites parallels that of the mosquito research described above. As transmission drops with increased bed net use in western Kenya, we will study the "population structure" of the malaria parasites using molecular methods to study genetic factors in the parasite populations. It is important because malaria has always been very resilient to control; history has shown that it is a difficult disease system to manipulate for purposes of controlling it. The malaria parasites are tough. They easily evolve resistance to drugs, and they have virulent forms. One thing that sometimes happens in disease control programs generally is that the control results in emergence of more virulent forms of pathogens. We would like to know if that happens in the malaria parasite populations during the course of a long term bed net implementation program. So we are studying some of their "virulence factors" using genetic methods. Secondly, we are studying the frequency and form of antibiotic resistance in the malaria parasites. Just as with the insecticide resistance issue mentioned above, we would like to find out if the use of bed nets (which we know already causes a drop in malaria transmission) also concomitantly results in reduced frequency of antibiotic resistance in the parasite populations, and reduced gene flow of the genetic factors underlying this resistance. Wouldn't it be wonderful if use of bed nets turned out to be a way to manage drug resistance in malaria parasite populations? So we are having a look at that possibility.

People
Lastly, we are studying people. There are two aspects to our studies of the rural residents of western Kenya where our bed net studies are taking place. First, we would like to know how well these people adopt the use of bed nets into their homes and their lifestyles. We have a situation underway where one population of people has already been engaged in a long term bed net study and so have been educated about their use and are very familiar with them. The other population of people has had no such experience but now has the opportunity to obtain bed nets through a Kenyan national bed net campaign voluntarily, but one that does not include an educational component. Will this latter group assimilate use of bed nets to a high enough coverage rate in their villages to have an effect? What is their knowledge of bed nets, and their opinion about them? We will ask them about these things, including economic and other barriers to use. It may be that we will find out that education is a crucial component of the national program, but as of yet we have not started that part of the study. You can see that this part of our research is oriented toward social sciences rather than biological sciences.

The second aspect of our study with people is more medical and epidemiological. We are enrolling groups of people (babies, children, and adults) into a program where we will obtain a small blood sample from them and analyze the blood for presence, type, and number of malaria parasites. We will also test the people for anemia, and we will use the malaria parasites we find for the studies outlined above. When we find malaria-infected people, we will treat them for the infection. This part of the study will engage people in the two study populations described above, i.e., the group that has had a long term experience with bed net use and the group that has not had this experience. We will do these studies over a 5 year period, with the goal being to find out if bed net use programs sustainably reduce malaria infection over the long term.

Thanks for your support and comments

First, thank you to all who have donated. As of this morning, we've achieved 15 percent of our goal. Outstanding!

Second, I'd like to thank Sandra for her thoughtful comments. I've asked Ned Walker to respond since he has been to Africa many times and has worked with local communities on bed net projects. While it would be great to buy all bed nets locally, my understanding is that there just aren't enough of them to meet the need. Also, the $10 per net cost through Nothing But Nets includes an education component -- what it is and how and why it works and why it's important to use it every night, as well as general information on how malaria spreads, its symptoms and how it's treated.

I have to admit I'm a little puzzled by your comments about bed nets creating tension. If it's that people will be upset if some households get nets and others do not, that could be valid. But based on my conversations with Ned, aid groups are working with local communities to make sure that everyone who wants a net gets one.

I'm sure that Ned will have more insights for us.

Thanks again to everyone!

Monday, March 17, 2008

We've Met 10 Percent of our Goal

The generosity of Spartan faculty, staff, alumni and friends is amazing. We've been engaged in this campaign for three days and we're already 10 percent toward our goal. Thanks to everyone for your support.

I see that MSU will be playing Temple in the first round. I hope our success rubs off on the basketball team and we're all cheering "Nothing But Nets!"

Friday, March 14, 2008

A Big Thank You!

I'd like to thank everyone who donated so far! We've only had the site up and active for a day and we're already 7 percent of the way to our goal. That's fantastic! We only get notification that someone donated (not your email address or the amount), so I can't send you all personal thanks as I'd like to do. But we are most appreciative!

It's also exciting that the Spartans beat Ohio State this afternoon to advance in the Big Ten tournament. As they move on, we're hoping that CBS, ESPN and other media hear about our Nothing But Nets campaign and cover it. If anyone's going to tomorrow's game against Wisconsin, make a sign!

Have a great weekend!

Thursday, March 13, 2008

Excitement about Bed Net Success

As part of his research, Ned Walker travels regularly to Africa and international conferences. Here are short reflections from two trips:

I just returned from the annual conference of the American Society of Tropical Medicine and Hygiene, where some of our work was presented but where further there is a general excitement about the clear reductions in incidence of malaria owing to national roll out campaigns of bed nets in Africa.

On my trip to Kenya I consulted with local Kenyans about this idea, in particular to pick some communities (villages) that we could use as partnered sites for a net distribution program. Two villages -- Tiengre and Kakwema -- near Kisumu in western Kenya are interested and offer local cooperation.

Why Bed Nets?

Despite its apparently simplicity, malaria has resisted rigorous attempts to control it. That is, until recently when insecticide-treated bed nets have emerged as a powerful and simple control tool. What we don't know is whether malaria will find some way to overcome this disruption to its system. That's what Ned Walker and his team are studying.