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Mozambique Clinic Provides Malaria Treatment While Doing Cutting Edge Research - 2003-09-23

A clinic in southern Mozambique is doing groundbreaking research on vaccines and treatments for malaria, while providing healthcare for tens of thousands of local residents. The clinic is helping to train a new generation of Mozambican scientists to fight a problem that has gotten worse in recent decades.

The boy is only four years old, but this is his seventh trip to the clinic for malaria infections. His mother, Laurinda Matusse, says he has another fever now, and he appears listless and exhausted.

Mrs. Matusse says she is very worried about her boy, Sebastiao, because she knows only too well what can happen if the doctors fail to get his malaria infection under control. She says one of her children has already died of malaria, and she has had two miscarriages because she got malaria while she was pregnant.

Malaria is the leading killer of children in Mozambique, and the second-highest cause of death among adults. Worldwide, the disease kills more than a million people a year, most of them children in Africa. Children under five are most vulnerable.

Little Sebastiao may be one of the lucky ones. He and his mother are waiting to see a doctor at the Manhica district hospital, where they can get better than average care because of a unique partnership between the hospital and a research center. And although he is far too young to understand it, Sebastiao and his family may also be helping to put an end to the scourge of malaria for good.

In the center's laboratory, three technicians peer intently through powerful microscopes. Using hand-held mechanical devices, they count malaria parasites in patients' blood samples. Overseeing the lab is a young Mozambican molecular biologist, Inacio Mandomando. "When we receive a slide from the outpatient department, we stain the slide to look at the parasite of malaria," he explained.

Mr. Mandomando is one of the Manhica Health Research Center's training fellows. The training program identifies promising young scientists and doctors and helps further their education. They work at the center for a few years, and then they receive grants so they can study overseas for an advanced degree.

The center's chief administrator, Gonzalo Vicente, says the point is to give something back to Mozambique, in the form of well-trained young scientists. "This has to be a Mozambican center because we are in Mozambique," he said. "We have to create capacities in Mozambique in order that there are doctors, there are Mozambican scientists who will be able to manage this center with a criteria of scientific excellence."

The Manhica Health Research Center's philosophy is based on helping the community it serves while trying to solve the malaria problem for the world.

The Center is a partnership between the government of Mozambique and the Hospital Clinic at the University of Barcelona in Spain, one of the world's leading institutions in malaria research. It is conducting the world's most advanced clinical trial of a potential vaccine against malaria. It is also involved in other research projects looking at innovative ways to prevent the disease from killing so many children.

The newest program is a study on a therapy developed in Tanzania, known as Intermittent Preventive Treatment in Infants, or IPTI. Children under the age of one are given three doses of a common anti-malaria drug, which appears to work with their natural immune system to protect them against the disease.

Dr. Rick Klausner thinks it is one of the most promising developments in years. He is head of global health research at the Bill and Melinda Gates Foundation, which recently gave $28 million to fund research into IPTI.

"What they found is that this intermittent treatment dropped the burden of malaria by over 50 percent," said Dr. Klausner. "But what is really extraordinary is that, following these children for over a year after all of this was stopped, they continued to be protected from malaria at about the 50 percent mark. This is extraordinary. It is almost as if it is a drug vaccine. … But we need to know for sure, does it work? Does it work throughout Africa? Does it work under all conditions of malaria transmission?"

But scientists say the battle against malaria cannot be won by scientific developments alone. The center's deputy scientific director, Ricardo Thompson, says poverty and malaria feed each other, and you cannot defeat one without fighting the other.

"One thing is true," said Mr. Thomason. "I believe bed [mosquito] nets are very good. I believe vaccines are very good, if they are efficacious. I think drugs are very good, if they are efficacious. I think the integration of all these interventions can be very good. But there is no better solution than fighting poverty. Development is the ultimate tool to fight malaria."

Development would bring better sanitary conditions and more income to the people, helping them avoid malaria and fight it when they get it. Mr. Thompson, a Mozambican, says he feels the people of his country have a duty to participate in malaria research. He says not only is the disease a crippling drain on Mozambican society and the country's economy, but its effect is just as bad or worse in other parts of Africa.

The kind of malarial parasite found in Africa is the most deadly in the world, and the mosquito that carries it is among the most prolific. The parasite itself is growing more resistant to many of the drugs used to treat malaria, and the Anopheles mosquito is growing resistant to most of the insecticides that used to kill it. Those two factors have combined to make malaria much more deadly now than it was 20 years ago. In southern and eastern Africa, the malaria death rate has doubled since then.

So although research on new medicines and new insecticides continues, scientists believe developing a vaccine must be the top priority. That makes the work being done at the Manhica Health Research Center even more critical.