Strengthening research capacity

Faculty of Medicine and School of Public Health, Makerere University, Kampala, Uganda

Makerere University is situated in Kampala, the capital of Uganda. It is one of the largest and most established universities in Africa, and now has over 30,000 students. It offers a wide range of postgraduate degrees and has an active Faculty of Medicine.

Malaria research is undertaken by several groups linked to the University, including the MU-UCSF malaria research programme built on a link between Makerere University and the University of California, San Francisco. This programme conducts high-quality malaria research (including clinical trials), builds capacity through training and strengthening of infrastructure, and helps to integrate research into policy by linking researchers, policy makers and district health centres. This programme receives support from the Gates Malaria Partnership and has strong links to LSHTM through a senior member of LSHTM staff based at Makerere.

Malaria research activities

Major initiatives and research activities currently being undertaken include:

MU-UCSF Malaria Research Collaboration research and training activities
A collaborative project between MU and UCSF with the following goals:
1. Conduct high-quality malaria research in clinical, laboratory, and community settings, 
2. Build capacity through training and strengthening of infrastructure, 
3. Integrate results of research into policy by linking researchers, policy-makers, and health workers, and 
4. Create a sustainable network of research activities and contribute to malaria control in Uganda. 

HIV and malaria co-infection in Uganda
The major goals of this project are as follows: 
1. Determine if HIV-infected children are at increased risk for symptomatic malaria, 
2. Assess the effect of malaria on the progression of HIV disease, 
3. Compare the response to therapy for malaria in HIV-infected and uninfected children and adults, and 
4. Assess the effect of TMP/SMX prophylaxis on the selection of drug resistant malaria parasites.

Interactions between HIV and malaria in African children
This study is ongoing in Tororo, on the eastern border of Uganda, an area of high HIV prevalence as well as high malaria endemicity. The hypotheses being tested are: 
1. TMP/SMX prophylaxis is effective in preventing malaria in both HIV-infected and HIV-uninfected children; 
2. The use of TMP/SMX prophylaxis is associated with an increased risk of infection with malaria parasites containing antifolate resistance-conferring mutations; 
3. The use of antiretrovirals is associated with a decreased incidence of malaria; and 
4. The efficacy, safety, and tolerability of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated malaria differ.

Strategies to Prevent Malaria and Improve HIV Outcomes in Africa- National Institute of Child Health & Human Development
The overarching goal of this project is to evaluate novel and strategic interventions to reduce the burden of malaria and improve HIV outcomes among children and pregnant women, the populations most affected by the overlap of these diseases. These studies will build on current knowledge to establish new approaches to reduce HIV and malaria burden in sub-Saharan Africa, and to advance the public health approach to both diseases. 

Uganda Malaria Surveillance Project (UMSP) Research, Surveillance and Training Programs
UMSP was established in 2001 with the purpose of creating a multi-site surveillance system for monitoring antimalarial drug efficacy and safety, malaria-related morbidity and mortality, and to build capacity for facility-based management of malaria with the goal of providing sustainable progress in malaria control. It brings together experts from the Uganda MoH, MU-SPH, MU Faculty of Medicine, and UCSF. MU-UCSF and UMSP are linked with the East African Network for Monitoring Antimalarial Treatment (EANMAT) as part of a region-wide malaria surveillance and control effort. The specific activities being conducted to strengthen malaria case management and surveillance in Uganda include:
1. Capacity building in malaria diagnosis at health facilities, 
2. Surveillance of malaria-related morbidity and mortality, 
3. Monitoring of antimalarial drug efficacy and safety and 
4. Pharmacovigilance of antimalarial drug safety.

Supporting the Implementation of Malaria Prevention and Control Strategies and Relevant Ancillary Activities in the Republic of Uganda as part of the President's Malaria Initiative
The specific objectives of this new initiative are: 
1. To develop and maintain a viable pharmacovigilance system for anti-malarial drugs in Uganda, 
2. To strengthen malaria surveillance activities in Uganda by the establishment and maintenance of a sentinel site surveillance network for the provision of quality data on malaria morbidity and mortality, 
3. To improve case management of febrile illness in Uganda and developing diagnostic capacity for malaria by supporting comprehensive training in malaria microscopy and rapid diagnostic tests for health-care workers at health centers and 
4. To evaluate the efficacy and effectiveness of anti-malarial drugs to provide timely, relevant, reliable, and understandable information to help guide Ugandan Government policy concerning those drugs.

UMSP pharmacovigilance study
These are population-based surveillance studies of the safety and tolerability of antimalarial therapy. The major goal of this project is to develop strategies for establishing a sustainable system for reporting of adverse events in Uganda, building on existing avenues of communication and local perceptions of antimalarial treatment. This system is designed to collect data from the community, and from the public and private health care sectors, using enhanced passive reporting of adverse events associated with antimalarial drugs. Pharmacovigilance is highly relevant for the implementation of wide-scale malaria control activities, and is supported by the MoH, NDA, and other partners.

Makerere University, UMSP, LSHTM, and CDC collaborative research activities. Verbal autopsy validation study in Uganda
UMSP is partnering with LSHTM and the CDC to conduct a validation study of verbal autopsy (VA) procedures in Uganda, which will be funded by PMI. This study will address a key difficulty in measuring malaria mortality in typical African conditions, where many children die outside formal health care settings. The primary objective of this study is to assess the diagnostic accuracy of VA procedures, using a questionnaire developed by the WHO, for determining malaria deaths in children less than five years of age in different epidemiological settings. In addition, we will assess the diagnostic accuracy of VA procedures in determining non-malarial deaths and other categories of death, and to develop and assess the performance of diagnostic algorithms to be used in classifying the cause of death from VA questionnaires.

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