Communities of practice
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Africa needs a new generation of scientists
4 Dec 2009
Tatum Anderson
Source: TropIKA.net
Professor Fred Binka.
Pessimism is rife when it comes to millennium development goals and whether they will be met in much of Africa. But one district in the north eastern corner of Ghana has managed to buck the trend.
Mortality rates in the district of Kassena-Nankana, a rural area near the border with Burkina Faso, have more than halved over the last 16 years. Importantly, the district looks set to achieve the millennium development goal on maternal health (1). The results have been attributed to a host of interventions – from vitamin A supplements and family planning, to insecticide-treated bednets.
Many achievements here have been put down to the effects of a demographic surveillance site (DSS), a research centre that continuously monitors households in the district. It records – among other things – births, deaths, causes of death, and migrations in and out of the area. That level of detail is unusual, as so little is routinely collected in rural sub-Saharan Africa.
That makes measuring the effects of new tools - such as insecticide-treated bed nets – much easier, says Professor Fred Binka, the first director of the site, which is based at the district capital Navrongo. “In Navrongo we can state today that district will meet the millennium development goals,” he says. “We don’t have to wait for others to tell us. We’ve been collecting data and charting year by year. It’s wonderful to have that.”
Gathering data regularly actually ends up having an effect on overall health of the population too. “You do something to the population – you change their habits. That’s the beauty of it,” he adds.
The Navrongo Health Research Centre (NHRC) evolved out of a groundbreaking large-scale study led by David Ross of the London School of Hygiene & Tropical Medicine with a team including Binka. An epidemiologist, he was employed to direct field work, including managing a team of field workers who collected data from 10,000 compounds every four months.
Indeed Binka left his job at Noguchi Memorial Institute for Medical Research in the capital to take up the post in an area so rural, the research team had had to dig a well to get started. “He knew all of that and still came. He had a perfectly good, secure job but wanted to learn how to do a big epidemiological study,” says LSHTM’s Ross. “There weren’t very many people who would do that.”
It was worth it. That study
, which established that vitamin A supplements substantially reduced mortality by reducing the effect on diarrhoeal diseases, respiratory infections and measles, was also the blueprint for a new surveillance site. The site had established an army of field staff, trained school leavers who helped many students through school and on to university – often with money earned from fieldwork – and even provided library services at Navrongo, says Ross. No one wanted all that work lost, so funding was found – initially from IDRC and then others, including Rockefeller Foundation – to establish a permanent site. Binka was appointed director and stayed for almost a decade.
South–South collaboration
It was Binka who later sent a team across to East Africa to set up a similar DSS site in Tanzania in a classic piece of South–South collaboration. “Navrongo was using innovative software and field techniques that were developed specifically to suit Africa,” says Professor Don de Savigny who worked in Tanzanian on the Rufiji DSS and is now based at the department of Epidemiology and Public Health at the Swiss Tropical Institute (STI) in Basel. “We avoided what was probably years of delays. We were able to start very quickly without any teething pains.”
The Ghana–Tanzania collaboration led Binka, de Savigny, Ross and other like-minded epidemiologists to set up a network of surveillance sites around the world. Called the INDEPTH Network, it has since swelled from 17 to over 35 sites from Tanzania to Thailand and is, arguably, the largest in the developing world. The not-for-profit organization publishes joint epidemiology monographs and publications. Information coming out of the joint studies is large-scale enough to influence global strategies, says de Savigny who, with Ross, remains on In-Depth’s Scientific Advisory Committee (SAC).
Importantly, the strong research basis at the sites spawned the Malaria Clinical Trials Alliance in 2006. Funded by a grant from Bill & Melinda Gates, the Alliance was developed by Binka to strengthen 16 clinical trials sites in 10 African malaria endemic countries. The aim is to be a network of sites that can be used by companies and product development partnerships that want to trial in Africa. Today, 11 of those sites are being used to test RTS,S, the malaria vaccine that is at the most advanced stage of development with fellow Gates grantees Malaria Vaccine Initiative (MVI) and the Medicines for Malaria Venture (MMV).
And there are plans afoot to run phase I trials of an interesting new vaccine from Sanaria, a US biotech company headed by Stephen L Hoffman. Sanaria’s PfSPZ vaccine is a weakened form of the whole malaria parasite harvested from irradiated mosquitoes and is likely to be tested in Burkina Faso at the Nanoro trial site managed by Dr Sodiomon Sirima of the country’s National Centre for Malaria Research and Training.
A new generation of African researchers
Although still involved to some extent with INDEPTH and MCTA, Binka has now relinquished his management role and is full-time dean of the University of Ghana’s School of Public Health.
The plan is to create the next generation of African researchers. The groundwork was laid at Navrongo. Many who trained there are now heading up DSS sites elsewhere or work in senior global health positions further afield. The MCTA has also trained a new generation of researchers to run trial sites that are available to test new drugs and vaccines.
Today, Binka says he is attempting to introduce a curriculum steeped in on-the-ground practical field experience he has gained in Navrongo. “I’m trying to bring new programmes that are relevant for today and build a research focus for the school,” he says.
Masters’ students are more often than not assigned to rural district to work on practical implementation problems with Ghana health service. “He harnesses the bright young students to get their boots dusty,” says STI’s de Savigny, who now reads the dissertations as external examiner. “I’m convinced it’s going to become a leading institution in Africa for public health in no time.”
New courses have followed; a Masters in epidemiology and disease control, which for the first time teams physicians and laboratory technicians with vets to track emerging infectious diseases. That model is gathering interest. Earlier this year, the school hosted a meeting with CDC and several other African countries on the approach.
This year too, the school introduced an MA in clinical trials – the first of its kind on the continent. Usually, the skills required to carry out clinical trials are usually picked up informally on the job. Binka says formal training in clinical trials is the only way to increase the number of African researchers, regulators, and ethics board members and cope with the increased complexity of trials.
Frustration with government
But the increase in African scientists, clinical trials and surveillance sites has been achieved in spite of, not because of, support from African governments says Binka. Indeed it is such a long hard slog to get innovative projects up and running, it’s hardly surprising so many bright and promising young scientists leave at the first opportunity he says. “You only find the lucky few that make it through all these challenges,” he adds.
“My biggest anger is with African governments – they do not fund science or research. They should be ashamed with themselves,” he says. “My country doesn’t put a dime into research.”
The paucity of investments in science is short-sighted he says. Countries do not have to be rich to invest in research and investing in expertise – more than just salaries - will reap benefits in the long term. “I’m not saying they should put a billion dollars in, but putting zero is not good enough,” he says.
With adequate investments countries would be less likely to import solutions that are not suited to them, says Binka.
Frustration is not just reserved for governments. Somewhat disillusioned with international efforts such as Roll Back Malaria Partnership (RBM) where he was a senior advisor and European Developing Countries Clinical Trials Partnership (EDCTP), where he served as board member, Binka left both to pursue other, more promising, projects.
His work on MCTA was a direct response to the lack of progress in funding new trial sites at EDCTP for instance. New infrastructure is vital says Binka. “They must put money into infrastructure so sites don’t look like old World War 2 remnants,” he adds. “African hasn’t got infrastructure to deliver and [international trial regulations] demand a change in the way infrastructure is designed and built.” Many problems exist today, he says. There are still not enough clinical trial sites, despite work by MCTA and another group, AMANET, which is upgrading other infrastructure and providing training too.
There must be far more investment in post-doctoral fellows too. “The North grew their scientists on the concept of postdoc fellows. You have a PhD and then you learn how to be on your own,” he says. “They have yet to establish a postdoctoral fellowship in Africa. How can we have the next generation of scientists?” EDCTP declined to respond.
About Fred Binka
Born: Fred Newton Binka was born in 1953 in Ghana.
Education: 1978 Legon University of Ghana medical degree, an MB. (ChB with a credit in community health), 1988 MPH with distinction from The Hebrew University, Jerusalem, Israel. 1997 PhD in epidemiology with a summa cum laude from the University of Basel in Switzerland.
Awards: First recipient of Rudolf Geigy Award 2001 for excellence in science and for dedication and outstanding contributions to malaria control and health development in Africa. Awarded by the R Geigy Foundation in Basel, Switzerland.
Career highlights:
Dean of School of Public Health, University of Ghana
Associate Professor of Epidemiology at the School of Public Health, University of Ghana in 2001
Executive Director of the INDEPTH Network
Medical Officer, Roll Back Malaria, World Health Organisation, Geneva (1998-2000)
Honorary Research Fellow in epidemiology and population sciences at the London School of Hygiene and Tropical Medicine (1994-1999)
Director, Navrongo Health Research Centre. Ministry of Health, Navrongo (1992-1998)Member of the National Malaria Advisory Committee that was set up to advise the Minister of Health on all matters related to malaria control in Ghana (1996-1999)
Epidemiologist and Head of Fieldwork, Ghana Vitamin A Supplementation Trials (1989-1991).
Reference
1. Mills S, Williams JE, Wak G, Hodgson A (2008). Maternal mortality decline in the Kassena-Nankana district of northern Ghana. Matern Child Health J; 12(5):577-585. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17957459
Selected publications
Arvay ML, Curns AT, Terp S, Armah G, Wontuo P, Parashar UD, Binka F, Glass RI, Widdowson MA (2009). How much could rotavirus vaccines reduce diarrhea-associated mortality in northern Ghana? A model to assess impact. J Infect Dis. 2009 Nov 1;200 Suppl 1:S85-91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19817619
Adjei GO, Goka BQ, Binka F, Kurtzhals JA (2009). Artemether-lumefantrine: an oral antimalarial for uncomplicated malaria in children. Expert Rev Anti Infect Ther;7(6):669-81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19681693
Binka FN, Bawah AA, Phillips JF, Hodgson A, Adjuik M, MacLeod B (2007). Rapid achievement of the child survival millennium development goal: evidence from the Navrongo experiment in Northern Ghana. Trop Med Int Health; 12(5):578-583. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17445125
Baiden F, Hodgson A, Binka FN (2006). Demographic Surveillance Sites and emerging challenges in international health. Bull World Health Organ; 84(3):163. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16583067
Binka F, Akweongo P (2006). Prevention of malaria using ITNs: potential for achieving the millennium development goals. Curr Mol Med; 6(2):261-267. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16515516
Chandramohan D, Owusu-Agyei S, Carneiro I, Awine T, Amponsa-Achiano K, Mensah N, Jaffar S, Baiden R, Hodgson A, Binka F, Greenwood B (2005). Cluster randomised trial of intermittent preventive treatment for malaria in infants in area of high, seasonal transmission in Ghana. BMJ; 331(7519):727-733. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16195288
de Savigny D, Binka F (2004). Monitoring future impact on malaria burden in sub-saharan Africa. Am J Trop Med Hyg; 71(2 Suppl):224-231. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/15331841
Binka FN, Hodgson A, Adjuik M, Smith T (2002). Mortality in a seven-and-a-half-year follow-up of a trial of insecticide-treated mosquito nets in Ghana. Trans R Soc Trop Med Hyg; 96(6):597-599. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12625130
Debpuur C, Phillips JF, Jackson EF, Nazzar A, Ngom P, Binka FN (2002). The impact of the Navrongo Project on contraceptive knowledge and use, reproductive preferences, and fertility. Stud Fam Plann; 33(2):141-164. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12132635
Ngom P, Binka FN, Phillips JF, Pence B, Macleod B (2001). Demographic surveillance and health equity in sub-Saharan Africa. Health Policy Plan; 16(4):337-344. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11739357
Ngom P, Akweongo P, Adongo P, Bawah AA, Binka F (1999). Maternal mortality among the Kassena-Nankana of northern Ghana. Stud Fam Plann; 30(2):142-147. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16617548
Binka FN, Nazzar A, Phillips JF (1995). The Navrongo Community Health and Family Planning Project. Stud Fam Plann; 26(3):121-139. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7570763
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