DR OKUMU FREDROS Going after residual in Africa In this insightful and personal interview, Dr Fredros Okumu explains his vast and varied experience studying mosquitoes that transmit malaria, and his hopes for the disease’s eventual elimination

Could you provide an insight into your four times more attractive than . I a greater chance of achieving global impact academic background, and describe what further completed an in-depth mathematical and sustainability if they are developed in first led you to develop a research interest in evaluation of the potential benefits, limitations conjunction with appropriate social and malaria control? and target product profiles of odour-baited business innovations. At IHI, our ultimate technologies for malaria prevention in goal is to align our research activities and I began health research in 2000, a few months Africa. Because of my strong interest in how technologies to meet community needs. Going after finishing high school. I worked briefly for geography relates to health, I also completed forward, we must therefore ensure that there is the International Centre of Insect Physiology Master’s research in geoinformation and Earth real social and economic value to our activities and Ecology, assisting resident PhD students observation sciences and have continued to and outputs. as a study volunteer and field technician. In work on health geographics. 2001, we began evaluating botanical products Looking ahead, what strategies need to be for controlling malaria mosquitoes in Western Your team has recently pioneered innovative implemented in order to eradicate malaria? , resulting in my first scientific manuscript. crowd-sourcing techniques to improve the surveillance of disease-transmitting To achieve zero malaria transmission, we I enrolled for undergraduate studies at Moi mosquitoes in rural . What does must re-invigorate our efforts for prevention, University’s College of Health Sciences in this involve? case finding and treatment; maintain the high Kenya (2001-05). As an undergraduate, I coverage of long-lasting insecticide bed nets; once again participated in short-term elective With the goal of low-cost participatory and thoughtfully introduce house spraying research activities, which included field approaches for targeting vector control with effective residual insecticides (indoor evaluation of sampling methods interventions, we conducted field trials in three residual spraying – IRS). Our studies have in Tanzania in 2004, and an assessment of different villages, where we gave community shown that while these strategies can be disease surveillance capabilities in the Kenya/ members gridded maps and asked them to insufficient on their own, decisions to combine Uganda border areas in 2005. In Tanzania, a rank the grids based on where they expected them should be based on local evidence, colleague and I worked for 24 consecutive 12- mosquitoes to be most abundant. Over a ensuring that selected insecticides are hour nights in the mosquito-dense Kilombero period of 12 months, concurrent mosquito trap effective against prevailing vector populations; Valley, performing a technique called ‘ surveys have consistently verified that these coverage is high enough to achieve the desired landing catches’ where one exposes his legs people correctly predicted areas as having high, impacts; and cost-effectiveness is achieved. and collects the mosquitoes that come to low or medium mosquito densities. Indeed, Moreover, we must ensure that all people bite. This is a risky sampling technique that preliminary evidence has shown great success with malaria symptoms get prompt access unfortunately remains the gold standard for and we continue to fine-tune this approach. to proper diagnosis and treatment, and that measuring human-mosquito contacts. The comprehensive surveillance-response is technique urgently needs replacing for obvious How does the concept of ‘integrated implemented even in hard-to-reach areas. ethical reasons. innovation’ underline IHI’s work on malaria? Looking ahead, we must also develop effective How have your studies on malaria As conceptualised by one of our funding new tools and strategies to complement these developed to date? partners, Grand Challenges Canada (GCC), current best practices, reducing transmission integrated innovation is the coordinated beyond the critical thresholds necessary to I joined Ifakara Health Institute (IHI) in application of scientific, technological, achieve elimination. The new strategies will late 2007 and in 2008 completed my MSc social and business innovation to develop fill gaps by, for example, controlling malaria thesis on olfactory responses of the malaria solutions to complex health and development mosquitoes that bite outdoors and would vector, Anopheles gambiae, working within challenges. This approach does not discount otherwise not be effectively controlled by an international consortium and funded the singular benefits of each of these types insecticidal bed nets or spraying. Local and through the Grand Challenges in Global of innovation, but highlights the powerful international partnerships, greater financial Health Programme of the Bill & Melinda Gates synergies that can be realised by aligning all investment, improvements of health systems Foundation. It was at this time that we also three. Integrated innovation recognises that and, most importantly, effective surveillance- developed synthetic mosquito lures that were scientific and technological innovations have response efforts remain key. 92 INTERNATIONAL INNOVATION DR FREDROS OKUMU

Scent imitation: innovations for tackling residual malaria mosquitoes in Africa

A group of researchers at Ifakara Health Institute, Tanzania, is developing innovative initiatives to lessen the prevalence of humans being bitten by and thus reduce the transmission of malaria

MALARIA HAS LONG been a major cause highlights great successes in malaria control mosquito attractants, which effectively mimic of illness and death worldwide, with by far over the past 10 years. While Tanzania is still and even exceed the lure of humans. the greatest burden of cases occurring in sub- among the most affected, the country has made Saharan Africa. Encouragingly, the past decade exemplary progress and is an excellent example The synthetic attractant has been tested has seen a huge scale-up of life-saving prevention of what is achievable, even in apparently difficult against human volunteers in field experiments and treatment interventions, resulting in sharp situations. According to recent epidemiological conducted in specially designed experimental decreases in malaria-related deaths. Yet many profiling – conducted jointly by IHI, the National huts. Interestingly, the scientists found that, at challenges remain, including the worrying rise in Malaria Control Program, WHO country office long range, the blend was three to five times insecticide-resistant mosquito populations across and the Kenya Medical Research Institute (KEMRI) more attractive to most mosquitoes than Africa and the lack of available interventions for Wellcome Trust – there has been more than a 50 the humans. The odour-blend can be readily outdoor- and early-biting mosquitoes. per cent decline in malaria prevalence in children aged between two and 10 since 2000: “Malaria Dr Fredros Okumu is a prominent research prevalence in mainland Tanzanian children is now IFAKARA scientist who is taking these challenges seriously. just under 10 per cent,” Okumu discloses. “In fact, Malaria is something that resonates personally today less than 2 per cent of people in mainland HEALTH INSTITUTE with him; he has seen it affect many people in Tanzania live in places that would be classified his community and family. Based in Tanzania at as having intense high transmission rates, while Ifakara Health Institute (IHI) is a leading Ifakara Health Institute (IHI) – an independent, more than 60 per cent of Tanzanians now live in research organisation in Africa with a strong non-profit health research organisation – he areas considered as having low transmission.” track record of scientific output and policy is currently investigating pioneering new influence. The Institute conducts research on technologies for surveillance and control that will However, these milestones are tempered with the entire continuum from basic biomedical contribute to malaria elimination. more sobering statistics. A 2012 Tanzania malaria and ecological sciences to intervention indicator survey suggested that the decline is studies, health-systems research and policy The principle of ‘integrated innovation’ is not uniform, and that progress has been slow in delivery. The Environmental Health and fundamental to all the research being carried southern and northwestern regions. More than Ecological Sciences thematic group – where out at Ifakara. Based on this, Okumu and his 90 per cent of Tanzania’s 45 million inhabitants most of IHI’s malaria research takes place team aim to build a practical and community- still live in areas at risk of malaria, representing – hosts 20 postdoctoral scientists and 20 focused outdoor mosquito control strategy, enormous health and economic concerns. There PhD or MSc students. The group’s scientific complementing current indoor-focused are currently an estimated eight to 12 million findings are regularly published in renowned interventions such as long-lasting insecticide malaria cases, and approximately 21,000 deaths peer-reviewed journals, and the researchers treated nets (LLINs) and house spraying with throughout the country annually. regularly participate in local and international residual insecticides. He is also conducting fine- scientific conferences. There is also strong scale surveillance of residual malaria vectors in emphasis on public outreach. Each year SYNTHETIC ODOUR BLENDS areas where these existing tools have already IHI hosts a National Malaria Forum, and significantly reduced the malaria burden but Certain malaria-carrying African mosquitoes have participates in regular meetings hosted by where transmission persists. This strategy will adapted to feed almost exclusively on humans, the Ministry of Health to update stakeholders lead to progressive reduction of both indoor and relying on chemicals present in human breath, on new findings and discuss how to improve outdoor malaria transmission, thus accelerating sweat and skin emanations to select their targets. current practices. The Institute also has a elimination of the disease in many low- and Many human odorants can be synthesised in special long-term relationship with rural and middle-income endemic communities. vitro and formulated into mixtures that mimic urban communities, whose members and humans, subsequently luring mosquitoes. In local health officials are regularly briefed on collaboration with research partners in the US the research progress at IHI through formal ACHIEVEMENTS AND CHALLENGES and Europe, Okumu and his colleagues at IHI feedback sessions. The most recent World Health Organization have used innovative techniques to develop and (WHO) World Malaria Report, published in 2013, evaluate odour blends consisting of synthetic For more information: www.ihi.or.tz

WWW.RESEARCHMEDIA.EU 93 INTELLIGENCE developed into accurate surveillance tools and have shown they would be highly acceptable perhaps even alternative interventions against and effective in rural and remote communities, INNOVATIONS FOR TACKLING RESIDUAL mosquitoes that transmit malaria parasites and a where mains electricity coverage is often less MALARIA MOSQUITOES IN AFRICA variety of other important pathogens. than 5 per cent,” enthuses Okumu. Indeed, lack OBJECTIVES of electricity access means that many Tanzanians rely on kerosene lights, firewood and moonlight, To develop mosquito control and surveillance requiring that significant proportions of evenings technologies that could complement current are spent outdoors, with an increased risk of best practices, so as to achieve malaria Okumu and his team aim to being bitten by mosquitoes. elimination in affected populations in Tanzania build a practical and community- and other low-income endemic countries. To FUTURE TARGETS FOR SURVEILLANCE maximise effectiveness, these innovations are focused outdoor mosquito control AND CONTROL OF RESIDUAL VECTORS being integrated with social innovations, to ensure affordable and sustainable community- strategy, complementing existing Although the global malaria burden has driven vector control. dropped in recent years, this progress has indoor-focused interventions evidently started to plateau. Along with new KEY COLLABORATORS interventions, improved malaria surveillance is vital to achieve elimination – yet as malaria Dr Rose Nathan; Dr Honorati Masanja, IFAKARA WELLBEING BOXES Ifakara Health Institute, Tanzania • Dr Sarah declines it is becoming increasingly difficult to J Moore; Professor Marcel Tanner, Swiss Promisingly, Okumu and his team have developed detect new infections and measure transmission. Tropical and Public Health Institute • Dr Gerry low-cost methodologies for dispensing these Additionally, measuring exposure is still unsafe Killeen, Liverpool School of Tropical Medicine, synthetic odour blends; designing outdoor due to its reliance on human volunteers, and a UK • Professor Jason Mathiopaulos; Dr devices dubbed ‘Ifakara Wellbeing Boxes’, or lack of suitable, affordable and scalable trapping Heather Fergusson, University of Glasgow, simply ‘Nancy Boxes’ (named after the PhD methods provide additional complications. UK • Professor Alvaro Eiras, Federal student who led most of the trials on the University of Minas Gerais, • Professor device). They believe that placing these boxes In view of these challenges, Okumu and his Willem Takken, Wageningen University and at optimal sites in malaria-endemic villages team at IHI are eager to continue developing Research Centre, The Netherlands • Dr Klaus where LLINS are also used will kill significant practical strategies for monitoring densities and Schonenberger, Swiss Federal Institute of numbers of mosquitoes, thereby disrupting transmission activities of residual malaria vector Technology Lausanne (EPFL) • Dr Andreas malaria transmission to humans. Mathematical populations. The researchers have begun to Rose Maria, Biogents AG, Germany. evaluations have corroborated this hypothesis, translate their experiences with synthetic odours suggesting that in places with high (80 per cent) and mosquito trapping technologies into systems FUNDING bed net coverage, approximately 20 devices that facilitate large-scale mosquito sampling Bill & Melinda Gates Foundation per 1000 people are needed to reduce malaria without the need for human volunteers. Working Grand Challenges Canada transmission beyond the critical thresholds with collaborators in the UK, Switzerland, Wellcome Trust necessary to achieve elimination. Tanzania and Brazil, Okumu and his team are also designing quantitative ecology models for CONTACT These innovative wellbeing boxes – which the multi-scale targeting of mosquito densities Dr Fredros Oketch Okumu are powered by solar energy – complement and malaria transmission. These models rely Research Scientist and Head of Thematic Group existing indoor malaria prevention methods: on observable biotic and abiotic environmental “They also provide energy for lighting, mobile variables to target residual transmission at both Environmental Health and Ecological Sciences phone charging and home tuition for school- landscape- (between villages) and fine-scale level Thematic Group going kids; and our anthropological studies (within villages). Ifakara Health Institute Plot 463, Kiko Avenue, Mikocheni Dar es Salaam, Tanzania >90% transmission mediated by vectors that 30-50% transmission mediated by resilient vectors that bite T +255 686 997 269 predominantly bite humans indoors and rest outdoors humans outdoors, rest outdoors and readily bite non-human hosts 450 E [email protected]

FREDROS OKUMU is Research Scientist at the 350 Impact of malaria interventions Ifakara Health Institute, where he is also Head (LLINs, IRS, diagnostics, of the Environmental Health and Ecological treatment and chemoprophylaxis) Sciences Thematic Group. He originally trained as a public health officer in Moi University’s 250 College of Health Sciences in Kenya and has Master’s degrees in Medical Parasitology and Entomology (, Kenya) and 100 Impact of improved living Getting to zero will require standards and urbanisation effective new tools for Geoinformation Science and Earth Observation surveillance and control of (Lund University, ). Okumu obtained 50 the residual vector species a PhD in Infectious Tropical Diseases from the London School of Hygiene and Tropical Medicine

in 2012 and was awarded the American Society transmission ( no. infectious bites per of malaria force Approximated villiage Tanzanian observations in a rural on ), based year person per 10 of Tropical Medicine and Hygiene Young 2000 2003 2005 2008 2010 2013 2015 Investigator Award in 2009. He is presently Nearly 1 million lives saved in Africa since 2000, due to enhanced malaria vector control, but there remains residual Wellcome Trust Intermediate Research Fellow in malaria transmission mediated by resilient and resistant sub-populations of vectors Public Health and Tropical Medicine. MAIN RESEARCH TEAM: Fredros Okumu, PhD (Team Leader); Robert Sumaye, PhD; Nancy Matowo, MSc; Arnold Mmbando, BSc; Stephen Mwangungulu; Irene Moshi, MSc; Edith Madumla, BSc; Salum Mapua; Gustave Mkandawile; Joseph Mgando; Sarah Mtali; Godfrey Ligamba; Emmanuel Kaindoa, MSc; Johnson Swai, BSc; Mwajabu Hamis, MSc; Sebard Mteteleka, BSc; Halfan Ngowo, BSc; Alex Limwagu; Elihaika Minja, BSc and Dickson Lwetoijera, PhD. 94 INTERNATIONAL INNOVATION