social sciences in malaria control

TRENDS in Parasitology Vol.18 No.5 May 2002

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195Research Update

Meeting Report

The second annual meeting of the

Partnership for Social Sciences in Malaria

Control was held at the London School of

Hygiene and Tropical Medicine, UK, from

8 to 10 January 2002.

In January 2001, the Partnership forSocial Sciences in Malaria Control(PSSMC) was formally launched at aninaugural meeting held at the LondonSchool of Hygiene and Tropical Medicine(LSHTM), UK. The PSSMC 2002 meetingreviewed the objectives and activities ofthis partnership. Various strategies toincrease the awareness and application ofsocial science in malaria control werediscussed. The aim of these strategies is toensure that human behavior, and social,cultural, political and economic contextsare integrated in the conception ofresearch and intervention programs.

The success of many malariaprevention and control strategies relies on understanding human behavior.Describing and comprehendingtreatment-seeking behavior, willingness toaccept and pay for prevention and treatmentservices, and understanding the policy andoperational processes related to changingand implementing national malaria controlpolicies are all examples of areas in whichsocial science expertise is required. Althoughsocial science involvement in malaria

control has increased noticeably in the pastdecade, most socio-behavioral research inmalaria control undertaken during thistime have used rapid assessmenttechniques often applied by people withlimited training in social science theory ormethodology. Personnel and healthprofessionals working in malaria controlprograms should be encouraged to usesocial science. However, in areas such asunderstanding the factors influencingadherence to treatment regimes, specialisttraining in social science methods can yieldvaluable data and insights, which areprobably missed by untrained personnel.

Currently, there are few trained socialscientists working in malaria and they arestill principally called upon to provide rapidanswers to behavioral questions within thecontext of large, generally epidemiologicalprojects. To address these concerns and toprovide a forum for advocating the use ofsocial science better in malaria control, theconcept of an international alliance ofsocial scientists involved in malariarelated activities was conceived.

The objectives of PSSMC are: (1) to contribute to malaria controlthrough enhancing appreciation andapplication of social science to publichealth; (2) to foster an alliance amongsocial scientists and institutions involvedin malaria control and (3) to strengthen

social science capabilities in malariacontrol. Presently, the activities of thePSSMC are limited to sub-Saharan Africa.

Review of previous activities

At the PSSMC 2001 meeting, the majorconstraints concerning the use of socialscience in malaria control were identifiedas follows:(1)Lack of trained social scientists within

sub-Saharan Africa.(2)Lack of access for social scientists,

particularly in sub-Saharan Africa, toliterature pertaining to behavioralresearch in malaria control.

(3)Poor communication between socialscientists working in malaria.

(4)Lack of capacity for social science inmalaria control programs (e.g. lack ofaccess to a trained social scientist andthe opportunity to develop general,social science skills).

(5) Poor advocacy by social scientists of theneed for greater rigor in conceptualizingand designing behavioral studies.

To address these issues several activitieshad been proposed and their progress wasreviewed.

Capacity building for social scientists insub-Saharan AfricaSeveral partners in the PSSMC have hadlong-term involvement in training social

Social sciences in malaria control

Caroline Jones and Holly Ann Williams

Perspective

Further analysis of the mechanism ofcercarial invasion should yield importantinformation on how cercariae perceive andrespond to chemical signals in theirenvironment. Because accidental invasionby Schistosoma spp. of non-human hosts isarrested by immune responses at thecercarial stage, a more completeunderstanding of cercarial invasion couldprovide new targets for a protective vaccine.

References

1 Stirewalt, M. (1974) Schistosoma mansoni:cercaria to schistosomule. Adv. Parasitol.12, 115–182

2 Haas, W. et al. (1997) Schistosoma mansonicercariae: stimulation of acetabular glandsecretion is adapted to the chemical compositionof mammalian skin. J. Parasitol. 83, 1079–1085

3 Fishelson, Z. et al. (1992) Schistosoma mansoni:cell-specific expression and secretion of a serineprotease during development of cercariae. Exp.Parasitol. 75, 87–98

4 Gordon, R. and Griffiths, R. (1951) Observationson the means by which the cercariae ofSchistosoma mansoni penetrate mammalianskin. Ann. Trop. Med. Parasitol. 45, 227–243

5 Lewert, R.M. and Lee, C.L. (1954) Studies on thepassage of helminth larvae through host tissues.J. Infect. Dis. 95, 13–51

6 Salafsky, B. et al. (1984) The role ofprostaglandins in cercarial (Schistosomamansoni) response to free fatty acids. J. Parasitol.70, 584–591

7 Salter, J.P. et al. (2000) Schistosome invasion ofhuman skin and degradation of dermal elastin aremediated by a single serine protease. J. Biol.Chem. 275, 38667–38673

8 McKerrow, J.H. et al. (1983) Degradation ofextracellular matrix by larvae of Schistosomamansoni. I. Degradation by cercariae as a model

for initial parasite invasion of host. Lab. Invest.49, 195–200

9 Keene, W.E. et al. (1983) Degradation ofextracellular matrix by larvae of Schistosomamansoni. II. Degradation by newly transformed anddeveloping schistosomula. Lab. Invest. 49, 201–207

10 Samuelson, J.C. and Caulfield, J.P. (1982) Loss ofcovalently labeled glycoproteins and glycolipids fromthe surface of newly transformed schistosomula ofSchistosoma mansoni. J. Cell Biol.94, 363–369

11 Samuelson, J.C. et al. (1984) Hatching,chemokinesis, and transformation of miracidia ofSchistosoma mansoni. J. Parasitol. 70, 321–331

James H. McKerrow*

Jason Salter

Sandler Center for Basic Research in ParasiticDiseases, University of California, San Francisco, CA 94143, USA.*e-mail: jmck@cgl.ucsf.edu

TRENDS in Parasitology Vol.18 No.5 May 2002

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196 Research UpdateResearch Update

scientists in sub-Saharan Africa. It wasagreed that the aim of the PSSMC is not toreplicate this process but rather to assistwith developing relationships andinformation flow between programs. Inaddition, research examining factors,which influence the involvement of socialscientists in malaria control, is beingundertaken by Centers for Disease Controland Prevention (CDC, Atlanta, GA, USA),LSHTM and The CHANGE Project(Academy for Educational Development,Washington, DC, USA) on behalf of thePSSMC. A case study approach will beused to investigate the post-doctoral careerpaths of scientists [e.g. those supported byWHO/Tropical Diseases Research(WHO/TDR) funding], who focused onsocio-behavioral aspects of malaria.Information obtained from this researchwill help to further develop recruitmentand retention strategies for socialscientists interested in malaria control.

Improving access to literatureA clearing-house for social science andmalaria literature has been established,which has >500 data entries, includingpublished and unpublished literature,technical reports, and oral or posterpresentations from regional, national andinternational meetings. Hard copies and,whenever possible, electronic copies of theliterature are archived at the CDC andLSHTM. To improve the accessibility ofthis literature to African social scientists,satellite centers will be established at theUniversity of Nairobi, University of Maliand the Instituto Nacional de Saúde,

Mozambique. Literature from this databaseis provided to the bi-weekly e-mail MalariaAwareness Bulletin, distributed to >470 readers by the Environmental HealthProject (EHP, http://www.ehproject.org). In January– April 2002, citations from thisdatabase will be available on a websitecreated by collaborative efforts betweenCDC, Multilateral Initiative on Malaria(MIM), EHP and The Malaria Foundation.

Improving relationships between socialscientistsA network of social scientists interested orinvolved in malaria activities has beendeveloped and >60 people are currentlyregistered. The goal of this network is toexchange ideas, and coordinate researchand training. It is hoped that this willassist in identifying senior social scientiststo act as mentors for junior scientists,particularly those working in sub-SaharanAfrica. For more information on thisnetwork, please contact the authors.

Social science capacity within malariacontrol programsThe PSSMC is working with theWHO/African Regional Office(WHO/AFRO) to determine the bestmethods for identifying and addressing thesocial science needs of national malariacontrol programs. Information concerningPSSMC was sent from AFRO to Roll BackMalaria committees in endemic countriesof sub-Saharan Africa. The PSSMC is alsoproposing to organize a session at theMIM 2002 conference in Arusha,Tanzania, to bring together personnel from

the National Malaria Control Program andmembers of the PSSMC to conduct a needsassessment and to develop proposals forincreasing social science capacity withinmalaria control programs.

Research and innovationThrough representatives andpresentations at various meetings, thePSSMC has provided examples ofinnovative socio-behavioral research andare advocating for a greater use ofethnographical field research, whichproduces greater insight and in-depthunderstanding of behaviors and theircontext in malaria control.

Perspective

The PSSMC 2002 meeting reviewed andaccepted the mission statement by membersof the steering committee. The PSSMC isdedicated to enhancing the generation, thesynthesis and use of social science researchand practice related to malaria control,furthering relationships between researchcommunities, policy and practice, andfacilitating access to information, trainingand mentoring opportunities.

Caroline Jones

London School of Hygiene and TropicalMedicine, Keppel Street, London, UK WC1E 7HT.

Holly Ann Williams*

Malaria Epidemiology Branch, Division ofParasitic Diseases, Centers for DiseaseControl and Prevention, Mail Stop F-22, 4770 Buford Hwy, Atlanta, GA 30341, USA.*e-mail: hbw2@cdc.gov

Examining EntamoebaSudha Bhattacharya, Alok Bhattacharya and William A. Petri, Jr

A conference on Amebiasis and the Biology

of Entamoeba histolytica was held in Agra,

India, from 11 to14 February 2002.

Parasite, host and environmental controlson virulence remain center stage in thescientific community’s efforts tounderstand and combat amebiasis.

Amebiasis in humans

Two reports highlighted the natural historyof amebiasis. Joerg Blessman (BernhardNocht Institute, Hamburg, Germany)demonstrated that 2.4% of males from

Hue Vietnam had a residual amebic liverabscess (ALA) detected by ultrasound(defined as a noncystic space-filling defectin the liver without evidence ofechinococcus or hepatocellular cancer),suggesting that the true incidence of ALAmight be underestimated. Rashidul Haque(International Centre for DiarrhealDisease Research, Dhaka, Bangladesh)detected diarrhea associated withEntamoeba histolytica infection in 10% andamebic colitis in 4% of Dhaka children overa period of two years. Acquired immunitywas associated with the production of

mucosal immunoglobulin (Ig) A against theparasite Gal/GalNAc lectin (an adhesinrequired for cytotoxicity). Harpreet Vohra(Postgraduate Institute of MedicalEducation and Research, Chandigarh,India) measured cell-mediated immunity,which demonstrated a mixed cytokineresponse to amebiasis.

Parasite invasiveness

David Mirelman (Weizmann Institute,Rehovot, Israel) discussed the possiblereasons why not all E. histolyticainfections result in disease. Do strains of