A World Malaria Day Q & A with PhD Student Claudia Duguay on Malaria, Covid-19 & NTDs

World Malaria Day is April 25th, & this year’s theme is “Harness innovation to reduce the malaria disease burden and save lives.” I reached out to PhD student Claudia Duguay to learn more about innovation in her malaria research, and how she has integrated Neglected Tropical Diseases into her work. She is a doctoral student in Epidemiology at the University of Ottawa School of Epidemiology and Public Health. She is focusing her research on identifying entry points for integrated disease control programs and effective prevention and control strategies during health emergencies for malaria and schistosomiasis in Tanzania and Benin.

Tina: So, Claudia, you are now in Benin, and you’ve also travelled to Tanzania earlier this year to carry out your PhD research project integrating diagnostic tools for co-infection of schistosomiasis and malaria. Can you tell us more about the work that you are doing?

Claudia: my work in Benin is assessing the impact of COVID-19 on malaria prevention which includes bed net usage and access as well as access to health care centers. How was malaria impacted by COVID-19? I have a meeting next week to disseminate that information with some key stakeholders to make sure we’re addressing malaria in times of COVID-19.

My project in Tanzania is still about malaria, but looking at risk factors for schisto and malaria since we know that these two diseases can impact the same people. And so why can’t we address them both at the same time? For my project, we are testing children for both malaria and schistosomiasis using rapid diagnostic tests. I leveraged an ongoing bed net trial and introduced a schisto component. Typically for schisto, you collect urine or stool samples, so you can see how that is a little challenging in the field setting. And so we used novel rapid tests that use a drop of blood from finger pricks – in fact, the same finger prick used for the malaria RDTs [Rapid Diagnostic Test]. It’s quick and it tells you if you have schisto antibodies – so if you’ve had Schisto in the past or if you’re currently infected, without the need for a laboratory. With these new diagnostic tests, I’ll be able to assess some risk factors in order to inform integrated programs moving forward.

Tina: That’s a great way to see how the research that you’re doing might affect future public health programs for children, working to see how services preventing and treating malaria can continue in a situation of COVID-19. And you’re also doing lots of work looking at schistosomiasis and malaria. Can you tell me a little bit about what these two diseases – malaria and schistosomiasis are?

Claudia: Of course! I’ll start with malaria. So, malaria is a parasitic infection transmitted by anopheles mosquitoes primarily affecting people in Sub-Saharan Africa. Schistosomiasis is one of the 20 Neglected Tropical Diseases and like most NTDs, affect the most vulnerable and marginalized people. Like malaria, it is transmitted by a parasite and mostly affect people in Sub-Saharan Africa. And now, unlike malaria, schisto is transmitted by coming in contact with contaminated water – such as a lake or pond where you may bath, do laundry, or collect water.

Tina: April 25th, is World Malaria Day, and June 23rd is the Kigali Summit for Malaria and NTDs. This is a big event within the NTD community. Can you explain from your perspective, what the relationship between malaria and NTDs means to you?

Claudia: The first thing that comes to mind is the relationship between malaria and schistosomiasis, as the same kids [in the communities where my study take place] are infected by both diseases. Why should we take a siloed approach in reaching our 2030 SDG 3.3 targets that address both diseases, the NTD roadmap for schisto and the global technical strategies for malaria? Why can’t we streamline how we work?

Tina: You’ve recently had an interesting experience with schistosomiasis (aka schisto). Can you tell me about it, and did this affect how you understand and approach this disease from a public health perspective?

Claudia: So, I’ll give you the whole story on how I found out that I had schisto. I went to Tanzania in January for a couple months, and then I was staying in a room in the team’s office. I was living really well. I had running filtered water, I had a shower. And so in my opinion, I did not assess this source of water as being at risk for being contaminated with schisto. You know, I’m not going to the freshwater lake to collect water where I know it could be infected with snails and subsequently schisto.

For my project, we were using these new rapid tests. When we first started the study, I noticed that almost every child that we tested had schisto antibodies – so either had schisto or currently has schisto. And so I thought that the tests were not great because these are new tests and they are mostly coming back positive. And then, to kind of spot check, I thought I’ll test myself. If I come back positive, then we know that the tests were wrong. And sure enough, the rapid test came back positive.

And then we decided to sample people working in the office with stool & urine tests which are the gold standard testing measures for schisto. It turned out that everyone at the office all tested positive for schisto.

Again, circling back to my project, some of the factors that I was assessing for risk for schisto & malaria were based on knowledge scores. So, knowledge of the transmission of schistosomiasis, for example. Well, having this being one of my projects, I feel like I would test really highly on those knowledge scores. So sometimes it’s not just about your knowledge of the diseases, but your exposure to these diseases. It’s really about your environment. And so that really emphasized to me that you really have to be careful in your environment and we have to identify what these risk factors [to these diseases] truly are.

Tina: I guess that’s when there’s a strong argument for mass drug administration (MDA) for treating people who just do have this repeated exposure with no alternative water sources?

Claudia: Exactly. We can give praziquantel once a year to reduce or treat infection. But re-infection in the communities that I work in is just so high. If you can’t get safe water, then you’re bound to get reinfected. But you can take care of the environment through snail control and clean water and sanitation which are really important for disease transmission.  But these [solutions] are a lot harder than providing low-cost Praziquantel once a year. However, I am optimistic, and through all these methods combined, we can really make a difference.

Tina: Can you tell me what the next steps are for the projects that you are working on currently in Benin and Tanzania?

Claudia: In Benin, we are really wrapping up the project. I am presenting my results of the impact of COVID on Malaria prevention to key stakeholders next week. In Tanzania, having worked with trialing the rapid tests I’m proposing in the fall to go back to Tanzania and validate the schisto tests. And then I’m also planning to do some drone imagery to really assess where all the fresh water sources are in the area to really accurately express where people can be exposed to schistosomiasis. Because another finding that I had in-country was that although Lake Victoria is one of the biggest freshwater lakes in the world, it’s not the only place where people can be exposed to schisto and it turns out there’s a lot of smaller water bodies & sources more inland. And so, I really want to get a good picture of that in Tanzania…in the fall. And again, these will be follow-up studies to the findings of my research in January and February.

Tina: Great. That sounds really fun!

Claudia: Yeah. It’s fun! I almost felt like I got more questions coming out of Tanzania than answers, but it’s fun to be able to have the chance to do a follow-up.

Tina: That’s a good way to deal with some remaining questions – to be able to actually go back and assess them.  Do you have any advice for students or young professionals like yourself who are looking to get involved and do NTD or malaria research?

Claudia: Just jump in, just get started, put one foot through the door. If this is what interests you, there’s no lack of work going on.

Tina: What you’re doing Claudia, combining, malaria research with NTD research, is really in the spirit of the Kigali declaration for NTDs.

Claudia: I’m really glad to hear that. I really do believe in integrating NTDs into other areas of health – that is my whole project! I really do feel like if we want to reach those 2030 [SDG] goals, we have to have all hands-on deck and have integration between programs – not everyone just working in their corner, you know

Tina: Definitely. Thanks so much, Claudia!