Dr Mwele Malecela: a Tanzanian medical research institution DG who as girl dreamed of becoming a researcher

A PERSONAL JOURNEY: FROM PARASITE IMMUNOLOGY TO DISEASE CONTROL.

MWELECELE MALECELA

My career at NIMR is a true story of serendipity rather than design. I joined NIMR in 1987 after graduating form the University of Dar-es-Salaam with a B.Sc. in Zoology in 1986. After an extremely rigorous interview process I was assigned to work at the Amani Center and to specifically focus on a disease they called Bancroftian Filariasis. Now I had heard of this disease in my classes at UDSM and the great tutelage of Dr Parkin but I had know idea what I was going to do. In my mind I wanted to work on malaria which at the time I thought was  more interesting area of research. So I must say I was quite depressed as at the time Malaria research had the most resources in terms of funding and equipment. I was told explicitly that I was to work to revive the Bancroftian filariasis work at Amani.

As one who always thrives on a challenge I set off for my long trip up the Eastern Usambara Mountains to this place they called Amani. The trip was up a series of undulating hills until we got to a point where I did not see houses or people. My fear was supressed by the breathtaking beauty of the drive, the beautiful forest, and the air getting clearer as we drove up the hill. On arrival at Amani my fears attacked me again, could I do it how was I expected to live here almost in the middle of nowhere. I consoled myself by reminding myself that there were several scientists here and that if they could live here so could I. My dad had a favourite saying that “its up to you to manage your circumstances” and that is exactly what I decided to do.

After several weeks of orientation I was finally designated to work in the helminthology laboratory where I learnt all about this parasite Wuchereria Bancrofti, the parasite that spreads bancroftian filariasis. I learnt to identify microfilariae of Wuchereria Bancrofti and Onchocerca volvulus. I learnt to dissect mosquitoes for infective larvae and the lab diagnosis of several parasites including schistosomes, hookworms, Trichuris etc. At the time mine was a predominantly wormy world and the people who truly initiated me into the wonderful world of worms were some great lab technicians and lab assistants who gave me the best hands on training I ever had. I treasure this training because it has played a great role in making me who I am today. One lab assistant liked to remind me that he started working on the month I was born. It didn’t affect me that they treated me like a kid I just soaked up all the information that was being given to me and enjoyed every moment. My family sometimes worried about how i was doing I would phone them from our old handle phones connected through the tiny exchange to tell them that I was doing fine and that I actually liked it there.

My early work included examining the relationship between eosinophilia and helminth parasites, I also looked at the impact of the trials for vector control for malaria on the transmission of Bancroftian Filariasis. I also worked with the late Prof Chris Curtis to control culicines in Muheza town using polystyrene beads.

I then went on to do my Msc and PhD at the London School of Hygiene and Tropical Medicine of the University of London, where I worked on filarial infection in cats. The cats was an experimental animal model that provided a lot of current knowledge in the understanding of the pathogenesis of filarial infection. The work I did focused on understanding how parasites evaded the hosts immune system and my findings indicated that there were surface immunoglobulins of the host that actually protected the parasite. This added to the body of knowledge on asymptomatic microfilaraemics people who have microfilariae but have no overt symptoms of the disease.

On my return I was involved in developing a study to understand immunoepidemiology of Lymphatic Filariasis Transmission, a study that took place in sites in Kenya(Kingwende) and Tanzania (Masaika). Several papers came out of this study which allowed us to getter a better understanding of the spatial dynamics of LF transmission which would be very useful in developing effective control programmes.

At the same time I was involved with developing a strategic plan for the Elimination of the Lymphatic Filariasis Program of Tanzania. This followed the WHA resolution in May 1997 that called for the Elimination of Filariasis as a public health problem. The development of the comprehensive plan was followed by appointment to be the Director of the LF programme in 2000. In the year 2000 the LF program was launched on the island of Mafia and my legacy from the lab to the field to control came full circle. There is a swahili saying that says “safari moja huanzisha nyingine” literally translated means the end of one journey is the beginning of another! In my case however there has been no end to this journey just different points where I have paused but moved on in the same direction.

The LF programme has moved from strength to strength and is now functional in 53 districts and has reached 13 million people. With the focus now on neglected tropical diseases the approach has been integrated to include treatment for schistosomiasis, Soil Transmitted Helminths and Trachoma. In many ways my interview at the NIMR Headquarters prepared me for a career in Lymphatic Filariasis Research and Control but like all things in life I did not know it then. It gave me great pride when President Kikwete announced that he was going to start an LF Fund to support the people with the debilitating manifestations of the disease. H.E the President announced this at the Global Alliance Meeting in Arusha and this has raised the profile of the patients both in Tanzania and other countries in Africa. Results from our sentinel site in Tandahima show that the programme may have succeeded in interrupting transmission in the district charting it our to be the first district to have attained interruption of transmission of LF on  Tanzania mainland

So is this a success story? Its a story about a young girl who dreamed about being a researcher, about a young woman who climbed the hills of Amani in search of that dream, and the woman who is living that dream doing research and contributing to the control of a disease she has worked on all her life! I would say that’s success wouldn’t you!

I am indebted to so many people who made this journey possible but most of all my parents Dr John Malecela and the late Mrs. Ezerina Malecela who told me in no uncertain terms that “yes I could”.

Relevant publications

Malecela M.N. Baldwin C.I and Denham D.A (1994) Hosts antigen on the surface of microfilariae of Wuchereria bancrofti and Brugia pahangi.

Transactions

Awarded prize for best presentation

Baldwin C.I., Medieros F, Malecela M.N. and Denham D.A (1994) Humoral responses in cats repeatedly infected with Brugia pahangi. Parasite 1,1S

Malecela (1995): Microfilariae and the immune response in cats repeatedly infected with Brugia pahangi. Ph.D. thesis, University of London.

P.E.Simonsen, D.W Meyrowitsch, W.G.Jaoko,M.N.Malecela, D.Mukoko, E.M.Pedersen, J.H. Ouma, R.T.Rwegoshora, N.Masese, P.Magnussen, B.B.A Estambale and E.Michael (2001) Bancroftian Filariasis infection,Diseaese and Specific Antibody Response Patterns in a high and a low endemicity community in East Africa. Parasite Immunology 23: 373-388

Michael E., Simonsen P.E., Malecela M., Mukoko D., Pedersen E.M., Rwegoshora R.T., Meyrowitsch D.W, Jaoko W.G., (2001)Transmission intensity and immunoepidemiology of bancroftian filariasis in East Africa. Parasite Immunology No 23. Pp 373-388

Paul Simonsen,Peter Bernhard, Walter Jaoko, Dan Meyerowitsch, Mwele N.Malecela-Lazaro, Pascal Magnussen and Edwin Michael (2002) Filaria Dance sign and subclinical hydrocele in two East African communities with Bancroftian filariasis. Transactions of the Royal Society of Tropical Medicine and Hygiene

Simonsen,P.E, Meyerowitsch, D.W, Jaoko W.G., Malecela, M.N., Mukoko, D., Pedersen, E.M., Ouma,J.H., Rwegoshora, R.T., Masese.N Magnussen, P., Estambale, B.B.A & Michael E. (2002) Bancroftian filariasis infection disease and specific antibody responses patterns in a high and low endemicity community in East Africa. American Journal of Tropical Medicine and Hygiene Vol 66(5) pp550-559

Simonsen P.E Meyrowitsch D.W., Mukoko D, Pedersen E.M., Malecela-Lazaro M.N., Rwegoshora R.T., Ouma J.H., Masese, N. , Jaoko W.G., Michael E., (2004) The effect of repeated half-yearly mass treatment on Wuchereria bancrofti infection and transmission in two East African communities with different levels of endemicity. American Journal of Tropical Medicine and Hygiene No 70 pp. 63-71

Paul E. Simonsen, Stephen M. Magesa, Samuel K. Dunyo, Mwele N. Malecela-Lazaro, Edwin Michael (2004) The effect of single dose ivermectin alone or in combination with albendazole on Wuchereria bancrofti infection in primary school children in Tanzania. Transactions of the Royal Society of Tropical Medicine and Hygiene 98,462-472

Simonsen,P.E., Meyerowistch D.W., Mukoko,D., Rwegoshora,R.T., Pedersen,E.M., Malecela Lazaro M.N., Jaoko W.G., and Michael E.(2005) The effect of eight half-yearly single-doses treatments with DEC on Wuchereria bancrofti circulating antigenaemia. Transactions 99,541-547