Research Projects
Schistosomiasis
This is a major health problem in many parts of Sudan. In the main cotton agricultural scheme of El Gazeera between the White and the Blue Niles, 80% of the population is infested. Serious research to control the disease started in the early 1960s with the formation of the Bilharzia Society, of which I happened to be the president. It included medical staff, veterinarians and scientists. Research was planned to tackle the problem in humans and cattle. Research into S mansoni infestation in the Gezeera agricultural scheme culminated in the Blue Nile Health project, which succeeded in reducing the infestation in the population from 80% to 6%. In addition to reducing morbidity and mortality, it had an economic impact by increasing workers' productivity and reducing absenteeism from work.
A member of the Blue Nile Health Project group headed a similar project in Egypt and achieved great success.
The research on S bovis in cattle by the veterinary group led to the discovery of the first effective vaccine against the disease.
In basic research, the Sudanese scientists, in collaboration with French researchers, succeeded in elucidating the genetics of susceptibility of humans to Symmer’s fibrosis, a major cause of death in those infested with S mansoni.
Leishmaniasis
Sudan is endemic for several forms of leishmaniasis, including Kala-azar, which is fatal if not treated. The Institute of Endemic Diseases, in collaboration with the University of Copenhagen, embarked on a joint project that continued for nine years. The project included training and capacity building at the Institute.
The epidemiology and the clinical spectrum of the disease were worked out, and new diagnostic tools based on molecular biology and immunology were introduced.
In addition to applied research, several basic research projects derived from field observations were identified and executed. As a result of this project, eight Sudanese and six Danish students obtained their PhD degrees in immunology and molecular biology. Sixty-seven papers were published in reputable international journals in leishmaniasis and malaria.
A similar successful project in leishmaniasis in collaboration with the University of Cambridge and sponsored by Wellcome Trust was established. Through this project, a Sudanese PhD student worked out the genetics of susceptibility to Kala-azar and its major complication (PKDL).
It was through these projects that we were able to help improve the health services of the marginalised communities in Gedaref State. For example, the villagers in Bazoura, south of Hawata, built a health center and asked the Institute of endemic diseases to run it. We staffed the center with two medical assistants, a laboratory assistant, and a midwife. When the facility was well established, it was taken over by the Gedaref State Ministry of Health. We then established another modern health center in Kassab near Gedaref. This is a research facility but also provides health care to the local community. A state-of-the-art tropical Hospital and research center were established at Doka village Gadaraf State.
Mycetoma
Mycetoma is a chronic disabling disease caused by fungi and higher bacteria. It is a disease mainly of farmers in rural areas. With the help of the Ministry of Overseas Development, a project was launched in the seventies and continued by a second-generation scientist.
The mycetoma Research Center, under one of my students, Prof. A H Fahal, now a Professor of surgery, is a leading international research center in mycetoma research. I work closely with him. Its main achievements are in the field of epidemiology, immunology, therapy and experimental infection of laboratory animals. A project on the genetic basis for susceptibility to the disease is being launched.
Basic versus applied research: leishmaniasis as an example
An important issue that I always deliberated on was research priorities in health research in a developing country. I was convinced that priority should be given to applied health research that aims to solve the health problems in the country. Basic research, however, should not be neglected. I found out that the most relevant basic research is the one that stems from applied research and addresses questions posed by findings encountered by the research worker while conducting applied research. I gave leishmaniasis as an example.
While working on leishmaniasis in the field, the following questions arose:
- Why do two ethnic groups differ in their susceptibility to visceral leishmaniasis (VL?)
- Why, within the same ethnic groups, only some develop the disease?
- Why do 60% of those treated for VL develop post-Kala-azar dermal leishmaniasis (PKDL), and the remainder do not?
- Why does PKDL persist in some patients and self-cure in others
To answer these questions
- We used our field observations and data and formed hypotheses, and tested them
- We studied the immune responses in VL and PKDL
- VL patients respond by a Th2 response. We showed that variation in NRAMP gene and Il-4 and IL 9 underlie susceptibility to VL.
- Mutations in the IFN-GR1 gene are associated with PKDL
- The rash in PKDL mirrors the clothing habits, affecting mainly sun- susceptibility exposed areas
- We found that the immune responses in the skin of PKDL patients are compatible with the effects of UVB light
- We observed that Individuals previously infected with L major did not develop VL (caused by L donovani)
- This resulted in the development of the first vaccine in the world against Kala-azar (Autoclaved L major +alum+BCG).
- It is now used as immunotherapy against a form of leishmaniasis (post-Kala-azar dermal leishmaniasis) that was previously difficult and expensive to treat.
