杜克大学

Tropical Parasitology: Protozoans, Worms, Vectors and Human Diseases

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This course provides students an understanding of important human parasitic diseases, including their life cycles, vectors of transmission, distribution and epidemiology, pathophysiology and clinical manifestations, treatment, and prevention and control. Tropical Parasitology is taught by faculty from an area highly impacted by tropical parasites- the Kilimanjaro Christian Medical University College in Moshi, Tanzania. The faculty include Drs. Frank Mosha and Mramba Nyindo (and two lecturers, Drs. Johnson Matowo and Jovin Kitau). Dr. John Bartlett, Professor of Medicine, Global Health and Nursing at Duke University, joins his faculty colleagues in this effort.

From the lesson

Protozoans

We are excited to begin our Protozoa cluster, focusing on malaria, trypanosomiasis, toxoplasmosis, and leishmaniasis. Despite advances in prevention and treatment, protozoal diseases contribute substantially to the global burden of morbidity and mortality. This cluster has a total of 153 minutes of video and 85 pages of reading spread out over the four lessons. Each lesson has all of the readings, lectures, and additional materials to help you understand the topic. You will have unlimited opportunities to take an untimed quiz after you’ve mastered the material in each lesson, and you have four quizzes to complete in this cluster. (Note: this cluster includes a case study practice quiz, ungraded, which is optional). This cluster kicks off with a close look at malaria vectors and the fascinating research being done on diagnosing, treating, and vaccinating against malaria. This is by far the largest cluster in the course, so you have up to 3 weeks to complete this cluster.

Malaria: Vectors - Dr. Johnson Matowo4:00

Malaria: Vector Control - Dr. Johnson Matowo6:59

Malaria: Insecticide Resistance and Management - Dr. Johnson Matowo 11:34

Malaria: Epidemiology - Dr. Franklin Mosha8:28

Malaria: Mosquito Breeding Sites - Dr. Franklin Mosha 0:43

Malaria: The Parasite in the Human Body - Dr. Mramba Nyindo11:46

Malaria: Invasion and Colonization of Red Blood Cells by Merozoites - Dr. Mramba Nyindo 6:58

Malaria: The Parasite in the Mosquito - Dr. Mramba Nyindo 7:29

Malaria: Pathophysiology - Dr. John Bartlett7:38

Malaria: Interview with Dr. Venance Maro 4:12

Malaria: Interview with Dr. William Howlett 4:17

Meet the Instructors

John A. Bartlett, M.D.
Professor of Medicine, Global Health and Nursing at Duke University Medical Center
Duke Global Health Institute
Franklin Mosha, Ph.D.
Professor of Parasitology and Medical Entomology
Mramba Nyindo, Ph.D.
Associate Professor, Kilimanjaro Christian Medical University College (KCMU Co.)

So the question you asked me about was malaria.

The burden of malaria,

clinically in what's called a referral center in Northern Tanzania.

I worked here for 10 years, originally from 83 to 92 as a physician and

I've come back in the same position since 2006 and also as a neurologist.

So I will have seen malaria in both eras as a track.

So, the significant thing is that the disease clinical malaria in

adults has decreased hugely over that 30-year period.

There's been a dramatic decrease in clinical malaria in

patients admitted to KCMC.

Now, the area of Kilimanjaro Christian Medical Center is situated in Moshi.

Moshi is at an altitude of 3,000 feet, roughly.

And we serve the Kilimanjaro mountain population,

which is well over a million and it's hinterland.

But traditionally, we are a low malaria area.

We're called an unstable area.

In other words, malaria can dramatically increase seasonally and

then go away between the seasons and that's corresponding to mosquito

breeding patterns during the rainy season, increase and

then having enough infected cases in the community to infect other numbers.

So in some ways, we're elitist for malaria generically in Tanzania.

And as I say, the dramatic thing is the decrease in clinically malaria and

we see that with patients presenting with anemia, fevers and positive blood slides.

Of course, now there's a sensitive test based on malaria antigen,

which we're using for screening, which is even more sensitive than microscopy or

at least microscopy done in the field, as it were.

So, we're using both now.

And certainly, we've seen I think almost ten fold increase in malaria.

A very good index of it is a disease, which we call cerbal malaria.

Cerbal malaria is a relatively rare complication of clinical malaria,

less than 1%.

Now I as a neurologist would have seen the disease and

in my ten years here from 83 to 92, I had no difficulty.

I think I had at that time about 120 cases and they did behind mortality there.

Since 2006, I have difficulty remembering a clinical case of summary malaria.

That's a huge decrease in summary malaria as an index,

overall index of what we call clinical malaria.

So commensurate then with this decrease in malaria in the community,

we're seeing a decrease in the burden of clinical malaria in admission patients.

We attribute this to the actomyosin drugs,

which are widely available now and cheap or free at the point of utilization.

And of course, what we call public health measures to decrease

transmission from mosquito to person, i.e., bed nets.

The combination of the two are extremely

effective in decreasing the birth of malaria in

an area that had a high malaria burden in the past.

And personally, I've lived in the area for almost 20 years now and

I've never taken malaria prophylaxis and

my family when they were here for 10 years, didn't either.

My son who grew up as a baby here for the first ten years of his life,

he had malaria that time.

But of course, so I'm just saying that its always

been a relatively low transmission area, but it has decreased from low transmission

being unstable going up in the rainy season to being much much less