So, why am I down here in Tanzania? Well, I've been asking myself that question for over two months now! ha.
Megan Enos, a Master's student in the Reid lab, came to Mwanza in June 2012 to get this project up and running. Her blog is here. The idea for this project was submitted to the Gates Foundation and it was awarded funding. Our lab is one of only three in Canada to ever be awarded funding from this foundation and the only one in London. Yay us!
Here are the basics about this project:
The bacteria in our body out-number our own human cells 10 to 1. What we don't know is how the composition and numbers of this 'microbiome' affects our bodily functions and disease. Some recent studies have shown that the gut microbiome (all the bacteria that lives in our stomach, intestines, colon etc.) differs between an obese and a 'normal' individual. In addition, these studies have suggested that an obese mother can pass on the characteristics of her gut microbiome to her infant which can pre-dispose them to obesity and problems related to obesity later in life. Although it hasn't been studied as much, if the gut microbiome of an under-nourished mother differs from a nourished mother, the under-nourished mother could be pre-disposing her child to problems related to under-nutrition. In fact, studies have suggested that children from under-mourished mothers are more likely to be under-nourished themselves and have decreased cognitive function later in life.
In Africa, the number of maternal and infant deaths due to undernutrition is staggering. And since we also wanted to investigate the effects of probiotic on the microbiome, Mwanza, Tanzania was the perfect place for our study. Ten years ago Western Heads East started up a probiotic yogurt kitchen in Mwanza in response to the AIDS crisis in Africa. Dr. Reid kindly donated the probiotic culture, Lactobacillus rhamnosus GR-1 to this initiative, NIMR (National Institute for Medical Research in Tanzania) was brought on board to produce the probiotic for the kitchens and something unique was born. Last year, the kitchens have expanded to 10 in Mwanza and there are some in Rwanda and Kenya as well. Recently, APYN (African Probiotic Yogurt Network) has been set up in Mwanza to help facilitate the delivery of the probiotic and help the kitchens out amongst so many other things!
Each kitchen is run by a woman's group and they learn how to become self-sufficient (microfinance) to buy the milk, pay rent, make the yogurt and sell it. Each kitchen supplies 75-80 people living with HIV/AIDS that are called 'beneficiaries.' A generous donation from an anonymous Canadian donor covers the costs for this yogurt for all the kitchens. Some kitchens make more yogurt and sell it at market to the community. Because of the proximity to these kitchens, several research projects have been conducted in Mwanza investigating it affects on various populations. This study is another one of these.
So after all that, the purpose of the study is to characterize the complete microbiome (gut, reproductive, oral and breast milk) of under-nourished pregnant mothers and their infants. Healthy 'normal' and healthy 'over-nourished' mothers were also recruited. A subset of the under-nourished and healthy mothers were given probiotic yogurt supplemented with Moringa to see if it will aid in changing the microbiome from a potentially adverse composition to a 'healthy' composition.
So Megan came down here with NOTHING and set the whole thing up, I've merely stepped in to take over the last couple months of visits because she had to return to London to do course work.
She had to:
- get ethics approval
- find a clinic willing to do the study and train them
- find the equipment needed and purchase if necessary
- get tables and such MADE for the clinic as there were none
- make up questionnaires and documents and get them translated into swahili
- find a translator to accompany her to clinic
- arrange transport
- arrange sample collation - buy all supplies necessary for this
- arrange with NIMR for lab space and technician time
- find a kitchen to make here yogurt - and train them how to do it PROPERLY
- find milk to make her probiotic culture and make it weekly to drop to kitchen
- find some way to get the yogurt to the mamas
- arrange payments for everything
- find suppliers here for things
- all this while trying to do it HERE, which is no easy feat!
- and a ZILLION other things! I'm truly amazed by the work she has done down here!
Recruitment (this was all done before I got here essentially):
The pregnant women comes to the clinic for her normal assessment and the nurse/doctor can make a decision if they may be suitable for the study. If they pass the eligibility questionnaire and consent, they are given an ID#. They have their initial visit and another visit, usually in a month, is scheduled. The mamas come from 2-10 visits depending on their gestational age.
Each visit, the women give stool, urine, saliva and vaginal swab samples. Three times they also give blood. Once the baby is born, they return twice and additional samples of breast milk, baby saliva and baby stool are taken. They are also tested for malaria, syphilis, HIV and their hemoglobin levels. The lab technician there also screens their stool for parasite larva and tests their urine. We take weight and other measurements.
When they arrive, they check in and our translator, Janeth, administers the dietary recall questionnaire to them (a record of what they ate for the last two days) and once they are finished that, they go to the lab for the samples to be taken and then to the doctor for the rest of the samples plus a check up. Then they return to us for bites and compensation. This can take anywhere from 1 hour to 3 hours per woman depending on how busy the clinic is that day.
So every day at the clinic is basically the same. I walk to NIMR in the morning to meet Janeth (who has packed up the coolers for the sample collection) and we hop in the Land Rover with Abel, our driver, for the ~30min drive to Buswelu. The main road is paved but the turn off to Buswelu is NOT and it is quite possibly the worst road ever. And that is saying something for Mwanza!
We wait for the woman to show up - sometimes having to gently remind them to come with a phone call. Tracking woman down is the hardest part - they tend to leave with a month or two remaining in their pregnancy to go back to their 'family' and it could be hours or DAYS away. And getting them to return is so hard.
Once all the mamas have made it through and have had their snack and been scheduled for the next appointment, I head to the 'lab' at the clinic to spin the blood and aliquot the stool samples into the smaller vials for freezing. If anyone had told me last year at this time I'd be scooping poop in Africa, I would have told them they were off their rocker! Yet, here I am.
Days with mamas and babies are fun and chaotic all at the same time. It's like musical babies - everyone has one and it gets shuffled off to whomever has a free hand. I've been peed on numerous times as disposable diapers aren't a thing down here! An old piece of fabric pinned around is the most common, sometimes just the fabric they are wrapped in is all they have and rarely, they have a plastic covering they tie around the piece of fabric.
The babies are also bundled up SO MUCH! I can't believe the layers of clothing and blankets they are wrapped in. Most have knitted hats and booties and two to three layers of fabrics wrapped around them. They also are carried close to mama and once they are put on the table for the examination they are quite sweaty! They are usually oblivious to anything that is happening - unless they are hungry!
Once, the lab stuff in completed, Janeth calls Abel and we return to NIMR with the samples. The gentlemen in Room 4, 'beep' in the samples to their system and store them in the freezers. I usually head to the lab to work on making the probiotic for the kitchen or prepping samples packages or head home for the day to repeat again in the morning.
I usually go to the clinic Monday, Tuesday, Wednesday and then spend Thursday and Friday in the lab or at home scanning all the documents into the computer. Super fun!
I'm slowly wrapping up the clinic visits. My last day out there will be next Wednesday. It will be sad but also exciting to get things finished off!
I volunteered to come here when asked. Moment of weakness? - maybe. Do I regret it? - no. Do I miss home? - YES. And I anxious to come back to see everyone and return to 'normal'?- you betcha! But I've had a great time with lots of new experiences I won't forget.
Well, this has been a lengthy post. I wasn't going to put photos but for those of you bored to tears with the science junk, they are for you!
Asante sana!
Megan Enos, a Master's student in the Reid lab, came to Mwanza in June 2012 to get this project up and running. Her blog is here. The idea for this project was submitted to the Gates Foundation and it was awarded funding. Our lab is one of only three in Canada to ever be awarded funding from this foundation and the only one in London. Yay us!
WARNING!!! WARNNG!!!! Science-geekery to follow! WARNING!!! WARNING!!!
Here are the basics about this project:
The bacteria in our body out-number our own human cells 10 to 1. What we don't know is how the composition and numbers of this 'microbiome' affects our bodily functions and disease. Some recent studies have shown that the gut microbiome (all the bacteria that lives in our stomach, intestines, colon etc.) differs between an obese and a 'normal' individual. In addition, these studies have suggested that an obese mother can pass on the characteristics of her gut microbiome to her infant which can pre-dispose them to obesity and problems related to obesity later in life. Although it hasn't been studied as much, if the gut microbiome of an under-nourished mother differs from a nourished mother, the under-nourished mother could be pre-disposing her child to problems related to under-nutrition. In fact, studies have suggested that children from under-mourished mothers are more likely to be under-nourished themselves and have decreased cognitive function later in life.
In Africa, the number of maternal and infant deaths due to undernutrition is staggering. And since we also wanted to investigate the effects of probiotic on the microbiome, Mwanza, Tanzania was the perfect place for our study. Ten years ago Western Heads East started up a probiotic yogurt kitchen in Mwanza in response to the AIDS crisis in Africa. Dr. Reid kindly donated the probiotic culture, Lactobacillus rhamnosus GR-1 to this initiative, NIMR (National Institute for Medical Research in Tanzania) was brought on board to produce the probiotic for the kitchens and something unique was born. Last year, the kitchens have expanded to 10 in Mwanza and there are some in Rwanda and Kenya as well. Recently, APYN (African Probiotic Yogurt Network) has been set up in Mwanza to help facilitate the delivery of the probiotic and help the kitchens out amongst so many other things!
Each kitchen is run by a woman's group and they learn how to become self-sufficient (microfinance) to buy the milk, pay rent, make the yogurt and sell it. Each kitchen supplies 75-80 people living with HIV/AIDS that are called 'beneficiaries.' A generous donation from an anonymous Canadian donor covers the costs for this yogurt for all the kitchens. Some kitchens make more yogurt and sell it at market to the community. Because of the proximity to these kitchens, several research projects have been conducted in Mwanza investigating it affects on various populations. This study is another one of these.
So after all that, the purpose of the study is to characterize the complete microbiome (gut, reproductive, oral and breast milk) of under-nourished pregnant mothers and their infants. Healthy 'normal' and healthy 'over-nourished' mothers were also recruited. A subset of the under-nourished and healthy mothers were given probiotic yogurt supplemented with Moringa to see if it will aid in changing the microbiome from a potentially adverse composition to a 'healthy' composition.
 |
| A cup of yogurt. It's really not all that bad! |
She had to:
- get ethics approval
- find a clinic willing to do the study and train them
- find the equipment needed and purchase if necessary
- get tables and such MADE for the clinic as there were none
- make up questionnaires and documents and get them translated into swahili
- find a translator to accompany her to clinic
- arrange transport
- arrange sample collation - buy all supplies necessary for this
- arrange with NIMR for lab space and technician time
- find a kitchen to make here yogurt - and train them how to do it PROPERLY
- find milk to make her probiotic culture and make it weekly to drop to kitchen
- find some way to get the yogurt to the mamas
- arrange payments for everything
- find suppliers here for things
- all this while trying to do it HERE, which is no easy feat!
- and a ZILLION other things! I'm truly amazed by the work she has done down here!
Recruitment (this was all done before I got here essentially):
The pregnant women comes to the clinic for her normal assessment and the nurse/doctor can make a decision if they may be suitable for the study. If they pass the eligibility questionnaire and consent, they are given an ID#. They have their initial visit and another visit, usually in a month, is scheduled. The mamas come from 2-10 visits depending on their gestational age.
Each visit, the women give stool, urine, saliva and vaginal swab samples. Three times they also give blood. Once the baby is born, they return twice and additional samples of breast milk, baby saliva and baby stool are taken. They are also tested for malaria, syphilis, HIV and their hemoglobin levels. The lab technician there also screens their stool for parasite larva and tests their urine. We take weight and other measurements.
 |
| The bathroom |
 |
| The 'toilet' Ugh! |
When they arrive, they check in and our translator, Janeth, administers the dietary recall questionnaire to them (a record of what they ate for the last two days) and once they are finished that, they go to the lab for the samples to be taken and then to the doctor for the rest of the samples plus a check up. Then they return to us for bites and compensation. This can take anywhere from 1 hour to 3 hours per woman depending on how busy the clinic is that day.
So every day at the clinic is basically the same. I walk to NIMR in the morning to meet Janeth (who has packed up the coolers for the sample collection) and we hop in the Land Rover with Abel, our driver, for the ~30min drive to Buswelu. The main road is paved but the turn off to Buswelu is NOT and it is quite possibly the worst road ever. And that is saying something for Mwanza!
We wait for the woman to show up - sometimes having to gently remind them to come with a phone call. Tracking woman down is the hardest part - they tend to leave with a month or two remaining in their pregnancy to go back to their 'family' and it could be hours or DAYS away. And getting them to return is so hard.
 |
| Megan buying bananas and nuts in the centre. |
On Monday's, I head into the market area to buy bananas and nuts for the week. I purchase sodas as needed and every day Mama Chapati drops by to bring us maandazi (fried dough) for the mamas. Once they are done their visit, they get a banana, a small bag of peanuts, a soda and a maandazi.
 |
| Some of Buswelu Centre |
Once all the mamas have made it through and have had their snack and been scheduled for the next appointment, I head to the 'lab' at the clinic to spin the blood and aliquot the stool samples into the smaller vials for freezing. If anyone had told me last year at this time I'd be scooping poop in Africa, I would have told them they were off their rocker! Yet, here I am.
Days with mamas and babies are fun and chaotic all at the same time. It's like musical babies - everyone has one and it gets shuffled off to whomever has a free hand. I've been peed on numerous times as disposable diapers aren't a thing down here! An old piece of fabric pinned around is the most common, sometimes just the fabric they are wrapped in is all they have and rarely, they have a plastic covering they tie around the piece of fabric.
The babies are also bundled up SO MUCH! I can't believe the layers of clothing and blankets they are wrapped in. Most have knitted hats and booties and two to three layers of fabrics wrapped around them. They also are carried close to mama and once they are put on the table for the examination they are quite sweaty! They are usually oblivious to anything that is happening - unless they are hungry!
 |
| One of my buddies. I managed not to make him cry to much and in return he didn't pee on me. |
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| Sample pack prepping |
I'm slowly wrapping up the clinic visits. My last day out there will be next Wednesday. It will be sad but also exciting to get things finished off!
I volunteered to come here when asked. Moment of weakness? - maybe. Do I regret it? - no. Do I miss home? - YES. And I anxious to come back to see everyone and return to 'normal'?- you betcha! But I've had a great time with lots of new experiences I won't forget.
Well, this has been a lengthy post. I wasn't going to put photos but for those of you bored to tears with the science junk, they are for you!
Asante sana!
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| Nyerere Dispensary - 'the clinic' |
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| The room at the front is the lab and our 'office' is behind it on the back. |
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| Megan in the 'office' |
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| Funky plant outside the clinic. |
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| Waiting for my ride |
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| This is the log book for the pikipiki driver who delivers the yogurt to the mamas.We need to watch him like a hawk! |
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| Pikipiki driver Matayo, his friend paul and Adjida, one of the mamas on yogurt getting her daily delivery. |
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