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Does Zika Virus Cause Birth Defects in Africa?

by Eric Osoro, a physician and medical epidemiologist with the Paul G. Allen School for Global Animal Health. Dr. Osoro serves as the Deputy Director of Public Health for WSU Global Health-Kenya. This column is a personal account of his research in Kenya on the Zika virus.

Dr. Eric Osoro (left) with field study coordinator Harriet Mireiri going over study procedures at the Bomu Hospital in Mombasa, Kenya.
Dr. Eric Osoro (left) with field study coordinator Harriet Mireiri going over study procedures at the Bomu Hospital in Mombasa, Kenya.

On a typical day, the maternal and child health unit at Coast General Hospital in Mombasa, Kenya, will be bustling with dozens of pregnant women waiting to be attended by the doctor and find out how their babies were progressing. For the women, this is a reassuring monthly routine in a country with high numbers of maternal and infant deaths. Besides the maternal and neonatal deaths, a worry which occupies the pregnant women is the possibility of a baby born with birth defects.

When the World Health Organization determined that Zika virus causes microcephaly, a birth defect that causes a baby’s head to be smaller than normal, there was concern about the potential implications in Kenya. Zika virus is transmitted by the Aedes aegypti mosquito, which is prevalent in coastal regions and was already associated with an outbreak of dengue fever—a disease related to the Zika virus. Furthermore, Zika virus was first detected in a neighboring country whose disease profile is similar to that of Kenya.

Could it be possible that Zika was responsible for some of the birth defects in Kenya and the health authorities were not aware?

In October 2017, researchers from the WSU Allen School commenced a study to determine the outcomes of Zika infection among pregnant women and infants in Kenya. In the study, we are recruiting pregnant women in early pregnancy in selected Mombasa hospitals. We will follow the women over the course of their pregnancy to identify any evidence of Zika virus infection and outcomes.

The pregnant women are often at the prenatal unit area early in the morning, well before the health workers start attending to them. While at the waiting bay, we approach the women and talk with them about the study. Typically, they would vaguely recall aspects of Zika virus, but could readily identify the mosquito transmitting the virus once we described it.

“If it is the same mosquito which bites during the day and brings dengue, I have been bitten by them several times,” said one woman, and it is a typical response.

We then provide them with information on the study and their involvement for purposes of informed consent. Once informed consent is obtained, the mother is taken through a questionnaire before a blood sample is drawn for Zika virus testing. She is then scheduled for monthly follow up until delivery. After delivery we will follow up with the infants to assess for growth and neurodevelopment.

The study is funded by Centers for Disease Control and Prevention and is collaboratively implemented by WSU and local partners including the Kenyatta National Hospital, University of Nairobi, Kenya Medical Research Institute, and Mombasa County government.

Laboratory technologist Samwel Wakithae processing blood from study participants in the Bomu hospital, Mombasa, Kenya.
Laboratory technologist Samwel Wakithae processing blood from study participants in the Bomu hospital, Mombasa, Kenya.

As part of the entry and preparation for implementation of the study, we conducted sensitization meetings with stakeholders including community women groups, local health workers, religious leaders, and the local administration.

“We have a lot of these mosquitoes and we thought they only spread dengue,” said one of the community women leaders. “We are very willing to learn how much Zika we have and what problems it is causing in our area.”

Dr. Hafsa Jin, an obstetrician in one of the study sites, welcomed the study and looks forward to the findings.

“We do see some children with microcephaly, but we rarely get to know the cause,” said Dr Jin. “This study gives us an opportunity to quantify the burden of birth defects and probably establish their causes. This will be very useful information for planning prevention.”

The study will provide data leading to evidence-based strategies to prevent Zika virus infection in pregnancy in Africa. It could lead to improved counseling of patients about risks to their pregnancies and their children. The information will also contribute to effective preparedness for health facilities providing services to affected children and families.

Message from the WSU Senior Director of Global Health

Our encompassing goal is to improve public health and catalyze human opportunity through research, teaching, and outreach. To achieve this goal, it requires committed individuals. In October, we celebrated professor Kariuki Njenga who was elected to the National Academy of Medicine. It is described as “one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service.” Read more at go.wsu.edu/Njenga. This richly deserved recognition adds to the national and international reputation of the Allen School faculty. All of WSU’s National Academy of Medicine members are Allen School faculty, six are fellows of the American Association for the Advancement of Science, and six are members of the Washington State Academy of Science, including professors Doug Call and Jon Yoder who were elected earlier this year. Election to these bodies reflects not only the highest levels of scholarship, but also a commitment to serving society through science. As impressive as these achievements are, they are in many ways only the “tip of the iceberg.” The Allen School has an outstanding group of young faculty, already widely recognized among their peers for their accomplishments, who will undoubtedly emerge as the next generation of nationally and internationally recognized fellows and academy members. I look forward to seeing how they help meet our goals to improve health and opportunity for everyone, everywhere.

Guy Palmer
Creighton Endowed Chair and
WSU Senior Director of Global Health

Celebrating 10 Years: A Big Thanks to You

“I’ve been proud to support the School for Global Animal Health because your work saves lives—in Africa and throughout the developing world. I’m happy to see that your efforts over the past decade have earned the school recognition as the preeminent institution of its kind. This gives you an even greater opportunity over the coming decade to substantially improve the quality of life for the families, communities, and nations in need of your expertise.”
—Paul G. Allen on the 10th anniversary of the founding of the school

Global health 10 year anniversary

Because of the generous support of Paul G. Allen and our hundreds of other private donors, the Allen School’s work has reached places as far away as Tanzania and Guatemala, and as close as right here in our very own Washington state. Over the last 10 years, we have become a preeminent global health program nationally and internationally. We continue to work directly with communities on three continents to improve the health of animals and people all over the world. We want to share with you just a few examples of our impact through innovative research and local programs. Impact that you help make possible.

Ending human rabies deaths by 2030.
Rabies is the deadliest zoonotic disease on the planet. More than 59,000 people die from it each year and about half of those deaths are children. Our research discoveries are helping to increase the effectiveness of dog vaccination campaigns. In Africa, dogs spread the disease to humans and wildlife, including lions. By vaccinating 70 percent of the dog population in Tanzania and Kenya, we can stop the spread of rabies.

Preventing the emergence and spread of antibiotic resistance.
Poor sanitation can harbor resistant bacteria that spread locally and globally Discovering causes for increases in antibiotic use and the spread of resistance, our scientists have helped implement ways to reduce infection and the spread of resistant bacteria in poor communities worldwide, which not only protects those communities but helps preserve effective antibiotics here in Washington state.

Improving human nutrition and childhood education.
Healthier livestock means better nutrition for mothers and their children. Our research has led to interventions to improve access to food and has shown that when cattle are vaccinated and protected from disease, the increased income is directed to education of girls.

Message from the WSU Senior Director of Global Health

The Allen School, and the broader global health programs at WSU, would not exist today without the support of Paul G. Allen and the over 300 individual donors who continue to invest in our mission. This support catalyzed the University’s subsequent investment in the Allen School and has dramatically changed the global health landscape at WSU. Over the past four years, our federal research support, principally from the National Institutes of Health and the Centers for Disease Control and Prevention, has increased more than 300 percent, demonstrating the multiplier effect of initial philanthropic support. Perhaps more impactful than this catalytic effect, donor support drives innovation in ways that state and federal support cannot. Multidisciplinary research such as demonstrating the linkage between livestock vaccination and secondary school education for girls in rural Kenya, highlighted by National Public Radio for its innovation, falls outside any funding agency’s remit. Similarly, current research on drivers of antibiotic resistant microbes in Guatemala and how to reduce the emergence and spread of this resistance requires strong international partnerships between universities and indigenous communities—all made possible with philanthropic support. But the greatest impact of donor support, independent of size, is the confidence placed in the faculty, staff, and students in meeting our mission of improving public health. We take your support to heart and pledge to ensure it makes a difference in human health and opportunity.

Guy Palmer
Creighton Endowed Chair and
WSU Senior Director of Global Health

Faculty News Summer 2017

photo of douglas in the field

Douglas Call, professor in the Allen School, received the Sahlin Faculty Excellence Award for Research, Scholarship, and Arts. His research has led to greater understanding about the ways bacteria develop resistance to antibiotics. In east Africa, where people, domestic livestock, and wildlife live close together, Dr. Call is leading a multidisciplinary team to understand how antibiotic resistance arises and spreads through communities.

Why Keep Chickens? A Chat with Tanzanian Farmers

Notes from the Field

by Zoë Campbell, a doctoral student in the Paul G. Allen School for Global Animal Health. This column is Campbell’s personal account giving a first-hand glimpse of her research in Tanzania to improve the lives of animals and people.

A farmer in the Arusha region next to her chicken coop.
A farmer in the Arusha region next to her chicken coop.

A Tanzanian village is not complete without chickens. Hens scratching in the dirt for insects, dusty chicks pushing their tiny bodies through tall grass to follow their mother, roosters delightedly crowing at all hours. They are the most common form of livestock, kept by 48 percent of rural households. As a graduate student working under the Program for Enhancing Health and Productivity of Livestock, I want to understand why some households vaccinate their chickens and others do not.

A group of farmers assemble in the shade of a tree in Chikuyu, a village in the Singida region in central Tanzania. Rains came last night, and thoughts turn to planting rice in the paddies on the edge of the village. The legs of the plastic chairs sink into the moist, sandy soil. Despite other responsibilities, everyone is here, curious about what the guests will say about Newcastle disease, which afflicts their chickens. It is certainly a problem, passing through the village and killing chickens, especially in September when the weather is cold and windy. Most of the farmers here today remember the 150 chickens they began raising as a group back in 2011; Newcastle disease killed all but forty. Today, the group has 10 birds. A spacious two-room chicken coop stands empty behind us as a reminder of better days. As I walked towards the group accompanied by my research assistant and the ward livestock officer, I heard one of the women whisper to her neighbor, “They are going to ask difficult questions.” There could not be a more fitting segue into the questions I had prepared for the morning. One joy of being both a researcher and a foreigner is that I can ask questions that in their simplicity is fitting to a four-year-old. For example, why do you keep chickens?

The answers come fast. For income, says a man sitting on the end of the log. For food, adds the woman next to him. If there is a problem at home, someone explains, you can sell a chicken. If someone gets sick, you can pay for the hospital bill and other expenses. By selling a chicken or eggs, you can help children at school pay fees or buy notebooks. “I paid all my village contributions last year by selling two chickens,” an older man proudly says.

There is now a pause, and people sip their sodas. Kenan Mwakalinga, a research assistant who has accompanied me since we began conducting focus groups in his home region of Mbeya, is patient and waits out the silence. Chickens are a household resource. A tall, young man in his early twenties who hasn’t spoken yet clears his throat. “When I watch my chickens, I feel happy. They lower my blood pressure. They refresh my mind.” Our final contribution comes from a mama dressed in bright kitenge fabric who has already identified herself as the comedian of the group. Sometimes when you are doing the tasks of the day, you get lazy and drop things, she says. The chicken will come and eat it. “In problems, the chicken is there. In cleaning, the chicken is there!”

True, the ultimate question is difficult. Why are some of these farmers vaccinating and others are not? Beginning in late April 2017, I administered a questionnaire to 500 households in six villages. The aim is to identify challenges to vaccination and factors associated with households successfully vaccinating. Still, I am convinced there is wisdom in the simple questions and conversations with the focus groups. Understanding more about the relationship farmers have with their chickens may help to explain how they think about vaccines, and lead to solutions that help more farmers prevent unnecessary losses due to Newcastle disease.

Zoe Campbell talks with vet officer and villager
Zoë Campbell (back, left), research assistant Kenan Mwakalinga (back, right), and Dr. Martin Halid, ward
veterinary officer (front, right) talking with a villager.

Message from the WSU Senior Director of Global Health Summer 2017

“Build a better mousetrap and the world will beat a path to your door.” Ralph Waldo Emerson’s famous aphorism may apply to mousetraps, but certainly not to all inventions, even those with potential to markedly improve lives and livelihoods. To the contrary, one of the great challenges in global health and development is to understand what determines whether a technology—such as a new vaccine, water collection system, or improved crop variety—is adopted and used. While the Allen School is heavily engaged in the discovery and development of new disease prevention and treatment tools, we are also mindful that these advances are only impactful if they are adopted. As you will read in “Notes from the Field,” interdisciplinary doctoral student Zoe Campbell is conducting research in Tanzania to understand why households decide to vaccinate their chickens, a critical nutritional and economic resource for smallholder families in east Africa,
against the leading cause of poultry death, Newcastle disease. While research has shown the vaccine is highly effective, use among rural households remains low. By understanding what factors lead a household to adopt the vaccine and those constraints that limit adoption, we can develop strategies to overcome the barriers to widespread use and ensure the full benefit of the vaccine. Importantly, women most commonly make the decisions on household chicken production. Understanding how women in low income and vulnerable communities make decisions is critical to improving health, not only in Africa, but here in the United States. In collaboration with WSU’s School of Economic Sciences, the Allen School has successfully recruited a new faculty member with specific expertise in female gender decision-making and the impact on health. Dr. Shanthi Manian will join WSU in August, strengthening our capacity to not only discover and develop new technologies, but to ensure they have the impact on health and opportunity that is central to the Allen School’s mission.

Guy Palmer
Creighton Endowed Chair and WSU Senior Director of Global Health