1. MASANGA HAEMOZOIN BIOSENSOR TRIAL CIARÁN DOHERTY

2. Masanga Hospital A rural compound, providing free healthcare in paediatrics, maternity, general medicine and surgery in Tonkolili district, Sierra Leone. Staffed largely by local auxilliaries, Dutch doctors and British & Danish volunteers.

3. Sierra Leone Location: West Africa Population: 6 million Infamous for the brutal civil war between ‘91 & ‘02, the country is now at peace, although still remains one of the poorest in the world

4. Malaria in Sierra Leone Malaria is the 5 th largest cause of death by infectious disease worldwide, accounting for around 200 million cases per year and up to 1 million deaths 100% of Sierra Leone is classed as a high transmission zone 10,000 cases of malaria were confirmed per every 100,000 people in 2010 Malaria is a major contributor to Sierra Leone having the 4 th lowest life expectancy and 2 nd highest infant mortality in the world (below only Afghanistan)

5. Haemozoin All species of the malaria parasite Plasmodium metabolise haemoglobin and excrete the toxic iron molecules as an inert crystal These crystals, known as haemozoin, are both magnetic and dichroic, meaning they absorb different polarisations of light in different amounts

6. Haemozoin

7. Exeter Team A team of physicists and engineers at the University of Exeter came together to produce a device that could detect haemozoin in the blood

8. Haemozoin Biosensor Aka. MOT (Magneto-Optic Test) The MOT detects the presence of haemozoin crystals by applying a magnetic field to a sample of infected blood, aligning them all in the same plane and then shining a polarised light across them A sensor at the other end detects changes in light absorption The diagnosis of malaria is made on the presumption that the haemozoin it detects is as a result of active infection

9. Original MOT The first MOT device developed

11. Current Prototype The handheld, portable MOT

12. What diagnostics are available? Rapid Diagnostic Tests (RDTs) Cheap and easy to use Sensitivity/specificity varies according to brand Must be stored in cool, dry environment Non-reusable Microscopy Gold standard Can differentiate species and give detail on gametocytes, parasitaemia etc. Expensive (labor time) Requires high level of training + equipment

13. Rapid Diagnostic Tests (RDTs)

14. Why test for haemozoin? Present in the blood only during active infection, unlike antibodies Requires just a pinprick of blood Quicker: takes just 30 seconds Cheaper: initial cost of machine only Easier: requires no expert training, gives a simple yes/no diagnosis of malaria No special storage requirements

15. Objectives Test 300 patients with ?malaria on the MOT To compare these results against both microscopy, two brands of RDT, and in cases of discrepancy, PCR Derive sensitivity and specificity values from the data As a side project, evaluate the difference in sensitivity and specificity of the two RDT brands in order to identify possible weaknesses in pre-existing rapid diagnostics

16. Our lab… Biosensors Power supply Sample prep

17. PCR prep

19. Results MOT data under non-disclosure agreement… Data currently being analysed and will be published in 2012/13 RDT comparison study showed significant differences between the two brands, with some sacrificing specificity for higher sensitivity and vice versa Hospital ran out of their own RDTs mid-way through trial, highlighting the impracticality of disposable tests in poor, rural settings

20. As an elective…

25. Any questions?