An island within the Bijagos archipelago

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Travellers to the distant African islands of Bijagos can anticipate finding a tropical paradise of pristine seashores and plush rainforest.

However the islands will not be simply stunning. They’re additionally a pure laboratory, offering a novel setting by which to check cures for among the world’s deadliest ailments.

A set of 18 islands and 70 islets off the coast of Guinea-Bissau, West Africa, the Bijagos are dwelling to about 30,000 folks with their very own language and distinctive traditions.

Additionally they teem with wildlife, together with the uncommon saltwater hippopotamus and big sea turtle, which thrive on this distant spot.

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Alamy

However these tranquil islands are dwelling to many severe diseases and circumstances. Life expectancy on Guinea-Bissau is about 60, and on the Bijagos Islands it’s considered a lot decrease.

Malaria, a extreme eye an infection known as trachoma, lymphatic filariasis – a persistent swelling generally generally known as elephantiasis – and intestinal worms are explicit issues.

Nevertheless, the islands can also maintain the key to tackling the very ailments that blight them.

A pure laboratory

Medical researchers have been engaged on the Bijagos Islands for a number of years to see if they will do away with sure ailments from sure islands.

The rationale that the islands work so properly as a pure laboratory is their remoteness.

Whereas this makes some on a regular basis actions tough, it’s a useful characteristic when attempting to eradicate illness.

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A ship in Bissau harbour making ready to make the journey to the Bijagos

The islands’ separation by water creates a pure barrier. This enables us to match totally different illness management strategies, with out the chance of cross-contamination between the take a look at websites.

On the mainland, folks can readily transfer out and in of trial areas, contaminating the websites and making it tough to determine trigger and impact.

An island set-up permits us to fastidiously and precisely measure the influence of any intervention made.

Whereas there are numerous archipelagos world wide, few have islands shut sufficient collectively to permit us to work there, however far sufficient aside to minimise interference throughout experiments.

There are additionally few islands with this structure which can be dwelling to so many ailments.

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Trachoma

Researchers from the London College of Hygiene and Tropical Medication (LSHTM) initially targeted on trachoma, an infectious illness that turns the eyelashes inwards. Affecting 1.9 million folks globally, it’s the world’s main reason for preventable blindness.

Trachoma may be transmitted if contaminated arms, clothes or contaminated flies come into contact with the eyes. It’s attributable to a type of chlamydia bacterium and infrequently spreads in crowded areas with insufficient sanitation.

The illness is present in 42 international locations world wide, and at one level, there have been some villages on the islands the place each single youngster had the illness.

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LSHTM

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Dr Anna Final analyzing a affected person for trachoma

Dr Anna Final from LSHTM identified high risk areas for trachoma, earlier than treating complete communities with antibiotics to finish the cycle of transmission.

Inside eyelid swabs, taken earlier than and after the remedy, helped the researchers to detect the illness at an early stage. They’re additionally getting used to establish which genetic sorts of an infection have been current.

This would possibly enhance understanding of what occurs after native elimination.

If the trachoma returns, we might be able to decide from its genetic pressure whether or not it got here from an out of doors supply or re-emerged from inside that neighborhood.

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The outcomes have been hanging. When she first started her work, 25% of individuals on the islands had the illness. Now, solely zero.three% of individuals have it.

Not solely is that this under the WHO threshold for elimination, which means the illness is all however eradicated from the islands, however the methods developed might now profit the broader world.

Attending to Bijagos

  • Sometimes attracts intrepid explorers, however not a typical vacation vacation spot
  • Attending to the islands may be treacherous, significantly within the wet season, when storms can come out of nowhere and trigger giant swells
  • The journey from the mainland takes no less than 5 hours, on a small ferry filled with folks and animals
  • There are few well being centres, with the biggest on the principle island of Bubaque – medical provides are restricted
  • Whereas medical professionals present the very best care they will, remoteness and inaccessibility at occasions make this tough

Malaria

Trachoma will not be the one drawback dealing with the folks of the Bijagos and a number of other different ailments on the islands at the moment are being tackled.

Our present focus is malaria. This illness is unfold when feminine mosquitoes contaminated with a parasite chew a human, resulting in preliminary signs equivalent to fever and a headache earlier than rapidly changing into extra extreme. Malaria kills nearly half 1,000,000 folks worldwide annually.

Given the prevalence of malaria on the islands – with as much as one in 4 folks contaminated – it’s unsurprising we discovered mosquitoes which can be excellent at transmitting the illness.

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LSHTM

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Researchers from LSHTM leaving Rubane island following a mosquito survey

Worryingly, we additionally discovered that some have been proof against pesticides.

This implies the most typical methods to regulate malaria – mattress nets and spraying homes with pesticides – could not work, which means another technique is required.

More like this

A brand new drug is about to be trialled, which is transferred to the mosquito through the sufferer’s bloodstream when it bites.

Previous therapies have tended to focus on the malaria parasite inside the human physique. However this drug targets each the mosquito and the malaria parasite, shortening their lifespan.

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LSHTM

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Islander Ansulmani accumulating mosquito larvae utilizing the dipping methodology

On this trial, all of the islands shall be given the usual management instruments, equivalent to mattress nets. Some, the “intervention” islands, may also be given the drug. Others, the “management” islands, is not going to.

A group of native islanders have been educated in medical expertise, equivalent to taking blood samples and screening them for malaria.

They’ve additionally discovered tips on how to accumulate and establish mosquitoes, with the assistance of Ba, one in all our area group hoping to turn into the primary entomologist, or insect specialist, on the islands.

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LSHTM

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Ba is finding out to be an entomologist

Trying to the longer term

Whether or not this drug will do away with malaria on the islands as soon as and for all stays to be seen.

Both manner, the teachings learnt from our research are prone to have an effect far past the distant Bijagos Islands.

Each examine helps us to be taught concerning the illness itself and the way it’s transmitted, which shapes future analysis.

On the islands, this may be finished extra rapidly, with larger management and accuracy. We will see what the consequences are in an outlined space, reaching a complete inhabitants.

The LSHTM venture will proceed on the Bijagos for no less than one other 5 years, and within the meantime, its findings are doubtless for use to sort out main ailments like malaria elsewhere.

About this piece

This evaluation piece was commissioned by the BBC from an expert working for an outside organisation. The 2-year examine in the direction of infectious illness elimination on the Bijagos Islands was funded by UK Research and Innovation.

Prof James Logan is head of the Division of Illness Management on the London College of Hygiene and Tropical Medication. Comply with him on Twitter at @ProfJamesLogan.

Edited by Eleanor Lawrie