Effective High-Throughput Blood Pooling Strategy before DNA Extraction for Detection of Malaria in Low-Transmission Settings

In the era of (pre) elimination setting, the prevalence of malaria has been decreasing in most of the previously endemic areas. Therefore, effective cost- and time-saving validated pooling strategy is needed for detection of malaria in low transmission settings. In this study, optimal pooling numbers and lowest detection limit were assessed using known density samples prepared systematically, followed by genomic DNA extraction and nested PCR. Pooling strategy that composed of 10 samples in 1 pool, 20 µl in 1 sample, was optimal, and the parasite density as low as 2 p/µl for both falciparum and vivax infection was enough for detection of malaria. This pooling method showed effectiveness for handling of a huge number of samples in low transmission settings (<9% positive rate). The results indicated that pooling of the blood samples before DNA extraction followed by usual nested PCR is useful and effective for detection of malaria in screening of hidden cases in low-transmission settings.

Use of foldback analysis to foster consolidation between academic and public health practice

INTRODUCTION

Departments of health can provide applied settings for students from academic public health programs to explore the connection of course work to real-life circumstances. Barriers exist for public health practitioners, however, that restrict their willingness to engage in joint efforts with academe. To address these barriers, they must be identified and characterized. That is, it is important for academics in public health to respect both barrier-issues and to understand underlying value constructs, if they hope to employ public health practice settings to advance their students' training.

METHODS

A 100% sample of all midmanagers was surveyed at the Hawaii Department of Health by the School of Public Health. Nine clusters of "key issues for continued collaboration" were identified and rank-ordered in importance. Further analysis of the rank-orders, using multidimensional scaling, distinguished important underlying value constructs crucial to improving joint activities between the school and department.

RESULTS

Working together, representatives from the Department and School identified the first three value dimensions as cooperation, implying the need for true reciprocal and equal interaction; obligation, signifying mutual responsibility and parallel investment; and, professional practice, suggesting the balanced interdigitation of research with practice. These value dimensions account for three fifths (58%) of the variance in opinion.

CONCLUSIONS

Detailed analysis of these dimensions suggests that low-cost strategies improve collaboration, and foster possible consolidation, between academic and clinical public health settings. A stronger partnership between the school and the department is likely, provided the two agencies can address these issues satisfactorily. Insights from the Hawaii experience may prove useful to other academic public health practice settings. Recommendations that may improve collaboration include holding joint semi-annual meetings, a school bulletin board listing practica at the department, a public health leadership course, improved electronic communications between the school and the department, joint appointments to the two agencies, faculty release time to conduct research to improve practices at the department, and the establishment of a steering committee for the collaboration.