6.6 Concluding Thoughts
7.1.5 Changes in research gov- ernance
sity developing a technique for Polymerase Chain Reaction testing of sputum samples which could be performed in mass screen- ing for the disease. Significant community- based studies on coronary risk factors were conducted in this year which provided an opportunity to re-assess interventions in the Coronary Risk Factor Intervention Study (CORIS) in three towns in the Western Cape, and to determine the nature of coronary risk factors in urban Africans in the Cape Town metropole. Other major events in- cluded the discovery of the chromosome on which the gene for albinism was located, and the launch of a national collaborative programme to advance the development of technology for health care.
The year saw studies into the provision of health services in Port Elizabeth, the evaluation of health services in two Cape Town teaching hospitals, an investigation of the attitudes of private practitioners to health care provision, and a consultative ap- proach to establishing the priorities for a post-apartheid health system. All of these marked a radical departure from the tradi- tional research agenda of the MRC up to that time, and heralded the beginning of a different emphasis on the role of research in the health of populations. Concurrent with this were efforts at defining newer sampling techniques in peri-urban areas, and the creative use of routinely collected data in these atypical environments.
7.1.5 Changes in research gov-
the bulk of research into AIDS and TB. The research into nutritional diseases highlight- ed the prevalence of nutritionally-induced (mainly iron deficiency) anaemia. In addi- tion, researchers pledged support for a na- tional nutritional surveillance programme and involvement in developing nutrition research capacity, both significant depar- tures from traditional nutrition research.
The National Malaria Research Programme was established in 1992, the year in which the programme leader participated in the Global Ministerial Summit on malaria in Amsterdam. This was the start of a regional initiative which was to lead to striking im- provements in malaria control in southern Africa, despite the increased migration consequent upon the political changes in the region. The Amoebiasis Research Pro- gramme, with the most comprehensive bank of amoebae in the world, continued its cutting-edge research in diagnostic and therapeutic measures, distinguishing between pathogenic and non-pathogenic species through iso-enzyme electro- phoresis.
The discovery of a faulty gene that caused deafness and blindness was discovered by genetic researchers in 1992. It was also found that a deficiency in the sixth compo- nent of complement, which made subjects susceptible to recurrent bouts of menin- gococcal meningitis, was common in the Western Cape. Exciting work on new antibi- otics, cloning the receptor which responds to gonadotrophin releasing-hormone, new anti-cancer agents, and advances in bio- physics and nuclear medicine continued in a number of centres. At the level of health
service provision, the cost-effective identifi- cation of high-risk pregnancies using Dop- pler flow velocimetry by the MRC’s Perinatal Mortality Research Unit and the new MRC/
University of Natal Pregnancy Hypertension Unit were important translational activities.
A Rural Injury Surveillance Study, multi-sec- toral strategies towards child safety and the completion of the Cape Metropolitan Trauma Study, the first of its kind in Africa, marked the research contribution to our understanding of these major public health problems. Laboratory research on tempera- ture regulation, vascular research and dia- betes produced significant new findings, while dental research and bone research were especially productive. Urbanisation research addressed adolescence, violence prevention and the health risks of domestic fuel use.
The Centre for Epidemiological Research in Southern Africa diversified the scope of its activities to include work on epidemiology and health systems, biostatistics, and re- search into chronic diseases of lifestyle. The new Technology Development and Transfer Initiative of the MRC marked the beginning of the implementation of the broader man- date provided by Act 58 of 1991.
In 1993, the MRC adopted the philosophy of
‘Essential National Health Research’ (ENHR), which altered its approach to research management. The distinction between so- called ‘basic’ research and so-called ‘applied’
research was to be no more. National health problems would be addressed scientifically in an integrated manner, and all research ef- forts would be utilised to answer pressing research questions. Regrettably, the organi-
sation’s early efforts to engage in private- sector technology development met with financial disaster. Millions of Rands were lost, and the organisation suffered staff retrenchments as a result. Research efforts continued, however, and a significant new finding was the discovery of a monoclonal antibody to overcome post-transplant bone marrow rejection, while progress was reported in xenotransplantation for kidney disease in animal models.
Major research activities included the initiation of Action TB, a R30 million ini- tiative funded by a pharmaceutical com- pany aimed at globally curbing TB, which brought leading scientists in South Africa and the United Kingdom together. Three South African centres of excellence, which included scientists from a number of uni- versities and the SAIMR, concentrated in this area on molecular genetics and drug resistance, virulence determinants and host-cell interaction, the provision of bulk mycobacterial organisms, and the mainte- nance of mycobacterial strains. July 1993 saw the establishment of a network of clini- cal researchers in TB and HIV, signalling a recognition of the implications for TB of the HIV/AIDS epidemic affecting the country.
Studies in identifying receptors involved in the induction of dysentery, including the use of enzyme-linked immunoassay (ELISA) and immune-electron microscopic tech- niques for the detection of small viruses causing gastroenteritis, was conducted with international scientists; the effect of the Ed- monston-Zagreb strain of measles vaccine on child immunity was tested by scientists in South Africa and the United States; while
the effectiveness of the 1990 mass measles immunisation campaign was assessed by the CERSA . Home-based care for HIV/AIDS, regional surveillance of HIV/AIDS, the role of sexually transmitted diseases (STDs) in HIV transmission, the role of traditional practi- tioners in combating the HIV/AIDS epidem- ic, primary care for HIV-infected subjects, and the use of simplified tests for diagnosis of HIV infection, amongst others, were on the research agenda in 1993. The malaria research programme included the develop- ment of a Malaria Information System, drug resistance, prophylaxis, mosquito repel- lants and malaria vector surveillance, while bilharzia research included testing different methods of disease control, including the use of newer drugs and the development of newer diagnostic techniques. At the same time, innovative diagnostic techniques for amoebiasis and the discovery of a link be- tween amoebiasis and Wegener’s Disease elicited great international interest.
Researchers discovered two new mutations of the gene for familial hypercholesterolae- mia and a mutation in a gene that codes for one of the apolipoproteins, and devel- oped diagnostic methods to identify gene defects in a number of conditions, includ- ing retinitis pigmentosa, Leber’s hereditary optic neuropathy, and Usher’s syndrome.
Other activities included research into Tay- Sachs disease, porphyria, genetic cardiac disease, and the discovery of a previously unknown genetic disorder.
Research in perinatal mortality, women’s health in a peri-urban area, ongoing follow- up in the Birth-to-Ten project, premature la- bour, prenatal care, midwife education and
a review of abortions dominated maternal and child health research, while popula- tion-based nutrition surveys, iron supple- mentation in schools, the distribution of io- dised salt, and vitamin D deficiency formed the bulk of nutrition research.
Health systems research included the inte- gration of curative and preventive services, evaluating the role of community health workers, a review of the registration of births and deaths, the stimulation of health pro- motion, the ‘Healthy Cities’ Project, and the introduction of violence-prevention projects.
Cardiovascular disease and lifestyle re- search included a costing of the burden of cardiovascular disease in South Africa, risk factors for coronary heart disease in adoles- cents, and the role of sodium in hyperten- sive heart disease. At the level of laboratory and animal experiments, studies clarified the role of monocytes in arterial disease, the prevention of heart attacks, and the re- lationship between certain endocrine cells and diabetes. Research into exercise physi- ology, oral and dental health, health care technology, and radiobiology continued to contribute to the increasingly diverse pool of health and medical science.
A conference organised by the Essential Health Research Group (later renamed the Community Health Research Group) of the MRC in June 1993 identified a number
of key issues affecting health and medical research in South Africa. The need to de- velop capacity in public health research, a concomitant need to develop research capacity at historically black universities4, and the over-riding need to make research results rapidly available to policymakers, were identified during the conference. This led to the allocation of 20% of the funds for proposal applications, bursaries, fel- lowships, internships and research trainee posts for historically black universities, and the establishment of the Research Capacity Development Group in the MRC. The excite- ment surrounding the political changes in the country also led to the MRC seeing an important role for researchers in policy de- velopment, and contributions were made to the National AIDS Convention in South- ern Africa, the national advisory commit- tees on primary health care, AIDS, tuber- culosis, trauma, nutrition and malaria. The organisation also played a facilitatory role in shaping a national cancer control policy for the country.
The number of visitors to South Africa con- tinued to rise and the MRC alone hosted 123 international guests during 1993. The year also saw increasing contacts between South African scientists and scientists in southern Africa.
4 Under apartheid, South African universities were established for different racial groups. Those created for black South Africans were under-resourced and under-funded, thus limiting their capacity for research.
7.1.6 Re-shaping health and