The largest source of medical funding in the world - the US National Institutes of Health (NIH) - has assigned more than US$9million to UCT research projects aimed at building capacity in Africa, helping the continent solve global health problems at home.

The University of Cape Town attracted more direct grant funding from the US-based National Institutes of Health (NIH) than any other non-American university in 2013 - a sum that has grown more than three times in the last three years. "NIH grants are highly competitive," says Deputy Vice-Chancellor for Research Professor Danie Visser. "This growing support is confirmation that UCT, along with other research institutions in South Africa, is recognised internationally for making a significant contribution to solving global health issues."

These research grants make it possible for UCT's researchers to tackle some of Africa's most intractable and neglected health problems, while building capacity in Africa: most of the projects are large-scale, and many involve collaboration with partner universities on the continent.

One of the recipients of this funding, Associate Professor Crick Lund from the Department of Psychiatry and Mental Health, believes this kind of success isn't just testament to UCT's top scientists and infrastructure; it's also about the university's location: "If we're talking about [building capacity in] lower- and middle-income countries, UCT is perfectly placed. We are the logical conduit for research in sub-Saharan Africa on a variety of health challenges."

What kinds of projects are being funded?

Sickle cell anaemia

Sickle cell anaemia is the number-one human monogenic disease in the world - 300 000 people are diagnosed with it every year, the average life expectancy for patients in the US is 47, and the only effective treatment at the moment is bone marrow transplantation, which is expensive and largely unavailable in Africa.

Senior specialist in the Division of Human Genetics Associate Professor Ambroise Wonkam is trying to find out why some patients get sicker than others. He and his colleagues - based in South Africa, Cameroon (Wonkam's home country), Ghana and Tanzania - are looking for genome variations that can determine which patients have the disease from birth.

"In Africa, we don't know, but we think around half may die before one year," says Wonkam. "Seventy percent of those with the disease were born in Africa, yet 70% of what we know about it was discovered outside Africa. It was first described 100 years ago in the US, but it has largely been abandoned since then, while other much more recently discovered diseases - such as HIV - have been attracting attention. We in Africa have to solve these problems ourselves: it is our duty."

Mental healthcare

There is currently one psychiatrist for every 2 million people in Africa, one psychologist for every 2.5 million, and at least 75% of people living with mental disorders in low- and middle-income countries have no evidence-based mental healthcare. Associate Professor Crick Lund is working on a model for low-cost mental health interventions that can inform ministries of health across Africa - focusing specifically on the use of non-specialist health workers to provide mental healthcare under specialist supervision and training, otherwise known as 'task-shifting'.

"If you were only to use specialists to treat mental disorders in Africa, the queue would stretch halfway across the continent," says Lund. "We are evaluating the cost-effectiveness of interventions delivered by non-specialist health workers, to narrow the treatment gap." AFFIRM (Africa Focus for Intervention Research in Mental Health) is part of a global drive to narrow the treatment gap; as part of AFFIRM, students from Ghana, Ethiopia, Uganda, Malawi and Zimbabwe are being funded to complete an MPhil in Public Mental Health.

Big data

Biological data from Africa so often has to be shipped abroad and analysed internationally - which also means international researchers are the first to publish findings. Associate Professor Nicola Mulder, head of the Computational Biology Group, is out to ensure African research stays on the continent. As part of H3ABioNet - a pan-African bioinformatics network comprising over 30 research groups distributed among 15 African countries - she's helping develop bioinformatics capacity in Africa, so that researchers can access and analyse data digitally, and compute and publish their own findings. "In order to make new discoveries about the genetic basis for disease today, you have to generate big data," says Mulder. "We are moving towards hypothesis-generating science, where you do big-data analysis to narrow down the gene involved. This requires training of the next generation of scientists with extensive skills in bioinformatics."

Genetics

Head of the Department of Psychiatry and Mental Health Professor Dan Stein is leading two NIH-funded projects: one on the genetics of schizophrenia in the Xhosa population of South Africa, and the other on the genetic and trauma-related risk factors for post-traumatic stress disorder (PTSD) and depression, and on what makes some people more resilient than others. Of his schizophrenia research, Stein says, "This project will be the first to use modern genomic sequencing approaches to study schizophrenia in a population of sub-Saharan African lineage. If successful, our approach will identify genes important for the disorder in populations worldwide – and help develop more effective treatment and prevention strategies."

As for the PTSD and depression research, Steyn says, "Despite the adversity faced by many Africans and South Africans, some cope and function remarkably well. Identifying genetic or other factors that allow these individuals to cope may elucidate the underpinnings of resilience, which could inform the search for novel preventative and therapeutic interventions for these prevalent and debilitating disorders."

Did you know?

UCT's Faculty of Health Sciences was rated among the top 50 health-science faculties in the world in the Times Higher Education World University Rankings in 2012 - the first tertiary institution from any developing country to make the grade.

Story by Carolyn Newton.