Dr. Sally Mtenga, a senior social research scientist at the Ifakara Health Institute, recently discussed her experience working in the field of malaria research in an interview that was published in the Swiss Tropical and Public Health Institute's (Swiss TPH) Malaria Course Alumni newsletter's June 2023 issue.

In the conversation, Dr. Sally discusses her early experience working with malaria, which dates back to the years 2013 and 2016, when she was asked to oversee a social and communication component within a clinical trial for a malaria vaccine being carried out by the Ifakara Health Institute in Bagamoyo district, Tanzania.

Read this Question and Answer (Q & A) piece in which she discusses her initial experience working with malaria and in public health, her greatest professional accomplishments while working in the field, and also shares advice for aspiring malaria researchers.  

________________

Q: Could you share with us your first experience working with malaria? Why have you been interested in public health? 
A: Well, my first engagement with malaria was in 2013 and 2016 when I was requested to lead a social and communication component within a malaria vaccine clinical trial that was being implemented by the Ifakara Health Institute in Bagamoyo district Tanzania. I was specifically leading a mixed-method research study that relates to the extent to which stakeholders perceived malaria vaccines as a new malaria prevention measure among under-five children and how women felt about their under-five children receiving malaria vaccine on top of the existing routine immunization services. 

The study revealed that various social aspects influenced stakeholders’ acceptance of the malaria vaccine including the perceptions on the side effects of the vaccine, religious aspects and the multiple questions that need to be clarified to the communities before they accept the vaccine. (https://malariajournal.biomedcentral.com/articles/10.1186/s12936-016-1209- 6#:~:text=The%20study%20findings%20suggest%20that,with%20other%20existing%20inter vention%20strategies). That meant that if at all malaria vaccine was to be introduced in Tanzania, the healthcare system would have to consider those factors as possible impediments against vaccine uptake. 

The findings from this study also made me appreciate that although the ‘malaria vaccine’ is a possible public health intervention against malaria transmission among children, still society has its own way of interpreting such public health intervention. The ‘social interpretation’ of public health intervention is usually underestimated or not well recognized by some public health practitioners, and this is one of the reasons for the poor uptake of the recommended public health interventions despite much investment. So, this was one of the important research evidences that evoked my passion to pursue research on the social determinants of health and well-being within the public health context. 

Q: Could you share a turning point or define a moment in your work as a scientist? 
A: The time that a significant change occurred in my career is when I left CARE International in Tanzania where I was working as a project officer and joined Ifakara Health Institute (at that time it was called Ifakara Health and Development Center (IHRDC). That was in 2003. 

At CARE, I was mainly involved with project management and supervision of 18 implementing agencies (IAs) from 6 regions of Tanzania. The IAs comprised nongovernmental organizations and community-based organizations that were implementing multiple health and nutrition interventions including vegetable plantations, advocacy against female genital mutilations, micro-credit groups and others. My specific role was capacity building for these IAs and strengthening their monitoring and evaluation systems. 

I joined CARE in 1999 and in 2003 I joined IHI to work under research capacity. This was a high turning point and sort of challenging paradigm shift for me since I had to learn a new norm of work. I felt challenged especially meeting new members who mainly focuses on research (at that time malaria research was the core business of IHI). 

The challenging part, but also interesting, was how I could integrate my implementation background into the research context. And how I could quickly adapt to a research environment and ethics. However, although critical, the pathway was simplified by the support given by many people including Dr. Rose Nathan, Dr. Honorati Masanja, Hon. Oscar Mukasa, Dr. Charles Mayombana, Dr. Hassan Mshinda and Prof. Marcel Tanner (later in career). I will never forget these people, they contribute significantly to who I am today. 

One interesting incident that always sticks to my mind is when I was requested to write a research proposal which was evaluated by the In-depth Network Secretariat for funding. At that time Prof. Binka was the director of In-depth Network, honestly, I could not think how I will achieve this task successfully and my question was that what happened if I fail to get the funds? But the psychological support given to me by the aforementioned team was superb, we even discussed the proposal ideas on the train on our way to Ifakara–Morogoro (at that time train was the main means of transport to Ifakara). 

I remember there is a day we were in the same compartment (inside the train) with Dr. Rose, Dr. Masanja and Hon. Oscar Mukasa and they were guiding me on how to tackle that research proposal. Finally, I managed to submit the proposal to the In-depth Network and I was called for a presentation in Accra Ghana. Thank God, after a few days I was informed that my proposal has been funded. I cried for joy…….and became more enthusiastic about research than ever. 

Q: What do you want to achieve with your research? 
A: I appreciate my Institute and the support that it has given me (especially my Director Dr. Honorati Masanja). Also, Prof. Marcel Tanner who supported my PhD career at Swiss TPH, Basel University and he is still supporting my professional career. 

I am now a senior social scientist with multiple research collaborations inside Tanzania and worldwide. I teach master students at the Bagamoyo training unit (masters of public health and research) under Nelson Mandela University in Tanzania. I am the Head of the Health System Impact Evaluation and Policy department at IHI. Among other previous awards, recently I won a MRC funding worth of GB £809,955 for multidisciplinary research on diabetes type 2 management in the context of COVID-19 that involves Tanzania, Kenya and the University of Glasgow. Thanks to my current mentor: Prof. Cindy Gray from the University of Glasgow-UK who has been guiding me untiredly. I also appreciate the support and the network provided by Prof. Sally Wyke from the University of Glasgow, they both have been contributing much to my career. 

Based on these credentials and resources around me, I see myself interested more in expanding my competence in attracting more research grants (mostly implementation research) and supporting the translation of research into possible policies and programs. I would also like to continue mentoring other young scientists and retain my teaching capacity. 

Q: What research topics are you currently working on and what papers do you have in the pipeline for next year? 
A: I am mostly engaging in research that relates to non-communicable diseases (NCDs), especially on changing the unhealthy lifestyle of patients with NCDs and supporting them to manage their illness effectively. I am also in the final touches of a research project that sought to investigate how we could improve the healthy food environment in Tanzania for the prevention of nutritional-related NCDs as well as the political and legal feasibility of implementing policies that would improve the healthy food environment in Tanzania. 
Currently, I have the following papers in the pipeline: 

1. Perceived challenges of managing type 2 diabetes during COVID-19 in Tanzania and Kenya: A call for sustained community and health systems supportive structures.
2. Factors associated with COVID-19 vaccine uptake among people with type 2 Diabetes in Kenya and Tanzania: a mixed-methods study.
3. Healthcare providers’ opinions on challenges experienced in managing illness during COVID-19. Qualitative study.
4. Dimensions of life disruptions experienced by patients with multimorbidity in Tanzania.

Q: Could you recommend a recent publication in the field of malaria and shortly explain why you liked it? E.g. did this article change something on the way you approach the field? 
A: My favorite paper in the field of malaria is: Ezezika O, El-Bakri Y, Nadarajah A, Barrett K. Implementation of insecticide-treated malaria bed nets in Tanzania: a systematic review. Journal of Global Health Reports. 2022;6:e2022036. doi:10.29392/001c.37363). 

This is a recent paper that was published in Tanzania. It has inspired me to find out that more evidence continues to prove that the uptake of public health recommendation interventions is influenced by the social determinants of health. 

The paper suggested that barriers to the implementation of insecticide-treated bed nets (ITNs) include cost, knowledge and beliefs, a poorly developed private sector, and inadequate distribution methods. All these factors are non-medical and are issues that can be prevented and addressed. 
The paper hasn’t changed my approach to public health problems but rather this is an inspiration for me to pursue more studies on the socio-structural determinants of various public health.

Q: What advice would you give to a new researcher in the field of malaria? 
A: As pointed out above, the evidence provided by the above paper (stakeholders’ opinion on malaria vaccine) indicated how the various social determinants can potentially influence public acceptance of health-recommended interventions. 

Social determinants of health are related to the non-medical aspects within the surrounding environment that can influence our health and health decisions. As such our health outcome is an outcome of how we have been raised, how we live, and the socio-economic conditions that surround us including policies, political environment, economic environment, social beliefs and others. 

This understanding is useful and I would advise the new researchers in the field of malaria that they need to appreciate the social determinants of health and well-being when investigating the various dimensions of malaria within the public health arena. 

Malaria elimination may require addressing the social environment factors that impede the effective uptake of the available malaria prevention interventions. One way to achieve this is to investigate the social determinants that contribute to poor uptake of malaria prevention interventions. ‘Illness’ and ‘health-seeking behaviors’ are socially constructed and cannot be understood outside the context of the social context.

___________

Dr. Sally Mtenga is a senior social research scientist working as the Head of Health Systems, Impact Evaluation and Policy departmentat at the Ifakara Health Institute. This interview was first published in the Swiss TPH's Malaria Course Alumni newsletter's June 2023 issue.

PHOTO:

Ifakara Health Institute, senior research scientist, Dr. Sally Mtenga. GRAPHIC | IFAKARA/KMC