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CLOSED: Job: Entomologist Malaria Study DRC

December 20, 2013 - 12:34 -- MalariaWorld Jobs
Organisation: Médecins Sans Frontières
Location: Amsterdam, Wageningen, DRC
Deadline for applications: 14 January 2014

 

Context
The Democratic Republic of the Congo (DRC) is a country affected by on-going violent conflict, a recurrent humanitarian crisis, acute health needs, limited access to humanitarian assistance and violations of basic rights and freedoms. In particular high morbidity and mortality are observed in areas affected by conflict where the institutional health system has been disrupted and few actors, whether Ministry of Health (MoH) or International Non-Governmental Organisations (INGOs), are providing basic healthcare services.
 
Médecins Sans Frontières-Operational Centre Amsterdam (MSF-OCA) has been working in the provinces of North Kivu, South Kivu and Katanga for many years. MSF-OCA operates 3 health programmes in Mweso (North Kivu), Baraka / Lulimba (South Kivu) and Shamwana (Katanga, South DRC). The North Kivu project comprises primary Health Care with supported Health Centres and Secondary Care in the Mweso Hospital. The South Kivu project comprises primary Health Care with supported Health Centres and Secondary care in Baraka and Lulimba Hospital. The Katanga project supports Health Centres and the Shamwana Hospital in order to provide free secondary Health Care.
 
Malaria control
Malaria is considered a major public health problem in DRC, a high transmission country (≥1 per 1000 population) . In 2011 DRC reported distributions of confirmed malaria cases of between 10 and ≥100 cases per 1000 population . Plasmodium falciparum is the major plasmodium species and Anopheles (A.) gambiae, A. funestus, A. nili and A. moucheti are the major Anopheles vectors in DRC1.
 
The WHO-recommended strategies for malaria control fall into two major areas, prevention and case management. Taken together, these strategies work against both the transmission of the parasite from mosquito vector to humans (and from humans to mosquitoes) and the development of illness and severe disease in humans . The former is achieved through long-lasting insecticide-treated nets (LLIN) distribution and indoor residual spraying (IRS) of dwellings and the latter through Artemisinin-Combination Therapy (ACT) treatment of confirmed malaria cases.
 
Background to malaria study
The study location will be Shamwana, where MSF is running a malaria intervention since Mid April 2012.
 
According to the MSF Outpatient Department (OPD) data for the year 2011, malaria represents the most common diagnosis, accounting for 23% of the total consultations during the year, with peaks of over 64% in Shamwana project during the rainy season. A significant percentage of those malaria cases were diagnosed in children under the age of five years. In addition, according to the IPD data, 53% of total admissions in Shamwana project sites were due to severe malaria. Since 2010 confirmed malaria cases observed in MSF-OCA programmes have almost doubled and since 2009 a 5-fold increase in the number of malaria cases has been observed. In Shamwana the increase in malaria incidence has been particularly evident in under-5 year olds but similar in <5 and >5 year olds. In addition two-three recurrent malaria episodes have been observed in the same individuals, it is not known if these are treatment failures or re-infections.
 
This alarming increase in malaria incidence cannot be explained by displacement of non-immune populations from non-endemic regions (mountains) to endemic malaria regions as the populations have been relatively stable since 2008.
 
In Shamwana MSF-OCA has been distributing LLINs in a targeted manner (ANC programmes and <5 year old malaria patients at OPDs). Although no IRS was carried out in Shamwana, MSF-OCA’s strategy of community health education targeted LLIN distribution and ACT treatment of confirmed malaria cases does not seem to be having an impact on malaria incidence that has increased since 2009.
 
There are several potential reasons related to LLIN and insecticide used for IRS that could explain why MSF-OCA is having little impact on malaria incidence:
1. Mosquitoes have developed a resistance to currently used insecticide on ITN
2. Mosquito species or sub species, specific to region have a different biting pattern, making LLITN or ITN less effective
3. Existing mosquito nets are of poor quality or have depleted insecticide activity to a level considered insufficient to be insecticidal.
4. Population do not use ITN correctly
5. ITN coverage is not sufficient to protect the population
 
Locations for study implementation
DRC South, Katanga – Shamwana
 
Methodology
  • Through field assessment, trapping and analysis (morphologically) identify down to sub-species level the main vector responsible for the transmission of malaria in the areas studied;
  • Using standard WHO tests establish whether or not malaria vector(s) are susceptible  to the family of chemicals (pyrethoid) used in LNs and IRS and others that are not currently being used;
  • Collection of a suitable sample of the identified vector for transport to a laboratory for identification down to sub-species level, presence/absence of knockdown resistance gene (kdr) and enumeration of circum-sporozoite infection rate;
  • Establish the residual insecticidal level of the ITN distributed and used in the communities;
  • The field activities and the laboratory part will be done and supported in collaboration with Wageningen University in The Netherlands.
Time frame
6 months, to start on 15th February 2014
 
General objectives of the post
  • To organise, design, implement and report on all aspects of the study;
  • Analyse the results of the study, present results in a report and give recommendations for further action.
Specific
  • Contribute to the understanding of malaria transmission in the site location by carrying out an assessment of the environment of the study site;
  • Identify the principal malaria vector (s) down to sub-species level in the study area using morphological index in the field;
  • Confirm sub-species by appropriately preparing enough principal malaria vector (s) and  using PCR at Wageningen University, The Netherlands;
  • Establish circum-sporozoite infection rate  by appropriately preparing enough principal malaria vector (s) and using the ELISA test in Wageningen University, The Netherlands;
  • Assess the feasibility (through trial) of successfully catching and rearing the larvae of the principal malaria vector (s);
  • Establish a baseline for the susceptibility of the vector to one or several organochlorine (OC), pyrethoid (PY) and carbamate (OP/C) based insecticides using WHO bio-assays carried out on field reared mosquitoes;
  • Establish insecticide levels in a suitable (randomly selected) sample of  the LNs used by the population,  by preparing them for transport and sending and testing them in Wageningen laboratory in The Netherlands;
  • Determine the most appropriate insecticide based measures used in the control of malaria transmission in MSF projects in DRC;
  • Interpret the increase in malaria cases in the study areas. Using the  results of this and other studies to be or having been carried out in the areas (KAP survey, ACT efficacy study and ACT adherence study).
Activities
For the study the following will be expected, although exact details may change depending on informed advice of the candidate, discussion with the study focal point(s)/supervisor(s), feasibility and context:
 
Part 1:
 
Short Desk Based Study/Assessment
  • Literature review of similar studies in the area (if they exist) and review of methodologies of any other similar studies, wherever they might have been carried out;
  • Study the malaria data from the study site to gain an overall impression of the public health issue and help (potentially) to better guide the study;
  • Study the results of the KAP2 survey carried out on LN coverage and usage;
  • Establish precise methodology (sample sizes, techniques etc.) of the study in conversation with the relevant advisors;
  • Establish a list of all materials beyond those that will be provided and might already have been procured which are necessary for the completion of the study as defined below or as adapted;
  • Produce a simple study plan including details of the activities to be carried out.

Initial Field Based Assessment

  • Carry out a thorough environmental survey of the study site to establish the breeding sites of potential vectors and risks to the population from that vector based on proximity to concentrations of population.
Part 2:
 
Vector trapping and identification
  • In randomly selected houses and other sites capture  mosquitoes using CDC light traps;
  • Identify morphologically3 the trapped mosquitoes down to species level or, if possible, to sub-species level;
  • Establish the likely principal malaria vector (s) in the area based on species identification and results of the environmental survey (of breeding sites and other factors);
  • Train a national staff members to carry out some of the basic operations of this activity.

Vector packing, transport and further testing

  • Establish a suitable sample number of trapped and inactivated (i.e. dead) mosquitoes for transport to the identified laboratory facility for further testing to establish circum-sporozoite infection rate;
  • Establish a suitable protocol and all necessary labelling for the above, training national staff to carry out the practice correctly;
  • Trap, inactivate, pack and label the samples and arrange for their transport.
 
Part 3:
 
Assess the feasibility of rearing larvae in the field in case mosquito capture are too low.
  • Provide input into the design of a simple facility in an appropriate location for the rearing of mosquito larvae to adulthood;
  • Make a first attempt to raise some larvae in suitable conditions to adulthood.
 
Rear larvae and carry out bio-assay tests on adulthoods.
Assuming that the above feasibility test has a positive outcome the following should be carried out:
  • Larvae of the principal malaria vector (s) in the study area will be captured at sites deemed from investigation to be the most suitable;
  • Larvae will be raised under ‘lab’ conditions (correct/appropriate temperature, humidity, light level etc.) to adulthood;
  • Young, female, sugar solution fed mosquitoes will be exposed to a suite of insecticide treated papers – DDT 4% (OC), Bendiocarb 0.1% (OP/C), Deltamethrin 0.05% and Permethrin 0.75% (PY) – using the standard WHO bio-assay procedure4;
  • Inactivate, pack and label appropriately all the surviving mosquitoes from the above test for transport to a laboratory for testing for presence/absence of the kdr gene,
Part 4:

Quality of the mosquito net and their insecticide level
  • Analyse results of the DRC KAP survey to establish the prevalence of various makes of LNs in the community;
  • Select two of the most popular nets in the study area;
  • Take (and replace by a new one if necessary) 30 randomly selected nets of each of the two types identified above (thus 60 nets);
  • Take samples out of the nets , pack and label them adequately and send them to a lab to be tested using gold standard testing.
Part 5:
 
Assessment of need to carry out further studies
  • Consider, present and justify any recommendation to carry out further tests to increase the relevance and/or accuracy of the study/research, e.g. bio-assay on LNs.
Laboratory based testing
The field entomologist will be carrying out the lab tests in Wageningen University lab in collaboration and under the supervision of the entomological department and will be involved in the presentation and analysis of the results. The following will be carried out on the samples:
  • Identification down to sub-species level using PCR;
  • Presence/Absence test for the kdr gene, indicating possible resistance to pyrethroid based chemical insecticides;
  • Enumeration of the circum-sporozoite infection rate.
Expected output
  • Regular updates and progress reports will be expected;
  • All test results are to be tabulated and compiled into a readable/usable format;
  • Production of a solid report with description of all activities as well as results of all tests. Results should also be analysed and presented with a discussion and recommendations;
  • Production of an article (depending on results).
Requirements for the position
  • Qualified Entomologist with solid field experience in similar studies,  prepared to travel and work in a challenging context;
  • A reasonable level of French, both spoken and written, is desired;
  • Fluency speaking and writing English;
  • Proven research and reporting skills.
Communication lines and reporting
The study is being overseen by one Water and Sanitation Advisor, the Epidemiology Advisor and Health Advisor (HA) based in Amsterdam. Expert advice will also be provided by Wageningen University. Furthermore full cooperation and communication will be necessary with the Katanga mission’s Medical Coordinator (MedCo). At field level the candidate is expected to detail and discuss all proposed activities with the Project Coordinator (PC) of the study site area.
 
Proposed schedule
4 months in DRC Katanga for field work and 2 months in Wageningen University in The Netherlands for laboratory analysis and report writing.
 
We are offering
A Specialist hybrid contract in field scale B with a gross salary of a minimum € 1,449.40 and
€ 3,331 maximum depending on relevant professional work experience, for a full-time appointment for the specified period. The report writing will be done in Amsterdam, The Netherlands in our HQ, a stimulating, professional working environment in an international organisation.
 
Information and application
If you would like additional information regarding this Entomologist position, please contact Jean-Francois Fesselet (Coordinator Water & Sanitation) phone + 31 (0)20 520 8770.
 
If you’re interested in this Entomologist position and believe that you fit the profile and meet the requirements, please send your application letter in English or French with your CV before Wednesday January 15 to officejobs@amsterdam.msf.org mentioning “Entomologist” for the attention of Ms Jaline Wijkhuizen (Personnel Officer HQ).  Would you be so kind to mention as well where you read or came across  this vacancy.
 
Interviews  by phone or Skype are planned in week 4 (20-24 January 2014).
 
 
Don't forget to mention MalariaWorld when applying for this position.

1World Health Organisation, Country Profile, Democratic Republic of Congo, Available from: http://www.who.int/malaria/publications/country-profiles/profile_cod_en.pdf, Accessed 9 December, 2013.
2Survey on Knowledge, Attitudes and Practice (KAP) survey of Long-Lasting Insecticide-treated BedNets (LLINs), in the Democratic Republic of Congo (DRC), MSF Report, August 2013.
3The Anophelinae of Africa South of the Sahara,  by Gillies, M.T. & De Meillon, B. (1968). 
4Test procedures for insecticide resistance monitoring in malaria vectors, bio-efficacy and persistence of insecticides on treated surfaces, Report of the WHO Informal Consultation, 28-30 September 1998, WHO/HQ, Geneva
 
 
 

 

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