INTERNS (8 September 2011)
INT014
Assessing whether a Plasmodium falciparum tyrosine kinase-like protein kinase (PfTKL2) expressed
on the surface of infected red blood cells is a target of natural immunity to malaria
City: KILIFI
Supervisor: Abdirahman Abdi & Pete Bull
Background
Development of an effective malaria vaccine remains a global public health priority. Children who grow
up in stable malaria transmission areas acquire antibody-mediated disease protective immunity (Marsh
1992) but the critical targets of this immunity remain unknown. A malaria vaccine that can elicit a response
similar to that acquired after repeated natural infections could save millions of lives especially of children
under 5 years of age. Development of such a vaccine requires identification of the parasite molecules
responsible for inducing these protective responses. The P. falciparum genome encodes approximately
5300 proteins, many of which could be targets of the observed disease protective immune response.
Identification of potential targets of this immunity is closely linked to efforts to develop malaria vaccines.
However, only a small fraction of these potential targets have been evaluated as vaccine candidates
(http://who.int/vaccine_research/links/Rainbow/en/index.html). So far efforts have been directed to two
main class of proteins: (1) surface proteins of the liver (sporozoite) and blood (merozoite) invasive stages
and those secreted during the invasion process, (2) proteins exported to the surface of infected red blood
cell (iRBC). A conserved P. falciparum tyrosine kinase-like kinase, PfTKL2 (PF11_0220) was recently shown
to be exported to the surface of the iRBC (Singh, Mukherjee et al. 2009). We will express recombinant
fragments of PF11_0220 in Escherichia coli and assess whether this protein is a target of natural immunity
and hence a vaccine candidate.
QUESTION TO BE ADDRESSED BY INTERN
Overall objective: To determine whether PfTKL2, an exported P. falciparum protein kinase is a target of
naturally acquired antibodies.
Specific Objectives:
• Clone and express fragments derived from the sequence encoding PfTKL2 as soluble recombinant
proteins in E. coli.
• Assess whether these fragments are targets of naturally acquired antibodies using archived
plasma samples collected from well-established cohorts for immuno-epidemiological studies.
• Determine whether the magnitude of the antibody response against PfTKL2 fragment correlates
with clinical protection against malaria.
SKILLS TO BE ACQUIRED BY INTERN
Molecular and biochemical techniques such cloning and in vitro expression of recombinant proteins, protein
purifications, western blotting, enzyme-linked immunosorbent assay (ELISA) and statistic skills necessary for
the data analysis
TRAINING BACKGROUND OF REQUIRED INTERN
Basic degree in Molecular Biology, Biochemistry, Zoology
REFERENCES
Marsh, K. (1992). "Malaria--a neglected disease?" Parasitology 104 Suppl: S53-69.
Singh, M., P. Mukherjee, et al. (2009). "Proteome analysis of Plasmodium falciparum extracellular
secretory antigens at asexual blood stages reveals a cohort of proteins with possible roles in immune
modulation and signaling." Mol Cell Proteomics 8(9): 2102-2118.
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT015
Molecular characterization of Adenovirus in Kilifi and the role of the different serotypes in respiratory
illness
City: KILIFI
Supervisor: Clayton Onyango
BACKGROUND
Adenoviruses cause a broad spectrum of clinical disease and are responsible for approximately 7 to 8%
of reported childhood viral respiratory infections worldwide. Other than respiratory tract infections,
adenoviruses are also associated with pharyngoconjuctival fever, conjunctivitis, hemorrhagic cystitis and
gastroenteritis in humans. Most adenoviral infections are self limiting, but some have been associated with
severe and in some cases fatal outcomes in both immunocompromised and healthy individuals. Up to
adenovirus serotypes have been identified and these are classified into 7 species. Serotypes 1-7 have
been associated mainly with respiratory illnesses, while serotypes 40 and 41 have been associated with
gastroenteritis. There is little information on the epidemiology of adenovirus species and serotypes
prevalent in sub Saharan Africa. It is therefore important to identify the different adenoviruses in
nasopharyngeal swabs collected from pneumonia admissions (at Kilifi district hospital) as well as those
collected at the community level (house hold study) with the aim of establishing their role in respiratory
illnesses. Recently, innovative molecular techniques have been modified to rapidly identify the different
serotypes with a better precision than the traditional methods of neutralization assays. By targeting
adenovirus hexon gene, up-to 51 serotypes can be identified and these include those viruses involved in
respiratory illnesses.
QUESTION TO BE ADDRESSED BY INTERN
• What are the dominant adenovirus serotypes in Kilifi?
• What role does a particular serotype play in a subsequent infection of the same host?
Skills to be acquired by intern
• PCR primer design
• RT-PCR of viral substrates
• Gene sequencing and sequence analysis
TRAINING BACKGROUND OF REQUIRED INTERN
BSc Biomedical sciences
Advantages include basic knowledge in:
DNA/RNA extraction techniques,
Polymerase chain reaction and
DNA sequencing
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT016
Developing a Socio-economic Index for Kilifi Health Demographic Surveillance System
City: KILIFI
Supervisor: Evasius Bauni & Jane Chuma
BACKGROUND
Socio-economic status (SES) has long been a predictive variable in studies on population health status and
access to health care services. How to ensure both the poor and the rich benefit from health interventions
remains a major concern in health and development debates. The KEMRI-Welcome Trust has had a Health
Demographic Surveillance System (HDSS) for the last 10 years. The KHDSS is an important resource for
researchers within the programme. Quite often many researchers have expressed interest in having a
socioeconomic index that categorises households in the KHDSS into various socio-economic groups. Until
recently (January 2011), complete data on socio-economic variables were not available from the KHDSS.
A socio-economic index will enable researchers to explore the relationship between socio-economic status
and various health outcomes. The overall aim of this project is to develop a socio-economic index that can
clearly distinguish households within the Kilifi HDSS.
QUESTION TO BE ADDRESSED BY INTERN
• The intern will be expected to conduct a scientific literature review on the range of variables used
to measure socio-economic status in developing countries
• Define and model a socio-economic index that clearly distinguishes households within the Kilifi
HDSS
• Compare the performance of the socio-economic index developed with others identified in the
literature, especially those used in Kenya.
SKILLS TO BE ACQUIRED BY INTERN
• Scientific literature review
• Data cleaning and management with support from Norbert Kihuha and George Oando.
• Data analysis
• Writing skills
TRAINING BACKGROUND OF REQUIRED INTERN
A Bachelors Degree in Economics and Statistics, Economics and Mathematics, or Economics
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT018
A comparison of 2 methods used in estimating the mid-point in measuring the Mid Upper Arm
Circumference; Its implication to accuracy
City: KILIFI
Supervisor: Martha Mwangome & James Berkley
BACKGROUND
It is common practice for health workers in a busy rural health clinic to identify and use simplified nonvalidated
procedures in measuring anthropometry among children. These summarized but informal
procedures which are largely borrowed from the long formal procedure, are normally aimed at shortening
the measuring processes and also at omitting steps perceived to be “irrelevant”. Regularly, health workers
measure the weight of a fully/half dressed children contrary to the instructions or measure the length of
children with one leg pressing onto the leg board and not two legs as instructed or using “eyeballing” to
estimate the mid- point of the upper arm in taking MUAC instead of using the tape measure/string as
instructed.
There is currently little information on how these informal procedures affect the accuracy of the outcome
measure and eventually their effect on their interpretation.
QUESTION TO BE ADDRESSED BY INTERN
Are there significant differences in the estimation of MUAC using the formal compared to informal
procedure of estimating the midpoint?
SKILLS TO BE ACQUIRED BY INTERN
Study design, Research methods, statistical analysis and fundamentals in nutritional assessment
TRAINING BACKGROUND OF REQUIRED INTERN
BSc Food, Nutrition and dietetics
BSc Nursing
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT019
Understanding the factors that enhance and constrain the effective delivery and uptake of ANC and
MCH services in Kilifi District
City: KILIFI
Supervisor: Caroline Jones & Bryn Kemp
AIM
To investigate the factors that influence the use of ANC and MCH services by women in Kilifi District and to
understand the challenges and facilitating factors that affect health care provider practices and impact on
the quality of services they provide.
BACKGROUND
Kenya has identified the need to improve birth outcomes as a public health priority. Based on current
estimates, deaths during the first 28 days of life exceed the entire Millennium Develop Goal target for
childhood mortality (MDG4). Whilst prematurity and fetal growth restriction are two of the key
determinants of newborn survival, their relative prevalence in the majority of Kenya and sub-Saharan
Africa remains unknown and data reporting the causes of stillbirth and perinatal death are limited.
However, at least 60% of the 4 million neonatal deaths each year are associated with low birth weight
(LBW). Causes of LBW include intrauterine growth restriction (IUGR), preterm delivery and
genetic/chromosomal abnormalities. The contribution of risk factors such as malaria, maternal
undernutrition, HIV and anaemia to abnormal fetal growth, and how the latter relates to infant growth
patterns in sSA is not known. A greater understanding of how these risk factors interact with fetal growth is
required to guide interventions targeted at reducing the burden of perinatal morbidity and mortality.
Recently, Kilifi District hospital (KDH) became one of the sites for INTERGROWTH-21st, an international
study which uses ultrasound to date pregnancies and assess fetal growth accurately. By measuring
neonatal/infant growth accurately and collecting data on the health status of the pregnant women, the
study will provide the first comprehensive description of the impact of maternal under-nutrition, malaria,
HIV and anaemia upon birthweight and pregnancy outcomes in Kenya and other parts of the world. A
unique feature of the study as it is being implemented in Kilifi is an assessment of how the introduction of
ultrasound technology for routine antenatal care (ANC) will affect care pathways for patients within KDH.
This socio-behavioral component of the Intergrowth study is concerned with investigating the factors that
influence the use of ANC and maternal and child health services (MCH) and the impact of the introduction
of ultrasound scans on the perceptions and behaviours of women attending these services. It is also
concerned with the perceptions and practices of the providers of care and identification of factors that
enhance and/or constrain the delivery of quality services and may impact on the implementation of
ultrasound scanning under routine ANC conditions. Data for this component of the study is being collected
through a combination of quantitative and qualitative methods such as observations (structured and unstructured),
in-depth interviews (with providers and pregnant women) and group discussions.
This internship will utilize part of the qualitative data already collected and will take part in additional
qualitative data collection activities to provide information on the factors that influence the use of ANC and
MCH services by women in Kilifi District and to understand the challenges and facilitating factors that
affect health care provider practices and impact on the quality of services they provide. The intern will
also conduct a literature review of relevant studies and undertake qualitative data analysis. The intern will
be supported by a senior social scientist (Dr Caroline Jones), and the PI of the broader study (Dr Bryn
Kemp).
SKILLS TO BE ACQUIRED BY THE INTERN
• Reviewing the literature;
• An understanding of the concepts and methods used in qualitative research
• Qualitative data collection; analysis & interpretation
• Scientific writing and presentation skills.
TRAINING BACKGROUND OF REQUIRED INTERN
• Social science training
• Experience in in-depth interviews and FGDs
• Ability to work independently
• Excellent communication skills and good team player
• Giriama speaker
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT020
Relationship between patients’ educational level and anti-epileptic drug adherence amongst adults in
Kilifi District
City: KILIFI
Supervisor: Michael Kihara & Caroline Kathomi
BACKGROUND
Non-adherence to epilepsy medications can interfere with treatment and may adversely affect clinical
outcomes. There are a number of studies on the strategies for improving adherence to anti-epileptic drugs
(AEDs) in patients with epilepsy (PWE). Interventions of education and counselling of PWE have shown
mixed success. However, behavioural interventions such as the use of intensive reminders and
'implementation intention' interventions provided more positive effects on adherence (Ai-Aqeel & Al-
Shabhan, 2011).
Studies have however overlooked the potential confounding effects of education level of the PWE in
adherence studies. A recent study in the US showed that the main cause of non-adherence was socioeconomic
status (Modi et al., 2011) while another pointed to forgetfulness as the reason for non-adherence
(Hovinga et al., 2008). Forgetfulness is a cognitive trait and so we speculate that level of education could
be associated with adherence to AEDs.
We have drug levels of PWE in the Kilifi DSS which were collected as part of a previous study. We intend
to invite these PWE to undertake a brief cognitive test and answer questions on their education
background.
QUESTION TO BE ADDRESSED BY INTERN
• Is there a relationship between AED drug adherence and education level
• Is there a relationship between AED drug adherence and performance on cognitive test.
• What are the contributing factors of poor adherence amongst adult patients with epilepsy
SKILLS TO BE ACQUIRED BY INTERN
• Development of a cognitive impairment tool
• Administration of assessment tools
• Statistical analysis using SPSS
• How to write systematic reviews
TRAINING BACKGROUND OF REQUIRED INTERN
• Graduate in Sociology or Nursing
• Knowledge of Mijikenda (added advantage)
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT021
Validation of immuno-adaptive genes by real-time PCR
City: KILIFI
Supervisor: Margaret Mackinnon & Martin Rono
BACKGROUND
We have identified some genes in malaria parasites that are associated with high levels of immunity. This
was done by comparing gene transcription levels in parasites taken from a high malaria transmission
(Kisumu) vs. a low transmission area (Kilifi) using whole-genome microarrays. We found some of the
parasites gene’s were consistently up-regulated in high transmission areas suggesting that these genes may
be adaptive to high levels of immunity.
QUESTION TO BE ADDRESSED BY INTERN
Using real-time PCR, transcription levels on each of these candidate adaptive genes will be performed on
samples taken from an independent sample from these populations. This will confirm whether the results
from the microarray assays are representative of what is found in the parasite populations from these high
and low transmission areas.
SKILLS TO BE ACQUIRED BY INTERN
Realt-time PCR. RNA extraction. Statistical analysis
TRAINING BACKGROUND OF REQUIRED INTERN
Biology. Molecular biology. Genetics
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT022
Examining the frequency of medical errors and associations with health worker training
City: Nairobi
Supervisor: Mike English & Philip Ayieko
BACKGROUND
Patient safety is a major focus of research in developed countries. There are however few studies on the
prevalence of significant medical errors in low-income countries. The 8 hospitals dataset produced by our
previous cluster RCT provides over 12,000 observations of patient care over more than 2 years from 8
hospitals across Kenya. Details of drug choice, drug dose and route of administration provide an
opportunity to assess the prevalence of errors and examine whether training is associated with a decline in
errors. At the same time developing the methods for these analyses will allow their future use on data to
be collected in studies of 10 hospitals planned for late 2012.
Question to be addressed by interns
• What is the frequency of drug prescription errors in a large data set of hospital admissions
• Is training associated with a decline in medical error frequency
SKILLS TO BE ACQUIRED BY INTERN
• Data manipulation to create suitable outcome and explanatory variables
• Determination of prevalence of errors
• Estimation of cluster adjusted prevalence of errors
• Regression modeling of errors and variables hypothesized to be associated with errors possibly
progressing to multi-level modeling
TRAINING BACKGROUND OF REQUIRED INTERN
• Statistics / biostatisitcs
• Epidemiology
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT023
Assessing the practicality of comprehensive inpatient data collection in rural Kenyan hospitals using
Open Clinica
City: Nairobi
Supervisor: Mike English & Naomi Muinga
BACKGROUND
Kenyan health information systems are currently very weak. In particular we have established that data on
inpatient mortality / morbidity is of such poor quality that it is uninformative. Ideally such data would not
only provide accurate and timely M&M reporting but would also allow evaluation of the uptake of new
clinical policies – such as the requirement to restrict use of anti-malarial drugs to children with a positive
malaria diagnostic. In collaboration with the MoH we continue to evaluate potentially useful approaches to
improving data collection. Recent success with Open Clinica in support of a pneumonia RCT suggests that
this system may be used, if adapted and linked with a data entry clerk, to provide timely M&M and
process of care data from inpatient settings. We intend to pilot such a system. Developing the methods for
such data collection will allow their future use in studies of 10 hospitals planned for late 2012.
QUESTION TO BE ADDRESSED BY INTERN
Can Open Clinica be used successfully to improve timely M&M reporting from rural inpatient settings and
also provide timely process of care data important for monitoring policy implementation
SKILLS TO BE ACQUIRED BY INTERN
• Ability to adapt and work with Open Clinica
• Establishing systems for remote data capture
• Establishing systems for reducing data entry errors
• Evaluation of data quality and scope for scaling up
TRAINING BACKGROUND OF REQUIRED INTERN
ICT / Computer Science
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT024
Field evaluation of efficacy and effectiveness biolarvicides in the control of malaria vectors
City: KILIFI
Supervisor: Simon Muriu & Charles Mbogo
BACKGROUND
Mosquito larval control interventions forms a key element of integrated vector management programs
which employs a variety of complimentary intervention tools in the fight against malaria and other
mosquito-borne diseases. Targeted larval control strategies have shown the potential of being effective,
low cost and with low environmental impact and consequently highly successful due to the limited mobility
of the pre-adult mosquito stages. Larviciding is one of the main strategies for decimating malaria vectors,
Anopheles species, and biological larvicides provide a promising alternative to the non-specific and often
environmentally harmful chemical larvicides. However, prior knowledge and understanding of the efficacy
and effectiveness of these bio-larvicides is crucial to their successful adoption and implementation in
malaria vector control programs. The experiments in this study will explore the efficacy and effectiveness
of three bio-larvicides under different concentrations in artificial and natural/field mosquito breeding
habitats. The survivorship of the targeted mosquitoes will be evaluated and molecular analysis of the
Anopheles species carried out to determine the identity of the mosquitoes targeted in the natural
environments.
QUESTION TO BE ADDRESSED BY INTERN
• What is the efficacy of the bio-larvicides against Anopheles mosquitoes under artificial and field
conditions
• How effective are different bio-larvicides in controlling malaria vectors
• How long do these biolarvicides remain effective?
SKILLS TO BE ACQUIRED BY INTERN
• How to conduct efficacy trials of bio-larvicides and other agents against malaria vectors
• Experimental biology of Malaria vectors
• Molecular techniques and procedures in vector biology (molecular entomology)
• Behavioral responses of malaria vectors in natural environment to control agents
• Research and analytical skills related to vector biology and vector control
• Malaria vector management in tropical environments
TRAINING BACKGROUND OF REQUIRED INTERN
• Biological/Biomedical sciences
• Interest in vector biology and vector intervention strategies particularly use of biological larvicides.
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT025
Immune responses to respiratory syncytial virus infection in the upper respiratory tract of children
City: KILIFI
Supervisor: James Nokes & Charles Sande
BACKGROUND
Respiratory syncytial virus (RSV) is the major viral cause of pneumonia in infants and children under 5
years old. RSV circulates as two main antigenic Groups (A and B) and a set of genotypes. This variation
may enable immune evasion. The virus first encounters the human host in the mucosa of the upper
respiratory tract and it is here that acquired immunity from prior infection can act to prevent re-infection
and subsequent transmission to other individuals or select for escape variants. Both IgG and IgA
immunoglobulin types are found in the mucosa of the upper respiratory tract. The nature of the primary
and secondary mucosal immune response, particularly in relation to the infecting variant, is not well
understood. Archived blood and nasopharyngeal specimens are available from household cohort studies
and childhood admissions.
QUESTIONS TO BE ADDRESSED BY INTERN
• What are the kinetics of the RSV-specific IgA and IgG mucosal immune responses in primary and
secondary infections?
• Is there a variant specific mucosal IgA/IgG immune response to RSV?
SKILLS TO BE ACQUIRED BY INTERN
• Cell culture and virus isolation techniques.
• Optimization of enzyme-linked immunosorbent assay (ELISA) for detection of RSV-specific IgA and
IgG.
• Virus strain characterization and vial diagnosis by molecular methods.
• Peptide selection.
• Literature searching and synthesis.
• Data manipulation and basic statistics.
TRAINING BACKGROUND OF REQUIRED INTERN
Lifesciences
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT026
Disease association and concurrency in respiratory virus infection
City: KILIFI
Supervisor: James Nokes
BACKGROUND
Respiratory viruses are a major burden of disease in infants and children. In paediatric pneumonia hospital
admissions a respiratory virus can be detected in excess of 60% of cases, and in 10-15% of these more
than one virus can be identified. The causal association between virus presence in the upper respiratory
tract and the observed disease is questionable. Where more than one virus is present the question of
which, if any, is the cause of the child’s illness is uncertain. There is some evidence that viral load is related
to disease severity. Interaction between concurrent viral infections has been proposed to result in enhanced
disease in some instances. Molecular diagnosis of 15 or more respiratory viruses using Real Time
Polymerase Chain Reaction (rt-PCR) has been undertaken on nasal specimens from childhood admissions to
Kilifi District Hospital since 2007. Rt-PCR provides semi-quantitative data on viral load in the sample.
These data provide a rich source to investigate viral interactions and disease associations.
QUESTIONS TO BE ADDRESSED BY INTERN
• Does viral quantity provide insight into disease association?
• Is there evidence for disease enhancement in concurrent viral infection?
SKILLS TO BE ACQUIRED BY THE INTERN
Database manipulation and statistical analysis. Use of statistical software, including STATA. Literature
search and synthesis
TRAINING BACKGROUND OF REQUIRED INTERN
Statistics, Lifesciences
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT027
Linking ITN coverage with malaria infection prevalence
City: Nairobi
Supervisor: Abdisalan Noor & Robert Snow
BACKGROUND
Insecticide treated mosquito nets (ITNs) are the main tool for malaria prevention in most sub-Saharan
African countries. ITNs have been shown to reduce significantly malaria infection and all-cause mortality.
Significant investments have been put in scaling up ITNs over the past 10 years in East Africa with recent
studies reporting substantial decline in malaria burden. However, quantifying the actual proportion of this
decline attributable to ITNs is complex and requires the assembly of both infections an ITN coverage data
at similar time-point of a long time series. The aim of the study will be to assemble data on ITN coverage
over 10 years for East Africa and link this to already assembled data on malaria infection prevalence.
QUESTION TO BE ADDRESSED BY INTERN
The space-time coverage of ITNs in East Africa from 2000-2011
SKILLS TO BE ACQUIRED BY INTERN
• Introduction to research methods
• Assembly of household survey data
• Analysis of household survey data
• Basic Bayesian Geostatistics
TRAINING BACKGROUND OF REQUIRED INTERN
• BSc in Geomatics or Applied Mathematics/Statistics or Geography
• Programming skills in R or C++ or Python
• Previous experience in Spatial Analysis especially geostatistics is an advantage
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT017
Validation of verbal autopsy (VA) tool for detectng and classifying causes of death in people with
Active Convulsive Epilepsy (ACE) in Kilifi, Kenya.
City: KILIFI
Supervisor: Anthony Ngugi & Caroline Kathomi
BACKGROUND
Epilepsy is one of the most common neurological disorders affecting close to 70 million people worldwide,
90% who live in Low and Middle Income Countries (LMIC). Epilepsy, particularly active convulsive epilepsy
(ACE) is associated with psycho-social problems and decreased life-expectancy.
In Africa, there are only a few studies that examine the mortality of epilepsy. These studies suggest that
mortality is increased, but the magnitude is unclear, and the risk factors and causes of death (COD) have
not been identified. The COD in epilepsy can be classified as directly related to epilepsy, related to the
underlying cause of epilepsy or unrelated to epilepsy. In the West, deaths related directly or indirectly to
epilepsy are infrequent, but these causes may be more frequent in LMIC.
While industrialized countries utilize postmortem records to provide data on COD, these records are often
not available in LMIC. The use of verbal autopsies (VA) in attributing COD in epilepsy has been
encouraged in LMIC where often less than half of the deaths are registered and the deceased person
often received no medical attention. VA involves the interviewing of family members or caregivers of the
deceased about the circumstances of a death and in some cases care seeking behaviour prior to the event.
Their use in epilepsy however raises some important methodological issues, particularly with regard to
robustness in detecting less well known COD such as sudden unexpected death in epilepsy (SUDEP), which
requires a full physical autopsy to rule out other COD. This method however has potential advantages over
death certification in that it does not require medical expertise in data collection, can be used for both
children and adults and is relatively cheap and easy to administer.
There are several VA tools in use in LMIC, all of which differ considerably in structure (design, layout and
sequence of questions) but not on content. One review identified 18 VA tools that are currently in use in
which key filter questions on signs and symptoms were not substantially different.
In Kilifi, the immediate causes and mode of death have been investigated in a cohort with ACE using the
standard WHO VA tool (WHO 1999 - International Standard Verbal Autopsy Questionnaires) which has
been extended to include more epilepsy specific items. However, the screening parameters of the
extended tool have not been established. We aim for the intern to conduct a validation study of this tool
against deaths (within this cohort) that occurred at the Kilifi District Hospital.
QUESTION TO BE ADDRESSED BY THE INTERN
• Validity of the tool in detecting cause-specific mortality in epilepsy.
• Validity in classifying deaths as epilepsy related or otherwise.
SKILLS TO BE ACQUIRED BY INTERN
• Organising and cleaning of admissions to hospital and epilepsy study databases.
• Epidemiological analysis to determine the screening parameters.
TRAINING BACKGROUND OF REQUIRED INTERN
• An interest in Epidemiology/Statistics/Databases.
• Nursing, Medical Officer, or Statistics.
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT029
Changes in the Incidence of Burkitts Lymphoma with changes in the incidence of malaria
City: KILIFI
Supervisor: Charles Newton & Mohammed Shebe
BACKGROUND
Burkitt’s lymphoma (BL) is an undifferentiated non-Hodgkins lymphoma that accounts for approximately
40-60% of all childhood malignancies in tropical Africa. There are three varieties of this aggressive B-cell
lymphoma have been described: endemic, sporadic and non-Burkitt’s lymphoma. The endemic version is
found in equatorial Africa where two predisposing factors malaria and Epstein Barr virus are common. This
form predominantly presents with tumours of the jaw in children.
There are three known predisposing factors for Burkitt’s lymphoma: Epstein Barr virus (EBV) infection,
malarial infection and chromosomal translocation usually involving chromosomes 8 and 14. BL is the most
common childhood malignancy seen in equatorial Africa where both. The coastal region of Kenya provides
an ideal backdrop for studying the epidemiology of Burkitt’s lymphoma. The coastal area is characterized
by P. falciparum transmission, but over the last 4 years the incidence of malaria has decreased
significantly.
Since 1993 a median of 4 cases per year have been admitted to Kilifi District Hospital, but in the last 2.5
years there has not been one case admitted. Whether this decrease in admissions of Burkitts Lymphoma is
related to the decrease in the incidence of malaria is not known.
QUESTIONS TO BE ADDRESSED BY INTERN
• Has the incidence of Burkitts Lymphoma significantly decreased on the coast of Kenya?
• If so, is this decrease associated with the reduction in the incidence of malaria?
SKILLS TO BE ACQUIRED BY INTERN
• Organising and cleaning a database of admissions to hospital of Burkitts lymphoma from Malindi,
Kilifi District Hospitals and Coast General.
• Epidemiological analysis to examine the incidence and compare with incidence of malaria.
TRAINING BACKGROUND OF REQUIRED INTERN
• An interest in Epidemiology
• Nursing, Medical officer, Epidemiologist or Statistician.
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
INT028
The impact of cotrimoxazole prophylaxis on neutrophil microbial kiling
City: KILIFI
Supervisor: Jay Berkley & Kelsey Jones
BACKGROUND
We are currently conducting a clinical trial of cotrimoxazole prophylaxis in severely malnourished children
who are highly susceptible to severe infection (CTX trial). There is some evidence that, in addition to a
direct antibiotic effect, one mechanism of action of cotrimoxazole may be to improve intracellular
bacterial killing. Neutrophil leukocytes are critical components of the early innate immune response. They
ingest phagocytose and kill extracellular bacteria and fungi in a process that depends on the production
of reactive oxygen species. This project aims to determine if cotrimoxazole affects microbial killing. The
intern will be working as a member of a small but busy immunology group and will benefit from daily
support and advice from the supervisors. Scientific and ethical approvals for the project have already
been obtained.
QUESTION TO BE ADDRESSED BY INTERN
Using both a traditional microbiological method and a new flow cytometry-based killing assay, does
cotrimoxazole prophylaxis alter neutrophil bacterial killing?
SKILLS TO BE ACQUIRED BY INTERN
Multiparameter flow cytometry; microbial phagocytosis and oxidation assay; ex-vivo stimulation assays;
ELISA; study design and analysis.
TRAINING BACKGROUND OF REQUIRED INTERN
BSc in immunology or a closely related laboratory science, preferably with lab experience or project
work.
To apply, please follow the link below:
http://careers.kemri-wellcome.org/frontpage
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