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Using IGERT interdisciplinary population and environment tools and methods to initiate a vaccine trial in Malawi


During summer 2009, IGERT trainee Sophia Giebultowicz and Carolina Population Center undergraduate intern Cameron Taylor spent two months in Malawi to assist with the initiation of a malaria vaccine targeted at infants and children, administered by UNC Project-Malawi and GlaxoSmithKline. UNC Project-Malawi is a collaboration between the University of North Carolina at Chapel Hill and the Malawi Ministry of Health. The primary goal of the trial is to measure the efficacy of the vaccine against clinical malaria, but secondary goals include measuring efficacy under different transmission settings. In the Lilongwe setting, one objective is to measure differences in efficacy by transmission. For example, local-level ecological differences in vector habitat and household ecology can influence malaria transmission and therefore could affect efficacy. Furthermore, individuals visiting relatives from other regions of the country with different malaria prevalence rates might also affect local transmission. To measure variation within the study area, the geographic information system (GIS) database was created and established such that spatial data would be continuously added to it in the future. Examples of relevant spatial information include population density, proximity of households to standing water locations, neighborhood-level household ecology (e.g., bed net usage), and mosquito trap data. Training as part of UNC’s IGERT Program in Population and Environment provided the needed background and skills.

Giebultowicz and Taylor developed strong working relationships with their team of fieldworkers, who were eager to build on their existing skills as well as learn new methods of spatial data collection. They spent their first week familiarizing themselves with the specific villages from which the study population would come from. They also observed recruitment of mothers in a local clinic as UNC Project-Malawi workers encouraged the immunization of children against a disease that is highly fatal. Data on all willing participants was collected at the clinic, including their place of residence. The potential recruits were then located within their villages, and coordinates of the households were recorded by UNC Project fieldworkers. Giebultowicz and Taylor conducted the GPS training in order to ensure accuracy in this recording process, and also introduced a simple and free mapping software called ArcReader. This software will be used by the local field team to display household locations as well as link information on the child’s age and gender as well as ecological factors. The trainees spent a great deal of time organizing both existing and newly gathered data into a larger database that could also be integrated with spatial analysis software. In order to obtain environmental and ecological data, they also developed a survey that would be administered every six months to the parents of children who received the vaccine. The survey includes questions about bed net usage, travel history of other family members, and family health history. In addition, the fieldworkers were instructed to look for nearby standing water, clusters of foliage, lack of windows in the house, and other factors that may influence malaria incidence and vaccine efficacy.

Address Goals

Spending several days in the field with the team, Giebultowicz and Taylor walked around the villages and learned first-hand the difficulty of trying to locate a physical household based on a mother’s description at the clinic. They also observed the vast differences in the ecology of neighborhoods within Lilongwe. While some families have glass windows and cement walls, others may lack even a proper door. These factors may greatly affect vaccine efficacy, and are of critical importance in the understanding of methods of administering immunizations to populations at high risk. Giebultowicz and Taylor were able to greatly utilize the training they received in their IGERT training at the Carolina Population Center and train others working on the Malawi Project in the same skills.