Global Health

Professor Sharon Brownie explains her research on nursing in LMICs Nurses are the largest part of the health care workforce an millions more will be needed in LMIC if high quality care is to be available to everyone. Research that addresses the consequences of the shortage of nurses but also helps generate ideas on solutions is important and should be conducted in partnership with the nursing profession.

Researcher Jalemba Aluvaala tells us about his work concerning newborn care in LMICs. Care for even the sickest newborns in many countries is limited by the resources available but there are some key interventions that can save lives. Delivering these interventions requires doctors and nurses to work together and often it is the continuous care provided by the nursing team together with families that is critical. Despite this a number of babies die and understanding risks is important to help provide information to families, to help plan care and should help us design better systems of care.

Jacob McKnight tells us about the challenges faced by nurses caring for newborns in Kenya. Caring for sick newborns in a poorly resourced hospital is a very challenging job. Yet this is not the only challenge many nurses face as they juggle supporting families and lives in a busy city. Some nurses have developed ways to cope in these difficult circumstances but for many the relentless pressure may cause them harm while upholding the ideals of nursing may seem impossible.

David Gathara tells us about his work leading nursing research Sick newborns require large amounts of nursing time, so what happens when nurses have to care for too many babies? By making direct observations of the care that is given this important new research identified how much care is missed. More care is missed when nurses have more babies to care for showing the direct consequences of health care worker shortages.

Social Scientist Jacinta Nzinga tell us about her research on the care of sick newborns. To really understand the work of nurses in very busy wards where care for sick newborns is provided, you have to be there. Using detailed observations, day, night and weekends, linked to narrative interviews, the routines, compromises and coping strategies that characterise the delivery of hospital care for newborns are brought to light providing critical information to understand why care is missed and to guide improvement efforts.

Professor Mike English tells us about the research project Health Services that Deliver for Newborns. Basic hospital care may be key to saving newborn lives. Professor Mike English, University of Oxford, outlines a multidisciplinary project engaging policy-makers and practitioners in Kenya. This project demonstrated poor coverage of Nairobi's 4.25 million population if a sick newborn baby needs quality hospital care. Using novel research approaches the team also identified how severe shortages of nurses contribute to poor quality of care for patients and negatively affect nurses themselves.

Professor Tran Hien, founder member of our OUCRU unit in Vietnam tells us about the development of this very successful Clinical Research Unit. Although incidence of malaria has decreased in Vietnam, the burden of infectious diseases remains high and weighs heavily on the health care system. Clinical research aims to allow investments to go further: findings in the laboratory, tested in clinical trials and then applied to the community, help improve diagnosis and management.

Professor Ronald Geskus from our OUCRU unit in Ho Chi Minh City, Vietnam, tells us about the contribution of biostatisticians to complex clinical research. The role of biostatisticians in clinical research is to contribute to trial design, by calculating sample size for example, and to help draw correct conclusions from the data, discriminating important information from noise. They are instrumental in the translation of a practical problem into a statistical model, and the translation of the result into practice.

Dr Audrey Dubot-Peres from our LOMWRU unit in Laos and IRD (Institut de Recherche pour le Développement, Marseille, France) tells us about her research on viral infections in Laos. Infections such as dengue and Japanese encephalitis are important problems in Laos but confirmed data are lacking, particularly from outside the capital Vientiane. Rapid diagnostic tests that can be kept at tropical room temperature help better diagnosis and treatment, and also inform policy to implement vaccination programmes.

Dr Juan Carrique-Mas from OUCRU, our Clinical Research Unit in Ho Chi Minh City, Vietnam, tell us about his research in the development of antimicrobial resistance in small-scale poultry production. Many households in Vietnam raise animals for food production, particularly chickens, using large amounts of antimicrobials with no veterinary support, and those antimicrobials find their way into the food chain. The ViParc project conducts intervention trials similar to human clinical trials, to help farmers reduce the level of antimicrobials used when raising chickens.

Dr Tri Wangrangsimakul from our MORU unit and based in Chiangrai, northern Thailand, tells us about his research on scrub typhus. Scrub typhus is an infection caused by Orientia tsutsugamushi, a bacteria transmitted by the bite of an infected chigger mite. Characterised by a variety of symptoms and a high mortality rate, scrub typhus is an underfunded, neglected tropical disease not even listed by the WHO. Better diagnostic tests and optimised treatments are being developed since no vaccine is currently available.

Professor Rogier van Doorn, director of our OUCRU unit in Hanoi, Vietnam, tells us about his research on antimicrobial resistance and avian influenza. Antibiotics are widely used in Vietnam, leading to widespread antimicrobial resistance. Monitoring antibiotic use helps inform the government to change treatment guidelines and implement antibiotic stewardship programmes. This may also prevent the transmission of resistant bacteria outside the country.

Professor Heiman Wertheim from our OUCRU unit in Hanoi, Vietnam, tells us about his research on drug resistant infections in low and middle-income countries. Drug resistant infections are a global crisis and we cannot focus on our own country only. Clinical trials in low and middle income countries where the burden is highest, as well as work with local communities and engagement with policy makers help influence public health policies.

Professor Guy Thwaites, director of our OUCRU unit in Vietnam, tells us about his research on tuberculosis meningitis. Tuberculosis meningitis affects a fractions of TB patients but causes high levels of mortality and morbidity. A recent trial at OUCRU showed that aspirin can greatly improve outcomes. Such trial is typical of the work done in our Vietnam units, where all the research is focussed on improving the outcome for patients directly.

Dr Motiur Rahman from our OUCRU unit in Ho Chi Minh City, Vietnam, tells us about his responsibilities in laboratory management. OUCRU laboratories provide support to the unit's extensive clinical research programme, from level 2 laboratory to SAPO 4 laboratory for high-risk pathogens responsible for zoonotic infections. Early diagnosis and detection of antimicrobial resistance help prescribe the right medicine in time, contributing to better patient management.

Dr Raph Hamers from our EOCRU unit in Jakarta, Indonesia, tells us how he developed collaborative clinical trials. Indonesia is a very populous country with a huge burden of infectious diseases such as TB, malaria, HIV and CNS infections. Running clinical trials requires high levels of expertise, currently developed and strengthened by institutions such as IOCRL (Universities of Indonesia and Oxford Clinical Research laboratory). Better collaborations will also help great ideas make a bigger impact.

Professor Jeremy Day from our OUCRU unit in Ho Chi Minh City, Vietnam, tells us about his research on central nervous system and HIV infections in Vietnam. Brain infections such as meningitis and encephalitis are highly debilitating diseases, and an accurate diagnostic is essential to give patients the best treatment available. For cryptococcal meningitis, clinical trials focus on prevention, for an early diagnosis, and novel ways to use existing treatments or repurpose old drugs.

Dr Abhilasha Karkey from our Clinical Research Unit in Kathmandu, Nepal, tells us how research is brought to local communities in Nepal. Antimicrobial resistance is a huge burden in Nepal, particularly in hospitals where many nosocomial infections are caused by resistant pathogens. With limited resources, little infection controls and proper guidelines in place, finding out the main risk factors helps reduce infection rates within a hospital and better target vaccination campaigns.

Dr Marco Haenssgen tells us about his research on Health policy and systems. There is long tradition of social sciences in medicine, and the communication with the medical sciences is now improving. Social researchers can help, for instance, better design clinical trials to include social factors, contextualise interventions and put the results at a population level perspective.

Dr Tom Crellen from MORU (Mahidol Oxford Research Unit) in Bangkok, Thailand, tells us about his research on transmission dynamics of infections aquired in hospitals. Multidrug resistant bacteria are a major problem in Southeast Asia, particularly for infections acquired in hospitals. Patients data and bacteria sequence allow the reconstruction of transmission networks. Using these date, we can also build simulations to investigate the impact of possible interventions, which then inform future clinical trials.

Dr Thomas Althaus from MORU (Mahidol Oxford Research Unit) in Bangkok, Thailand, tells us about his research on antibiotic prescription at the point of primary care. Prescription of antibiotics at the point of care is very high in Southeast Asia. Simple tests can help health workers determine which patients actually need antibiotics, but we need to ensure that the benefits and advantages are clearly explained. In the long term, those tests could represent a sustainable alternative to the massive prescription of antibiotics in developing countries.

Dr Janjira Thaipadungpanit from our MORU unit in Bangkok, Thailand, tells us about her research on molecular diagnosis and bacterial genotyping A molecular microbiologist, Dr Janjira's research focusses on using bacterial typing based on genome to confirm which disease is present in a patient. She aims to develop a single whole genome sequence type test using mutliple-PCR assays that can determine from a single sample of blood what bacteria or viruses are present in a patient's blood – thereby speeding up diagnosis and potentially saving lives in resource-limited settings. Head of Molecular Microbiology at MORU, Dr Janjira Thaipadungpanit's research interests include the molecular epidemiology of leptospirosis and melioidosis using multilocus sequence typing or genome data and molecular diagnosis to identify the causes of acute febrile illness and sepsis in patients.

Dr Markus Winterbert from our MORU unit in Bangkok, Thailand, tells us about his research on biomarkers for tropical diseases Having a background in malaria physiology and biochemistry, Markus Winterberg's research focus is on the interaction between host, pathogen and drug, the metabolism of antimalarial drugs and discovering biomarkers for tropical diseases. Markus aims to use these biomarkers to develop non-invasive, field-based rapid diagnostic tests for tropical diseases that quickly identify pathogens, thereby improving diagnostics and the treatment of patients. Dr Markus Winterberg is Head of Laboratory and a Principal Investigator in MORU's Department of Clinical Pharmacology. The key aspect of his research is ‘trop-med-omics', the application of mass spectrometry-based bioanalysis in tropical medicine, particularly using proteomics and metabolomics to identify a disease in a patient.

Premjit Amornchai from our MORU unit in Bangkok, Thailand, tells us about her work as biosafety level 3 lab manager and microbioogy safety officer To prevent relapse or reinfection, melioidosis requires a specific and prolonged treatment. Melioidosis is endemic at least 45 countries, but greatly under-reported, with a microbiological culture required to confirm diagnosis. This can take 2-7 days. In Thailand, up to 40 percent of hospital admitted melioidosis patients die. Premjit works with MORU researchers who have produced a rapid diagnostic test that aims to improve both diagnosis and public awareness of melioidosis. Microbiologist Premjit Amornchai heads MORU's Bio-Safety Level (BSL) 3 Laboratory in Bangkok, Thailand. Safety is very important for Premjit. The BSL3 Lab handles several dangerous materials, most notably, Burkholderia pseudomallei, a highly pathogenic bacterium commonly found in soil and water in Southeast Asia and northern Australia. The pathogen causes the difficult to diagnose, deadly bacterial infection melioidosis.

Dr Olga Tosas-Auguet from our unit in Kenya tells us about her research on mapping bacterial antibiotic resistance Dr Olga Tosas-Auguet aims to develop ad evaluate a new approach to large scale surveillance of bacterial antibiotic resistance in low income settings. This approach can then be taken forward to a testing stage, initially in partnership with an emerging network of policy makers and healthcare practitioners in Africa. Resistance to antibiotics is a growing issue worldwide. Mapping where the resistance is as well as its distribution and diversity is hampered by the lack of laboratory facilities in many parts of the world. New technologies allow the characterisation of whole pathogen communities, giving us clues where multi-drug resistant organisms come from. This can help set up a better public health perspective surveillance.

David Dance from our LOMWRU unit in Laos tells us about his research on bacterial infections in Laos, particularly melioidosis David Dance is a Clinical Microbiologist supporting the work of LOMWRU (Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit) on bacterial infections of importance to public health in Laos. He is particularly interested in all aspects of melioidosis (Burkholderia pseudomallei) infection, especially gaining a greater understanding of the global distribution of the disease and the environmental factors that underpin its distribution. Laos is seing a growing number of melioidosis, a bacterial infection caused by a bacterium that lived in the environment. Meliolidosis is a disease greatly under-recognised and treatment is specific, making it a major threat to farmers in developing countries. A better understanding of the prevalence of this infection and how it spreads allows us to better target prevention and treatment.

Dr Gail Carson is Head of ISARIC Coordinating Centre (International Severe Acute Respiratory and Emerging Infection Consortium), a network of networks established in 2011 to ensure a rapid research response to outbreaks of pandemic potential. A quick and efficient response to an outbreak requires strong central communication and coordination. Information needs to be shared quickly and then fed into patient care and policy. A wider approach, cutting across disciplines and specialities, helps limit the number of infected people and the impact on the economy.

Professor Frank Smithuis is the director of MOCRU, Myanmar Oxford Clinical Research Unit. MOCRU involves a network of 6 clinics and 650 community health workers in remote areas. Up until now, Myanmar has spent little on heathcare and receive little assistance from rich countries. Prevention is difficult, which leaves diagnosis and treatment. MOCRU has set up a network of community health workers, trained and supplied with diagnostics and treatments, to help improve access to healthcare for remote communities.

LOMWRU researchers conduct clinical research to help improve global, regional and Lao public health. They focus on infectious diseases, and also investigate diseases of nutrition and poverty. Poor quality medicines are a serious threat to our health. Falsified medicines and substandards medicines are a problem for all countries, but particularly for low and middle income countries where we see, for example, a large epidemic of fake anti-malarial drugs. Globally, better medicine regulatory authorities will help improve the quality of our medicines.

Director of OUCRU-Nepal, Dr Buddha Basnyat studies high altitude illness as well as undifferentiated febrile illness in the tropics, both common but neglected problems in Nepal. High altitude illness can be prevented by a simple rule: don't go too high, too fast. Drugs can also be used, and Dr Basnyat showed that a much lower dose of Diamox, a commonly used drug, is as effective. His research also focusses on the effect of high altitude on pilgrims, an older, poorer and more vulnerable population.

Professor Kevin Baird leads our Eijkman-Oxford Clinical Research Unit (EOCRU) in Jakarta, Indonesia. Delivering health care in Indonesia is a challenge, made more difficult by the geography and distances. Our EOCRU unit specialises in clinical trials on tropical infections, particularly Plasmodium vivax malaria. Current treatments with primaquine are effective but very toxic for patients with G6PD deficiency. Better point of care diagnostics can help us treat all patients safely.

This webinar features introductions from Francois Van Loggerenberg, scientific lead at the Global Health Network, and community engagement consultant Georgia Bladon to the community engagement platform Mesh. Learn how this platform might be useful to you, how it fits within the Global Health network and what we mean by good community engagement. Plus, take a tour and see examples of the content we create, host and share so that you can add to, use and navigate the site to get the most out of Mesh and your community engagement with health plans.

Professor Ben Cooper from MORU in Thailand uses mathematical modelling and statistical techniques to help understand the dynamics of infectious disease and evaluate potential control measures. Antibiotic resistance is one of today's major global health problems. Mathematical models help us answer what if questions and evaluate the impact of specific interventions such as hands hygiene on the spread of bacterial drug resistance. Effective solutions are then translated into policy changes or changes in practice at national or international level.

Dr Richard Maude's work combines clinical studies, descriptive epidemiology and mathematical modelling of malaria in South and Southeast Asia. Malaria epidemiology focuses on two main challenges to malaria elimination: antimalarial drug resistance and the movement of people that are spreading the malaria parasite. Travel surveys and cellphone records, combined with population parasite genetics help predict the spread of malaria and of drug resistance. Close coordination with all groups and agencies involved is crucial to malaria surveillance and elimination strategies.

Naomi's work focuses on supporting researchers to collect, clean and store research data. PRESERVING EVIDENCE FOR THE FUTURE Research is only as good as the evidence it generates, and data management is a critical part of this process since it supports findings. High quality data must be preserved for long term use and available to the research community. Ultimately, data is not about numbers, but about people's lives and health.

Dr Kesinee Chotivanich's laboratory provides facilities and resources to researchers, students, and collaborators who are interested in tropical diseases, with the aim to improve patients' care. More effective diagnosis and treatments are needed to reduce the morbidity and mortality affecting malaria patients. Researchers at the Malaria Laboratory at MORU study the pathophysiology of the disease, and test new compound drugs for anti-malarial activity. In the context of growing artemisinin resistance, this research will have a global impact.

The Cambodia Oxford Medical Research Unit (COMRU) is based in Siem Reap, northern Cambodia, which remains one of the poorest countries in South East Asia with extremely limited health services. PNEUMONIA IN CAMBODIA Infectious diseases are prevalent in Cambodia, a country that is struggling with poor infrastructure. Streptococcus pneumoniae causes the most severe form of pneumonia and is now targeted by the pneumococcal conjugate vaccine. Dr Paul Turner is studying the effect of this vaccine in field conditions in SE Asia, as well as other direct applications such as the evaluation of a new diagnostic test for Typhoid and interventions to reduce the burden of infections acquired within hospitals.

Dr Direk Limmathurotsakul's research focuses on the epidemiology of melioidosis, a bacterial infection caused by Burkholderia pseudomallei. Melioidosis is endemic in at least 45 countries, but greatly under-reported. Up to 50% of cases seen in hospital die. Our researchers at MORU have produced a rapid diagnostic test that aims to improve both diagnosis and public awareness. Better coordination between researchers and policy makers is needed to face upcoming emerging infectious diseases.

Dr Claudia Turner heads the clinical research program at the Cambodia Oxford Medical Research Unit (COMRU), in collaboration with the Angkor Hospital for Children. Whereas children mortality has dramatically decreased over the past 15 years, almost half the remaining mortality still occurs during the first 4 weeks of age. Neonatology, or care of newborns, doesn't need to be difficult or expensive. Low cost intervertions involving communities, such as keeping babies warm, save lives.

Dr Chris Paton studies the use of open-source Electronic Health Records (EHR) software, online learning and mobile technology to improve healthcare delivery in low-resource settings. LEARNING HEALTH SYSTEM In a learning health system, health care providers use electronic health records to identify problems, implement local solutions and check if the solutions are effective. Health informatics, or the use of IT in healthcare, needs to find innovative solutions for low income settings, such as the use of open-source softwares and mobile technology. This approach has been used to deliver training to rural healthcare workers in Kenya.

With 390 million infections occuring each year, dengue is the most important mosquito-borne viral infection, and no vaccine is currently available. DENGUE The majority of people infected with the dengue virus experience a flu-like febrile illness, but in a small proportion of patients, particularly children, the virus causes the blood vessels to become leaky which can induce shock and lead to death. Improved diagnosis and understanding of the disease process enable better outcomes for patients with severe dengue.

Identifying and addressing ethical issues are key to the success of any clinical trials, particularly when working with vulnerable populations. Dr Phaik Yeong Cheah leads the Department of Bioethics & Engagement at the Mahidol Oxford Tropical Medicine Research Unit (MORU) in Thailand. She is particularly interested in ethical issues in community engagement, data sharing, consent and assent in paediatric research.

In settings with high level of poverty and over-stretched health services, researchers have even greater responsibilities to the communities and study participants. SOCIAL AND BEHAVIOURAL RESEARCH A social scientist and public health researcher based in Kenya, Professor Vicki Marsh aims to understand and strenghten policies based on social and ethical aspects of international collaborations. Improving communications between researchers and the patients and local communities is not only ethically important; it can also lead to better research.

Economics and health are interlinked in many ways, as seen in the vicious cycle between poverty and ill health. Dr Yoel Lubell leads the economic team at the MORU Mathematical and Economic Modelling Group, based in Bangkok, Thailand. His research focuses on the evaluation of diagnostics, treatments and vaccines for infectious diseases, with the aim of providing guidance on malaria elimination and control of artemisinin resistance in the Mekong region.

Dr Christiane Dolecek speaks about the research on enteric fever she conducted in Vietman and Nepal Dr Christiane Dolecek's clinical research focuses on tropical diseases, in particular enteric fever and malaria. She has led enteric fever clinical trials in Vietnam and Nepal with the aim to systematically assess the current WHO recommendations as well as new treatment options.

Genetics and genomics of Streptococcus pneumoniae Angela Brueggemann's main focus is using high-throughput genotyping and whole genome sequencing techniques and unique collections of isolates to understand pneumococcal evolution, especially evolutionary changes related to antimicrobial and vaccine selective pressures.

Oxford Health Systems Research Collaboration (OHSCAR) Professor Mike English leads the Health Services Unit at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya. This unit aims to strengthen equality in access to affordable quality health care in Africa. Studies are based on health systems clustered around five main topics: malaria, service delivery & access, information for decision making, governance and financing. Professor English leads efforts to develop multidisciplinary links with Oxford through the Oxford Health Systems Research Collaboration (OHSCAR).

Governance in practice Dr Sassy Molyneux's main interests reside in Social science and Ethics in Public Health. Over the years, social scientists have developed a programme of empirical work on research ethics. This work is based on an understanding that while the ethics of human subjects research may be universal, there can be big differences across contexts and circumstances in key ethical issues or principles.

Rickettsial Disease Rickettsial diseases such as scrub typhus are important causes of fever in southeast Asia especially in rural communities. Discovered quite recently and not big killers, these diseases are among the most under-reported and under-diagnosed illnesses that are both treatable and preventable. Rickettsial studies at he Mahidol Oxford Tropical Medicine Research Unit (MORU) focus on the epidemiology and incidence of the disease using hospital-based fever studies in Thailand and Laos. Our research unit has developed highly improved acute diagnosis of rickettsial illness. MORU also has ongoing studies to determine the pathophysiological mechanisms of scrub typhus infection.

Infectious diseases in South East Asia The Mahidol Oxford Tropical Medicine Research Unit (MORU) is a collaboration between the University of Oxford and Mahidol University, and was established with the Wellcome Trust in 1979. MORU aims to fight the infectious tropical diseases affecting rural communities in Asia and elsewhere in the developing world. MORU's malaria research aims to directly improve the treatment of the disease globally. It's researchers focus on the treatment of severe malaria, the spread of antimalarial drug resistance, and the pathophysiology of falciparum and vivax malaria. These studies are used to formulate novel adjuvant therapies, and have been translated into recommendations for the use of artemisinin based combination therapies.

Microbiology in Thailand Acurately diagnosing infections is particularly challenging in tropical environments. Researchers at the Mahidol Oxford Tropical Medicine Research Unit (MORU) are working to develop effective and practical means of diagnosing and treating malaria and other neglected tropical diseases, such as dengue fever. The development of rapid tests for dengue, similar to pregnancy tests, allow rapid and acurate diagnostics in the field.