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London School of Hygiene & Tropical Medicine

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Clinical PhD programme in Global Health Research 30 Nov 2016

Our goal is to train a cohort of academically outstanding clinicians committed to research careers focussing on the health problems of low and middle income countries, providing them with the skills and mentorship they need to become independent clinician scientists and future academic leaders. Our programme will be based in the Wellcome Trust Bloomsbury Centre for Global Health Research, a partnership between the London School of Hygiene & Tropical Medicine, University College London, Queen Mary University of London, Kings College London and St George’s, University of London established in 1995, in collaboration with the Wellcome Trust Centre for Global Health Research at Brighton and Sussex Medical School. Our 99 potential supervisors cover the academic disciplines needed for global health research and a wide variety of clinical specialties. We are applying for 5 fellowships a year, and will focus on six themes in which our partner institutions have a strong track record of global health research and a history of successful collaboration: HIV/AIDS, TB and malaria; neglected tropical diseases; maternal and child health; mental health; antimicrobial resistance; and non-communicable diseases. Our partner institutions have committed a total of more than £1 million to support the programme and provide additional fellowships.

Amount: £7,520,000
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...

Bridging the Gap Between Community-led Initiatives and Humanitarian Agencies to Meet Refugees’ Health Needs in Lebanon: A Feasibility Study 10 Nov 2016

Seed funding is requested to conduct a feasibility study that will explore to what extent humanitarian agencies can build on initiatives led by refugee health professionals to pilot public health interventions for refugees (registered and unregistred) in Lebanon. The process by which displaced health professionals provide health services to refugee communities is poorly documented and understood. Our main goals are to identify initiatives led by Syrian displaced health professionals to meet refugees' health needs in Lebanon, and determine whether identified initiatives could benefit from international support to implement public health interventions. We will conduct an ethnographic study in the Bekaa Valley which is the home of the vast majority of Syrian refugees in Lebanon to gain a better understanding of the grassroots response led by Syrian health providers, along with a clearer appreciation of its structure and financing. We will also explore interactions between Syrian health providers and other agencies and organisations. Our findings will contribute to current humanitarian debates and will be used to inform a large-scale collaborative research proposal.

Estimating the burden of dengue, chikungunya and Zika in Latin America 19 Apr 2017

Since the mid 1990s, Latin America has seen a resurgence of arboviral disease. All four serotypes of dengue are now endemic and recent invasions of chikungunya and Zika viruses threaten to also persist. New strategies are urgently needed to combat co-circulation of arboviruses and the diseases they cause. Estimates of arbovirus burden are crucial to ensure these new strategies are optimally prioritised, targeted, measured and evaluated, however traditional passive surveillance suffers some key systemic biases. This research aims to improve the estimates of arboviral burden in Latin America by quantifying the main biases and gaps in passive surveillance data. This will be achieved by comparing passive data to equivalent metrics generated from applying mathematical and statistical models to community-based seroprevalence and routine laboratory testing data. Final burden estimates disaggregated by virus, disease severity, country and year since 2010 will be generated by leveraging information from multiple data types and propagating their uncertainty. Engaging Ministries of Health to explain, investigate and ultimately improve these estimates will be an important final output to achieve impact. Beyond the project, these burden estimates can be used to design rational strategies against what is rapidly becoming the biggest public health priority in Latin America.

Vacation Scholarships 2017 - London School of Hygiene & Tropical Medicine 16 Jun 2017

Vacation Scholarships 2017 - London School of Hygiene & Tropical Medicine

Evaluating the World Health Organization-Europe’s Evidence Informed Policy Network 25 May 2017

In 2012, the World Health Organization Regional Office for Europe (WHO-Europe) launched the Evidence Informed Policy Network Programme (EVIPNet-Europe) to promote evidence-informed policy-making (EIP) in its member countries. EVIPNet-Europe facilitates establishment of Knowledge Translation Platforms (KTPs) in each member country, comprised of government policy-makers. KTPs are then supported toward using evidence to design and implement national health policies. The overall aim of my Secondment Fellowship project is to evaluate EVIPNet-Europe, and by doing so contribute to knowledge on how to most effectively use research evidence to influence policy. The key goals of the project will be: To evaluate EVIPNet-Europe in selected WHO-Europe countries using a quantitative monitoring and evaluation framework. Outputs will include a report for WHO-Europe and a journal article. To qualitatively analyse the impact of EVIPNet on policy-making, identifying factors that influence this impact. I will use a case study of alcohol policy in Moldova, gathering perspectives of local policy-makers on EVIPNET’s effectiveness, acceptability and sustainability in their context. Outputs will include a report for WHO-Europe and a journal article. To gain personal experience of how research evidence is used in policy-making, and how I and other researchers can improve the impact of our research on policy.

Lancet Series on 'Environment, Agriculture, Food and Health 30 Sep 2018

We have been invited by the Lancet to write a new series of articles that will draw on a critical and under-researched area of planetary health, namely the interactions between the environment, food systems and population health. The series will draw on some of our existing interdisciplinary WT-funded research and also expand with new partnerships into issues of infectious disease and equity. The cross-sectoral policy opportunities that emerge from the novel analysis will be drawn out and engagement activities are planned to maximise the impact of the series. Following meetings with the Lancet we have identified five papers for the series: Problem statement: outlining the critical interplay between the environment, agriculture, food and health. Scenario analysis: novel analysis of possible future agriculture and food scenarios under environmental change with a particular focus on non-communicable disease. Expanding the focus: including agriculture-related infectious disease outcomes and how these might be affected under environmental change. Inequality: taking a specific equity lens to the debate with a focus on LMICs. Solutions: identifying potential cross-sectoral policy options to safeguard human and planetary health. The series is due in late-2018.

MSc Public Health 11 Jul 2018

This MSc covers the whole breadth of public health, encompassing high-, middle- and low-income countries. The aim of the programme – consistent with LSHTM’s mission to improve health worldwide – is to provide students with the knowledge and skills necessary to improve the health of populations, communities and particular groups within them. The emphasis is on the use, development and critical evaluation of conceptual models, evidence and methods of analysis, and on effective interventions and policies at local, national and international levels. On successful completion of the programme, students will receive a Master's degree in Public Health. Students can follow a general public health course or concentrate on one of five more specific streams: environment and health; health economics; health promotion; health services management; health services research. In addition to choosing a stream, students holding the Wellcome Trust Studentship will follow a humanities and social science ‘pathway’ through the programme. This will involve taking specialist modules in humanities and social science subjects (such as history, anthropology and sociology) and producing a dissertation rooted in one of these disciplines. The students will be guided along this pathway by a personal tutor with a background in the humanities or social sciences.

Fieldworkers, ethics and the medical research process in developing countries. 08 Jun 2006

The research project proposed is an ethnographic examination of the role of medical research fieldworkers in the ethics debate, with a particular focus on HIV research. The aims are to examine the role played by fieldworkers in the delivery of ethical research and to inform the debate with a fresh perspective from the field. There are substantial limitations to the current bioethical research guidelines, which are challenged when applied to developing countries. These limitations have been highlighted by the ongoing ethics debate of medical research in developing countries and in particular in the field of HIV/AIDs. The current debate represents a largely theoretical and academic discussion of ethics, rather than the challenges and ethical dilemmas faced at the point at which the data are collected or produced. In recognition of the limitations of theoretical examination, social scientists emphasise a focus on the 'everyday' practicalities of conducting research in order to improve the existing guidelines. Examining the role of the fieldworker has emerged as a key component in gaining a greater understanding the ethics of medical research. As the 'intermediaries' in the research process they occupy a role between the Principal investigators and the participants. As fieldworkers are at the frontline of research, they are also at the point where potential ethical challenges are most likely to occur.

Alcohol and mortality: from aetiology to intervention. 16 Feb 2006

In 2003 Russian male life expectancy was 58 years, below India, Pakistan and Bangladesh. Alcohol has been hypothesised to contribute to this low figure, inferred largely from analyses of the sharp fluctuations in Russian mortality since 1985. We have new evidence from a case-control study that hazardous drinking alone accounts for 40% of all deaths among men aged 25-54 years - equivalent to around 175,000 deaths per year for Russia as a whole. Autopsy studies will be undertaken to examine the pathological and bio-marker evidence of alcohol's contribution to deaths at working age. We propose to re-interview 1300 men recruited 30-months earlier as population-based controls. Self and proxy-reported alcohol consumption patterns will be collected, together with bio-markers of alcohol consumption and damage plus cardiovascular risk factors. This will provide a unique longitudinal perspective on changes in hazardous drinking patterns and their social and bio-medical correlates. Hazardous drinkers will be recruited into an exploratory trial of 'brief' interventions. The feasibility of full-scale prevention and treatment trials in routine settings (such as schools and clinics) to reduce hazardous drinking prevalence will be assessed. The programme will provide a context for capacity building in epidemiology and public health.

Anaemia in pregnant Zanzibari women: do common genetic polymporhisms affecting iron metabolism explain different responses to iron supplementation? 16 May 2006

Anaemia in pregnancy threatens maternal and infant health in developing countries. Measures to control anaemia have been less successful than anticipated. Even in carefully controlled interventions there is large variability in response to iron supplementation. In malaria-endemic areas there are strong interactions between host-genetic factors, malaria infection and haematological outcomes. Polymorphisms in the haptoglobin gene determine how iron is recycled following haemolysis. We have evidence from The Gambia that haptoglobin variants affect susceptibility to malaria-induced anaemia more strongly than other previously known genetic variants. This study will test whether haptoglobin gene polymorphisms influence anaemia rates in pregnant Zanzibari women and modulate the effects of iron supplementation on haemoglobin responses. We will analyse haptoglobin, G6PD, alpha- thalassaemia and HbS genotypes in 1303 women previously enrolled in a maternal iron supplementation trial (Mama na Afya Trial) for whom antenatal, anthropometric, haematological and malariometric data are already available. We hypothesise that the Hp2-2 genotype will predispose to greater malaria-induced anaemia and less efficient utilisation of exogenous iron. Putative mechanisms will be explored through cross-sectional analysis of haptoglobin polymorphisms and markers of iron and redox status in third trimester pregnant women (n=254). Understanding factors leading to defective iron recycling could help the development of new intervention strategies.

Studying trial communities: an ethnographic study of a medical field trial site in Western Kenya. 22 May 2006

Overseas medical research ethics are concerned with the social relations within, for example, clinical trials. The interaction between scientists and study subjects is the scientifically crucial one, but also other relations, such as among scientists or community members, and between these and the public, produce ethical concerns. Together, these interdependent and dynamic relations constitute an unusual form of community - the 'trial community. Ethnography is a way of conducting fieldwork and writing about the social life of communities. Conventionally, these were 'traditional' village-type communities, but increasingly, wider and 'modern' networks and the social practices and processes that constitute and transform them are studied ethnographically. The ethics of social interaction are necessarily central to ethnography. Hence, ethnographic studies of 'trial communities' could elucidate ethical problems from the viewpoint of practice, moving beyond the concerns with formal principles that at present dominate ethics debates. The aim of this project is thus to contribute to sustainable and fair relations in trial communities, and to ongoing ethics debates about these, by ethnographically describing and analysing the ideas and practices of the members of a specific trial community: the KEMRI/CDC AIDS-research programmes in western Kenya.

Monitoring trends in malaria transmission using serological markers of malaria exposure. 28 Mar 2006

Planning of malaria prevention and control programmes requires knowledge of the regional, national and community level distribution of the parasite; monitoring the effectiveness of these programmes requires information about the change in parasite distribution over time. Furthermore, prediction of future malaria epidemics would be enhanced by being able to identify areas that were previously endemic for malaria or where previous epidemics have occurred. Existing methods for estimating malaria transmission and, thus, for assessing the burden of disease and need for prevention, are based on detection of circulating parasites in humans or of sporozoites in mosquitoes; both approaches lack precision and data are expensive to collect. Thus, we propose to evaluate the utility of serological parameters as measures of current and past malaria transmission intensity. This will include identification of suitably immunogenic and non-polymorphic antigens for use worldwide at all levels of trans mission; testing of serum samples from Africa, Asia and S. America, comparison of serological data with conventional measures of malaria transmission and mathematical modelling of these data to estimate exposure history, force of infection and likely outcomes of malaria interventions. The long term aim is to produce an assay for routine use for monitoring malaria transmission world wide.

Environmental and genetic determinants of obesity and diabetes in India. 18 Oct 2007

Indians are at high risk of diabetes which is attributed to increased central adiposity. Recent discoveries of nine replicated common genes increasing risk of type 2 diabetes and of the FTO gene which also increases the risk of obesity in Europeans will be examined in Indians. Collaborators in this proposal have contributed to these recent discoveries of susceptibility genes. We want to know if these genes have similar effects in Indians and whether migration, a major environmental exposure, results in differential phenotypic expression of obesity and diabetes in people with similar alleles. We will use data from the Indian Migration Study to conduct a) studies of the prevalence of likely risk alleles in the different regions of India, representing its ethnic diversity; b) examine associations between these alleles with obesity and diabetes phenotypes in migrant and non-migrant people; c) examine biological and behavioural mechanisms by which genetic susceptibility operates to prod uce obesity and diabetes. In addition to scientific outputs this research will produce a DNA and phenotypic databank with wide representation of India s population which will be of value to scientists for discovery of genetic variation in a wide range of phenotypes relating to cardiovascular and metabolic disease.

The effect of age at infection with common herpesviruses on immune function in children in a multi-ethnic population. 18 Oct 2007

There is considerable evidence that early life infections influence subsequent risk of immune disorders, but no large studies using laboratory evidence of infections in the first two years of life. This project will investigate the influence of age at infection with common herpesviruses on immune function. The study will be conducted within the multi-ethnic Born in Bradford cohort. Blood samples will be taken at 12 and 24 months to estimate the age-specific prevalence of CMV, EBV and VZV infec tion. Congenital CMV infections will be identified using cord blood samples. Maternal CMV, EBV and VZV seroprevalence by ethnic group and country of birth will also be estimated using blood samples collected in pregnancy. Antibody response to measles, tetanus and pneumococcal vaccines will be measured at age 2 to provide measures of immune response, and the association with age at CMV and EBV infection will be quantified. This study will help elucidate the role of herpesvirus infections in imm une development and demonstrate how age at infection may influence the risk of immune disorders in later life. It will provide unique population-based data on age-specific prevalence of these viruses and will help evaluate the potential benefits and risks of future vaccine programmes.

Malaria in school-aged children: Epidemiological risk, disease burden and strategies for control. 19 Jun 2008

Malaria exerts its greatest toll in early childhood, and research and control has justifiably focussed on this high-risk group. Less attention has been given, and as a consequence little is known about the epidemiology of malaria in school-aged children or the appropriateness of intervention strategies. Clinical attacks and deaths still occur in this age group, but chronic asymptomatic parasite carriage, an important cause of anaemia, is more common. Prevention of malaria has recently been shown to halve the prevalence of anaemia and improve attention in African schoolchildren in an area of high transmission, which could have a beneficial impact on learning and educational achievement. This project will use a combination of epidemiological studies and intervention research to quantify the impact of malaria on the health and education of children of school-going age (5-14 years) living in a contrasting situation of low-moderate seasonal transmission, where the impact of malaria may be g reater, and to evaluate the impact and cost-effectiveness of malaria prevention in this population. Two delivery approaches will be compared. The information generated will provide decision-makers with a better knowledge of the epidemiology and impact of malaria in school-aged children, and information on the benefits and cost-effectiveness of malaria control.

Partnerships and sexual behaviour in rural South Africa in the era of HIV and ART. 04 Dec 2007

Diagnosed HIV positive people form an increasingly large sub-population in South Africa, one that will continue to grow with the advent of antiretroviral therapy (ART). ART introduces new influences on relationships, sexuality and sexual behaviour. It is not yet clear to what extent ART will impact sexual behaviour and HIV transmission, thus the pressing need to monitor trends in sexual risk behaviours. Given the recency of public access ART, few studies have examined the impact of treatment on sexual behaviour patterns in African populations. The fellowship aims to investigate the relationships between partnership, cohabitation, sexual behaviours and HIV risk in South Africa; and to measure the impact of ART on these factors. Historical, political, social, cultural and economic processes in South Africa have resulted in high migration, union instability, extra-marital births, concurrent relationships and HIV prevalence. The aims will be achieved using 10 years of longitudinal popu lation-based data on sexual behaviour, partnership and HIV, complimented by new data collection in migrant partners and in two ART clinical cohorts. The findings will inform future behavioural intervention development for couples in the era of ART.

Web access and database linkage for the British Voluntary Hospitals Database. 21 Nov 2007

The aim of the proposed project is to prepare and implement web access for an existing database of British voluntary hospital statistics from the period immediately preceding the establishment of the National Health Service. This database was prepared at the University of Portsmouth, 1996-98, by digitising annual statistical returns reported in several sets of hospitals yearbooks, principally Burdett's Yearbook of Hospitals and Charities, then subsequently the Red Cross/Order of St John Hospitals Yearbook. The content falls into three main areas: 1. Finance: sources of income and areas of expenditure 2. Utilisation: numbers of in- and out-patients 3. Provision: numbers of beds and medical and nursing staff The data cover the period 1891-1947, and there are 1,342 British hospitals in the database, with the levels of detail highest for larger institutions. The value of the database has been convincingly demonstrated by the applicantsin a series of publications including those in peer-reviewed journals. We nowwish to make this rich and important resource easily available online to otherresearchers. It will be of particular interest to historians of the hospital and of British social policy and to urban and local historians. Users will access the institutions through a map which takes them to a list of hospitals in a given town or county, and shows the data available. We will also link tothe Wellcome/National Archives 'Hospital Records Database' (HOSPREC), so that users searching for online information about hospital records can easily access our statistics through this site.

Infection and Immunity Research and Training for Uganda. 27 May 2008

This is a capacity building proposal for research and training in infection and immunity for Uganda. Key goals are: 1. To create an academic partnership between two internationally-respected Ugandan Institutions: the Uganda Virus Research Institute (UVRI) and Makerere University. 2. Through this partnership, and regional and international collaborations, to provide an exceptional research platform for outstanding mentorship and research training. 3. Using this platform, to establ ish a UVRI/Makerere Research Training Programme to produce East African scientists capable of competing internationally for sustainable research funding. Opportunities for research experience will range from primary school to post-doctoral level: young people will be introduced to excellent science through Open Days and undergraduate internships; a competitive scheme of fellowships from Masters to post-doctoral level will offer an attractive academic career path to high-calibre Ugandan and East African scientists. Projects will address problems in infection and immunity relevant to the developing world. By offering an outstanding programme in Uganda, we aim to reduce the loss of talented Africans to northern institutions during the formative stages of their research career. By a programmatic approach, we aim to achieve a critical mass of expertise in infection and immunity in Uganda, beyond the reach of piecemeal funding strategies.

Amount: £1,056,565
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...

Capacity development in malaria research in Africa. 27 May 2008

The key goal of this proposal is to improve malaria research capacity in Africa. This will be achieved by further developing the skills of 35 African scientists previously supported through the Gates Malaria Partnership and by the training of a further 20 African scientists to doctoral level. Support for previously graduated PhD scientists will be provided through a mentoring and small grants programme. A new, highly competitive PhD programme will be established based on universities in Ghan a, Malawi, Senegal, Tanzania and Uganda. Successful applicants to this programme will be encouraged to undertake the majority of their research in Africa. Each student will be co-supervised by at least two supervisors, including one from a northern and one from a southern partner in an integrated way. Each student will receive an award of up to 50k for their research and will be encouraged, with guidance, to develop their own personal development programme. Successful graduates will be eligible to apply for a competitive re-entry grant. The output of this programme will be a significant contribution to research on the treatment or prevention of malaria and the establishment of an effective PhD programme that may act as a model for other African universities.

Amount: £7,311,244
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...