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CHild malnutrition & Adult NCD: Generating Evidence on mechanistic links to inform future policy/practice (CHANGE project)
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
GCRF Mech Nutition award To improve future treatment programmes by better understanding how child malnutrition affects the risk of long-term (adult) NCD.
Factors affecting childhood exposures to urban particulates (FACE-UP)
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
GCRF Health and Context award looking at factors affecting childhood exposures to urban particulates (FACE-UP) in Indonesia and Nepal
An implementation trial of continuous quality improvement for antenatal syphilis and HIV detection and treatment in Indonesia: The MENJAGA study
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
The dual elimination of mother-to-child transmission (EMTCT) of HIV and syphilis through screening and treatment of pregnant women has been identified as a global public health priority. Indonesia has set an ambitious EMTCT target of 2030. Currently, only 27% of pregnant women are tested for HIV and 1% for syphilis (using a mixture of rapid tests and laboratory-based testing), this is despite 98% of pregnant women attending antenatal care at least once during pregnancy. Moreover, only 48% of those testing positive for HIV and 30% for syphilis receive treatment. This poses a formidable challenge and is recognised as one of the most significant gaps in antenatal care in Indonesia. Persistent barriers to antenatal screening for HIV/syphilis include (but are not restricted to): limited awareness among health workers of the need for universal screening; some women are fearful of the test; lack of local standard operating procedures at the clinic level; supply chain gaps in tests and treatments; problems with the referral processes; and difficulties tracking women as they move across the health system. Context-specific interventions to better support the integration of HIV and syphilis testing and treatment into the Antenatal care (ANC) platform are urgently needed in Indonesia. Continuous Quality Improvement (CQI), which involves local ANC teams systematically collecting and reflecting on local data to inform the design and implementation of service delivery, has been effectively used to strengthen ANC services in a number of Sub-Saharan African countries. This approach holds considerable promise for Indonesia, a highly populous and diverse country where a 'one size fits all' approach to the delivery of quality ANC rarely applies. Using a cluster-randomised design, we will evaluate the effectiveness, cost-effectiveness, acceptability, fidelity and reach of a multi-faceted CQI intervention to improve antenatal testing and treatment of HIV and syphilis in public and private ANC clinics in 6 districts across 3 Provinces (West Java, South Sumatra and South Kalimantan). This 3-year multi-disciplinary study will involve clinicians, epidemiologists, economists, social scientists, health services researchers and policy-makers from the Indonesian Ministry of Health (research partner), the London School of Hygiene & Tropical Medicine, the Universitas of Gadjah Mada, the University of Sebelas Maret and the Kirby Institute. A range of other stakeholders will be involved throughout the study (e.g. patient advocacy groups; implementing agencies; specialist professional associations; clinics and ANC services) to assess the appropriateness and acceptability of the intervention and barriers and facilitators to scale up. This research has the potential to contribute significantly to improved maternal and child health in Indonesia while also strengthening the underlying health system.
Psychological, social & biological predictors of child mental health and development: shared and distinctive risk and protective factors in UK & India
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
WHO figures estimate mental health problems affect 12.8% of children in India, which equates to 60 million children. There is an urgent need for culturally sensitive longitudinal studies of community samples starting in pregnancy, designed to examine the earliest origins of child mental health problems to optimally inform the development of new and early interventions. Our study aims to do this in India and the UK. Research in western settings suggest that child mental health problems arise from a complicated mix of social, psychological and biological influences, in which key factors probably include, prenatal stress, early infant temperament, and harsh parenting as risks, and warm parenting as protective factors. There is now good evidence that individual variations and environmental exposures in early life contribute to risk for mental health problems in later childhood and beyond. However, previous research has been conducted almost exclusively in countries with Westernised standards of medical care and family arrangements, and where additional risks such as low birth weight and under-nutrition are rare. The aims of the proposed research are to compare early risk and protective factors for childhood mental health problems in UK and India to identify those that are common to Western and South Asian populations and those that are distinctive. We propose to follow up around 741 families of children in the Bangalore Child Health and Development study (BCHADS) who are living in the urban slums of Bangalore city, at age 4.5 years and age 7 years. We will compare the information we gather on these children's lives to that of the children taking part in our UK Wirral Child Health and Development Study (already collected). In both studies we have two rich data sets with parallel measures of risk and protective factors for child mental health outcomes from pregnancy onwards, including age 8-10 wks, 6 months, 14 months, 2 years, 4 years and 7 years of age. We have gathered detailed repeated measurement of key likely 'shared risks' and associated 'mechanisms' for conferring risk (e.g., gene activity, stress reactivity) and these include measures of early life stress, social support, poverty and economic adversity, early temperament, and caregiving (touch, interaction quality, parenting quality), cognitive and physical development. We will also assess risk and protective factors that may be 'distinctive' or particularly relevant to the South Asian setting: maternal nutrition in pregnancy, early immune function and gender discrimination associated with cultural favouring of the male child, and the practice of shared-caregiving as opposed to primary maternal rearing in Western societies. We also aim to advance cross-cultural measurement methods and develop new culturally sensitive measures of gender discrimination and the 'shared caregiving' parenting environment in India. This work will aid clinicians and researchers to refine their measurements in clinical practice and be able to conduct more reliable research when trying to combine data from multiple cohorts. Finally, this is a joint UK-Indian study and together we will run a series of training events to build capacity and share expertise in conducting longitudinal cohort studies, sampling and retention, measurement issues, data management and state of the art statistical methods needed in longitudinal analysis of complex data sets.
An inter-disciplinary approach to understanding the contribution of household flooring to disease burden in rural Kenya
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Access to adequate, safe and affordable housing plays a fundamental role in human health. This includes thorough limits our exposure to infectious diseases such as those that cause diarrhoea, which remains a leading cause of death in children under five. Conventional approaches to reducing environmental exposure to faecal pathogens include ensuring universal access to safe water and basic sanitation. Recent evidence has suggested that this alone may be insufficient to reduce the high levels of environmental contamination seen in poor rural communities, and that transformative cross-sectoral approaches will be required to see real impacts in child health. For example, these approaches fail to address the fact that most poor rural homes have rudimentary (earth, sand or dirt) floors that are difficult to sanitise, providing an ideal environment for the survival of faecal pathogens and other parasites. These floors can also host parasitic infections including intestinal nematodes and sand fleas, both of which are responsible for considerable morbidity and poor quality of life. We propose to examine flooring and its impact on enteric and parasitic diseases in three culturally and environmentally diverse settings in Kenya, and aim to address two related questions: 1. What is the importance of household flooring as a driver of enteric and parasitic infection risk in rural communities, and does this vary across wider social and environmental contexts? 2. Can infection risk be mitigated by replacing existing rudimentary (earth, sand or dirt) floors with improved (sealed, washable and durable) materials, and what additional behaviour changes are required to ensure impact? We expect that successful installation and ongoing maintenance of improved flooring will reduce the transmission of enteric and parasitic infections, by preventing direct exposure and through an intermediate effect of improved domestic hygiene. This will however be influenced by local context. A priority in each setting will therefore be to explore the interplay between domestic flooring, water and sanitation infrastructure, domestic hygiene behaviours, and the wider socio-cultural and environmental context. Our planned approach involves comprehensive formative research, intervention development conducted in collaborative partnership with recipient communities and key stakeholders, and then implementation trials to test the effects, feasibility and acceptability of the resulting intervention. We will assess the impact of the intervention on a range of child health outcomes, including prevalence of enteric and intestinal worm infections, prevalence of tungiasis, and incidence of gastrointestinal illness. We will also monitor levels of environmental contamination, and explore the impact of the intervention on domestic routines and self-reported wellness. During implementation, we will work with recipients and stakeholders at community, regional and national level to assess the extent to which interventions are acceptable to target communities, feasible given existing resource constraints, and can be scaled-up across Kenya and elsewhere. This includes work undertaken to understand options for scale-up should the intervention prove successful. This study is the first of its kind to comprehensively assess feasibility and effects of combining improved flooring technologies with tailored behaviour change programming on a wide range of parasitic and enteric outcomes. In doing so, we aim to provide important policy and technical guidance on the impact and effectiveness of new transformative approaches to community health. This is an important first step towards the establishment of transformative, community-driven and cross-sectoral approaches to building out water, sanitation and hygiene-related diseases.
Scalable TRansdiagnostic Early Assessment of Mental Health (STREAM)
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Worldwide, over 250 million children are at risk of not obtaining their developmental potential due to exposure to adverse circumstances. India and Malawi house some of the most disadvantaged populations in the world, with over 10% of all children aged 2 to 9 years estimated to have neurodevelopmental disorders. However, social and economic barriers to access qualified health personnel mean that most of these children do not receive any assessment of neurodevelopment or a clinical diagnosis when needed. Moreover, many parents are unaware of developmental milestones, so clinical opinion is sought only when symptoms become more pronounced and begin to impact daily life with a lost opportunity for early interventions. This avoidable delay is an unfolding tragedy in light of evidence showing that frontline worker delivered interventions can lead to better behavioural and social outcomes and improve long term developmental trajectories. Scalable methods to assess child neurodevelopment and mental health would promote early referral to specialist facilities, ultimately connecting families with affordable, community-based interventions. Directly measuring neurodevelopment allows us to identify the most vulnerable children as early as possible, allowing limited resources to be focused on those most likely to benefit from preventive approaches. Taken together, focusing on brain development in early childhood is critical to revolutionising global mental health of young children. We will realise this goal by developing a Scalable Transdiagnostic Assessment of Mental Health (STREAM), a mobile platform usable in the home or in a routine health facility by non-specialist workers. STREAM will be delivered on a tablet PC and will collect different types of data from 4000 children in India and Malawi. First, parents will be asked simple questions about their child's everyday behaviour, based on established questionnaires that have been validated in low income settings. Second, gamified tasks designed to measure motor, social, and cognitive abilities will be administered on the tablet. Additionally, novel low-cost eye-tracking technology on the same tablet PC will be used to monitor the child's eye movements in simple tasks, such as those assessing preference for social versus non-social images, and measuring how quickly attention shifts to new objects appearing on the screen. Finally, a segment of parent and child interaction will be recorded using the inbuilt camera, and used to code for signs of atypical behaviour. This combination of multiple measures will provide independent channels of data collected on a single platform, significantly improving on current assessment methods that often rely on one technique and expensive, highly skilled but scarce human resources. STREAM will be designed such that it will require minimal training to be administered by non-specialist workers in low and middle income countries, thereby promoting task-sharing, a concept endorsed by the World Health Organization to reach wider populations. This task-sharing approach reduces the burden on the small number of highly-skilled mental-health and child development professionals in these low resource settings. STREAM can also help develop community awareness and, in the longer term, address the barrier of low demand for services in these areas. The development and application of the STREAM platform involves collaborations across the breadth of basic and applied sciences. Our network comprising clinicians, neuroscientists, public health specialists and data scientists spread across UK, India and Malawi is optimally suited to leading this challenge because of our combined expertise deploying novel technologies to measure early childhood neurodevelopment in low-resource settings.
GCRF Action against Stunting Hub
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
The global community aims to decrease the number of stunted children under five by 40% by 2025. While targeted and specific, we know that this is presently unachievable. Part of the problem is that over the last three decades, the search for the 'silver bullet' or the specific driver, which if addressed could solve this intractable problem, has narrowed praxis. This is not to say that gains have not been made, but rather our efforts have not been entirely impactful. While substantial disciplinary advances have occurred, often they have not been joined-up. And while systematic reviews abound, pan-disciplinary understandings, do not. Hence, child stunting is an intractable problem, waiting for a unified solution. If we perceive child under-nutrition as a mosaic, we have knowledge of many of the individual elements. For example, biological advances demonstrate there is an identifiable 'epigenetic signature' of stunting. Children who are stunted also have immature gut micro-biomes and we also know a large proportion of the global malnutrition burden is caused (either directly or indirectly), by infectious agents ranging from viruses and bacteria to protozoa and helminths. Food-borne toxins also impact stunting. Equally, we know a range of elements can help to prevent stunting from animal source Foods (ASF) to behavioural elements from dietary choices to feeding practices to water, sanitation and hygiene (WASH). Yet overall, it may be argued that we are missing the shape and structure of the mosaic and the synergies between the component parts. In many quarters, the literature on child under-nutrition is viewed as 'siloed' and non-relational (Perkins et al., 2017). But equally importantly, 'integrated' nutritional programmes have often not had the expected impacts. Herein lies the problem and the related solution: we urgently need to understand the 'cascade' of factors driving child stunting and the synergies and inter-relationship between drivers. And equally importantly, we need to better understand the 'tipping points' or the critical points along this cascade where healthy linear growth diverges to slow or no growth. To do this, we propose to transform our exploration of child under-nutrition from the component parts to the 'whole child'. Where the biological, social, environmental and behavioural context in which stunting occurs is understood in its entirety and where the strength and directionality of these drivers, inform related interventions. Based on this joined-up approach, we will explore the ability of a range of child-centred interventions to disrupt the cascade of factors that inhibit the ability of a child to grow. These actions and outcomes will then form the basis of a decision-making platform to enable users to identify the ex-ante and ex-post impacts of potential interventions. Embedded in this process, however, is a values-based approach that ensures that from the outset, our research directly connects to and betters the lives of the children, families and communities involved. We will work across three countries: India, Indonesia and Senegal in over 50 communities. We aim to decrease child stunting by up to 10% our communities. Finally, to enhance our impact and legacy our Hub, we will engage a range of end-users in both our outputs and in the wider 'whole child' approach. We will support new regional platforms on maternal and child nutrition proposed by UNICEF linking the work of FAO/The World Bank/WHO at the country-level. We will also engage our network of over 100 civil society organizations in our findings. Over the course of the project, we expect to positively impact the lives of up to 1 million children.
Effect of urban vs rural context on effectiveness of a community intervention to prevent diarrhoea and stunting in young children in Mali
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
GCRF Health and Context award - The Problem Globally 1.7 billion diarrhoea episodes result in approximately 2 million deaths in 2010.1 Regionally, Africa has the greatest burden. Alongside poor infant feeding, diarrhoea diseases also contribute to infant malnutrition.2-4 Despite new vaccines, treatments and public health measures,3 diarrhoea and malnutrition remain considerable public health problems in low- and middle-income countries (LMIC). The period when a child starts eating solids (usually 6-24 months called complementary food (CF)), is associated with the highest rates of diarrhoea: over 50% of all diarrhoea deaths occur at 6-11 months.1 Most low-income households in LMIC cook ingredients at home or obtain food from informal street food-sellers who prepare the goods in their homes. Therefore home food handling, preparation and storage determine the scale of food contamination. Although many studies explore the effects of improved water supply, hygiene and nutrition of infant diets on infant diarrhoea and growth development, much less attention paid to studies of food safety remain scarce. Research in this area has been too general to reduce diarrhoea through food contamination. The World Health Organisation (WHO) advocates targeted interventions to support CF safety and hygiene. Ideally CF safety needs to be accompanied with achieving optimal dietary intake for young children, which also remains a challenge in LMIC. Research shows that infant health and safety advice has limited impact on behaviour change unless accompanied by means to motivate and empower mothers in the community. Yet previous interventions targeting diet or diarrhoea have seldom drawn on cultural dramatic arts and community assets to motivate behaviour change. African communities have a particularly strong cultural heritage to underpin such potential impact. Our Aim We propose a low-cost, scalable, and adaptable community intervention to reduce diarrhoea and improve the growth of young children in urban-poor and rural Mali. We will assess the effects in both settings, to inform replication and scaling of the intervention, because the dynamics of community life vary in each. Our Previous Work We combine two complementary interventions shown to be effective elsewhere in LMIC. A trial in the Gambia (developed through former work in Bangladesh, Nepal and Pakistan) evaluated efforts to improve hygiene and safety of CF, while a trial in Kenya evaluated a community programme to improve breastfeeding and weaning food content. Our Plan After adaptation with communities, our intervention will empower local families to implement behaviour change. It will include campaign-like activities such as culturally relevant dramatic arts (drama, songs, stories), public meetings, certifications, and home visits, delivered by a small team: 5 days of community campaign visits dispersed during 35 days and including home visits by trained female volunteers, plus a reminder campaign day at 9 months. We will allocate 120 urban and rural sites in Mali by chance to receive the intervention, or not, and assess 27 households in each site after 15 months. The study is designed to quantify the influence of urban vs rural context, and to examine other societal influences (e.g. household poverty, women's work, and education, etc). Using observations, interviews, discussion groups, surveys and laboratory tests we will compare the implementation of the intervention in urban-poor and rural settings. Importantly, the intervention is designed to be sustainable through peer-education among mothers and older female volunteers (demonstrated after 32 months in Gambia), thus requiring only small levels of coordination resources from central government.
Understanding phenotype and mechanisms of spontaneous preterm birth in sub-Saharan Africa (PRECISE-SPTB)
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Preterm birth, birth before 37 weeks of pregnancy, is a major cause of infant death and illness in sub-Saharan Africa. Over 80% of preterm births globally have been estimated to occur in sub-Saharan African (sSA) and Asian countries, the majority being due to women going into preterm labour spontaneously or their membranes (waters) rupture early (classified together as spontaneous preterm birth, SPTB). Despite knowledge of the global impact of SPTB, most of the research into this often devastating pregnancy outcome has focussed on pregnant women in high income countries such as the UK and USA. Much less in known about SPTB in women from low income countries. However, the underlying biological causes of SPTB are complex and heavily influenced by environment, nutrition, infection and other risk factors that pregnant women are exposed to. Region specific research is essential if we are to improve maternal and newborn healthcare in countries where the burden of preterm birth is highest. Addressing this need, we plan to study to clinical and social risk factors (from 5000 women recruited to the PRECISE Network pregnancy cohort, https://precisenetwork.org/) combined with biological markers of SPTB in the female reproductive tract, blood and placental tissue in women from Kenya, The Gambia and Mozambique. We will integrate these data to enhance our biological understanding of SPTB as well as identifying novel biomarkers relevant to sub-Saharan African populations to predict risk of SPTB. We will also create sustainable teams of SPTB researchers by training five new African scientists and supporting their supervisor as research leaders. We will, with colleagues in The Gambia, establish a bioinformatics training programme and a laboratory science network for our researchers in Sub Saharan Africa and the UK. We anticipate that this work will impact future strategies for clinical risk management, prevention and treatment that specifically addresses the needs of women in sub-Saharan Africa, as well as having potential relevance to SPTB globally.
OpEx Delivery Costs
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Delivery costs in completing relavant GCRF/ODA activities
IndiaZooRisk+: Using OneHealth approaches to understand and co-develop interventions for zoonotic diseases affecting forest communities in India
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Zoonotic diseases (that spread from animals to humans) disproportionately affect poor tropical communities and can lead to loss of life, impaired livelihoods, health and welfare. Forest habitats are a significant source of such diseases. For communities that depend on forests for food, fuel and income, accessing forests comes with the increased risk of being exposed to zoonotic pathogens. Although we know that zoonotic diseases are increasing globally, we still lack knowledge on how these diseases circulate between wildlife, livestock and people as they use forests, and how environmental changes like forest degradation interact with human migration, local culture and society (knowledge sharing), and policy (land tenure, disease prioritisation) to exacerbate emergence and spread. Focussing on India as a key global hotspot for endemic and emerging zoonotic diseases and bringing together a network of policy makers and practitioners from the human health, animal health and environmental sectors with experts (public and animal health, ecology, epidemiology and social science) - thereby following the One Health approach -, this project aims to reduce health, welfare and livelihood impacts of zoonotic diseases by (1) better understanding the impacts of different drivers on health outcomes and spread of zoonotic diseases (2) co-develop improved interventions, integrating traditional knowledge, with affected forest communities and, thereby building the capacity of local communities to be more resilient to zoonotic diseases. Three neglected zoonotic diseases, Leptospirosis, Kyasanur forest Disease and Scrub Typhus that are widespread across the Western Ghats forest communities and cause severe complications and death if untreated, yet have different transmission routes, will be taken as key case-studies for field research. The research underpinning these improvements will include: (1) understanding how local culture and policies, nutrition and environment factors affect community interventions, perceptions and health outcomes from zoonotic diseases. (2) investigating how different communities share knowledge on diseases and health intervention, including traditional knowledge, both with each other and with practitioners and managers, to improve communication strategies. (3) studying the role of different wildlife and livestock hosts and tick and mite vectors in transmission of disease to humans in different seasons. (4) understanding how long distance seasonal migration of pastoralists may promote resilience or increase their exposure to diseases and environmental change. (5) developing computer models and risk maps, integrating environmental and social data, for predicting the distribution and spread of diseases. (6) building capacity in research, data analysis and cross-sectoral collaboration to underpin future One Health approaches in India. Improved decision-support tools and Apps and prioritisation of traditional knowledge will help disease managers, policy makers and community workers to develop novel interventions and better target vaccination and communication efforts towards the communities that are most at risk and help managers in agriculture and environmental sectors to understand how, for these communities, disease impacts may coincide with other negative impacts of environmental change. The project platform and approach of co-developing research, training and decision support tools on zoonotic diseases with stakeholders across sectors, accounting for their needs and underlying ecological and social processes, will build significant capacity in science, policy and practitioners to respond to these emerging and endemic global threats in India and beyond.
Long-term health after Severe Acute Malnutrition in children and adults: the role of the Pancreas - SAMPA
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Whilst there is an increasing prevalence of overweight and obesity worldwide, malnutrition remains common. In addition, malnutrition, overweight, and infections often interact. It is well established that malnutrition in pregnancy, resulting in an infant born with low birth weight, can increase the risk of diseases such as diabetes, heart disease and cancer in adulthood. However, the consequences of malnutrition after birth are much less studied. Severe acute malnutrition in childhood, indicated by extreme thinness, remains common in Africa and Asia. In addition, substantial numbers of adult patients with tuberculosis or HIV, diseases which are common in Africa and Asia, may become malnourished. We are interested in diabetes, which in Africa and Asia affects people at younger age and lower weight than in Europe. There is evidence from epidemiological studies that severe malnutrition in childhood and possibly in adulthood increases the risk of later diabetes but the evidence is piecemeal and there is little information as to the mechanisms involved. It is thus difficult to determine what treatments or preventative strategies are appropriate. We wish to focus on the pancreas which is a key organ in digestion and metabolic processes, especially in relation to diabetes. We will investigate pancreas size, microscopic structure, hormone and digestive enzyme production, and the body's response to these hormones among groups of people in Tanzania, Zambia, India and the Philippines. These groups have participated in the research team's previous studies of malnutrition and were malnourished before birth, as children, or as adults. They now live in places with a wide range of access to foods high in fat and sugar which could affect their risk of diabetes. We will use modern clinical methods to compare their pancreas function to that of never-malnourished controls at each site. We will use advanced statistical methods to understand the links between early malnutrition and later diabetes, taking into account the factors often associated with diabetes such as age, current overweight and infection. The project will have a substantial training component so that staff at all sites can be trained in assessment methods for nutritional status including body fat and lean content, diabetes, and pancreas function and in statistical methods. We will work with local clinicians and patient support groups to ensure that results of the project are taken up and used locally. We also plan to conduct workshops with the child participants to help them understand aspects of the science in which they are involved. Even if we find no important link between early malnutrition and later diabetes, the research will lead to improved understanding of the long-term consequences of malnutrition and the presentation and underlying metabolism of diabetes in Africa and Asia. Thus, the project will lead to improved health care for both malnourished and diabetic people.
Responding to the challenge of MERS-CoV: Development and testing of interventions to reduce risk among Bedouin populations in Southern Jordan
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a recently identified 'emerging infectious disease' first seen in Jordan and Saudi Arabia in 2012. Clinical cases can present as a sudden acute respiratory infection, with rapid onset pneumonia and death, although milder infections also occur (in some cases without any symptoms at all). Since the initial outbreaks in 2012, there have been almost 2500 confirmed cases, with over a third of those infected subsequently dying from the disease (848 people to date). Confirmed cases have been reported across 27 countries, although the majority have been in the Arabian Peninsula, with Saudi Arabia the disease epicentre (over 80% of all confirmed cases). Primary infection in humans occurs through contact with infected dromedary camels (or camel products) and camel populations act as the host reservoir for the virus, however infection in camels causes only mild symptoms, similar to a common cold (and may cause no symptoms at all). Once someone becomes infected in this way secondary human-to-human transmission of the virus can then occur (often in a hospital setting) with the potential to cause large scale outbreaks such as those seen in South Korea and Saudi Arabia in recent years. Jordan's strategic location at the centre of current Middle Eastern crises means that its stability within the region is of global significance. Enormous influxes of displaced peoples into Jordan from the conflicts in Syria, Iraq and Yemen among others (accounting for over 30% of the population) have placed unprecedented demands on Jordan's national disease surveillance, response and health-care services and increased the risk of catastrophic disease outbreaks occurring in the future, including MERS-CoV. Jordan's long, porous border with Saudi Arabia, across which frequent movements of people and livestock occur (particularly among rural Bedouin populations in the south of the country) and large camel populations, mean that the risks posed by MERS-CoV remain high. The World Health Organization (WHO) have designated MERS-CoV to be a Blueprint Priority Disease for Research and Development, alongside other 'emerging infectious diseases' that represent a potential global threat, including Ebola, Lassa and Nipah viruses. The development of vaccines against MERS-CoV, for use in both camels and humans, is already at an advanced stage, however knowledge regarding the diseases epidemiology and cultural context (which are essential for effective vaccine deployment) is currently lacking. A similar lack of knowledge has delayed the deployment of other vaccines in the past (e.g. recently the Lassa virus vaccine in West Africa) and so it is important that deployment of future MERS-CoV vaccines is not delayed for the same reasons. It is crucial therefore that appropriate research be conducted among high-risk populations. With this in mind, and building on the findings of successful GRCF Foundation Award research, we aim to conduct state-of-the-art interdisciplinary research to determine the biological and sociocultural contexts of the disease among at-risk Bedouin populations in southern Jordan. In particular, we are seeking to understand which individuals, or camels, should be targeted for future vaccination, the correct seasons for the deployment of such vaccines and the sociocultural issues that are driving the infection, with consideration of these sociocultural issues vital when looking at potential control measures for the disease, including vaccination. Through this project we thus aim to develop appropriate, community based behavioural interventions that will reduce the risk of infection among these communities (as well as considering the potential role of vaccines in the future). We are also aiming to build Jordan's capacity for strategic research, surveillance and control activities to confront the challenge posed by MERS-CoV (as well as by other 'emerging infectious diseases').
Building resilience and resources to overcome depression and anxiety in young people from urban neighbourhoods in Latin America
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Background The numbers of people with depression and anxiety greatly increases during adolescence. Adolescents who live in big cities more commonly experience stressful events such as conflict, poverty, substance misuse and social isolation. This includes adolescents from Latin America - which is the most urban part of the world. Although many individuals experience stressful events, the majority do not develop either depression or anxiety. Furthermore, when people do experience them, up to half recover within a year. This raises the question of what helps people to prevent depression and anxiety, and what helps people recover. We have called these resilience factors. Our aim is to understand resilience factors so we can develop new approaches to treat depression and anxiety. Objectives The overall aim is to identify resilience factors that are linked to either prevention of depression and anxiety, or to recovery. We will focus on adolescents and young people who live in three large Latin American cities - Buenos Aires, Bogotá and Peru. To achieve this, we aim to: 1. Develop new ways of measuring resilience factors that can be used with adolescents and young people, 2. Identify which resilience factors prevent depression and anxiety, 3. Identify which resilience factors help adolescent and young people to recover from depression and anxiety within one year, 4. Develop case studies about existing approaches that promote prevention and recovery, 5. Build up the research skills and knowledge of researchers in Latin America, 6. Involve adolescents and young people through an interactive arts-based project. Methods The project is organised into six work packages (WPs). In the WP1, we will ask young people and staff who work in schools, youth organisations and healthcare services to help us develop new ways of measuring resilience factors to create an assessment tool. The new tool will be used in a study that will compare 1020 adolescents (15-16 years old) and young people (20-24 years old) with depression and anxiety to 1020 adolescents and young people without. We will look at personal factors such as health behaviours and social factors including relationships. We will test if there are differences between the two groups. This will help us discover which factors are linked to prevention. The individuals who have depression and anxiety will be asked to complete the same measures after one year. We will compare individuals who recovered from depression and anxiety to those who did not. This will tell us about recovery. To promote prevention and recovery we will conduct interviews with participants who did and did not recover and with different stakeholders. This will help us identify areas of "good-practice" which we will write up as case studies. This may include initiatives such as health centres or social-groups in the community (WP4). So that researchers in Latin America can continue studying resilience and recovery, we will provide training and activities focused on research skills (WP5). Finally, we want to involve adolescents and young people in our research. To do this, we will run an arts-based project where we will ask those with depression and anxiety to use different materials such as photographs, films, and graffiti to document their experience. We will hold exhibitions to display the art. We hope this will encourage other young people to get involved in research (WP6). Expected results The project will lead to new knowledge about what prevents depression and anxiety and what help people recover. Understanding this will help us develop new approaches to improve the mental health of adolescents and young people and reduce the burden of mental disorders. Our communication methods will ensure the research is widely disseminated. Although the project focuses on Latin America, our learning will help other countries, including many Low and Middle Income countries, which are becoming more urban.
Economic and Social Research Council (ESRC) Delivery costs of International Science Partnerships Fund (ISPF) ODA activities
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Operational costs occurred at Economic and Social Research Council (ESRC) associated with hosting and/or managing ODA International Science Partnerships Fund (ISPF) programmes
Cumulative costs of the delivery of ODA-eligible activities developed and realised for Global Challenges Research Fund
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
The activities developed for the Global Challenges Research Fund and approved as promoting the overall ODA commitment of HMG, have been delivered by the appropriate BBSRC teams (including the Research and Innovation Funding Delivery Team sitting within the Capability & Innovation Domain). During the delivery stage, the plan set out in the commissioning stage is implemented, subject to any changes required as part of the commissioning process. The responsible teams support our external communications, call documentation, peer review/panel processes, and funding decisions cross a broad range of strategic and responsive funding mechanisms, and have been instrumental for the success of the Global Challenges Research Fund activities.
BBSRC ISPF delivery costs of ODA eligible activities
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Operational costs occured at BBSRC associated with hosting and/or managing ODA ISPF programmes
British Academy Agile Response to Emergencies - Researchers at Risk Fellowships
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
The Researchers at Risk Fellowships Programme is being delivered by the British Academy on behalf of UK National Academies and in partnership with the Council for At-Risk Academics (Cara). The Fellowships will support researchers at risk to continue their research in the UK for up to two years. The programme is receiving £3 million of funding from the Department for Business, Energy and Industrial Strategy (BEIS), plus £8.88m from transition funding as the Global Challenges Research Fund closes and the new BEIS fund starts. The Nuffield Foundation, an independent charitable trust, is contributing £0.5 million towards the scheme.
Programme delivery costs for EPSRC's GCRF allocation - supporting delivery of ODA eligible projects
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Programme Delivery costs for EPSRC activities funded through the Global Challenges Research Fund - supporting cutting-edge research to address challenges faced by developing countries.
Delivery Costs for Newton Fund ODA Eligible Activities
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Newton Fund. AHRC Staff delivery costs for ODA eligible activities
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