R4D Maternal Health

Which abdominal incision is best to use in Caesarean section?

Fri, 06 Nov 2009 14:49:00 GMT

Miscellaneous 2009 Evidence Update, Maternal Health Series. Effective Health Care Research Programme Consortium, Liverpool School of Tropical Medicine, Liverpool, UK, 2 pp. Each Evidence Update is a 2-page summary of a Cochrane Review of healthcare interventions relevant to people in low-income and middle-income countries.

This Evidence Update is adapted from Mathai M, Hofmeyr GJ. Abdominal surgical incisions for caesarean section. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004453. DOI: 10.1002/14651858.CD004453.pub2.

The Joel-Cohen incision appears better than the Pfannenstiel incision.

What drug should be used to treat primary postpartum haemorrhage?

Fri, 06 Nov 2009 14:38:00 GMT

Miscellaneous 2009 Evidence Update, Maternal Health Series. Effective Health Care Alliance Programme, Liverpool School of Tropical Medicine 2pp Each Evidence Update is a 2-page summary of a Cochrane Review of healthcare interventions relevant to people in low-income and middle-income countries.

This Evidence Update is adapted from Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD003249. DOI: 10.1002/14651858. CD003249.pub2.

There is not enough evidence to determine the best drug treatment for women with primary postpartum haemorrhage.

Primary HIV Infection in Antenatal and Postnatal Women, Northern KwaZulu‐Natal, South Africa

Wed, 28 Oct 2009 15:19:00 GMT

Miscellaneous S. Mepham 2009 Presentation at Imperial College London, 18 May 2009. 44 pp.

Reducing financial barriers to obstetric care in low income countries

Wed, 28 Oct 2009 15:10:00 GMT

Miscellaneous S. Witter 2009 Presentation at the University of Aberdeen, 1 June 2009. 38 pp. This presentation deals with:

1. The role of financial barriers for delivery care in low- income settings
2. Approaches to addressing financial barriers
3. Some recent case studies: experiences of different approaches
4. Policy recommendations on effective strategies.

Quality of care for maternal and newborn health: the neglected agenda

Wed, 28 Oct 2009 14:52:00 GMT

Miscellaneous N. R. van den Broek and W. J. Graham 2009 BJOG: An International Journal of Obstetrics and Gynaecology (2009) 116 (s1) 18-21 [doi: 10.1111/j.1471-0528.2009.02333.x] The quality of care received by mothers and babies in developing countries is often reported as poor. Yet efforts to address this contributory factor to maternal and newborn mortality have received less attention compared with barriers of access to care. The current heightened concern to achieve Millennium Development Goals 4 & 5 has illuminated the neglected quality agenda. Whilst there is no universally-accepted definition of "quality care", it is widely acknowledged to embrace multiple levels from patient to health system, and multiple dimensions, including safety as well as efficiency. Quality care should thus lie at the core of all strategies for accelerating progress towards MDG4 & 5. Interventions to measure and improve quality need themselves to be evidence-based. Two promising approaches are maternal and perinatal death reviews and criterion-based audit. These and other quality improvement tools have a crucial role to play in the implementation of effective maternal and newborn care.

Professional assistance during birth and maternal mortality in two Indonesian districts

Wed, 28 Oct 2009 14:43:00 GMT

Miscellaneous C. Ronsmans, S. Scott, S. N. Qomariyah, E. Achadi, D. Braunholtz, T. Marshall, E. Pambudi, K. H. Witten & W. J. Graham 2009 Bulletin of the World Health Organanisation (2009) 87: 416-423 [doi:10.2471/BLT.08.051581] Objective: To examine determinants of maternal mortality and assess the effect of programmes aimed at increasing the number of births attended by health professionals in two districts in West Java, Indonesia.

Methods: We used informant networks to characterize all maternal deaths, and a capture-recapture method to estimate the total number of maternal deaths. Through a survey of recent births we counted all midwives practising in the two study districts. We used casecontrol analysis to examine determinants of maternal mortality, and cohort analysis to estimate overall maternal mortality ratios.

Findings: The overall maternal mortality ratio was 435 per 100 000 live births (95% confidence interval, CI: 376498). Only 33% of women gave birth with assistance from a health professional, and among them, mortality was extremely high for those in the lowest wealth quartile range (2303 per 100 000) and remained very high for those in the lower middle and upper middle quartile ranges (1218 and 778 per 100 000, respectively). This is perhaps because the women, especially poor ones, may have sought help only once a serious complication had arisen.

Conclusion: Achieving equitable coverage of all births by health professionals is still a distant goal in Indonesia, but even among women who receive professional care, maternal mortality ratios remain surprisingly high. This may reflect the limitations of home-based care. Phased introduction of fee exemption and transport incentives to enable all women to access skilled delivery care in health centres and emergency care in hospitals may be a feasible, sustainable way to reduce Indonesias maternal mortality ratio.

Confidential inquiries into maternal deaths: Modifications and adaptations in Ghana and Indonesia

Wed, 28 Oct 2009 14:35:00 GMT

Miscellaneous J. Hussein, L. D'Ambruoso, M. Armar-Klemesu, E. Achadi, D. Arhinful, Y. Izati and J. Ansong-Tornui 2009 International Journal of Gynecology & Obstetrics (2009) 106 (1) 80-84 [doi:10.1016/j.ijgo.2009.04.007] Objective: Factors contributing to the limited use of confidential inquiries into maternal deaths include the negative focus and demotivating effect of such inquiries, perceptions of unavailability of sufficient documentation of events, and lack of time and resources. To ascertain whether these problems can be overcome, variations to confidential inquiries into maternal deaths were introduced in Ghana and Indonesia.

Methods: Clinical review panels were set up as part of the usual process of confidential inquiries, and modifications to the confidential inquiries were introduced. In Ghana, the traditional confidential inquiry process focusing on health facility care was modified to introduce the assessment of positive factors. In addition to the assessment of positive factors, adaptations in Indonesia consisted of including cases of obstetric complications, as well as deaths, and the use of interview testimonials as data sources. Information about resource and time needs for conducting confidential inquiries was collected.

Results: The introduction of positive aspects to the process provided a balanced and more motivating setting for the inquiry. The data obtained from case notes in district hospitals and interview testimonials provided sufficient information to assess why maternal deaths and severe complications occurred. The costs of conducting the inquiries ranged from US $4000 to US $11 000 (per study), and the estimated time required for a panel member to review each case was more than 3 hours.

Conclusion: This study introduced practical ways to encourage the implementation of maternal death reviews, inquiries, and audits that are context specific and, therefore, acceptable to local practitioners.

Task shifting for emergency obstetric surgery in district hospitals in Senegal

Wed, 28 Oct 2009 12:12:00 GMT

Miscellaneous V. De Brouwere, T. Dieng, Mohamed Diadhiou, S. Witter, E. Denerville 2009 Reproductive Health Matters (2009) 17 (33) 32-44 [doi:10.1016/S0968-8080(09)33437-0] Due to a long-term shortage of obstetricians, the Ministry of Health of Senegal and Dakar University Obstetric Department agreed in 1998 to train district teams consisting of an anaesthetist, general practitioner and surgical assistant in emergency obstetric surgery. An evaluation of the policy was carried out in three districts in 2006, covering trends in rates of major obstetric interventions, outcomes in newborns and mothers, and the views of key informants, community members and final year medical students. From 2001 to 2006, 11 surgical teams were trained but only six were functioning in 2006. The current rate of training is not rapid enough to cover all districts by 2015. An increase in the rate of interventions was noted as soon as a team had been put in place, but unmet need persisted. Central decision-makers considered the policy more viable than training gynaecologists for district hospitals, but resistance from senior academic clinicians, a perceived lack of career progression among the doctors trained, and lack of programme coordination were obstacles. Practitioners felt the work was valuable, but complained of low additional pay and not being replaced during training. Communities appreciated that the services saved lives and money, but called for improved information and greater continuity of care.

EVIDENCE press, Issue 2

Wed, 28 Oct 2009 11:58:00 GMT

Miscellaneous 2009 EVIDENCE press issue 02:09, 2 pp. A selection of news & resources from Immpact, including a list of recent publications, is presented.

TARGETS Newsletter Issue No. 10

Tue, 27 Oct 2009 15:54:00 GMT

Miscellaneous 2009 October 2009, 2 pp. This issue has an article on 'Acceptable Interventions for Malaria in Pregnancy: innovative ways of working with health care users and providers,' by Lucy Smith (LSHTM). Details are also given of Forthcoming Events and TARGETS Partner Research News.

This is Open Access Week

Mon, 19 Oct 2009 01:00:00 GMT

This week, 19-23 October 2009, is the first International Open Access Week, which aims to broaden awareness and understanding of Open Access.

New funding opportunities for four health-related Research Programme Consortia (RPCs)

Mon, 24 Aug 2009 01:00:00 GMT

DFID is calling for expressions of interest for service providers to lead Research Programme Consortia (RPCs) to work on four health themes. Closing date 9th October 2009.

DFID releases a new project database

Fri, 21 Aug 2009 01:00:00 GMT

Information about projects funded by DFID, ranging from emergency aid for countries affected by conflict or humanitarian crises, to ongoing support to improve health, education and sanitation in the poorest countries, is now available online.

Drugs For Neglected Diseases Initiative (DNDI)

Mon, 03 Aug 2009 14:51:00 GMT

Current

Purpose of engagement:

The Drugs for Neglected Diseases Initiative (DNDi) was launched in 2003 as an independent, not-for-profit organisation. It focuses on research, development and access to drugs for the worlds most neglected diseases.

Most neglected diseases, such as sleeping sickness, Chagas disease, leishmaniasis, etc. almost exclusively affect people in developing countries who are too poor to pay for any kind of treatment and do not constitute a market that can attract investment in drug Research and Development (R&D). Current treatment for neglected diseases is often too expensive, no longer produced, highly toxic or ineffective. Recent international efforts to revive pharmaceutical R&D for neglected diseases on the basis of public private partnerships have focused mainly on malaria, TB, and HIV/AIDS. Therefore an initiative like DNDi is especially needed to fill the research gap into other neglected diseases.

DNDi's research efforts play a significant role towards progress for Millennium Development Goal 6, to combat HIV/AIDS malaria and other diseases, with a particular emphasis on "other diseases". DNDi is developing drugs for neglected diseases and is using existing R&D capacity and strengthening R&D capacity in countries where these diseases are endemic. DNDi is also raising awareness about the lack of R&D for neglected diseases. Its advocacy efforts aim to stimulate the international community, and national government leadership in setting the priority research agendas, creating an enabling regulatory environment and providing the necessary funding needed to address the neglected disease agenda.

DNDi's goal is to improve the health of poor and marginalized populations that are affected by neglected diseases. DNDi has a purpose to develop new improved and accessible treatments for some of the most neglected diseases and ensure that they are suitable for, and accessible to, the millions of people suffering from neglected diseases, who are often living in poverty and in remote areas. If successful, the DNDi clinical development projects will have a major impact on patient care in developing countries, as they will provide considerable improvements over out dated, existing treatments in terms of toxicity, length of treatment course and/or price.

DFID engagement Strategy/DFID line:

Funding for DNDi fits within the DFID research strategy to address the need for new or improved products to combat diseases of the poor, for which prevention or treatment is lacking or inadequate. Development of new treatments will help to achieve the Millennium Development Goals, notably to reduce poverty and child mortality, improve maternal health and to combat malaria and other neglected diseases. The work of DNDi also fits with the DFID AIDS strategy as it addresses the major impact on HIV of neglected diseases (such as Leishmaniasis).

To develop new improved and accessible treatments for some of the most neglected diseases and ensure that they are suitable for, and accessible to, the millions of people suffering from neglected diseases, who are often living in poverty and in remote areas. The delivery of two new fixed dose artemesinin-combination therapies (ACTs) for adults and children against malaria, ASAQ and ASMQ.

ASAQ was launched with sanofi-aventis in 2007 and prequalified by WHO in 2008.

ASMQ was launched with Farmanguinhos/ Fiocruz in March 2008 in Brazil and a South-South technology transfer between Farmanguinhos, Brazil and Cipla, India is underway to ensure availability in Asia.

WHO prequalification for a treatment for VL.

Work in conflict zones

UNDP/UNFPA/WHO/World Bank Special Programme Of Research: Human Reproduction Programme (HRP)

Mon, 03 Aug 2009 13:56:00 GMT

Current

Purpose of engagement:

Research on reproductive health has been identified as one of the top ten global research priorities. Improved access to reproductive health services enables women and men to exercise choice in childbearing and improves the health and quality of life for parents and children. It can also have a direct impact on gender equality and poverty reduction. The September 2005 UN World Summit reaffirmed the commitment of the international community to achieve the goal of universal sexual and reproductive health and rights as set out in the Cairo agenda of the International Conference on Population and Development (ICPD).

The Human Reproduction Programme (HRP) is central to the United Nations system for research in human reproduction, bringing together policy-makers, scientists, health care providers, clinicians, consumers and community representatives to identify and address priorities for research aimed at improving the sexual and reproductive health of developing country populations. HRP is a joint Special Programme, based at the World Health Organisation (WHO). The programme places a strong emphasis on research with practical application and developing countries have a voice in the management of the research.

The goal of HRP is to contribute to improved sexual and reproductive health. Its purpose is to support the generation of knowledge, products and capacity to help countries meet the sexual and reproductive healthcare needs of their populations. It does this through research, development of norms and standards guidance, training, and capacity strengthening focused on improving the quality, range and availability of reproductive health services in poor countries.

DFID engagement Strategy/DFID line:

Reproductive health is central to attainment of the MDGs (particularly 3 - 6, but also 1, 2 and 8) and so is in line with many DFID strategies and policies.

DFID's ongoing commitment to research into reproductive and sexual health is captured in the Research Strategy 2008-2013, and reflects DFID's firm policy commitment to realising international targets on sexual and reproductive health and rights. Funding HRP activities fits this agenda well and their work complements and builds upon other DFID funded programmes (both operational and research) and covers areas of linkages, for example, between sexual and reproductive health and HIV.

To support the generation of knowledge, products and capacity to help countries meet the sexual and reproductive healthcare needs of their populations, through research, development of norms and standards guidance, training and capacity strengthening focused on improving the quality, range and availability of reproductive health services in poor countries. 1. With the latest research information HRP established a model of antenatal care that halves the time and money women spend accessing services without compromising the quality of care. At least 15 developing countries now use the model. USAID has adapted it and promotes its use as "focused antenatal care." The health sector could save as much as $16 billion annually by implementing this new approach world wide.

2.HRP pioneered research in emergency contraception, led an international consortium including industry to put a dedicated product on the market, and confirmed a new, effective emergency contraception regimen that has now been registered in more than 100 countries covering 80 percent of the world's population.

3. With others in WHO, HRP revealed the extent and nature of domestic violence against women in 10 countries and the impact on sexual and reproductive health. The findings support advocacy and new ways to help women and health care providers to manage, treat and prevent such violence.

4. For the first time, HRP demonstrated that women who have undergone genital mutilation have increased complications at childbirth and that the risk of death of their newborn is increased. These results have boosted advocacy movements to stop the practice and are supporting the development of training materials for health care providers. With ten other UN agencies WHO developed a new Interagency Statement on Eliminating Female Genital Mutilation, launched in 2008.

5. After two years of convening global experts, HRP on behalf of WHO, submitted recommendations for sexual and reproductive health indicators to measure progress within the context of MDG 5, in particular the new target 5B, 'achieve universal access to reproductive health'. These recommendations became officially recognized by the United Nations in January 2008, following deliberations within the Interagency and Expert Group on MDG indicators.

DFID seeks applications for three posts in the Research Uptake Team

Tue, 21 Jul 2009 01:00:00 GMT

DFID is seeking to fill three posts in the Research Uptake team within the Policy and Research Directorate - Team Leader and two Research Evidence Brokers

International AIDS Vaccine Initiative (IAVI)

Fri, 17 Jul 2009 09:56:00 GMT

Current

Purpose of engagement:

The International AIDS Vaccine Initiative (IAVI) is a not-for-profit foundation whose mission is to ensure the development of safe, effective, accessible, preventive HIV vaccines for use throughout the world. IAVI was established in 1996, and was the first product development public-private partnership (PDP) to target the neglected diseases of disproportionate impact on the worlds poor. Since its foundation it has enabled the development and evaluation of a wide range of candidate vaccines.

There are no AIDS vaccines available at the moment and the last two years have yielded disappointing research results as potential vaccines being tested have not been effective and trials have been stopped early. IAVI is one of the organisations leading the global research effort to understand the basic science and find innovative approaches to the development of potential AIDS vaccines.

DFID engagement Strategy/DFID line:

Funding for IAVI fits within the DFID research strategy to address the need for new or improved products to combat diseases of the poor and the DFID AIDS strategy with its focus on treatment and prevention. Development of new prevention technologies for HIV will help to achieve the Millennium Development Goals, notably to combat diseases such as AIDS, reduce poverty and child mortality, and improve maternal health.

To ensure the development of safe, effective, accessible, preventive HIV vaccines for use throughout the world Advancing six HIV vaccine candidates to testing in human trials. Evaluation of two additional vaccines.

Conducting 20 trials in 11 countries.

Setting up the first global scientific consortium to address key challenges impeding AIDS vaccine R&D.

Building a strong clinical and laboratory network throughout East & South Africa and India.

HIV studies funded by IAVI have provided opportunities for over 80,000 people to receive HIV prevention and treatment services.

Building infrastructure, providing equipment, support and enhancement of communications and IT, capacity built for clinical and lab staff and community workers and administrative and financial staff.

International Partnership for Microbicides (IPM)

Fri, 17 Jul 2009 09:11:00 GMT

Current

Purpose of engagement:

The International Partnership for Microbicides (IPM) is a not-for-profit foundation whose mission is to prevent HIV transmission by accelerating the development and availability of safe and effective microbicides for use by women in developing countries. An effective microbicide will not only protect women against HIV inflection, but also interrupt the cycle of transmission from and to men and to newborns by preventing infection in the mothers.

There are no effective microbicides available at the moment although a number of different compounds have been tested. A DFID-funded trial, the microbicide development programme, will report its results at the end of 2009. IPM is one of the organisations leading the global research effort to test the next generation of microbicides will be based upon antiretroviral (ARVs) drugs.

IPM is a not-for-profit foundation, set up in 2002 to act as a small pharmaceutical/biotechnology company. IPM has scientific collaborators across nine countries, spanning the Americas, Europe, and Africa. Advocacy and access programs run across a similar range of settings.

DFID engagement Strategy/DFID line:

Funding for IPM fits within the DFID research strategy to address the need for new or improved products to combat diseases of the poor and the DFID AIDS strategy with its focus on treatment and prevention. Development of new prevention technologies for HIV will help to achieve the Millennium Development Goals, notably to combat diseases such as AIDS, reduce poverty and child mortality, and improve maternal health.

To prevent HIV transmission by accelerating the development and availability of safe and effective microbicides for use by women in developing countries. Securing royalty-free licenses from a number of leading pharmaceutical companies.

Developing promising ARVs as microbicide candidates. This has expanded the pipeline, both in number and potential mechanisms of action.

Developed new drug delivery models such as vaginal rings, vaginal tablets and films, and has developed analytical methods to test these formulations.

Established a clinical trial material (CTM) manufacturing facility.

Strengthened and/or expanded clinical infrastructure capacity at 15 research centres.

Completed 15 human studies at a number of locations with an additional 12 studies planned for 2009.

Established ethical guidelines for IPM clinical trials.

Raised the profile of microbicides through a network of advocacy organisations and high-profile champions to place microbicides on the global agenda (UNGASS, MDG Review, and G8) as well as the national agenda in many donor countries.

Built strong partnerships with funders and established an efficient organization.

Poverty and maternal health in Ghana: A spatial analysis of exclusion from care

Thu, 22 Jan 2009 12:06:00 GMT

Current Improving maternal health has been established as a key development priority and is associated, through the Millennium Development Goals (MDGs), with the eradication of poverty. Ghana is a country with a high level of maternal mortality that is currently undergoing substantial efforts to scale up the provision of maternal health services. Exclusion from maternal health services in Ghana represents a serious constraint to the attainment of both better maternal health and lower infant mortality and is known to be driven in part by poor availability and physical inaccessibility of these services. The overall aim of this project is to quantify the spatial links between poverty and poor utilisation of maternal health services in Ghana. This project builds on previous work in a range of African countries which showed that individual and community characteristics alone do not go far towards explaining service use at childbirth, especially in West African countries. However, previous analyses did not use poverty map estimations of local deprivation, nor did they control for varying geographical accessibility to services via facility mapping and analysis of realistic ground distances using modern geographical information system (GIS) techniques. The specific aim of this project is, therefore, to establish whether there is a relationship between the level of deprivation within communities and the use of health services during pregnancy, childbirth and the postpartum period after controlling for other factors such as the type and quality of services available, physical access, and characteristics of the woman herself. By investigating factors related to both physical accessibility and availability of health services, the research will facilitate an understanding of the effect of poverty on patterns of spatial variation in service use. The results will, for the first time, provide policymakers with spatially explicit explanations for exclusion from care throughout Ghana through nationwide maps of causative factors. 1) To prepare spatial data on use of maternal health services, poverty and physical accessibility at various levels of aggregation by:
*creating maternal health service utilisation maps derived from Demographic and Health Survey data (2003) at individual and district levels for pregnancy, childbirth and postpartum services in Ghana.
*creating a district level welfare poverty map of Ghana using census data and the Ghana Living Standards Survey 2003
*estimating the distance to services based on digital facility maps which include information on maternity provision in health centres and hospitals throughout the country.

2. To identify, by linking all three data sources listed above spatially in a regression analyses, the key factors determining service exclusion throughout Ghana.

3. To provide a more precise understanding of maternal health service utilisation in three case study districts of Ghana.

4. To interpret the findings of regression analyses and case studies based on local and national understandings of using maternal health services in Ghana / by interviewing national and district level health service managers, health facility staff and women who are pregnant or have recently given birth. The project also seeks to establish a methodological approach to producing linked poverty, health access and physical availability maps which can be applied in other data-rich contexts.

Linking Migration, Reproduction and Wellbeing: Exploring The Reproductive Strategies of Low-Income Rural-Urban Migrants in Vietnam

Thu, 22 Jan 2009 11:37:00 GMT

Current Rural-urban migration is a core livelihood strategy for many poor people in the developing world and in post-socialist economies, like Vietnam and China, its significance is growing rapidly. Poor migrants often find themselves vulnerable to exploitation and serious concerns have been raised about the impact of migration on wellbeing. However, the reproductive dimensions of migration and its linkages with changes in wellbeing have been rather poorly understood. Reproductive concerns around migrants have revolved around issues such as poor access for migrant workers to reproductive health services, whilst wider reproductive concerns, such as the impact of migration on marriage, childbearing and child-rearing strategies, have been neglected. These wider concerns are significant for maternal and child health, for parenting and child development, and because they will profoundly shape the gendered outcomes around new economic opportunities. Understanding the way that migrants manage their reproductive lives needs to be integral rather than peripheral to thinking about what new opportunities for economic migration mean for poor people's wellbeing. This study will focus on the reproductive strategies of low-income rural-urban migrants and their implications for wellbeing in Vietnam. It will ask:
- How do the reproductive aspirations of poor male and female migrants fit into their migratory strategies for building a life?
- What are the strategies that poor male and female migrants use for managing their reproductive lives?
- How do institutional conditions enable and constrain the gendered strategies of poor male and female migrants for managing reproductive life? This research will develop new understandings of the gendered linkages between reproduction, migration and wellbeing for poor men and women. Its objectives are to:
- Explore the reproductive aspirations of migrant men and women
- Develop understanding of how migrants manage their reproductive lives
- Investigate how these strategies are shaped by varying institutional conditions
- Explore the implications for wellbeing over time of self, spouse and children.

DFID seeks research fellows to design and execute research programmes

Wed, 20 Aug 2008 01:00:00 GMT

Notification of forthcoming appointment opportunities at the Department for International Development (DFID) for senior research fellows

DFID's Research Strategy on Health

Tue, 22 Apr 2008 01:00:00 GMT

DFID's focus will be operational research to make health programmes more effective, research on health systems and the development of drugs and vaccines for major diseases

The Mental Health and Poverty Project: Mental health policy development and implementation in four African countries.

Tue, 25 Mar 2008 11:27:00 GMT

Current The research programme consortium aims to provide new knowledge regarding comprehensive multi-sectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme will undertake an analysis of existing mental health policies in African countries, provide interventions to assist in the development and implementation of mental health policies in those countries, and evaluate the policy implementation over a 5-year period. 1. Conducted the first large-scale situation analysis of mental health systems in 4 African countries: Ghana, South Africa, Uganda and Zambia. These studies highlighted the neglect of mental health in current policies, the meagre resources available for mental health, lack of data for mental health service provision and widespread stigma against the mentally ill.

2. Established partnerships between research teams and Ministries of Health in all four countries and built capacity for mental health research and policy development through training workshops, exchanges and supervision.

3. Currently conducting and evaluating interventions that are having a significant impact on policy and practice in the four countries, including:

Ghana: reform of mental health legislation and establishment of mental health information systems for routine service monitoring.
South Africa: development of a strategic plan for mental health in the Northern Cape and development of mental health information systems in Northern Cape and KwaZulu-Natal.
Uganda: development of a national mental health policy, national strategic plan and reform of mental health legislation.
Zambia: reform of the mental health legislation.

4. Establishing models of best practice for the integration of mental health into primary health care, through demonstration projects in all 4 countries.

5. Conducted the first systematic literature review of the relationship between mental health and poverty in low and middle income countries. From this process and our engagement in the four African countries we have identified a range of interventions that have the potential to address the vicious cycle of poverty and mental ill-health.

Research and capacity building in reproductive and sexual health and HIV/AIDS in developing countries

Thu, 24 Jan 2008 14:40:00 GMT

Current Reversal of the spread of HIV/AIDS is one of the Millennium Development Goals (MDGs). Failure to achieve this goal will jeopardise other MDGs on poverty eradication, education, and maternal and child health. Success depends critically on improving access to effective interventions for those who are particularly vulnerable to infection (e.g. the poor). Access may be improved and protective behaviour increased through a number of strategies: e.g. mass communication of safe sex messages, together with social marketing of products such as condoms and STI diagnostic tests; provision of integrated SRH and HIV services which decrease stigma and thereby increase uptake; and provision of more effective biomedical interventions which can bring improved diagnostics and preventive technologies to all sections of society. Consortium partners have a long history of working in each of these areas. To support a research programme that will strengthen the evidence base to enable policy makers to identify and prioritise interventions that will improve reproductive and sexual health and reduce HIV incidence among economically poor populations in Africa and Asia. Strategies for behaviour change.

Integration of SRH and HIV services.

New biomedical tools.

Two large community randomised trials measuring the effectiveness of school-based and peer-led adolescent SRH interventions in Tanzania (Mema kwa Vijana study) and Zimbabwe (Regai Dzive Shiri study) have shown that young peoples knowledge about how to prevent HIV increased, and that these effects were sustained for at least 5 years. However, the interventions did not lead to a reduction in HIV, other STIs or unplanned pregnancies. These results will be important in guiding the future direction of HIV prevention activities for young people. The two studies communicated their results simultaneously in several fora including with national and international policy makers and researchers and have proven very influential in shaping the WHO Adolescent and Child Health Departments strategies for curbing HIV incidence in young populations.
A study commissioned by the National AIDS Control Programme in Pakistan, funded by DFID Pakistan and conducted by LSHTM researchers and collaborators from Pakistan shed much-needed light on the health and behaviour of populations often neglected or persecuted, in South Asia and elsewhere. The research has shown that violence, abuse and discrimination are commonly experienced by sex workers and injecting drug users, and can increase the likelihood of HIV and sexually transmitted infections. A future HIV epidemic is likely to be concentrated in those with highest levels of STIs and the highest levels of abuse transgender sex workers. Our research has also shown that policy recommendations targeted at transgender sex workers will have little support among society, and will be difficult for the government and public sector to implement, but they could be implemented successfully by NGOs, with donor funding and support.
As a result of our published evaluations which showed that the new point-of-care (POC) diagnostic dipstick tests for syphilis perform well in screening programmes for pregnant women, these tests were made available at discounted prices through the WHO bulk procurement programme. In 2009, a decision was made to use them for antenatal screening in Ghana, and they will now being rolled out nationally to all antenatal clinics in the country. In Tanzania, our results encouraged the government to agree to introduce one of POC test as a demonstration project, which we will evaluate. The Brazilian government has also decided to use them for screening hard-to-access populations in the Amazonas Region, following several evaluations which we conducted in the region.

Is health legislation in China being implemented effectively?

Tue, 20 Nov 2007 00:00:00 GMT

Completed To examine the extent to which health legislation is an effective means of ensuring access to basic health care, particularly for the poor, and vulnerable groups using the implementation of the Maternal and Infant Health Care Law in rural China as a case study.

Scaling up health services in low and middle income countries: constraints and opportunities

Tue, 20 Nov 2007 00:00:00 GMT

Completed The Commission on Macroeconomics and Health (CMH) was established in January 2000 by the WHO Director-General to place health at the top of the development agenda. Its objectives were to analyse the impact of health on development, to produce studies of health-related interventions and their impact on economic growth and equity in developing countries, and to recommend a set of measures to minimise poverty and maximise economic development. The CMH report was launched at the end of 2001.

The analytical work of the CMH was structured around working groups on key topics. Working Group 5, Improving Health Outcomes for the Poor, had the task of elaborating options and costs for mounting a major global effort to improve dramatically the health of the poor over the next 5 and 15 years. Given widespread concerns about the poor performance of the health sector in many low and middle income countries, and awareness amongst donors of failings of the international aid effort in health, providing helpful analysis of difficulties in scaling up health services was a particularly important task. Four areas of analytical work have been undertaken for WG5.

1. Conceptual thinking on the nature of factors (termed constraints) which hampered the achievement of high levels of coverage of priority health services such as immunisation, treatment of childhood diseases, maternal health services, and interventions for HIV, TB and malaria, and how they might affect the feasibility and returns from rapid scaling up of health services

2. Identification of indicators of constraints at country level and empirical analysis of a cross-country data set including these indicators
A systematic literature review of evidence on how constraints affecting the performance of health systems in low and middle income countries might be relaxed, including the role that vertical (categorical) programmes might play

3. Three country case-studies exploring constraints in practice and examining the experience of attempts to strengthen delivery of health services.

These studies have been published as a special issue in the Journal of International Development

Young Lives in India

Mon, 11 Sep 2006 01:00:00 GMT

A presentation at The International Conference on Child Cohort Studies in Oxford aims to shed light on child poverty in India