Dr Claudia Turner heads the clinical research program at the Cambodia Oxford Medical Research Unit (COMRU), in collaboration with the Angkor Hospital for Children. The three main themes of clinical research at COMRU are neonatal health care, childhood pneumonia and technology enhancement. Claudia’s work includes clinical teaching and infrastructure development.
Whereas children mortality has dramatically decreased over the past 15 years, almost half the remaining mortality still occurs during the first 4 weeks of age. Neonatology, or care of newborns, doesn't need to be difficult or expensive. Low cost intervertions involving communities, such as keeping babies warm, save lives.
Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.
Q: Can you tell us a little about your research?
Claudia Turner: I am based in Cambodia, with the Cambodia Oxford Medical Research Unit (COMRU): we have collaborations there with the Angkor Hospital for Children. Our research is very much clinically based, and my particular interest is in neonatal medicine.
A neonate is a baby up to about 4 weeks of age, and it is a particular time of life where worldwide, there is a lot of mortality. My research concentrates on looking at low cost interventions that can be put in either in the community setting or in a hospital setting that will reduce neonatal mortality.
Q: How do you work with communities yourself in your research?
CT: There are a couple of ways that we work with communities. The first is conducting research in a community. One project that I have just finished and I found particularly interesting was to go out into community and ask village leaders, mums and dads, grandparents about the barriers and the problems faced during pregnancy and childbirth and the first four weeks of life.
In the hospital, we see babies coming in who are in terrible condition. Before we can start decreasing the number of babies who die, we have to understand why this happens. Is it because there are practises that are happening in the community that are detrimental to the baby? Or are there other barriers faced? That was a nice piece of research because we could get in and understand from people's point of view, from people who are actually going through these things, what stops them from getting to the hospital in time.
Unfortunately, our conclusions from that study were that it was down to resources and money. For a family to be able to afford to take a child to hospital, they often have to sell a possession, a cow for example, and that of course delays it. Working with the community in that way we can understand what is going on and what those barriers are, and then we can start tailoring interventions and research to overcoming those.
Q: What are some of the challenges you face doing research in a place like Cambodia?
CT: There often are some challenges, but I think the main challenge that we have is the same anywhere in the developing world: people misconceive neonatal care, and think that looking after babies up to four weeks of age is difficult and expensive.
Actually, we are showing simple low cost interventions such as keeping a baby warm (have an effect). You wouldn’t think that in the tropics that was going to be a big problem, but in a recent study, we were looked at babies who are coming into the hospital, and (found that they) had a much increased risk of dying if they came to us cold. If we can do an intervention that means we keep a baby warm before they get transferred to hospital, then we are going to save lives. That is one challenge.
Resources, logistics can also be difficult working in the tropics. You have to have a good sense of humour; you have to allow things to go wrong and to work out moving forward how you can work through that.
Q: What are the most important lines of research that have emerged in the last 5-10 years?
CT: Globally, one the most important things that have happened is the realisation that looking after babies of up to four weeks of age is not the same as looking after all children under five years of age.
For example, there has been an absolutely amazing decrease in the number of children who are dying globally. From 1990 to 2015, there has been a 58% reduction in the number of children under five who are dying. Unfortunately, that has not been mirrored in that first four weeks of life where still nearly half of all mortality in the under fives occurs. Within the research field, people realise that 'one size fits all' doesn’t work and we need to concentrate on the neonatal period. That is reflected in a lot more research being done in the communities, because this is often where the babies die. The communities are really where you need to focus the work. There is some beautiful work from Bangladesh and other parts of the world involving communities, involving mothers in the care of their new-borns.
Q: Why does your line of research matter and why should we fund it?
CT: It is a real world situation where we have all these babies dying, and there are things we can do to stop babies dying. It is not always that you can transfer one solution from one area to another area but you can make a blueprint. It means that different interventions can be tailored to different communities and you can actually decrease the number of babies who die.
Q: How does your research fit into translational medicine within the department?CT: One of the most important things about the research involving the communities is that it is a problem faced by these communities. They realise that there is an issue there, and we are giving them solutions to be able to tackle that.