The Africa Oxford Initiative (AfOx) invites applications for the 2019 AfOx Visiting Fellowships Programme. Our programme is designed to enhance academic mobility and network building. We support African scholars and researchers working over various areas to spend periods of flexible time in Oxford.
Posted 21/09/2021. The WHO's ‘5 moments’ is the dominant paradigm for hand hygiene globally. While ‘5 moments' has many benefits and has had a significant clinical impact, it also has many weaknesses. Jacob McKnight and colleagues explore how this important paradigm can be improved to reflect the latest research in hand hygiene.
Posted 27/08/2021. Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for paediatric complex and chronic conditions, however such expansion is threatened by workforce shortages. Yingxi Zhao and colleagues reviewed how task sharing could support expanded paediatrics services provision in LMICs, especially beyond acute infectious diseases and malnutrition that are widely and historically shifted.
Posted 06/08/2021. Preprints are increasingly being used to share non-peer-reviewed manuscripts to enable the rapid dissemination of research. In particular, they have become an important source of information for wider audiences keen to follow COVID-19 research developments, including news, social media and policymakers. This practice raises several challenges in publication ethics and integrity. Paul Newton and colleagues set out the need for good practice.
Posted 03/08/2021. Ribavirin is the only available Lassa fever treatment. The rationale for using ribavirin is based on one clinical study conducted in the early 1980s. However, reanalysis by Alex Salam and colleagues of previous unpublished data reveals that ribavirin may actually be harmful in some Lassa fever patients. An urgent reevaluation of ribavirin is therefore needed.
Posted 23/07/2021. Effective management and leadership are essential for everyday health system resilience, but health managers are often under-prepared and under-supported in these roles. Particular challenges have been observed in communication skills, emotional competence and supportive oversight. Jacinta Nzinga and colleagues share their learning from implementing a package of leadership development interventions in Kenya
Posted 20/07/2021. The ethical dilemmas faced by frontline staff conducting health research among ‘vulnerable’ populations are increasingly recognized. However, there is little documented on how staff might be supported in identifying and handling these dilemmas. Sassy Molyneux and colleagues share an approach and tools they developed in Kenya, centred on group reflections linked to a set of policy responses tailored to the context. They encourage further adaptation and evaluation of the approach
Posted 02/07/2021. Chemoprophylaxis against emerging and pandemic infections offer potential for prevention. Lakshmi Manoharan and colleagues evaluated significant design features of COVID-19 chemoprophylaxis trial registrations. The findings illustrate that the majority of trials were underpowered to detect clinically meaningful protection at epidemiologically informed attack rates. Future trials should be large enough to generate strong evidence and allow structured entry and exit of candidate agents. International trial coordination mechanisms and collaboration is required.
Posted 25/06/2021. In the ISARIC multicentre, cohort of 48 902 patients, admitted to UK hospital with COVID-19 during the first pandemic wave (6 Feb-8 June 2020), bacterial infections were uncommon. 85% of patients were prescribed antibiotics, with substantial regional variations highlighting that antimicrobial stewardship should be prioritised and integrated into Covid19 care pathways, by Louise Sigfrid and colleagues.
Posted 18/06/2021. Grace Irimu and colleagues show that newborns account for 46% of admissions and 66% of deaths among children 0-13years in Kenyan hospitals. Most deaths are caused by preventable and treatable causes. The authors call for need to prioritize newborn care for Kenya to achieve the SDGs target.
Posted 09/06/2021. Chris Paton and colleagues describe how predictive human-computer interaction (HCI) modelling could be used to improve the safety and usability of digital health systems. We reviewed the history of predictive modelling in HCI and describe how modelling could be integrated with the human-centred design techniques used when developing digital health interventions.
Posted 28/04/2021. While Health and Demographic Surveillance Systems (HDSS) involving verbal autopsy provide essential data on deaths, births and other health-related events in LMICs where alternative sources are limited, Vicki Marsh and colleagues argue that current regulatory frameworks do not sufficiently recognise their nature as a form of non-traditional epidemiological research. Ethical challenges include risks of uncompensated burdens that alternative regulatory approaches may more successfully identify.
Posted 13/04/2021. Self-regulated learning (SRL) remains unexplored for healthcare workers in low-income countries. Tim Tuti, Chris Paton and Niall Winters detail how SRL strategies impact on healthcare providers’ learning gains when using digital learning platforms. We apply Latent Profile Analysis (LPA) to questionnaire responses. We provide insights into the learner factors to consider when implementing technology-mediated learning.
Posted 15/04/2021. Philippe Guérin co-authored a letter published in The Lancet drawing attention of the risk of pooling data from uncomplicated illness and more severe ill hospitalised patients in the development of COVID-19 treatment guidelines. Although SARS-CoV-2 is one virus, the COVID-19 disease has a complex and evolving physiopathology pathway and requires different therapeutic approaches depending of the stage of the disease. In low-resource settings, the prevention of hospital admission is the therapeutic priority.
Posted 31/03/2021. Patient safety is a key goal of WHO but identifying harms and developing strategies to deliver safe care has been given little attention. Mike English and colleague describe a ‘portfolio’ approach to safety improvement in four broad categories: prioritising critical processes, improving the organisation of care, control of risks and enhancing responses to hazardous situations that we believe is relevant to low resource settings. We focus attention on the possible roles of practitioner groups and professional associations as key to advancing patient safety through collaboration and skill development in this field
Posted 22/02/2021. Paper continues to be an important medium for recording inpatient care in low‐ and middle‐income countries. Naomi Muinga and colleagues synthesise evidence on how paper‐based nursing records have been developed within inpatient settings to support documentation of nursing care, and that a human‐centred design approach might better meet users' needs
Posted 16/02/2021. Dexamethasone has been shown to reduce mortality in COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Rima Shretta and colleagues estimate that approximately 12,000 lives could be saved in the UK and 650,000 globally between July-December 2020. Dexamethasone is a cost-effective option with an incremental cost of GBP 940 per life-year gained.
Posted 12/06/2020. Safety of drugs is important, particularly during pregnancy. Makoto Saito and colleagues have pooled the data of 4503 women who had malaria in pregnancy and found that the currently used artemisinin-based combination therapies are equally safe for fetus. This study also highlights that risk of small-for-gestational-age (SGA) is high after malaria in pregnancy even treated with highly efficacious drugs, suggesting that prevention is important for reducing SGA in malaria endemic areas.
Posted 14/04/2020. Enormous emergency efforts are underway to find optimal medical products, to prevent, diagnose, and treat COVID-19, that 7.8 billion people will depend on. With dire disruption of pharmaceutical production and supply and increasing falsified and substandard products, we need strategic planning now to ensure global access to quality-assured medical products and monitoring of supply chains
Posted 02/01/2018. Technological potentials have raised high hopes on healthcare access in LMICs like India. However, five years of research by Dr Marco Haenssgen paint a less optimistic picture and show adverse consequences of mobile phone diffusion, which creates more competition and new divisions and leaves the poorest strata of population worse off than before.
Posted 20/03/2020. 199 patients received standard care, of which 99 received lopinavir-ritonavir for 14 days. Lopinavir-ritonavir didn’t induce significant clinical improvement, and mortality was similar in both groups. However, patients treated with lopinavir-ritonavir spent less time in hospital and in intensive care. The trial enrolled severely ill patients and was not big enough to detect modest benefits. Much larger studies are warranted to confirm or exclude if lopinavir-ritonavir treatment can help.
A new, large-scale systematic review published in PLOS Neglected Tropical Diseases has identified clear, significant research gaps in the diagnosis and treatment of Chagas disease. The paper also highlights significant differences in study design, diagnostic methods, duration of follow-up, and the timing of outcome assessment used by investigators even in the last decade.
Despite the limitations and paucity of data, the most comprehensive review of visceral leishmaniasis to date in pregnant women and vertical transmission of leishmaniasis has confirmed that liposomal amphotericin B is the safest treatment option and it is critical to ensure access to this.
The RECOVERY Trial has won the Project Management Institute’s Special Covid-19 UK Response Project Award. The award specifically recognised RECOVERY’s work to investigate whether the cheap steroid dexamethasone was an effective treatment for patients hospitalised with severe COVID-19.
COVID-19 has exposed our vulnerability to pandemic infections and shown what works, and what does not. It has tested the effectiveness of the Oxford-based global, open-source, collaborative approach set up 10 years ago to prevent illness and deaths from infectious disease outbreaks: ISARIC, the International Severe Acute Respiratory and Emerging Infection Consortium.
The RECOVERY trial has been jointly awarded Health Data Research UK’s 2021 Impact of the Year Award. This award is open to projects which had effectively used health data to improve people’s lives, including through clinical practice, policy, software, algorithms, or publications. The award was presented by James O’Shaughnessy at HDR UK’s online Annual Scientific Conference: Data Insights in a Pandemic.
A new study led by the University of Oxford has found that previous infection, whether symptomatic or asymptomatic, does not necessarily protect you long-term from COVID-19, particularly against new Variants of Concern.