Search results (131)
« Back to Research HighlightsDefining the noma research agenda
Posted 30/04/2025. The results from a September 2024 symposium on Defining the Noma Research Agenda at the Swiss Tropical and Public Health Institute has identified research needs and the way forward. The symposium included noma survivors as well as clinical and epidemiological researchers, and follows the WHO’s official recognition of noma as a neglected tropical disease. By Philippe Guerin.
Creating different global health futures: mapping the health research ecosystem and taking decolonial action
Posted 29/04/2025. Decolonisation in global health emphasises the need to challenge and change entrenched power asymmetries and unfair health research practices. Nadia Tagoe, Sassy Molyneux, Caesar Atuire and colleagues have proposed practical decolonial action using a four-step framework and a reflexive tool that can help transform key domains of the global health knowledge ecosystem.
Longitudinal tracking of healthcare professionals: a methodological scoping review
Posted 09/04/2025. How do health workers move through their careers - and how do we know? A new scoping review led by Yingxi Zhao and colleagues examined 263 studies tracking healthcare professionals over time, exploring how career choices, working conditions and wellbeing are measured. The review highlights the need for stronger, standardised tracking methods to inform workforce planning and better support health worker wellbeing across contexts.
Situational analysis of antibiotic prescriptions in Kenyan neonatal units for antimicrobial stewardship: a retrospective longitudinal study
Posted 08/04/2025. High antibiotic use in Kenyan neonatal units may contribute to antimicrobial resistance. A study of 88,000 neonatal admissions in 22 hospitals found 62.6% received antibiotics at admission, mostly first-line drugs. However, non-first-line use was higher in outborn neonates. Monitoring antibiotic patterns at scale feasible and crucial for assessing antimicrobial stewardship and reducing resistance. With Jalemba Aluvaala and Mike English
Effects of health system limitations on the use of blood culture and sensitivity testing in Kenyan county hospitals: an interview-based qualitative study using causal loop diagrams
Posted 02/04/2025. Antibiotic resistance is rising in Africa, but blood culture and sensitivity (BCS) testing faces challenges in Kenyan hospitals. A study using a complex systems approach across eight hospitals found that interconnected issues in both demand and supply, including cost, turnaround time, and logistical barriers undermine the use and sustainability of BCS testing at scale; targeted antimicrobial stewardship may offer a viable alternative. By Jacob McKnight & Mike English with KWTRP colleagues.
Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security
Posted 01/04/2025. Medical oxygen is a critical treatment in severe illness, yet global access remains inequitable, especially in low-income countries. The COVID-19 pandemic highlighted these disparities. The Lancet Global Health Commission emphasizes systemic improvements, investments in infrastructure, workforce training, and affordability. Addressing these gaps can save millions of lives and strengthen global health resilience. With Jacquie Oliwa and Mike English as members of this Lancet Commission.
Treatment and treatment outcomes of snakebite envenoming in Uganda: a retrospective analysis
Posted 20/03/2025. Snakebite envenoming is a neglected tropical disease that causes significant morbidity and mortality in rural sub-Saharan Africa. While victims seek emergency care, documentation on their treatment remains limited. Stella Nanyonga and colleagues reviewed snakebite management in Uganda among 532 snakebite victims and found that only 6.9% of patients received snake antivenom.
Can solidarity in global health curb the next outbreak? A commentary on mpox
Posted 18/03/2025. Appeals to solidarity are common during disease outbreaks. Yet, what solidarity means and how it is practiced varies across contexts. Caesar Atuire and colleagues bring conceptual clarity by distinguishing between deep and responsive solidarity. They argue that global health needs deep solidarity to curb outbreaks like mpox and to ensure that responsive solidaristic appeals are effective.
Submicroscopic malaria in pregnancy and associated adverse pregnancy events: A case-cohort study of 4,352 women on the Thailand–Myanmar border
Posted 11/03/2025. Malaria is known to be dangerous for pregnant women and their developing babies. But how much malaria is too much malaria? Using an ultra-sensitive PCR method that detects one parasite per drop of blood, Mary Ellen Gilder and SMRU colleagues found that even infections with very few parasites are associated with adverse pregnancy outcomes.
Antibiotic duration for common bacterial infections - a systematic review
Posted 07/03/2025. Reducing antibiotic duration is key to antimicrobial stewardship. A review of 315 trials found strong evidence for shorter courses in common infections but limited data for severe infections and low-income settings. Only 15% had low bias risk. More research is needed in critical care and resource-limited environments. By Mo Yin
Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial
Posted 04/03/2025. Previously, the REGARD-VAP trial found that giving patients with ventilator-associated pneumonia (VAP) a personalised, shorter antibiotic treatment was just as effective as usual care. Mo Yin and colleagues showed this approach is also cost-effective in Nepal, Singapore, and Thailand. This approach could save money, reduce antibiotic use, and help policymakers make better healthcare decisions despite some uncertainties.
Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study
Posted 04/02/2025. In Kenya and Uganda, hospital care for under-fives is intended to be free. James Berkley and colleagues studied families’ healthcare, travel, other costs, and loss of earnings due to child admissions at six hospitals. 74% to 92% of households experienced ‘catastrophic’ expenditure (depending on the definition used) in relation to monthly income.
After neonatal care, what next? A qualitative study of mothers’ post-discharge experiences after premature birth in Kenya
Posted 28/01/2025. Each year, 15 million babies are born prematurely, with Sub-Saharan Africa and Asia accounting for over half. Weak healthcare systems and poverty in SSA worsen outcomes for mothers and babies. This study by Justinah Maluni and Dorothy Oluoch explores the challenges mothers face post-discharge and suggests strategies to improve care and reduce mortality and readmission rates.
Population genomics and transcriptomics of Plasmodium falciparum in Cambodia and Vietnam uncover key components of the artemisinin resistance genetic background
Posted 17/12/2024. Tom Peto and colleagues collected Plasmodium falciparum parasites from malaria patients in Cambodia and Vietnam between 2018 and 2020 in the MORU-led TACT-CV study. Novel molecular analyses of these samples at Nanyang Technological University identified new genetic factors that appear under selective pressure and may contribute to artemisinin resistance mechanisms in clinical settings.
Public service motivation, public sector preference and employment of Kenyan medical doctor interns: a cross-sectional and prospective study
Posted 11/09/2024. Daniel Mbuthia and colleagues surveyed 356 Kenyan medical doctors, to understand what influences their career choices at labour market entry, specifically understanding the role of public service motivation. They highlighted that nearly all surveyed doctors are public service oriented, many doctors stated intention to work in the public sector but were unable due to lack of job opportunities. Unfortunately, 13% of the doctors were unemployed one year after completing their internship.
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems: Findings from an empirical study of medical and nurse interns in Kenya
Posted 03/09/2024. Yingxi Zhao, Stephanie Nzekwu and colleagues examined new Kenyan doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. The research highlighted three dimensions of liminal experiences in professional practice, relational inter- and intra-professional identity and status, and professional careers.
Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review
Posted 10/07/2024. Physician associate and nurse practitioner roles have been developed largely to meet changing healthcare demand and increasing workforce shortages. Yingxi Zhao and colleagues summarise the factors influencing their development and integration in hospital teams, advocating for organisation context-specific workforce solutions, long-term investment, substantial resources, and transparent processes to meet evolving healthcare challenges.
Obesity differs from diabetes mellitus in antibody and T-cell responses post-COVID-19 recovery
Posted 04/07/2024. Some known risk factors for severe COVID-19 outcomes disproportionately affect South Asian populations. In Bangladesh, Mohammad Ali and colleagues showed that overweight/obesity is linked to lower neutralising antibody levels and higher T-cell responses post-COVID-19 recovery, while type 2 diabetes does not alter antibody or T-cell responses. This research highlights the importance of targeted vaccination and treatment strategies.
Rectal artesunate: lives not saved
Posted 03/06/2024. Childhood deaths from severe malaria can be prevented by giving rectal artesunate suppositories (RAS) but in January 2022, based on preliminary interpretation of a flawed observational study, WHO issued a moratorium on RAS. This has now been partially lifted, but use of RAS has markedly declined and thousands of malaria deaths have not been prevented. By Nick White.
New Tools and Nuanced Interventions to Accelerate Achievement of 2030 Roadmap for Neglected Tropical Diseases
Posted 15/05/2024. Collection of articles in the Clinical Infectious Disease Journal supplement. NTDs are a major cause of death, disability, and economic hardship, particularly in low- and middle-income countries. The research by Professor Déirdre Hollingsworth et al aims to better understand which interventions are needed to achieve the 2030 NTD targets, determine the best strategies for keeping NTDs under control after target achievement, and assess the costs associated with different options.
Decolonising global health: why the new Pandemic Agreement should have included the principle of subsidiarity
Posted 14/05/2024. The WHO Pandemic Agreement aims to promote a better global response to pandemics. Caesar Atuire and colleagues argue that not including the principle of subsidiarity as a pragmatic strategy was a missed opportunity to decolonise global health governance and promote global solidarity. Subsidiarity empowers local units to make decisions and address issues at their level, fostering collaboration, coordination, and cooperation. We discuss the elements of subsidiarity—agency and non-abandonment—and highlight the need to strike a balance between them.
Climate change, malaria and neglected tropical diseases: a scoping review
Posted 10/05/2024. The NTD Modelling Consortium contributed to the World Health Organization scoping review led by Petra Klepac et al. It highlights the urgent need for collaborative modelling and greater evidence to understand the effects of climate change impacts on neglected tropical diseases and malaria.
Accelerating Progress Towards the 2030 Neglected Tropical Diseases Targets: How Can Quantitative Modeling Support Programmatic Decisions?
Posted 08/05/2024. The NTD Modelling consortium and WHO hosted a stakeholder meeting to identify priority modelling questions that are relevant for decision-makers, especially those designing, implementing and evaluating national and subnational programs, to achieve the ambitious targets set out in the NTD 2021–2030 road map. Future modelling studies should continue to move towards models which support better programmatic action by incorporating local context. By Andreia Vasconcelos.
Comparison of lumefantrine, mefloquine, and piperaquine concentrations between capillary plasma and venous plasma samples in pregnant women with uncomplicated falciparum and vivax malaria
Posted 01/05/2024. Makoto Saito and SMRU colleagues compared capillary and venous plasma concentrations of mefloquine, lumefantrine, and piperaquine in pregnant women with malaria. While there was a strong correlation, direct interchangeability was limited. Predictability within a ±10% precision range varied by drug. Caution is needed when converting capillary samples at the individual level.
Strategies for Deploying Pediatric Death Audit to Improve Quality of Care
Posted 26/04/2024. Pediatric death audits can be used to improve health care quality and outcomes for children. In this report, MOMENTUM Country and Global Leadership examined the use of death audits in Kenya, Nigeria, Sierra Leone, South Africa, and Zambia. These experiences suggested both challenges in the use of death audits for improving pediatric quality care as well as options to begin developing effective systems that incorporate audits, even in low-resource settings. Three HSC researchers are members of the Momentum team.
Effectiveness of a multi-country implementation-focused network on quality of care: Delivery of interventions and processes for improved maternal, newborn and child health outcomes
Posted 12/03/2024. The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) works with healthcare professionals to improve quality of care at global, national and local levels. In this evaluation Mike English and colleagues explore QCN’s effectiveness in Bangladesh, Ethiopia, Malawi and Uganda and provide useful knowledge for future multi-country global health networks.
Breaking the silence on first referral hospitals and universal health coverage
Posted 01/03/2024. First referral hospitals (FRHs) are neglected in the current discourse on universal health coverage (UHC) in low-income and middle-income countries. Mike English and colleagues propose a comprehensive approach that increases the focus on FRHs in the UHC discourse and shows that they are integral to enhancing primary health care (PHC) in low-income and middle-income countries.
First referral hospitals in low- and middle-income countries: the need for a renewed focus
Posted 28/02/2024. First referral hospitals (FRHs) fulfil important functions in health systems in low- and middle-income countries. Through three reviews Rosanna Mazhar and colleagues found confusion around the definition and function of FRHs and called for renewed interest and investment in FRHs from the global health academic and policy-making community.
Individualised, short-course antibiotic treatment versus usual long-course treatment for ventilator-associated pneumonia (REGARD-VAP): a multicentre, individually randomised, open-label, non-inferiority trial
Posted 26/01/2024. Ventilator-associated pneumonia is common amongst critically-ill patients. Mo Yin and colleagues investigated a personalized approach to shorten antibiotic duration, and found it as effective as a longer treatment in terms of death or pneumonia recurrence; it also reduced antibiotic side effects significantly. This study provides crucial evidence to guide antibiotic prescription to reduce resistance emergence.
Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs
Posted 19/01/2024. Newborn mortality rates post-hospital discharge in low-and-middle-income countries are a growing concern, with most deaths occurring within 30 days of discharge. Gulraj Grewal and colleagues highlight the interventions used to support care continuity post-discharge, assumptions underpinning these interventions, opportunities and challenges, and whether participatory methods were used in intervention development.
Characterising support and care assistants in formal hospital settings: a scoping review
Posted 05/12/2023. The adoption of ‘Care Assistants’ in formal hospital settings as a HRH strategy is gaining more traction in the Global North than the Global South. Vincent Kagonya and colleagues highlight their effect on care as well as gaps in the labelling, role assignment, training, clinical governance, and regulation in the clinical environment.
The influence of internship training experience on Kenyan and Ugandan doctors’ career intentions and decisions: a qualitative study
Posted 28/11/23. Medical internship is a key period for doctors’ individual career planning and also a transition period for the broader labour market. Daniel Mbuthia and colleagues highlighted how experience during internship shaped medical doctors’ career intentions in Kenya and Uganda, and emphasized the importance of job availability and context in influencing doctors’ career choices.
Development and validation of a new measurement instrument to assess internship experience of medical doctors in low-income and middle-income countries
Posted 22/11/2023. Routine surveys are used to understand the training quality and experiences of junior doctors but there are lack of tools designed to evaluate the training experiences of interns in LMICs where working conditions and resource constraints are challenging. Yingxi Zhao and colleagues described their process developing and validating a “medical internship experience scale”.
A systematic review of neglected tropical diseases (NTDs) in Myanmar
Posted 21/11/2023. Neglected tropical diseases (NTDs) are a group of preventable and treatable diseases common in Myanmar, primarily affecting marginalized rural communities. Myo Swe and colleagues provide an overview of reported NTDs in Myanmar over 100 years, indicating gaps in knowledge about certain diseases to inform future research directions related to NTDs in Myanmar.
‘We were treated like we are nobody’: a mixed-methods study of medical doctors’ internship experiences in Kenya and Uganda
Posted 15/11/2023. Medical interns are an important workforce providing first-line healthcare services in hospitals. Yingxi Zhao and colleagues provided an overview of doctors’ internship experience in Kenya and Uganda, and highlighted challenges experienced by interns spanning from burnout, stress, challenging working environment, inadequate support and poor quality of supervision.
The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance
Posted 10/22/2023. Sean Cavany and colleagues publish a new perspective in Nature Communications that describes the possible mechanisms by which substandard and falsified antimicrobials could affect antimicrobial resistance and suggests ways to improve our understanding of this relationship. The article arose from the work of the FORESFA project, funded by a Wellcome Collaborative Award.
Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic
Posted 07/11/2023. As COVID spread globally support for LMIC focused on skilled, technologically enabled ICU care. This ignored fundamental weaknesses in health systems and the need for basic, effective care to save lives in all clinical settings. Whole of system vigilance and response requires reorientation of priorities and effective change management, by Mike English.
A rapid review of community engagement and informed consent processes for adaptive platform trials and alternative design trials for public health emergencies
Posted 30/08/2023. Alternative Design Trials (ADTs) and Adaptive Platform Trials (APTs) have enabled efficient large-scale testing of biomedical interventions during recent Public Health Emergencies (PHEs). Alun Davies and colleagues aimed to rapidly review evidence on engagement and informed consent for ADTs and APTs during PHE to consider what (if any) recommendations can inform practice.
Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study
Posted 30/08/2023. This study by Makoto Saito and colleagues analysing 213 severe malaria cases in pregnancy at SMRU, MORU and OUCRU showed vital organ dysfunction led to high maternal and fetal mortality. In contrast, severe anaemia or hyperparasitaemia alone did not. This marked difference may explain the variation of mortality reported in the literature. Early diagnosis and treatment of malaria and anaemia in antenatal care should be promoted.
Quality of inpatient paediatric and newborn care in district hospitals: WHO indicators, measurement, and improvement
Posted 25/08/2023. Mike English and colleagues outline in their Lancet Global Health Viewpoint the challenges of measuring quality of care and the challenging pathways from measurement to actual improvement in health service delivery. They argue in particular that collecting data for measuring quality is too often the main focus with little attention is paid to the complex work required to actually change health care practices.
Not just surveys and indicators: narratives capture what really matters for health system strengthening
Posted 25/08/2023. Dorothy Oluoch, Lisa Hinton and colleagues in a new Viewpoint explore the rich potential for patient narratives to complement typical epidemiological and health service evidence on the status of health systems in low-income countries. They explain that we have much to learn about the improvements needed to systems and where to intervene from patients’ stories about their experiences of health care, and that doing this is key to developing person-centred care.
Examining the absorption of post-internship medical officers into the public sector at county-level in devolved Kenya: a qualitative case study
Posted 23/08/2023. Kenyan medical schools are now estimated to be training and graduating increasing numbers of doctors, however recent data suggested that only less than half of these trainees are being absorbed by the public sector. Yingxi Zhao and colleagues conducted a qualitative case study to understand how post-internship medical trainees are absorbed into the Kenyan public sector.
Medical device regulation and oversight in African countries: a scoping review of literature and development of a conceptual framework
Posted 22/08/2023. Medical devices are a fundamental component of health systems, but how are these governed to ensure benefits are achieved and harms are minimised? Naima Nasir and collesgues explore governance arrangements for medical devices in African countries and proposes a conceptual framework for the exploration of governance realities across the health system.
Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya
Posted 26/07/2023. Critical illnesses cause several million deaths annually, many occurring in low-resource settings. Despite great efforts and investments, lower income countries faced constraints in upscaling critical care during the COVID-19 pandemic. Rosanna Mazhar, Jacquie Oliwa and colleagues explore how Kenya’s efforts to do so were operationalised, offering insights into some of the challenges faced.
COVID-19 and unintended steps towards further equity in global health research
Posted 21/06/2023. In this paper, Tamara Willows and colleagues share how COVID-19 helped reflect on our global health research practice during the POETIC study. We add to ongoing discussions about decolonisation of global health by sharing the steps we took to put into action our commitment to equity within global health.
Experiences, coping strategies and perspectives of people in Malaysia during the COVID-19 pandemic
Posted 20/06/2023. The SEBCOV study reveals captivating insights into the Malaysian experience during the COVID-19 pandemic. With a nationwide Movement Control Order and a race to administer vaccines, Malaysians faced unprecedented challenges. Phaik Kin Cheah, Phaik Yeong Cheah and colleagues highlight the coping strategies, economic impacts, lifestyle changes, and evolving perceptions of the COVID-19 vaccine.
Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review
Posted 15/03/2023. In this systematic review, Abdulazeez Imam and colleagues summarise the evidence on missed nursing care in low-income and middle-income countries (LMIC). Missed nursing care undermines nursing standards of care, and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept remains understudied in LMIC settings which have 90% of the global nursing workforce shortages.
Respecting relational agency in the context of vulnerability: What can research ethics learn from the social sciences?
Posted 08/03/2023. Research ethics struggles in practice to adequately account for and respond to the agency and autonomy of people considered vulnerable in the research context. Jennifer Roest and colleagues discuss some of the core concepts and critiques emerging from the literature on women and children's agency in under-resourced settings.
A framework for managing health research capacity strengthening consortia: addressing tensions and enhancing capacity outcomes
Posted 03/03/2023. Nadia Tagoe, Sassy Molyneux and colleagues conducted a case study involving three health research capacity strengthening (HRCS) consortia to critically examine their decision-making processes, strategies for resolving management tensions and potential implications for consortia outcomes. The researchers propose an evidence-informed management framework for consortia leaders to use to support decision-making to optimise research capacity gains.
After sharing how we do research, build teams, transfer know-how and build research careers and systems, what next?
Posted 17/01/2023. PLOS Global Public Health features a blog on The Global Health Network Conference 2022 that took place at the University of Cape Town, South Africa from 24 – 25 November 2022. The theme of the conference was Enabling Health Research in Every Healthcare Setting and 10 Years of addressing inequity in where research happens, who leads and who benefits. There were almost 900 abstract submissions and researchers, clinicians, practitioners, donors, and policymakers from across the world attended.