Author: Institute of Global Health Innovation

International Youth Day, plenty of reasons to celebrate

By Professor Beate Kampmann, Professor of Paediatrics and Director of IGHI’s Centre for International Child Health (CICH)

August 12 is International Youth Day.

This special day was created by the United Nations in 1999 to recognise efforts of the world’s youth in enhancing global society.

The theme of this year has been put forward by the UN as “The Road to 2030: Eradicating Poverty and Achieving Sustainable Production and Consumption”.  In my opinion this theme sets out an over-ambitious agenda, and many of our International Youth might feel overwhelmed by the responsibilities it implies.  It represents a far-reaching goal, not only for “Youth”, defined as 15-24 year olds, but for people of all ages.

Eradicating poverty? Since when have adolescents shouldered the burden of poverty eradication? What influence do they have on sustainable production and consumption, when too often they are victims of child labour themselves and their consumption is determined by powerful industries and the politics and expectations of the societies in which they happen to grow up?

  • The UN should not be asking or quietly demanding International Youth work towards eradication of poverty, sustainable production and consumption.
  • This remains the job and responsibility of members of society who own power, money and who wield political clout. It is they whose job it is to ensure that the future of the “International Youth” is less affected by these global issues.

However, there are many examples of important contributions of “International Youth” that ought to be acknowledged and celebrated on August 12.  In many resource-poor settings, adolescent girls and boys work tirelessly for their families to at least contribute to the amelioration, if not eradication, of the poverty in their individual households. Many are exploited in doing so, sacrificing their own educational opportunities. (more…)

The global burden of viral hepatitis

By Dr Graham Cooke, Clinical Senior Lecturer in Infectious Diseases, Imperial College London

A couple of weeks ago we published our paper on the burden of viral hepatitis. We’d hoped that the Lancet would publish it in time for World Health Assembly in May and it might get a bit of attention. That couldn’t be done, so it came out on the 6th July. The same day as Chilcot. Not a brilliant piece of planning, it has to be said, and a reminder of how much I have to learn about PR.

With colleagues at Imperial, we have been studying and writing about hepatitis for some years. But there’s always been a feeling that hepatitis has been relatively low profile in the global health community, and not just because of major enquiries into wars. So how did we end up writing a paper on the burden of hepatitis?

Most of the health impact of viral hepatitis is from two viruses, hepatitis B (HBV) and hepatitis C (HCV) – both cause liver scarring (cirrhosis) and liver cancer (hepatocellular carcinoma). The world has had a good HBV vaccine for a long time, and in the last few years we have seen great progress in new treatments for both viruses. Hepatitis B can be controlled, like HIV, with daily medication. But a revolution in treatment really kicked off in late 2011 when data was presented on the first a new class of curative treatments for hepatitis C, sofosbuvir (then known catchily as PSI-7977).  As soon as we saw that data it was clear that the step forward in treatment could transform treatment, not just in developed health systems, but potentially in all health systems. (more…)

COPD – son of a TB

By Andre F.S. Amaral, Research Associate, National Heart and Lung Institute

Chronic obstructive pulmonary disease (COPD) is characterised by chronic airflow obstruction and is the third most common cause of death worldwide, especially in low and middle income countries (LMICs). The main risk factor for this disease is tobacco smoking. However, smoking is still uncommon in many LMICs and more than 20% of people with COPD do not have a history of smoking.

What could then be causing COPD among people who do not smoke?
Some have advocated that the high number of deaths by COPD among non-smokers, especially in LMICs, could easily be explained by a high exposure to smoke from burning biomass for cooking, heating and lighting. However, large studies have ailed to find an association of airflow obstruction with use of biomass.

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Others have suggested that infectious diseases, which are still common in LMICs, could have a role in COPD. Pulmonary tuberculosis (TB) is the leading cause of mortality due to respiratory infection worldwide, but with its death rate decreasing since 1990 several millions of people are saved every year. Broadly speaking there is considerable overlap between regions with high incidence of TB and high mortality from COPD, therefore it makes sense to improve our understanding of the relationship between these two diseases.

(more…)

World Blood Donor Day 2016: Blood connects us all

By Professor Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases and Director of Centre of African Research and Engagement, Imperial College London. 

Each year, World Blood Donor Day highlights the importance of blood donations as the transfusion of blood is a life-saving intervention. In any health system, the provision of adequate supplies of safe blood for transfusion is an essential undertaking.

Slide1The World Health Organization (WHO) estimates the blood requirement for countries to be in the region of 10 – 20 units per 1000 population per year. Yet in many sub-Saharan African countries, donations are far lower, in some countries as low as 2 units/1000 population/year. The demand for blood transfusion is very high, especially in children (largely due to infection) where up to 15% of children admitted to hospitals are transfused, with most being given as emergency interventions.

Over the past decade, several countries in sub-Saharan Africa have made progress in achieving the goals defined by the WHO to improve both the supply and blood safety, which have been financed largely by international donors.  This has led to an increase in the number of total blood donations and the proportion from voluntary donors, and improved safety of blood; but this is expensive to maintain therefore concerns about the sustainability of systems requiring a high level of financial support in low-income countries when cost recovery is unlikely. (more…)

Tackling Stroke with University Innovation

By guest blogger and Imperial alumnus Margaux Lesaffre

Stroke is the silent killer; there are no clear symptoms until people realise they can’t talk, move or even swallow. Annually, over 5 million deaths worldwide are caused by strokes, ranking this disease in the first ten leading cause of deaths.  In developed countries, the incidence of stroke is dropping, but the outcome is still severe with some stroke victims left permanently disabled.

So what’s the way forward?

University researchers have developed remarkable innovations that could deliver significantly more reliable diagnostics and treatment. This blog looks at different ways university research can tackle this insidious disease.

Focus on Innovative Rehabilitation

When a blood vessel bursts in the brain, or when a blockage forms, parts of the brain may stop receiving oxygen. This can cause brain cells to die. In the regions affected by cell death, the ability to control primary body functions, including speech and muscle control, can be lost.

The aftermath of a stroke depends on which part of the brain is affected and the extent of damage. This is why a stroke is a time-critical emergency. Even if better prevention can ultimately reduce the incidence of strokes, it cannot be completely eliminated. With the consequences of this disease being so severe, a number of academic researchers are focusing their energy on stroke rehabilitation. (more…)

World No Tobacco Day 2016: Get ready for plain packaging

By Tahrima Choudhury, Centre for Health Policy Intern

On the 31st of May every year the World Health Organisation (WHO) and partners mark World No Tobacco Day (WNTD), drawing attention to the dangers and health risks associated with tobacco consumption, and advocating for better policies to reduce tobacco use. This year’s WNTD will focus on the standardised (also known as plain) packaging of tobacco products, in the hope that it gains traction worldwide (1).

Australian_cigarette_pack_with_health_warning_December_2012The standardised packaging of tobacco products refers to limiting or banning of brand images, company logos, colours and promotional information on packaging. This only permits the display of brand and product names on a dark olive green coloured box with a standard font in conjunction with a graphic health warning image (2).

The notion behind this campaign is that tobacco packaging is seen as a mobile billboard. It is the final communication vehicle tobacco companies have left with people, silently promoting the consumption of tobacco, and distracting individuals, particularly children, from health warnings. Stripping away the glossy veneer will expose tobacco products for what they really are: a box of toxic, addictive product that is responsible for the death of around six million people a year (2).

Worryingly in the UK, two-thirds of smokers currently start smoking before they reach 18 years of age (3), beginning an addiction which kills up to two in three long-term smokers from a smoking-related cause (4). Tobacco use in the UK is the single greatest cause of avoidable deaths and preventable illness, with 100,000 people dying from a smoking associated cause each year (4). (more…)

Towards Eliminating Schistosomiasis in Africa – A Multi-Disciplinary Effort

By Dr Michael Templeton, Reader in Public Health Engineering, Department of Civil and Environmental Engineering, Imperial College London

Wednesday, May 25th 2016 marks Africa Day, the 53rd anniversary of the founding of the Organisation of African Unity, the forerunner of the African Union. There have been so many wonderful developments in Africa in the last 53 years, but sadly the quality of life of many of the poorest people in Africa continues to be limited by the burden of a group of debilitating diseases known collectively as neglected tropical diseases (NTDs), which have afflicted millions of Africans since ancient times. Therefore, it is hugely exciting that in 2012 The World Health Assembly put forward an important resolution to not only control but completely eliminate one such NTD, schistosomiasis.

It has been estimated that 200 million people in developing countries, most of whom live in Africa, are infected with the parasite causing schistosomiasis, which manifests itself in a range of symptoms, including enlargement of the liver and spleen, anaemia, increased risk of bladder cancer, exacerbation of the transmission of HIV and its progression to AIDS, and in extreme cases seizures. The parasite lives within infected people, with aquatic snails acting as intermediate hosts and releasing cercariae (the larval form of the parasite) into water bodies, which then penetrate the skin of other people who come in contact with the contaminated water. Preventing people from coming into contact with contaminated water and preventing urine and faeces from passing into water bodies should stop this cycle, however most endemic countries lack adequate water and sanitation provision. Achieving the WHA’s ambitious elimination goal will therefore require a coordinated, multi-disciplinary strategy, involving mass preventive chemotherapy with the drug praziquantel but also improving access to water, sanitation and hygiene (WASH).   (more…)

On this Africa Day, we need to talk about nutrition

By Alice Marks, Agriculture for Impact, Imperial College London

Credit Ag4Impact - women farmers in mozambiqueAs we celebrate Africa Day 2016, it’s time to reflect on the state of nutrition in Africa and the weighty effect malnutrition has on the continent’s ability to prosper. Progress has been made over the past decades, for example through the Millennium Development Goals (MDGs), to reduce extreme hunger and starvation. However, it is the quality of food that people consume and a lack of variety that is of increasing concern. A few weeks ago, Roger Thurow, a Senior Fellow at the Chicago Council on Global Affairs, released a new book, The First 1,000 Days: A Crucial Time for Mothers and Children—And the World. The book lays out that nutrition, or lack thereof, in the first 1,000 days of life – from conception to the age of two – has a profound and lasting influence on a child’s ability to grow, learn, develop and work.

Stunting is a measurable impact of malnutrition, but the height of a child doesn’t tell the full story. The development of the child’s brain is also affected, so stunted children are more likely to fall behind in school, fail to achieve decent incomes, and perpetuate the cycle of poverty for the next generation. The cumulative effect of widespread malnutrition in a group of people can therefore directly impact, and limit, a society’s ability to develop and prosper. Thurow’s book highlights Uganda in particular, where half of women of childbearing age are anaemic and about 35% of children suffer stunting due to malnourishment. Indeed, a staggering 40% of all under-five deaths in Uganda are caused by malnutrition. Tragically, Uganda is not an isolated case in sub-Saharan Africa, where 40% of all children under the age of five are stunted. (more…)

World Malaria Day 2016: Africa, children and malaria

By Professor Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases and Director of IGHI’s new Centre for African Research and Engagement (ICCARE).

5050015921_99fda97f5c_oAcross large parts of sub-Saharan Africa the major rains have got underway; which typically means that in a few weeks, hospitals will witness a seasonal upsurge of admissions into the children’s wards. Most of these will be children suffering a new bout of malaria, with around ten percent of these malaria admissions having life-threatening complications such a coma (cerebral malaria), severe anaemia (requiring urgent life-saving transfusion) and rapid breathing (to try to compensate for the build up of acids in their bodies). Outcome remains poor. Despite implementation of the new fast-acting effective antimalarial drugs, in-patient mortality remains unacceptably high (~10%).

In many parts of the world, including several sub-Saharan African (sSA) countries, the scale-up of control efforts has led to substantial reductions in the burden of malaria since 2000.  The World Health Organization estimated that severe malaria killed up to 500,000 African children in 2013. Whilst the last decade has witnessed a transformation in the epidemiological landscape of malaria, with many areas reporting substantially less malaria. However, this has not occurred equally within or across countries in Africa. In parts of the continent, where the pattern of transmission has not changed appreciably, malaria continues to contribute most to the global disease burden (e.g. Nigeria, DRC, Uganda, Mozambique). Early optimism that the most promising malaria vaccine candidate developed to date (RTS,S) would reduce the burden of severe and fatal malaria has proved premature with the recent publication of long term follow up data reporting a waning vaccine efficacy after 20 months. There seems little prospect for further reducing the substantial mortality burden from severe malaria within the foreseeable future hospitalized with malaria serves as a “barometer” of how well local, national and regional malaria control is performing.   (more…)

TB or not TB?

By final year Imperial Medical PhD student Harriet Gliddon – winner of our Student Challenges Competition 2015/16 

TB is a major public health challenge in developing countries
TB is a major public health challenge in developing countries

World TB Day (24th March) commemorates the anniversary of Robert Koch’s 1882 discovery of the causative agent of tuberculosis (TB). Since then, it has been the subject of intense research, with hundreds of millions of dollars spent on TB research and development every year. Despite this, we still lack the antibiotics, vaccines and diagnostic tests needed to control the disease properly, and TB therefore remains a major public health challenge, particularly in developing settings like much of sub-Saharan Africa. As of last year, TB is the leading cause of death worldwide due to an infection. Added to that, the WHO estimates that 37% of cases go undiagnosed or unreported, largely because of our ineffective, costly and time-consuming tools for diagnosing the disease.

My work aims to address this by developing a test for TB that works in a completely different way to TB diagnostics currently in use. Instead of trying to detect the TB bacteria, I want to detect an individual’s response to TB infection. But just diagnosing TB isn’t enough – the test has to be fast, affordable and easy to use.

When someone is infected with TB, certain genes are switched on to fight the infection, and other genes are switched off. The combination of ‘on’ and ‘off’ genes makes up a unique gene signature for TB, which can be used to diagnose the disease. Our current tools to measure the levels of these genes currently require highly trained personnel, bulky and costly equipment, and stable power supplies; not techniques you could imagine using in resource-limited settings. (more…)