Blog posts

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…)

From women’s health to women empowerment

By Guest blogger Natasha Chainani 

With it being International Womens Day this week, I thought it would be apt to recognise breakthrough innovations in women’s hygiene that have been doing the rounds of social media lately. Even more so, it would be apt to recognise that women’s health need not be pioneered by women alone by highlighting the efforts of a common man turned social entrepreneur and frugal innovator in rural India taking the feminine hygiene industry by storm.

Photo courtesy of Asian Development Bank, Flickr

In a country where sanitary products remain a luxury and accessible to those who can afford to buy pricier, international brands, women still resort to traditional methods – often unhygienic and at risk of disease[1]. Although the momentum to spread awareness around menstruation and feminine hygiene is picking up, stigma to talk about it by households and the larger society largely remains. Rightly so, these barriers continue to impact improvement efforts around women’s health in developing countries.

Arunachalam Muruganantham (Photo courtesy TED@Bangalore)

Enter Arunachalam Muruganantham. Hailing from a simple family in Coimbatore, India and educated till school1, he was brought to realise the dire state of feminine hygiene in rural, low resource and poor communities when he noticed his wife having to choose between purchasing family meals and monthly sanitary supplies[2].  A market research study by AC Nielsen evaluated that 88% of women in India resort to using unhygienic practices such as ash, dried leaves and newspapers when faced with a lack of sanitary supplies, putting 70% of these women at risk of reproductive tract infections and associated cancers[3]. Driven by what he saw, Arunachalam Muruganantham set out on an uphill task to develop low-cost sanitary towels from available resources. After years of development and product-testing trials, he now holds the patent rights for a machine that not only manufactures low-cost, hygienic sanitary towels but its user-friendly technology has created jobs for women in an industry setting he built. The manual machine costs about £723, employs 10 women, produces 200-250 cotton pads and can supply 3000 women at a cost of £0.025 for each towel1. Small-scale businesses and not-for-profit organisations currently buy these machines to directly manufacture and sell these sanitary towels across 27 states in India3. (more…)

Cholangiocarcinoma: What is it and why is it so prevalent In Thailand?

By Imperial medical students Thomas Hughes and Thomas O’Connor 

Today, 17th February 2016, marks the first ever World Cholangiocarcinoma Day.

Cholangiocarcinoma (CCA) is a primary liver cancer, usually formed from glandular structures in the epithelial tissue (adenocarcinomatous). It occurs in the bile ducts and is classed as being either intra-hepatic (IHCC) or extra-hepatic (EHCC) depending on whether the tumour forms inside or outside of the liver.

CCA is the second most common form of primary hepatic malignancies in the world, with survival beyond a year of diagnosis being <5%.[1] It represents 30% of primary hepatic malignancies with a mean survival rate of 3-6 months after diagnosis, due mostly to the late presentation of symptoms which massively reduces treatment success rates.[2],[3] In the western world the causes of CCA are not well known with 80% of cases being random with no specific risk factor. Despite this, several associations have led to risk factors being identified. The majority of risk factors are associated with chronic biliary inflammation, the most common of which is primary sclerosing cholangitis. The human pathogen Cryptosporidiosis has been associated with CCA and typhoid carriers have been found to have a six-fold increase in CCA. Aside from this, hepatitis B and C have both been found in higher proportions in the CCA population.

CCA is much more prevalent in south-east Asia, particularly north-east Thailand, than elsewhere in the world, with 80-90 cases per 100,000 people.1 The reason for the high incidence is due to biliary infestation with liver flukes, most notably Opisthorchis Viverrini (OV). OV has been recognised as a type 1 carcinogen since 1994 due to its role in causing inflammation of the bile ducts which leads to fibrogenesis and increasing tumorigenesis.3Oxidative stress has been proven to play a key role in transforming a chronic OV infection into CCA via advanced periductal fibrosis.4 OV makes it’s way into the human body via the consumption of raw or undercooked fish, a delicacy in Thailand, particularly in the Isaan region. (more…)

Search for an immortal cure: The urgent need for global cancer care

By Centre for Health Policy Intern Natasha Chainani

A few days ago, the American Cancer Society reported an incidence of 4.3 million cancer cases in China in 2015 alone along with 2.8 million deaths due to cancer[1].

A few years ago, during my early teens, when I was just learning the ways of the world, I was told I had lost family members to cancer. Throat cancer and pancreatic cancer to be precise.

A few decades ago, the scientific and clinical world was just discovering what cancer was and its capabilities.

cancer day posterAnd today, 4th February 2016 is World Cancer Day. As you read this, good samaritans across the world are today engaging in raising awareness of this disease called cancer. Social media is abuzz with empowering hashtags and reports on cancer statistics and prevention breakthroughs are being disseminated. Research laboratories and the medical industry are feverishly working to continue understanding the evolving reach of cancer. President Obama, in last month’s State of the Union Address, has urgently called upon America to find a cure to cancer[2].

As a recent graduate in the life sciences and public health, I have been learning about cancer and its debilitation for the past five years. I remember studying the cancer mechanisms within our bodies in Immunology lectures, and then learning about the debilitating burden of cancer in the world during my Chronic Epidemiology lectures.

But it was only last month that the crippling nature of the disease and potential for pain and loss really hit home. (more…)

Introducing HarvardX’s Massive Open Online Course (MOOC): Practical Improvement Science in Healthcare: A Roadmap for Getting Results

Developed through a collaboration between HarvardX and the Institute for Healthcare Improvement, ‘Practical Improvement Science in Health Care: A roadmap for getting results’ is a free online course, which starts 20th January and lasts for 6 weeks.  It aims to provide learners with the valuable skills and simple, well-tested tools they need to translate promising innovations or evidence into practice.

Learners will dive into short, engaging lectures and have access to additional materials and resources. They also will have full access to the social network provided by the edX platform, which provides immediate peer-to-peer feedback and facilitates shared learning.

The course is designed so that learners will begin building and applying basic practical improvement skills right away, regardless of their role in health or health care, and regardless of previous improvement experience.

At the end of the course, participants with grades above a certain threshold are able to purchase a certificate of completion or proof of continuing education credits.

IGHI’s Director Professor the Lord Ara Darzi tells us more in the short video above.

To review the course website and sign up, visit their website https://www.edx.org/course/ph556x-practical-improvement-science-harvardx-ph556x

Part 4: The future of Universal Health Coverage and how we can achieve it globally

To mark Universal Health Coverage Day on 12th December, we interviewed former CEO of the NHS and Adjunct Professor at IGHI, Sir David Nicholson.

Universal health coverage (UHC) improves how health care is financed and delivered – so it is more accessible, more equitable and more effective.

In the final video of our series below, Sir David talks about how the key to obtaining and maintaining UHC across the world is to get the support required from leadership and politicians in order to make it happen.

He provides examples of countries that are already working towards UHC and addresses how IGHI are contributing towards the UHC system in order to make quality and safe healthcare a reality for all.  This includes our work for the World Innovation Summit for Health (WISH) forum on Universal Health Coverage, of which Sir David was chair.  The WISH report ‘Delivering Universal Health Coverage: A guide for policy makers’ focuses on how to create a robust, yet accessible framework laying out the key questions that senior policymakers should consider when attempting the implementation of UHC.

IGHI’s work on frugal innovation also allows us to work on low cost, high impact innovations which can be distributed globally and are affordable to all.

Get involved 

To get involved or find out more about Universal Health Coverage Day, visit their website.

Part 3: Universal Health Coverage in the UK

david youtubeIn the third of our video series with Sir David Nicholson, former CEO of the NHS and Adjunct Professor here at IGHI, Sir David talks about how the delivery of Universal Health Coverage (UHC) took route in the UK.

The current UHC model has been serving us well for over 60 years.  However, there is still room for improvement and there are challenges ahead which we must face in order to sustain UHC in the UK.

To mark Universal Health Coverage Day (12.12.15), Sir David Nicholson provides a few suggestions on how we can achieve and maintain a safer, robust and resilient model for UHC, which will allow us to sustain the current model of care for generations to come.

Part 2: The economic and political case for Universal Health Coverage

By Dr. Matthew Harris, Senior Policy Fellow in Public Health, Institute of Global Health Innovation

I never really stopped to think why there was a need for a Universal Health Coverage Day.  Who could argue against the need for healthcare?  Who could argue against the common sense policy of equal access to health care, for equal need – irrespective of ability to pay?  However, despite many advances around the world in providing universal health care for whole populations, there are still many places where people suffer catastrophic financial burden as a result of relatively simple healthcare needs.

There have been many successes, but there is still a long way to go. In the US, although the Affordable Care Act has led to many millions more people being insured for healthcare, there are many millions still that have no protection against illness and will have to pay out-of-pocket for their care.  In Brazil, although the Family Health Strategy now provides decent primary care services to over 120 million people, the poor distribution of primary care doctors in remote areas has led to the need for the Government to import them from Cuba.  In Burundi, until not too long ago, poor women undergoing life-saving cesarean sections were being imprisoned with their babies because they were unable to pay their bills.

In many ways, Universal Health Coverage is a ‘no-brainer’.  It protects people from the catastrophic financial burden associated with unexpected ill health, and it provides a safety net for the most vulnerable in our society.  Researchers using data from 153 countries concluded in The Lancet that ‘broader health coverage leads to better access to necessary care and improved population health, with the largest gains accruing to poorer people.’

But, as Sir David Nicholson, former Chief Executive of the NHS in England, explains in our video below, achieving UHC needs strong political will and a genuine desire to drive forward policies that create a harmonious society.  Some drivers include the economic benefits of UHC outlined in this 2015 WISH report. The reduction in deaths resulting from better health care coverage accounts for 11% of economic growth in low- and middle-income countries – 24% of growth if you use the country’s ‘full income’ as a measure.  UHC reduces inequalities and poverty, and allows families to save sensibly as the fear of financial burden is reduced.

And there are political benefits too. Reacting to the 2005 Human Rights Watch report, the President of Burundi immediately launched UHC policies such as free healthcare for pregnant women and children under 6 years of age, improved access to essential medicines, and increased pay to front-line healthcare workers. In 2010, President Nkurunziza was re-elected.

On this UHC Day (12th December 2015), lets be thankful that we have a universal health coverage system in the form of the NHS, but mindful too that we must protect its principles of free at-point-of-use healthcare, for all.

Part 1: The importance of Universal Health Coverage Day

Ensuring universal access to effective, quality and safe health care services, without the fear of financial hardship, is a basic human right.

uhc-day-badgeUniversal Health Coverage Day, commemorated each 12 December, is the anniversary of the first unanimous United Nations resolution calling for countries to provide affordable, quality health care to every person, everywhere.

The United Nations has adopted 17 sustainable development goals for eliminating poverty and building a more resilient planet. One of those goals includes providing universal health coverage.

Universal health coverage improves how health care is financed and delivered – so it is more accessible, more equitable and more effective.

In our new 4 part video series, Sir David Nicholson, former CEO of the NHS and Adjunct Professor here at IGHI, outlines the importance of Universal Health Coverage Day.

About Sir David

Sir David Nicholson was Chief Executive of the National Health Service (NHS) in England from September 2006 to March 2013. From October 2011 to March 2014 he was the first Chief Executive of NHS England, the body responsible for overseeing over £100bn NHS funding per annum to improve quality and secure the best possible outcomes for people.

Sir David retired from the NHS in March 2014 following a career spanning over 35 years. He held senior leadership positions in acute and mental health services, and at four regional health authorities, including London. He was awarded the CBE in 2004 and was knighted in 2010, both for his services to the NHS. In 2014 he was appointed as an Adjunct Professor at IGHI and also Chair of Universal Health Coverage Forum at the World Innovation Summit for Health (WISH).

World Toilet Day 2015: Making sanitation sustainable and safe

By Dr Michael Templeton, Reader in Public Health Engineering

toilet signToday, Thursday 19th November, is World Toilet Day. Sadly, it is estimated that 2.5 billion people around the world still lack access to an adequate toilet. Many others rely on only basic pit latrines which eventually fill up and can become unsanitary. Many countries failed to meet their Millennium Development Goal target for access to improved sanitation, and the recently stated Sustainable Development Goals continue to emphasise improving sanitation as a key objective towards global development.

Research at Imperial College London by the group of Dr Michael Templeton in the Environmental and Water Resource Engineering section of the Department of Civil and Environmental Engineering is investigating ways to make sanitation more sustainable and safer.

The ‘Tiger Toilet’ is an innovative, low-cost toilet design that uses tiger worms to compost human waste within latrines, thereby reducing the fill rate of the latrine. Envisioned through a collaboration with colleagues at Bear Valley Ventures and the London School of Hygiene and Tropical Medicine, the goal was to create a toilet that will last for much longer than currently available latrine and septic tank designs before needing emptying. Side benefits are that the tiger worms produce a safe and easy-to-handle compost material and treat the liquid portion of the waste. After lab- and pilot-scale testing at the Centre for Alternative Technology in Wales to determine the optimum toilet design parameters, Tiger Toilets have been trialled by Bear Valley Ventures and local partners for use in communities around the world, and have recently been launched commercially in Maharashtra province, India in partnership with PriMove. Research is ongoing to understand the factors affecting the performance of the Tiger Toilet on-site and to assess the quantity and quality of compost material produced. (more…)