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Global health

Global Health

GlobalHealth_685x200px_BannerIt is estimated by the World Health Organisation that approximately 800 women die every day due to complications in pregnancy or childbirth , 99% of which are in low-income countries (LIC). Between 1990 and 2015, following a commitment by the international community to reduce maternal mortality, the number of deaths worldwide dropped by about 44%. This led to countries uniting behind a new target to reduce the global maternal mortality ratio even further, to less than 70 per 100,000 live births between 2016 and 2030.

Global Maternal Health activity at King’s is a collaborative aiming to improve care in low and middle income countries, brought together under the Women’s Global Health Group, part of the KHP Women’s Health Academic Centre. The work of the group is diverse, from strengthening healthcare systems through in-country training initiatives to developing innovative technologies. The group holds over eight research grants specific to Global Health Research, with collaborations spanning 17 countries.

line_blueKey Projects and Collaborations

 

CRADLE

Tanzania, South Africa, Mozambique, Nigeria, Zimbabwe, Zambia, Uganda, Malawi, Ethiopia, Sierra Leone, Haiti, India & Pakistan

The CRADLE projects (Community blood pressure monitoring in Rural Africa: Detection of underlying pre-Eclampsia) is led by Professor Andrew Shennan. CRADLE 1 and 2, funded by the Bill and Melinda Gates Foundation, have seen the development and rigorous testing of a novel vital sign device specific for use in a low resource setting, the CRADLE VSA. CRADLE 3 Trial, funded by MRC/DBT/DFID is evaluating whether implementation of this device into routine maternity care in 10 low resource settings can reduce maternal mortality and morbidity. This trial will run until December 2017. The process evaluation, led by Professor Jane Sandall, will give important insight into the barriers to maternity care in this context. This successful collaboration between seven internationally esteemed universities and three pioneering charities (Maternity WorldwideWelbodi Partnership and Hope Health Action) is certain to be key in leading future work in this field. 

Professor Andrew Shennan

Professor Jane Sandall

Professor Lucy Chappell  

 

Collaborations with University of Sao Paulo

Brazil  

Over the last 15 years Professor Debra Bick’s has collaborated on several projects with the University of Sao Paulo. Together with Professor Jane Sandall, they have successfully secured funding from FAPESP to evaluate the Mother and Baby Friendly Hospital Initiative in Brazil. Professor Bick’s work on assessment and management of perineal trauma, PEARLS, has also led to a series of interdisciplinary training workshops in Rio de Janerio. Plans are underway to develop further work to identify outcomes important to women who have sustained perineal trauma. 

Professor Debra Bick

Professor Jane Sandall 

MRC Global Health Group 

Brazil

As a member of the MRC Global Health Group (representing the Population Sciences and Medicine Board), Professor Lucilla Poston plays a role in the MRC strategy for addressing research needs across the spectrum of global health. Together with Dr Dharmintra Pasupathy, they are undertaking research in maternal nutrition in Brazil and the impact on fetal wellbeing.

Professor Lucilla Poston

 

Dr Dharmintra Pasupathy

MRC Newton Fund Grant

Brazil

Dr Dharmintra Pasupathy and Professor Poston are undertaking research in maternal nutrition and health in Rio de Janeiro Brazil. This work is funded by the MRC Newton Fund MRC Newton Fund.

Professor Lucilla Poston

Dr Dharmintra Pasupathy

PREPARE trial

Brazil

As part of the Pregnancy Co-Laboratory Consortium, Professor Lucy Chappell also has successful collaborations in Brazil. PREPARE trial (Prematurity Reduction by Preeclampsia Care), funded by the Bill and Melinda Gates Foundation, aims to improve risk stratification and management of preeclampsia and therefore reduce the number of preterm births in Sau Paulo.

Professor Lucy Chappell

 

Professor Peter von Dadelszen

Professor Laura Magee

Mahatma Gandhi Institute for Medical Sciences / MAMTA Health Institute for Mother & Child

India

Dr Rachel Tribe is currently collaborating with colleagues in India (Mahatma Gandhi Institute for Medical Sciences in Sevagram and the MAMTA Health Institute for Mother and Child in New Delhi) to evaluate low-cost salivary progesterone testing for detecting the risk of preterm births in rural community settings of India. This work is funded by DBT-BMGF-BIRAC-USAID Grand Challenge India – All Children Thriving – India (July 2016 to May 2018).

Dr Rachel Tribe

Ndola Central Hospital

Zambia

Guys and St. Thomas’ Hospital also has a long standing partnership with Ndola Central Hospital in Zambia. Led by Mr. Eugene Oteng-Ntim, the partnership currently has a focus to scale up the care of mothers with HIV and hypertensive disease in pregnancy. 

Dr Eugene Oteng-Ntim 

Early Nutrition and Immune Development Trial

Gambia

The Early Nutrition and Immune Development (ENID) Trial is a randomised, partially-blind trial established in 2010 to assess whether nutritional supplements to pregnant women and their infants (from six to 24 months of age) in The Gambiacan enhance infant immune development. Within ENID, women were recruited in early pregnancy, and follow up on children is ongoing (currently approved for follow up to 6 years of age). The trial has thus created a birth cohort of unprecedented detail for this setting. In addition to the primary objectives, the available data and biobanked samples will allow a comprehensive analysis of numerous maternal and infant health-related issues. Future planned work will utilise this cohort to investigate the longer-term impact of the supplementation regimens on child health and development.

Trial protocol paper

Trial registration

MRC Unit The Gambia

Dr Sophie Moore  

HERO-G

Gambia

The primary objective of the Hormonal and Epigenetic Regulators of Growth (HERO-G) study, (PI Robin Bernstein, University of Colorado, Co-PI Sophie Moore) is to conduct a detailed examination of growth failure and its hormonal correlates during the first 1000 days of life (conception to two years of age). This will allow us to investigate nutritionally-responsive growth-modulatory hormone systems and their epigenetic mediators and to evaluate the extent to which this is translated into healthier growth. This study is in progress, with the antenatal phase completed in May 2016, and the infancy phase ongoing. The HERO-G study forms part of the Bill and Melinda Gates Foundation (BMFG) ‘Grand Challenges in Global Health’ awards to ‘investigate mechanisms of healthy growth’.

Dr Sophie Moore

Mr Andy Doel

The Mothers, Infants and Lactation Quality (MILQ) Project

Gambia, Bangladesh, Brazil & Denmark

Exclusive breastfeeding is recommended by the World Health Organization for the first six months of life, and it is important to support this recommendation by all possible means. This includes paying more attention to the nutrient content (“quality”) of breast milk and the nutritional status of the mother and infant during the first 6 months postpartum, especially in resource-poor settings. Despite this, we currently lack valid information on the nutrient content of human milk, and especially on micronutrient content, and there are no Reference Values (RV). The Mothers, Infants and Lactation Quality (MILQ) Project is a multi-center study, recently funded by the Bill and Melinda Gates Foundation, aimed at providing RVs based on the longitudinal follow up of lactating women and their infants in four countries. This study is being led by Professor Lindsay Allen, Director of the USDA ARS Western Human Nutrition Research Center (WHNRC). Dr Moore is Co-I and will lead on the Gambia site.

Dr Sophie Moore

Mr Andy Doel

The PRECISE Network

Gambia, Senegal, Kenya & Mozambique

The PRECISE Network is a new and broadly-based group of research scientists and health advocates mainly based in the UK and Africa, but also including the World Health Organization. With funding from the Research Councils of the UK, we are establishing this network through a shared project that will investigate three important complications of pregnancy, namely high blood pressure (hypertension), babies who are smaller than they should be before birth (fetal growth restriction) and babies who die before birth (stillbirth). We estimate that about 46,000 women and two-and-a-half million babies (both before and after birth) die due to these problems every year, and half of them die in Africa. In addition, about 50 million women and babies will have their short and long term health altered because of these complications. These numbers represent one of the great global inequalities of our time. In developed countries like the UK, we know that these three pregnancy complications are caused by problems with the afterbirth (placenta), and we know quite a lot about how they develop and complicate pregnancies. In contrast, in sub-Saharan Africa, we know very little about how and why these placental conditions occur. This is especially complex as women in Africa often have many other challenges: limited diets that change with the seasons, chronic infections such as HIV or malaria, acute infections like Ebola, limited power to make decisions for themselves, life in communities that are prone to either flooding or drought and are remote from health facilities. Therefore, the way that pregnancy complications arise are probably very different for these women in sub-Saharan Africa, compared with women living in the UK. Yet, these women and their babies bear most of the burden of death and illness related to pregnancy complications. PRECISE is designed to address this area of neglected global health research. 

Professor Peter von Dadelszen

Professor Laura Magee

Professor Lucilla Poston

Professor Andrew Shennan

Professor Jane Sandall 

Professor Guillermina Girardi

Dr Sophie Moore

Dr Rachel Tribe

BRIGHT

Gambia & UK

The recently established Brain Imaging for Global Health (BRIGHT) study (PI Prof Clare Elwell (UCL), Co-PI Sophie Moore) builds on the success of a completed BMGF Phase I Grand Challenges Exploration (GCE) Grant to investigate the feasibility of using an optical brain imaging technique, functional near infrared spectroscopy (fNIRS), to provide biomarkers of brain development in Gambian infants. The resulting pilot studies provided the first brain imaging of infants in Africa and proved the efficacy of fNIRS measures of brain function in Gambian infants over the first two years of life. The aim of the BRIGHT study is to combine fNIRS brain imaging with a range of other measures to deliver brain function-for-age curves in both Gambian (n=200) and UK (n=50) infants from birth to 24 months of age. These markers will be used to map the effects of pre- and post-natal insults on early brain development and provide an assessment tool for monitoring the efficacy of nutritional, and other early-life, interventions.

Global fNIRS 

MRC Unit The Gambia

BRIGHT twitter feed

Dr Sophie Moore

OpeN-Global: An Open Access Knowledge Hub of Nutritional Biomarkers for Global Health

Bringing together academic, technology and industry experts working in global health and nutrition research, the main objective of OpeN-Global is to create a freely available, online resource (a ‘knowledge hub’) to support the objective, accurate and detailed assessment of nutritional status in populations from low- and middle-income countries (LMICs). Through OpeN-Global we will also identify research innovation opportunities, where existing methodologies are not yet practical for implementation in low resource settings or for use in large, population based research in LMICs. The knowledge hub created will enable and support all nutrition and health related research activities in LMICs contributing towards evidence based knowledge of the nutritional status amongst populations in these settings.

This project is funding by the Medical Research Council (UK) under their 'Confidence in Global Nutrition and Health Research' call as part of a suite of activities under the Global Challenges Research Fund (GCRF).

Dr Sophie Moore

 

line_blueThe group 

Dr Sophie Moore
 sophie-moore-global-health
Professor Andrew Shennan

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Professor Jane Sandall
Professor Laura Magee
laura-magee-global-health
Professor Peter von Dadelszen
 peter-von-d-global-health
Professor Lucilla Poston
 Poston,Lucilla140x180
Professor Lucy Chappell

Dr Rachel Tribe

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Dr Eugene Oteng-Ntim

eugene oteng ntim

Professor Karen Edmond

karen-edmond-global-health

   

 

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Case studies

CRADLE

cradle_blueCommunity blood pressure monitoring in Rural Africa:
Detection of underlying pre-Eclampsia

 

PEARLS (Perineal Assessment and Repair Longitudinal Study)

 pearlPrematurity reduction by preeclampsia care                                                                         

PREPARE

A trial to evaluate implementation of placental growth factormeasurement and fullPIERS model application to women
with pre-eclampsia to enable appropriate risk stratification.

 
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Working with... 

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Florence Nightingale Faculty of Nursing & Midwifery
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