Catherine Wilson, University of Liverpool
Project: The epidemiology of E. coli and non-typhoidal Salmonella at a household level in Malawi.
The main goal of this study is to identify the transmission routes of bacteria between humans, animals and the environment of rural and urban households in Malawi.
To do this I plan to take stool samples from human and animal members of the same households in urban Blantyre and three villages in the Chikwawa District, Malawi.
At the same time samples will be taken from the household environment to ascertain whether there are specific household areas, e.g. the latrine or animal handling areas, where it is particularly likely areas that transmission of bacteria between animals, people and the environment takes place.
I am going to look specifically for the bacteria E. coli and non-typhoidal Salmonella. E. coli is present in the digestive tract of all animals and is usually harmless although some types can cause disease in animals and humans. There are many types of non-typhoidal Salmonella, which can also be carried in the digestive tract, some of which can cause disease in animals and humans.
By growing these bacteria in the laboratory and sending them to the UK for their DNA to be analysed, we will be able to tell exactly which types of bacteria are present and whether they are moving around the household members and their environment, as well as ideally which route they are taking.
By identifying these transmission routes, human and veterinary public health recommendations to minimise disease spread can be made.
ORCID 0000-0002-7150-3081
Derek Cocker, Liverpool School of Tropical Medicine
Project: Study of WASH behavioural practices and environmental contamination influencing Antimicrobial Resistance in Malawi (SWARM).
Escherichia coli (E. coli) is a bacteria which is able to acquire resistance to antibiotics. Drug-resistant bacteria can lead to life-threatening or untreatable infections, and it is estimated that by 2050 10 million people will be at risk from these infections annually.
The presence of these drug-resistant bacteria in the environment has long been recognised, but the precise role the environment plays in the transmission and stable acquisition of these bacteria is still unknown. It is likely that areas where there are poor water and sanitation (WASH) infrastructure, and behavioural practices which bring people in close contact to these environments will be key areas to understand.
For this reason, we have designed a study which is located in an urban area of a low-income country (Blantyre, Malawi), where there is a lack of adequate sanitation infrastructure.
We hope to explore the following:
- To what extent are drug-resistant E. coli present in the household environments of people living in urban Malawi.
- To what extent are drug-resistant E. coli present in the wider environments that surround these households (rivers, farms, markets, wastewater treatment plants and hospital effluent)
- What is the effect of local behavioural practices relating to water and sanitation on the chance of acquiring drug-resistant E. coli.
- What is the genetic link between drug-resistant E. coli in the environment and drug-resistant E. coli in people blood stream infections.
ORCID 0000-0002-6670-2713
Maryke Nielsen, University of Liverpool
Project: Risk Factors and Biomarkers for Neonatal Infection in Malawi.
Close to a quarter of newborn deaths in the first month of life are thought to be due to infection with most of these occurring in Asia and Africa.
Babies with infections deteriorate rapidly therefore they are started on antibiotics as soon as there is any possibility of infection. Symptoms can be very subtle such as not feeding or being sleepy so many newborns without infection receive antibiotics.
This is a problem as bacteria are increasingly not killed by antibiotics available.
A well-baby may be started on antibiotics after birth if there are features which put the baby at high risk of infection e.g. maternal fever. In Sub-Saharan Africa there has been little research to understand these risk factors. Markers of infection (biomarkers) measured in blood from the umbilical cord, baby or in amniotic fluid have been shown to improve diagnosis of neonatal infection in high income countries and can be used to guide how long we give antibiotics for. Their accuracy in Sub-Saharan Africa is not clear.
We need to reduce the number of newborns without infections started on antibiotics and ensure that when antibiotics are started they are stopped promptly whilst making sure all babies with real infections receive them quickly.
The aim of this project is to investigate risk factors for neonatal infection that could be used in the future to guide initiation of antibiotics in newborns in Malawi and to establish the accuracy of biomarkers for diagnosis and management of neonatal infections.
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