Amir Kirolos, University of Liverpool
Project: Medium- and long-term outcomes of adolescents and young adults treated for severe malnutrition in childhood: A follow up of the ChroSAM (Chronic Disease following Severe Acute Malnutrition) longitudinal cohort study.
Childhood malnutrition remains a widespread problem in low-income countries. Children with malnutrition are more likely to have severe infections and die in the short-term, but survivors also suffer from poor long-term growth and development.
We are following up 320 teenagers in Blantyre, Malawi who were previously treated for severe childhood malnutrition. We will compare them to their siblings and other children in the community who did not suffer from severe malnutrition. We expect malnutrition to be associated with poorer body growth and a higher risk of heart disease and diabetes in later life which we will measure by assessing height & weight measurements, blood pressure and glucose tolerance.
We also expect malnutrition to be associated with changes in the way the brain functions. We will investigate this by measuring brain wave function (EEG), attention and problem solving using direct measures. We will also assess surviving adolescents’ mental health & behaviour using questionnaires and will measure cortisol in hair samples to assess chronic stress.
The results from this study will provide information on the long-term impacts of malnutrition and will inform treatment policies regarding the care of children with malnutrition in other settings.
ORCID 0000-0003-2995-330X
Helen Dale, University of Liverpool
Project: Can a theoretical framework for the immunoepidemiology of non-typhoidal salmonella (NTS), using age-stratified epidemiological data, estimate a population antibody correlate of protection against invasive disease?
Invasive non-typhoidal salmonella (iNTS) causes fever, septicaemia, meningitis and death in 15% of cases, mostly in sub-Saharan Africa. It affects adults with HIV and children under the age of 5; particularly with those with malaria, malnutrition, and anaemia.
Currently no vaccine exists, however, several are in development. Immune markers that correlate with a reduced risk of disease can be used to determine vaccine efficacy and accelerate early vaccine licensure.
Blood samples for antibody levels and function against iNTS will be taken from 2000 children aged 0 to 5 years in a rural, high malaria region of Malawi. Malaria positivity, anaemia and malnutrition status will be determined. Additional samples collected from a peri-urban area of Malawi as part of another study (STRATAA), will also be available for analysis. Using the age-distribution of existing blood culture confirmed iNTS cases; the level of antibody that correlates with protection against invasive disease in 95% of children will be estimated using modelling techniques.
Comparison of the immunological response between rural and peri-urban areas within Malawi will be made. Data from 1000 children 0 to 5 years will be available from three additional sub-Saharan African sites (within iNTS vaccine consortium) allowing comparison across different geographical settings.
ORCID 0000-0002-4171-1226
Nicholas Riches, Liverpool School of Tropical Medicine
Project: A spatiotemporal analysis of liver disease and its determinants in urban and rural Malawi: Identifying disparities in disease burden and opportunities for public health intervention.
The impact of liver disease in sub-Saharan Africa (SSA) is increasing over time, including deaths from liver cirrhosis and liver cancer. Treatment options are limited in this setting and most cases present late with poor outcomes.
Current evidence indicates that the leading risk factor is viral hepatitis, followed by excess alcohol consumption and non-alcoholic fatty liver disease. Often these interact to produce more severe disease. All are either preventable or can be controlled on treatment, highlighting the critical importance of prevention, early diagnosis and treatment.
Nested within a large population study in Malawi, my work will screen approximately 50,000 people for alcohol consumption across urban and rural sites. A sub-sample of 610,000 people from within this group will then have blood samples taken for viral hepatitis testing.
Evidence on who is at risk, and in which areas, will inform policy, including the design of preventative interventions and approaches to improve access to clinical care. Participants at high risk of liver disease will be invited to undergo further investigations and clinical assessment which will improve understanding of the burden of liver disease in Malawi, the unmet need for antiviral treatment, and how best to identify cases in future.
ORCID 0000-0002-1729-7635
Marie Stolbrink, Liverpool School of Tropical Medicine
Project: Airways disease in a high TB and high HIV prevalence setting – making the correct diagnosis and investigating accessibility to care.
Adults in sub-Saharan Africa have a high burden of chronic respiratory symptoms such as breathlessness, wheeze or cough. Symptoms are caused by e.g. asthma, chronic obstructive lung disease (COPD) or post-TB lung disease. The availability of diagnostics is limited. Rather than using preventative medication continuously the chronic disease is often only treated when it flares up.
We have little understanding of the barriers to preventative care for chronic lung disease and how to overcome them.
The aim of this study is to identify those who may benefit from a steroid inhaler out of those coming to hospital with a flare-up of chronic lung disease, using lung function, allergy tests and scans. Cape Town offers a unique opportunity to study those with the greatest need with diverse methods.
Through interviews with people with chronic lung diseases and others immediately involved in their care (e.g. nurses, pharmacists, doctors) we will explore the lived experiences of chronic lung disease and identify barriers to care. A survey of the availability, accessibility and affordability of lung function, pharmacological and non-pharmacological treatments in sub-Saharan Africa, to allow comparison between Cape Town and the region, will also be conducted.
ORCID 0000-0001-6091-9316
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