Dr Melissa Gladstone MBChB, BSc, MRCP, FRCPCH, MD, DipND

Senior Lecturer in Neurodevelopmental Paediatrics and International Child Health Women's and Children's Health

Research

Creation of developmental tools to assess children globally

Our team is working with teams globally to understand how and what works in assessing children's development at population level, programmatic level and at the level of the individual child for assessment of neurodevelopmental disorders and disabilities in multiple settings presentlyIYCD. We are interested in understanding what can work cross-culturally (what is culturally neutral) and what is not and how the interplay of culture, health and adversity affect the attainment of child development milestones across settingsGSED GSEDMeasuring child development globally.

Dr Gladstone started research on the Malawi Developmental Assessment Tool in 2000. The MDAT is the first cheap, open-access, robustly validated and culturally appropriate tool to directly assess early child development (ECD) across settings. The experience of the work on the MDAT has been used to underpin the development of new population based ECD measurement tools (GSED, IYCD and INDIGO). These tools will enable tracking of the Strategic Development Goal which aims to improve ECD on a global scale.

Our team are now specifically working on tools which can better identify children with disabilities early and which can then link to support packages of care and have piloted a number of packages for use within early childcare systems for community based rehabilitation and perapatetic teachersINDIGO study.

Interventions to support children's development and to support children and families with disabilities

Our team has done focussed both on systems approaches to providing interventions to support better outcomes for families and their children particularly focussed around stimulation and development of children. We have conducted detailed research looking at process evaluation and systems of care for children within communities in Africa - particularly in relation to the use of the WHO UNICEF Care for Child Development intervention package. We have modelled best approaches for conducting research using methodology for assessing complex interventions within systems of careCare for Child Development Feasibility Scoping feasibilty of early child developmentJob Analysis of Community Workers.

Our group are commencing new studies looking at these similar approaches specifically for children who are admitted to malnutrition units and to understanding what might work best with regards to systems for interventions and support of families in these very low resource settings.

Our team are also focussed on looking at the systems approaches and possible interventions for supporting families of children with disabilities in low and middle income settings. We have conducted research on interventions that can improve the mental health of these families and on how to integrate these programmes into complex systems which span across health, disability and education.

Assessment of child development outcomes in children affected by infections, nutrition, antenatal factors and environmental circumstances

Our team have worked on multiple studies where child development and childhood disability are studied as an outcome of a disease which has affected children in utero (Zika) or in the early neonatal period (prematurity, hypoxic episodes at birth, neonatal sepsis, HIV exposure), in childhood (nutrition, cerebral malaria, HIV, WASH interventions). We continue to develop new and better methods for assessing children and for understanding what works best in terms of quality, sensitivity and feasibility in new trials set in low and middle income settings where capacity for training and expertise may be limited. Our team advocates for the use of the most appropriate measures for studies being conducted and for the use of more wide ranging tools for measuring not just brain structure and function but moving beyond this to look more closely at family well-being and participation of children and families - particularly those with disabilities.

Research Grants

Interdisciplinary interventions for stunting and wasting in Zimbabwe, Pakistan and Zambia

MEDICAL RESEARCH COUNCIL (MRC)

August 2018 - January 2019

A cluster randomised trial to evaluate the effectiveness of household alcohol-based handrub for the prevention of sepsis, diarrhoea and pneumonia in Ugandan infants (Babygel)

EDCTP (NETHERLANDS)

February 2019 - January 2024

Screening for Neurodevelopmental Disorders in LMIC settings - creation of a network and validation of a tool to identify the right children early

MEDICAL RESEARCH COUNCIL (MRC)

March 2018 - August 2019

Neurodevelopmental follow up of children at 2 years enrolled in the SHINE study Zimbabwe

BILL & MELINDA GATES FOUNDATION (USA)

November 2015 - May 2018

WHO 0-3 Developmental Indicators Study

WORLD HEALTH ORGANISATION (SWITZERLAND)

June 2016 - May 2017

Neurocognitive outcomes in children with cerebral malaria provided with Rosiglitazone for cerebral malaria (an RCT) in Mozambique

UNIVERSITY HEALTH NETWORK (CANADA)

October 2016 - September 2025

Creation and validation of a tool for identifying children with functional visual impairments in children with hemiplegia

THE BRITISH ACADEMY OF CHILDHOOD DISABILITY (BACD) (UK)

September 2011 - December 2015

Feasibility and pilot study using the Care for Development Package in Malawi

THE ACADEMY OF MEDICAL SCIENCES (UK)

March 2012 - February 2014

Rehabilitation of Children with Acute Brain Injury at the Queen Elizabeth Central Hospital, Blantyre, Malawi: Experiences and Perspectives of Families and Healthcare Staff

SIR HALLEY STEWART TRUST (UK)

May 2012 - April 2014

BabyGel: a cluster randomised trial of maternal alcohol hand gel to prevent newborn infection

MEDICAL RESEARCH COUNCIL (MRC)

April 2015 - July 2016

Early childhood development and education for children with visual impairment in Malawi

SIGHTSAVERS (UK)

September 2012 - February 2014

Research Collaborations

Professor Andrew Prendergast and Professor Jean Humphries

Project: SHINE Trial (Sanitation, Hygiene Infant Nutrition Efficacy TrialO
External: LSHTM and Zvitambo, Harare, Zimbabwe

We have collaborated closely on the follow up of children at 2 years of age as part of the SHINE trial and are now working with a fellow on further follow up of those children.

Professor Amina Abubakar

Project: ASD - Open source tool and PRECISE-DYAD
External: Aga Khan University Kenya and Oxford University

Prof Abubakar and myself are embarking on a project for Autism Speaks to pilot a tool for screening and measurement of autistic spectrum disorder across three countries (Kenya, South Africa and the UK). We are also working jointly on the new DYAD Wellcome Trust collaborative grant with Peter von Dadleson and the PRECISE network team.

Professor Magdalena Janus

Project: IYCD and GSED
External: McMaster University

Magdalena and the IYCD and GSED teams have been working jointly with our teams at the University of Liverpool on these projects for the past five years.

Dr Abbie Raikes

Project: GSED (Global Scales of Early Development)
External: University of Nebraska College of Public Health

Abbie and the team from GSED have been working jointly with our teams at the University of Liverpool on the GSED project and will continue with this collaboration for at least another year in order to complete work on validating a tool to assess children across countries globally.

Peter von Dadelszen

Project: PRECISE-DYAD
External: Kings College London

We are beginning a new collaboration on a study which has been funded by Wellcome Trust which will be looking at the follow up of infants and children who's mothers have been closely assessed in terms of their pregnancy health across Kenya and Gambia.

Professor Suzanne Filteau

Project: Bright-SAM
External: London School of Hygiene and Tropical Medicine

Professor Suzanne Filteau, George Praygod and the team from the University of Cophenhagen have just secured a grant to conduct a pilot study in Tanzania looking at providing an intervention to stimulate parents of children who have been admitted to a paediatric nutrition unit in Mwanza, Tanzania. The funding is to look at process evaluation and to pilot the intervention.

Dr. Meta van Heuvel

Project: CHAIN-ND
External: Sick Kids Hospital Toronto

Meta and myself have been working on the follow up component of CHAIN (Children with acute illness) neurodevelopmental component over the past few years where children have been assessed and followed up across Uganda, Malawi and Pakistan. We are looking at some new grants to follow up these children further.

Prof Henrik Friis and Dr Mette Olsen

Project: Bright SAM
External: University of Copenhagen

We will be piloting an intervention to support parents of children with malnutrition in stimulation, play and responsiveness in Mwanza, Tanzania.

Professor. Gillian Lancaster

Project: Global Scales of Early Development, Infant and Young Child Developmental Indicators, INDIGO study and new STREAM study
External: Keele University

Gillian Lancaster and her team at Keele and the team at the University of Liverpool work closely together on work looking at measurement of child development for population based and programmatic work. Prof Lancaster and Dr. Gladstone have worked together for over 15 years on the MDAT and then subsequent tool development.

Professor Andrew McIntosh and Dr. Robert Stewart and Professor Mia Crampin

Project: Generation Malawi
External: University of Edinburgh, College of Medicine Malawi and London School of Hygiene and Tropical Medicine

The Generation Malawi project will be looking at the follow up of over 8,000 women and their children in Karonga and Lilongwe in Malawi and will be liking family mental health, genetics and outcomes in terms of child development, health and mental health. The team in Liverpool will be supporting the measurement of child development outcomes for this study.

Professor Stephen Allen and Helen Nabwera

Project: NeoNUT
External: Liverpool School of Tropical Medicine

Stephen Allen and Helen are leading a project looking at routine data collection for children born in to neonatal units in Kenya and Nigeria. I have collaborated on this project particularly from the perspective of thinking about long term follow up of these infants.

Professor Vikram Patel and Dr Gauri Divan

Project: STREAM
External: SANGATH (Dehli, India) and Harvard University

Vikram, Gauri and the team at Reading are working jointly on the STREAM project which will be assessing neurodevelopment in children across Malawi and India in order to better understand what assessments can work to provide information about child neurodevelopment in a scaleable way.

Dr Emmie Mbale

Project: STREAM, Generation Malawi and INDIGO (Identification of Children with Neurodevelopmental Disorders Globally)
External: College of Medicine

Dr Mbale and myself work closely on a number of projects. She is leading the Malawi team on the INDIGO project as well as on the new STREAM project which has been funded across India and Malawi to understand how better to make transdiagnostic tools to assess neurodevelopment in a scaleable way in low income settings. Dr Mbale is also working on the Generation Malawi study with my support.

Dr. Harriet Babikako

Project: INDIGO and CHAIN
External: Makerere University, Kampala, Uganda

Dr. Babikako has worked closely with the INDIGO collaboration on the recent study which is looking at better early identification of children with neurodevelopmental disorders across countries. This study is running between Malawi, Uganda and Pakistan and is closely linked to the CHAIN study where the original collaboration from this study came. CHAIN (Children with acute illness network) has linked teams interested in the follow up of children with malnutrition across sites and is presently analysing data from the three countries.

Professor Bhisma Chakraborthy

Project: STREAM (Scaleable Transdiagnostic Evaluation and Assesment of Child Neurodevelopment)
External: University of Reading

Professor Chakraborthy and myself have just gained an MRC Mental Health grant to look at creating a tool to measure neurodevelopment across two settings - Malawi and India. This tool will be tested against gold standard assessments of child neurodevelopment and will provide normative data and profiles across two settings for use in assessing children in the future.

Professor Atif Rahman

Project: Creation of a tool to assess outcomes in children with disabilities globally
Internal

Professor Rahman and myself have successfully co-supervised a PhD student who is now writing up the work on validating a version of the Q-DAS (Disability Assessment Score) for Children in Pakistan.

Professor David Taylor Robinson

Project: C-GULL project
Internal

We will be collaborating on this innovative project which will look at following up a cohort of infants and children born to mothers in Liverpool over the next few years.

Professor Andrew Weeks

Project: BabyGel and Outcomes of children with neonatal sepsis
Internal

Professor Weeks and Dr. Gladstone have been working closely on the BabyGel studies where an intervention (alcohol hand gel use by mothers) to improve the rates of neonatal sepsis is being trialled in Uganda. Prof Weeks and Dr. Gladstone co-supervise Kathy Burgoigne who is completing her PhD on outcomes of infants with possible neonatal sepsis.

Patricia Kariger

Project: GSED and IYCD projects
External: The World Bank Early Development Group

Patricia Kariger and the teams working on IYCD and GSED have been working together on this joint project for over 5 years now to move forward in creating a tool which can work across settings in measuring child development at a population and programmatic level.

Dr. Terrie Taylor

External: University of Michigan

Ongoing collaboration of work post cerebral malaria looking at outcomes (neuropsychiatric) with cerebral malaria.

Dr Charles Masulani

Project: Mental health interventions for families of children with disabilities in Malawi
External: College of Medicine in Malawi and St John of God Community Services, Mzuzu, Malawi

Dr Masulani has completed his PhD on the creation and use of interventions to support families and children with disabilities in Malawi. Charles and myself are writing up the final paper on the randomised wait list trial of this intervention.

Dr. Mac Mallewa

Project: FoCuS, STREAM and post cerebral malaria outcomes
External: College of Medicine in Malawi

Dr Mac Mallewa and myself work on a number of projects which focus on the identification and support of children who are at risk of disability and developmental disorders in Malawi.