World leaders commit to ending TB at landmark UN meeting

Heads of state meeting at the UN General Assembly have committed to ensure 40 million people with tuberculosis (TB) are successfully treated by 2022. They have also agreed 30 million people will receive preventative treatment by 2022 to protect them from developing the disease.
The Political Declaration on the Fight Against TB was publicly endorsed at the first High-Level Meeting on TB in New York. Leaders also reaffirmed the commitment to end the TB epidemic globally by 2030 in line with the Sustainable Development Goals target.
“Today is a landmark in the long war on TB,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO). “These are bold promises – to keep them partnership is vital. WHO is committed to working with every country, every partner and every community to get the job done.”
The Deputy Secretary-General Amina Mohammed said the “vicious” TB epidemic is drastically under-funded, with a gap of around $13 billion a year. She called for a system-wide approach to ending TB that promotes the broader health and wellbeing of entire communities and breaking out of “disease-specific silos and single goals.”
Heads of state and government agreed to mobilise $13 billion a year by 2022 to implement TB prevention and care. A further $2 billion was committed for research.
President of the 73rd Session of the UN General Assembly María Fernanda Espinosa Garcés said funding and research for TB needs to be “dramatically scaled up.”
“We have before us the opportunity for a clear win – a chance to save the lives of millions, to preserve billions in resources, to demonstrate the success of the Sustainable Development Goals, and to reaffirm the utility, efficacy and necessity of multilateralism and the UN System,” she said.
Professor James Newell, Co-Director of COMDIS-HSD, said:
“I am delighted to see the UN High-Level Meeting’s endorsement of the Political Declaration on TB, which has great potential to increase political awareness of the importance of TB as an ongoing global problem.
“However, we must not miss the opportunities that the High-Level Meeting have brought, and allow TB to once again slip from the notice of politicians.”
Speaking on behalf of the UK Government, International Development Secretary Penny Mordaunt said:
“Today we have seen a Political Declaration that signals a step change in the international leadership commitments necessary to drive progress in fighting TB.
“TB is the biggest killer among infectious diseases globally. The UK is already leading the way to tackle TB through investment in research and development. UK aid will help develop three new TB drugs, which offer quicker-acting treatments for the millions of people affected by drug-resistant TB each year.
Commenting on this announcement, Professor Newell said:
“The UK government should be commended for the substantial support it provides to TB programmes and for research to develop new drugs for TB.
“However, we should remember that drugs alone is not the answer – it is widely recognised that TB is a social disease, and it is vital we understand and respond to the social circumstances that make TB so difficult to treat and control.”

Soft skills are essential for ensuring successful project management

Panel members from (left to right): Libby Clark; Pamela Campbell; Teresa Lawrence; Mike Cipriano

Programmes fail when project managers lack soft skills, argues COMDIS-HSD Consortium Manager, Libby Clark, at Project Management in Practice Conference.
Last month, I travelled to Boston, USA to present at a panel session on soft skills in project management at the annual Project Management in Practice conference. Incorporating communication, interpersonal, influencing, negotiation, problem solving and leadership skills, soft skills are increasingly recognised as critical to project success, but are often not prioritised.
The premise I put forward to the panel was that technical competency on its own is not enough, and that projects and programmes fail or operate far below optimum capacity when project managers do not demonstrate a strong suite of soft skills. Projects are not ‘business as usual’. They are temporary, unique, cross-functional and, because they often involve change and uncertainty, come with a higher level of risk. When things go wrong with projects they usually go wrong quickly and can be hard to get back on track. A good project manager needs to act quickly by asking difficult questions, considering the facts and then taking decisive action. Building good relationships, exploiting the huge value in face-to-face communication and continually demonstrating the benefits of working within a project management methodology (particularly to those who doubt its efficacy) are crucial skills. After all, what use is a Gantt chart if no one understands what it is, why it is relevant to the project or how to respond to the information contained within it?
My panel followed the opening keynote by Dr Jeff Sutherland, meaning I was lucky to have a captive audience! Fellow panel members were Dr Teresa Lawrence of International Deliverables and Pamela Campbell and Mike Cipriano, both of Boston University. Teresa expertly chaired our session, giving each panel member time to present their key thoughts before she facilitated a Question & Answer (Q&A) session with the audience.
COMDIS-HSD is a complex international programme and my presentation gave me the opportunity to talk about the work we do and how I approach and tackle the challenges that are inherent in a programme of this size. The Q&A session was excellent and we worked well as a panel, each of us taking a lead on a particular area of practice or expertise, in order to provide delegates with clear and comprehensive responses to their questions and issues. I’m a very pragmatic person by nature so I tried to focus on giving practical, concrete ideas that delegates could take away and implement in their own setting.
The rest of the conference offered great food for thought. Every session gave me something to take away and consider or implement in my own day-to-day practice, and networking time with other project management professionals gave me new insights and contacts.
And my take home message? Projects come and go, some are short lived, others develop and change over time, but the human element remains the same. Regardless of what you are working on and where in the world you are based, the challenges of working with people to build strong, coherent and high-achieving teams remains a major challenge of projects and programmes. Project managers ignore this critical aspect of project work at their peril!

New research unit seeks to improve healthcare interventions in Eswatini

Dr Rejoice Nkambule, Deputy Director Health Services – Public Health, formally launching research unit on behalf of the Ministry of Health

A new research organisation in Eswatini has been launched building on the previous work of COMDIS-HSD, which has delivered applied public health research in the Lubombo Region for 10 years. The Lubombo Health Research Unit (LHRU) is a collaboration between the Bradford Institute for Health Research, Eswatini Ministry of Health, Lubombo Regional Health Management Team and Good Shepherd Hospital, Siteki.
The organisation aims to catalyse and support the design, delivery and application of innovative research focused on improving the effectiveness, efficiency and accessibility of healthcare interventions in the Lubombo Region.
“Science is most effective when researchers with overlapping interests collaborate,” said Dr Rejoice Nkambule, Deputy Director for Health Services – Public Health, who formally launched the research unit on behalf of the Ministry.
Nkambule highlighted the benefit of routinely integrating evidence into all aspects of health care, and outlined Eswatini’s aspiration to be an international leader in high-quality health research. She explained the role of LHRU in meeting these objectives and thanked COMDIS-HSD for strengthening research capacity in Lubombo.
Lubombo has a number of challenges in delivering health care, as its predominately rural population means many people live in isolated communities. Current HIV prevalence is 29.4% and increases in non-communicable diseases, such as diabetes and hypertension, are a growing concern.
“Female BMI in Eswatini is now the highest in Africa,” said Dr Nick Riches, LHRU Public Health Registrar. “Diabetes prevalence is set to increase by 50% between 2010 and 2025. We have to look at these patterns and what interventions can prevent them.”
Riches gave a summary of the LHRU strategy, including its vision, aims and values. He outlined the intended structures and procedures of the new unit and provided a summary of current and recent research delivered through the UK-Eswatini link.
“Lubombo is leading the way in non-communicable disease decentralisation,” he said. “The region is a great place to stress test interventions: if it can be done in Lubombo, it can be done anywhere.”
“What we are doing in Lubombo can be, and is being, replicated elsewhere in Africa and the majority of the world. The foundation of this unit is a real opportunity for Lubombo and Eswatini to lead in applied global health research.”

Integrating tobacco cessation in primary health care

Integrating tobacco cessation into primary care is overlooked in many countries, highlighting a need to develop suitable interventions. Dr Sushil Baral, Managing Director of HERD International, reports on the recent regional workshop for capacity building in tobacco cessation organised by the World Health Organization South East Asia Region in New Delhi, India.
Action plans for the development and implementation of locally appropriate tobacco cessation models in primary health care have been drawn up by the member states of the World Health Organization South East Asia Region (WHO SEAR). These include establishing quit-line services, introducing behaviour change approaches, and integrating tobacco cessation in routine primary health care settings.
A regional workshop organised by WHO SEARO on 23-24 April in New Delhi, India saw participants from all WHO SEARO member states and Cambodia (WHO Western Pacific Region) discuss the implementation of Article 14 of the WHO Framework Convention on Tobacco Control (WHO FCTC) and the WHO MPOWER technical package for tobacco cessation.
Article 14 requires parties of the Convention to design and implement effective programmes aimed at promoting the cessation of tobacco use. This includes developing and disseminating appropriate, comprehensive and integrated guidelines based on scientific evidence and best practices, taking into account national context and priorities, and taking effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence. The WHO MPOWER (Monitor, Protect, Offer, Warn, Enforce and Raise) package is a tool used to assist countries with WHO demand reduction tobacco control measures.
The “O” of MPOWER refers specifically to “Offering Help” to tobacco users to quit smoking. However, many countries in the South East Asia Region (SEAR) are struggling to find appropriate mechanisms to help tobacco users quit.
Nepal has the third highest number of young female tobacco users in the SEAR, while the percentage of young male tobacco users ranks fifth. The percentage of male (fifth) and female (fourth) tobacco users overall is also significant. While Nepal has made notable progress in introducing tobacco control related acts and policies in recent years, their effective implementation remains challenging. This includes support mechanisms for tobacco cessation.
A study conducted by the Health Research and Social Development Forum (HERD)/HERD International, Nepal in collaboration with the Nuffield Centre for International Health and Development, University of Leeds, UK in two primary health care centres in two districts of Nepal, showed 37% of smokers who received a behavioural support intervention to promote tobacco cessation were able to quit smoking. The study was funded by UKAid under the COMDIS HSD research programme consortium.
Though the study highlighted a few limitations, the findings were clear enough to say that strengthening tobacco cessation in primary health care is the best way of “Offering Help” to tobacco users trying to quit.
“To reach out to the large number of people who require support, we need to promote integrated partnership at the primary health care level,” said Dr Dongbo Fu of WHO FCTC. “It could be programmes related to tuberculosis, oral health, maternal and child health, or non-communicable diseases like the package of essential non-communicable (PEN) disease interventions.
“If every primary care provider is able to give certified advice as part of their routine practice, we will be able to reach large numbers of tuberculosis patients. As this is an opportunity that they come to primary care level for other health problems,” he added.
To provide support at the primary care level, suitable interventions need to be designed, healthcare providers need to be trained on how to use the interventions and supportive supervision is needed for the successful implementation of the interventions. This requires investment and political commitment.
Dr Jagdish Kaur of WHO SEARO said: “Basically, tobacco cessation has to be a priority. There has to be political commitment, resources to meet their action plan and international cooperation and coordination among the partners and stakeholders. I think these are the important key issues.”
Dr Tibor Szilagyi of WHO FCTC said: “Countries should come up with the plan to ensure that such resources are available. Of course there are international donors and assistance can always be found, but in some cases this might be difficult. So to start, every partner to the convention should think about how to ensure the necessary resources for its programmes.
“Tobacco taxation is a very good example, because taxing a product that kills every second consumer is a very good step. There is a need for advocacy with the Ministry of Finance that tobacco control is an intervention worth financing with more resources. It’s relatively easy to argue that part of the state income generated by tobacco taxation should be turned back into tobacco control programmes,” he added.

Is open access really open for researchers in the Global South?

In this blog post, COMDIS-HSD Research Communications and Uptake Manager, Nilam Ashra-McGrath, reflects on the challenges of open access in the Global South. 
The academic publishing industry has a global footprint, but how much of what it produces – research articles, books, conference papers – is actually accessible to those outside of academia, particularly researchers who choose to use their skills in other sectors, and the communities and citizens that research claims to benefit?
At COMDIS-HSD, I have the unique vantage point of being based within an academic institution in the UK (University of Leeds), yet work exclusively with NGOs in the Global South. From this vantage point, I can see there is an enormous imbalance in how evidence is accessed depending on whether a researcher is based inside or outside an academic institution – a symptom of an imbalance of power between the Global North and South.
Researchers who are based at academic institutions enjoy privileged access, whilst researchers who choose to work in other sectors (NGOs, media outlets, charities, businesses) face barriers that they would not ordinarily encounter if they had remained in an academic institution. Having experienced first-hand the effect this has had on our consortium of NGOs, I believe there are two changes that universities, academic publishers and access schemes like Research4Life could do to help address this imbalance.
The first is to give researchers working outside academia the same status and privileges as those working in universities. Evidence is the lifeblood of any researcher and any barriers to accessing evidence cuts off their blood supply. It also has a negative impact on the capacity of researchers in low and middle income countries (LMICs) to do their job effectively. By contrast, easy access to evidence gives them life, and sustains their career well beyond the walls of academia, irrespective of the sector in which they choose to work. Qualified researchers therefore need access to the same information and privileges they had when they were training in the UK; this is fundamental to them being able to earn a living as a researcher.
The second is to ensure that access rights follow the migratory pattern of researchers into different organisations and sectors throughout the lifetime of their careers. The Royal Society highlighted that 42% of postgrad researchers in the UK are international. Many are from LMICs. When they receive training in the UK (and North America and Europe for that matter), they have an infrastructure around them to help access and share research findings, to design and implement research based on what has come before, and to add to an existing body of knowledge.
When they return home, it’s not uncommon that, when faced with a dearth of university based jobs, they look to other sectors to use their research skills. This includes, but is not limited to, working for government ministries, NGOs and civil society organisations, international aid agencies, businesses, media outlets, or even as independent researchers. As qualified researchers, their skills are highly valued by other sectors. However, the infrastructure that they were once able to make use of while training in the UK is now absent, meaning that they now have to rely on significantly smaller amounts of literature to conduct research.
One way to ensure that researchers have continued free and easy access throughout their career, is for universities to allow postdocs to keep their university email address and associated library access as alumni. Some universities already offer this, but it comes with limited access to journals. Granting all postdocs lifetime access to research evidence via their former universities is either a staggeringly simple solution, or a political and resource intensive minefield (I’m guessing the latter). Nevertheless, it’s an idea that needs exploring as at the moment, it’s only the academic setting that allows researchers to do their jobs effectively.
What we need is a system that gives equal access rights and privileges for all researchers, irrespective of where they career takes them. This would be a positive step in helping researchers in LMICs flourish without relying on Northern institutions and schemes to access research evidence.
Voices from the NGO community have been on the periphery of the open access debate. With the academic publishing industry experiencing an unprecedented level of disruption, the time is right for the peripheral voices to be heard.
This article represents the views of the author, and not the position of the Department for International Development, or of the University of Leeds.

Commonwealth leaders commit to halving malaria cases in 5 years

Leaders of the 53 commonwealth countries have committed to halving the number of cases of malaria in their countries by 2023.
If achieved, this will result in 650,000 lives saved and prevent 350 million cases of malaria.
The announcement was made at the Malaria Summit London, held during the Commonwealth Heads of Government Meeting, where £2.9 billion ($4.1 billion) was pledged to tackle the disease. Co-hosted by the Governments of Rwanda, Swaziland and the United Kingdom, key speakers included His Royal Highness the Prince of Wales, Bill Gates, and the Director General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus.
Delegates were made up of leaders from 19 Commonwealth countries, scientists, heads of business and civil society advocates.
Leaders also urged that efforts should be accelerated to reduce malaria globally by 90% by 2030.
Malaria affects 90% of citizens living in commonwealth countries and accounts for half of all global cases and deaths from malaria. In 2016, 46% of global malaria deaths occurred in eight Commonwealth countries, half of which were in Nigeria.
Speaking after the summit, Charles Nelson, chief executive of Malaria Consortium, said:
“The commitments announced today represent an important step towards mobilising the resources we need to drive progress against malaria.
“As well as increasing investments for malaria, both across the Commonwealth and beyond, we also need a smarter, more targeted approach to how we fight the disease. By investing in disease surveillance systems and strengthening the collection, analysis and use of data, malaria interventions can be more targeted, outbreak responses can be more rapid, and as a result, the impact of our work can be much greater.”

Our Malaria research

COMDIS-HSD has been involved in a number of malaria projects in commonwealth countries.
Our study with the Centre for Global Health Research in Ghana looked at the use of Intermittent Preventative Treatment in children in an area with a long malaria transmission season, and evaluated the use of a longer acting antimalarial for treatment as a means of chemoprevention.
It revealed convenient access to seasonal malaria chemoprevention (SMC) drugs, including door-to-door delivery by trusted community health workers, makes SMC more acceptable to caregivers and leads to better adherence. By extending SMC from the usual 3 months to 5 months, it can significantly reduce the burden of malaria in areas with longer rainy seasons.
Read our research brief on extended seasonal malaria chemoprevention in Ghana.
Watch our video brief on seasonal malaria chemoprevention in children under 5 years.
Working with Malaria Consortium, our study in Uganda aimed to increase the uptake of intermittent preventive treatment for malaria in pregnancy (IPTp).
It revealed that text messaging improved health worker knowledge of IPTp and increased IPTp coverage. As a result, the Ministry of Health in Uganda adopted a text messaging approach for health worker education and learning in its national malaria in pregnancy training strategy.
Read our research brief on introducing an mHealth pilot intervention in West Nile, Uganda.
As part of the same project, we identified barriers to two-dose intermittent preventive treatment (IPT2) in pregnancy in Uganda, offering a number of key recommendations, including the development of a job aid for health workers and the introduction of computerised recording and reporting systems at health facilities.
Read our research brief on assessing and addressing barriers to IPT2 uptake in Uganda.

Universal health coverage in Bangladesh hindered by communicable and non-communicable diseases

From left: Dr Khaleda Islam, Dr Md Zakir Hussain, Mr Md Ashadul Islam, Dr Shelina Ahmed, Dr Syed Abdul Hamid

The rising burden of communicable and non-communicable diseases is preventing universal health coverage in Bangladesh, the Director General (Additional Secretary) of the Health Economics Unit, Ministry of Health and Family Welfare (MOHFW), has said.
Speaking at a health policy event in Dhaka organised by MOHFW and ARK Foundation, Dr Md Zakir Hussain said constrained resources and increasing demand are making the delivery of safe, high-quality services for the entire population challenging.
“Resources are limited, so we need to consider how we can provide services more efficiently,” he said. “We also know that we need to ensure our health services are of high quality, with patient safety at their core; and we need to consider new and innovative ways to deliver services to citizens in their homes and communities.”
The event assessed the present state of health service delivery in Bangladesh. It saw senior level policy makers, service delivery personnel, development partners, academics and researchers come together to consider future options for achieving universal health coverage.
The double burden of communicable and non-communicable diseases was also emphasised in a keynote delivered by Dr Rumana Huque, Executive Director of ARK Foundation. Presenting lessons learned from studies undertaken by COMDIS-HSD, she said training of community health care providers on integrated management of childhood illness helped them to appropriately diagnose and refer selected infectious diseases, and developed their skill in rational use of drugs, including antibiotics.
Insufficient funding was revealed as one of the biggest issues affecting successful health care delivery within the country. Dr Shelina Ahmed, Health Advisor for the UK’s Department of International Development in Bangladesh, said underspend in budgets allocated for the health sector remains a problem. She called for the need to develop institutional capacity to ensure sustainability of investment.
Dr Syed Abdul Hamid, Chairman of the Institute of Health Economics at Dhaka University, highlighted current expenditure for basic health care is almost 50% lower than the minimum requirement. Around US$ 65 is needed per person each year for basic health care services in Bangladesh, yet current spending is only $US 37 per person.
Referring to work undertaken by COMDIS-HSD, Dr Khaleda Islam, Director of Primary Health Care, Directorate General of Health Services, said improving health service delivery in Bangladesh requires facility readiness, referral and transport, routine data and monitoring, quality improvement, capacity building and retention, and social and behavioural change communication.
Mr Md Ashadul Islam, Secretary (In-Charge), Bangladesh Karmachari Kallyan Board, Ministry of Public Administration, said that service coverage should be expanded, along with increased resources that are used efficiently. He emphasised the importance of ensuring coordination across operational plans of the MOHW, and coordination among stakeholders in improving health service delivery.

World TB Day 2018: Leading the fight against TB

The University of Leeds and Leeds City Council organised key landmarks to be illuminated red to promote awareness of the global burden of TB

COMDIS-HSD partners led the way in international events for World Tuberculosis (TB) Day on 24 March. Activities were organised across the globe to promote awareness of the disease under the theme “Wanted: Leaders for a TB-Free World”. The World Health Organization called on anyone affected by the disease to come forward as leaders in the fight against TB. Alongside heads of state and political leaders, this included doctors, health workers, patients and families.
COMDIS-HSD: Lighting the town red against TB
The University of Leeds and Leeds City Council organised public buildings to be illuminated as part of a Stop TB global initiative to light up key landmarks. The town hall, civic hall and university’s Parkinson building were all lit up red to show commitment to tackling TB.
Academics from COMDIS-HSD were also involved in a joint letter sent to UK Prime Minister, Theresa May, urging for more action against TB.
James Newell, Professor of International Health at the University of Leeds, said:
“TB continues to be the top infectious killer worldwide, claiming over 4,500 lives a day. Increasing rates of TB resistant to the drugs commonly used for treatment – so-called multidrug-resistant TB – poses a major global health threat and threatens gains made in the fight against the disease.
“Because TB and multidrug-resistant TB are spread from one person to another through droplets in the air, they pose a threat to everyone in the world, not just people in developing countries: in fact, rates of TB are higher in some areas of the UK than in parts of Africa and Asia.”
Helen Elsey, Associate Professor in Public Health at the University of Leeds, said:
“TB is still an important health issue in Leeds, affecting some of our most vulnerable communities, with 425 new cases in 2016 in Yorkshire and Humber.
“The most significant impacts of TB are seen in low income countries, where 95% of cases and deaths occur. The global community has set a goal to end the TB pandemic by 2030.
“However, a recent World Health Organization report warned that current global actions and investments fall far short of those needed to achieve this goal. There is an urgent need to mobilise political, social and resource commitments to ensure that here in the UK and globally we can end this debilitating and dangerous disease and the human suffering which it brings.”

ARK Foundation take to the streets in their annual World TB Day rally

ARK Foundation: We have to work together to eliminate TB
ARK Foundation took to the streets of Dhaka once again for their annual World TB Day rally. Around 1500 people joined the procession led by TB leaders, which followed a route from the Bangladesh National Museum to the iconic Doel Chatar sculpture.
Dr Mozaffar Hossain Paltu, President of the National Anti-Tuberculosis Association of Bangladesh, said: “It has been more than 100 years since TB was discovered by Dr Robert Koch and we haven’t stopped it yet. We have to work together to eliminate TB from Bangladesh and the world.”
To accompany the rally, Ark Foundation produced 15,000 fact sheets circulated to hospitals, clinics and health centres nationwide. They were were also sent to administrative divisions before the event.
HERD International: laying the foundations against TB
HERD International were involved in a programme organised by the National Tuberculosis Centre in Thimi, Bhaktapur.
As part of the day’s events, Minister of State for Health, Padma Kumari Aryal, laid the foundation stone for the future National Chest Disease Hospital in Bhaktapur. It is to be a specialist, tertiary referral hospital for difficult cases of TB and other respiratory diseases, and will be developed as a “centre for excellence” at the national level.
“The hospital will help to provide timely treatment to tuberculosis patients,” said Dr Kedar Narasing KC, Director of the National Tuberculosis Centre.
Featuring 300 beds, it is planned to be constructed within 3 years.
ASD: Creating awareness about TB prevention
In Pakistan, activities took place in 13 districts where ASD have been implementing public-private mix TB interventions. During March, 25 community gatherings were held to create awareness about TB prevention, alongside 25 chest camps screening individuals for TB. Seminars were held in each district with an average attendance of 50-60 people. TB awareness banners were displayed on rickshaws, with larger banners displayed in prominent places. Press briefings were held in eight districts and local cable networks broadcasted TB awareness messages for 2 weeks.
In 12 teaching/specialised hospitals, health staff gathered at Programmatic Management of Drug-Resistant TB sites to celebrate World TB Day. Where possible, walks were organised around hospital premises. Lectures were delivered by the MDR physician/professor of pulmonology at each site, outlining the prevalence of TB, transmission of the disease, diagnosis, and the free treatment provided by The Global Fund.

James Newell, COMDIS-HSD Co-Director, reflects on our impact and influence in 2017


Here at COMDIS-HSD, we’ve been reflecting on our impact and influence in 2017, which began with a 2-year extension to continue some of our work. Our review of 2017 showcases our influence and work in Bangladesh, China, Nepal, Pakistan and Swaziland – I hope you enjoy reading about some of our successes in TB, malaria, antibiotic resistance, gender and open access.
I’d also like to thank all our partners for their great work and support in developing and initiating this work, including, but not restricted to:

  • international and government partners for working with us to identify research questions of global importance
  • COMDIS-HSD research partners for developing and carrying out the research and working closely with government and other partners
  • the team in Leeds for providing research, communication and operational support
  • Consortium Advisory Group members for guidance and support
  • Colleagues at DFID for providing funding and supporting us in navigating new DFID requirements.

All this input means we have been able to continue to develop and assess strategies that are designed to be appropriate for context, scalable and sustainable, and that over the years have helped improve the health of millions of people in our study countries and beyond.
I am particularly excited by three new areas of work: 1) hepatitis prevention and care; 2) psychosocial support to people with MDR-TB; and 3) improving health care, particularly for communicable diseases, in urban areas. Although time is tight, we aim to deliver findings in these areas that will guide national and disease control programmes and international bodies by providing feasible and practical solutions to these major problems.
I am also delighted to welcome Libby Clark, our newly appointed Consortium Manager, to the team. Libby comes to us with a wealth of programme management experience coupled with a background in gender and development – a great fit for our consortium.
I’d like to end by thanking everyone involved for their continuing support. We look forward to reporting on our impact in these areas of work in 2018.

How our research has helped reduce unnecessary antibiotic prescribing for children in China

This news story was first published on the University of Leeds health news pages. It describes our work at COMDIS-HSD to combat the inappropriate use of antibiotics – a major global risk factor in the development of drug-resistant ‘superbugs’.

collaboration between scientists has helped reduce the prescription of unneeded antibiotics to children in rural China.

Young people in some areas of the country are being given antibiotics, often intravenously, to treat a cold, ear or throat infections – but the drugs are not effective against virus-based illnesses.

The inappropriate use of antibiotics is a major risk factor in the development of drug-resistant “superbugs”.

Antibiotic use halved

The collaboration brought together rural hospitals in two counties in rural China, Chinese health officials and academics at the University of Leeds (COMDIS-HSD) and the University of Toronto.
The aim was to devise and evaluate a system of ‘anti-microbial stewardship’ that could be used in other parts of the Chinese health system and would give doctors the confidence to say no to requests for inappropriate antibiotic treatment.
The stewardship programme was rolled out to a group of primary care hospitals in Guangxi province in Southern China.
Much of the demand for antibiotics in the Chinese primary care sector comes from parents and grandparents who have children with upper respiratory tract infections such as a sore throat or earache.

Doctors working in the primary care hospitals come under considerable pressure from parents to prescribe antibiotics to children who have upper respiratory tract infections

John Walley, Professor of International Public Health at the University of Leeds, said:
“Doctors working in the primary care hospitals come under considerable pressure from parents to prescribe antibiotics to children who have upper respiratory tract infections.
“They can feel that if they don’t give the antibiotic, the parents will just go elsewhere and get it.
“These are difficult decisions for the doctor. They may have a very ill child in front of them – and they do not have a battery of tests results to rely on. They are having to make a clinical judgement about the risks involved in not giving antibiotics.”

New guidelines for doctors

University academics and Chinese experts drew up clinical guidelines based on those produced by the UK’s National Institute for Health and Care Excellence to help doctors decide when it would be appropriate to prescribe antibiotics and alert them to the warning signs of more serious illness.
Two groups of primary-care hospitals in Guangxi were selected for the evaluation. Baseline data was collected about the prescribing practices for children attending with upper respiratory tract infections.
In the first group, containing 12 hospitals, doctors received training in how to explain to parents why antibiotics are not necessary. Medical managers also conducted monthly prescription reviews to monitor doctors’ compliance with the guidelines.
In the second group, made up of 13 hospitals, medical staff continued to prescribe in the usual way.

The results showed that in the group that had received stewardship training, the antibiotic prescription rate had dropped from 82 per cent to 40 per cent

Six months later, several thousand prescriptions were selected at random from the two groups and compared with the baseline findings. The results showed that in the group that had received stewardship training, the antibiotic prescription rate had dropped from 82 per cent to 40 per cent. In the business-as-usual group, the rate went from 75 per cent to 70 per cent.
The findings were reported in Lancet Global Health.
Taking account of statistical issues, the researchers say the stewardship programme resulted in a 48 per cent reduction in the prescribing rate of antibiotics for children with upper respiratory tract infections.
Professor Walley said: “There have been other approaches that have tried to change the behaviour of doctors and patients – but none has delivered the scale of change that we have seen.”
Typically in successful trials the change is between five and 25 per cent.
The Chinese Health Ministry has policies to reduce antibiotic use but the challenge is to get that aim delivered in primary care clinics and hospitals, Professor Walley said.
He said the key to success was to “embed” stewardship programmes within the health system, giving doctors the skills and encouragement to give antibiotics when there is a real clinical need – and to refuse them when their use would be inappropriate.
The problem of the overuse of antibiotics exists in many low and middle income countries, and existed in the UK – although healthcare policies in recent decades have resulted in more careful use of antibiotics.
Read more:

  • See our full research findings: Wei X, Zhang Z, Walley J, Hicks J P, Zeng J, Deng S, et al. (2017) Effect of a training and educational intervention for physicians and caregivers on antibiotic prescribing for upper respiratory tract infections in children at primary care facilities in rural China: a cluster randomised controlled trial. The Lancet Global Health. DOI
  • Read our policy brief for a summary of our findings and key recommendations and see our research brief for further details on our study methods.