Global child health, infectious diseases and antimicrobial resistance

Together with partners in Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, we are conducting longitudinal surveillance of the efficacy of the first line ACT, i.e. artemether-lumefantrine, for the treatment of uncomplicated Plasmodium falciparum malaria in Bagamoyo district. The efficacy of artemether-lumefantrine is assessed by parasite clearance times, crude and PCR adjusted cure rates, and temporal selection of genetic markers of drug resistance among the parasite population. In addition we are evaluating new strategies of ACT use, such as extended treatment and triple ACT, as well as the assessing the diagnostic accuracy and utility of new point-of-care diagnostic tools for improved malaria case detection.

Collaborators
MUHAS, KI.

Funding
Swedish Research Council, Sida

Responsible researcher/contact person
Andreas Mårtensson, andreas.martensson@uu.se
Billy Ngasala, bngasala70@yahoo.co.uk

Together with the Zanzibar Malaria Elimination Programme (ZAMEP) and partners, we are conducting longitudinal surveillance of the impact of malaria interventions on community parasite prevalence, confirmed malaria infections at public health care facilities and all cause child mortality, as well as uptake of the interventions by triangulating data from community based cross sectional surveys, records on confirmed malaria infection from all public health care facilities and vital statistics. The aim of the project is to assess if it is possible to eliminate malaria in Zanzibar as a case study for sub-Saharan Africa.

Collaborators
ZAMEP, KI, UCSF

Funding
Swedish Research Council

Responsible researcher/contact person
Andreas Mårtensson, andreas.martensson@uu.se

Systematic mapping of antibiotic usage patterns among sick children across low- and middle-income countries from 2005–2017 and its health system, policy and epidemiology drivers

There is a critical need to achieve balance between access to and excess use of antibiotic medicines in order to combat resistance, one of today’s top global health challenges. While high-income countries must limit excess antibiotic use, millions of people worldwide lack access to life-saving medicines. Yet, the access-excess divide in antibiotic consumption is more complicated than simply between rich and poor countries. There are also important geographic and socioeconomic differentials in antibiotic usage across low- and middle-income countries that need to be identified and addressed to reduce access disparities. Previous global antibiotic consumption assessments have primarily relied on pharmaceutical sales data, which were to a large extent from high-income and upper-middle-income countries, with little representation of low-income and lower-middle-income countries. Pharmaceutical sales data also do not directly measure population antibiotic usage or its variations across socioeconomic groups. To fill this evidence gap, this project aims to analyze national population-based surveys comparably conducted across low- and middle-income countries in 2005–2017 to identify global trends, regional variations and socio-economic differentials. These large-scale analyses will be complemented by in-depth field studies on antibiotic stewardship practices in Uganda. Taken together, project findings will provide new and important evidence of changing antibiotic use patterns for sick children in low- and middle-income countries including key health system, policy or epidemiological drivers.

Collaborators
Makerere University, Gothenburg University

Funding
Uppsala Antibiotic Center

Responsible researcher/contact person
Emily White Johansson, emily.johansson@uu.se

AKU has an internationally recognized pedigree in infectious disease research, neonatology, nutritional management, community health surveillance and child development intervention

Development of a gestational age and birth weight assessment field tool to prevent mortality in preterm and low birth weight babies in the rural setting

PhD student: Shiyam Sunder

Supervisors: Sara Saleem, Andreas Mårtensson, Nick Brown

To optimize management of small and vulnerable babies, it is essential that both birth weight and gestational age are known. These have major implications for appropriate initial treatment and referral in a setting with very high rates of neonatal mortality due to associated complications. When routine antenatal ultrasound is not available, LMP unclear and neonatal scales unreliable, this is challenging and reliable alternatives important. This project aims to test the predictive value of foot length (an easily obtainable parameter) for weight and gestation in the field in Thatta, close to Karachi.

Neurocognitive and Psychosocial Outcomes among Pediatric Brain Tumor (PBT) Patients Presenting to Tertiary Care Hospital of Karachi, Pakistan. A Prospective Cohort Study

PhD student: Nida Zahid

Supervisors: Ather Enam, Naureen Mushtaq, Nouman Mughal, Mariya Moochhala, Salman Kirmani, Sadaf Altaf, Andreas Mårtensson, Nick Brown

Newer treatment regimens and longer overall survival of children with brain tumors has increased the neurological and neurocognitive toxicity related to treatment with higher rates of neurocognitive dysfunction among brain tumor patients as compared to survivors of non-CNS malignancies. Therefore, it is imperative to diagnosis these impairments during their long term follow up. These assessments will be essential in facilitating the need for education services and following the developmental trajectory of each and every child over time.

The goal of this project is to assess the neurocognitive and psychological outcomes of children with brain tumor before treatment and 12 months after treatment. In addition, the expression of molecular markers and their association with neurocognition will be assessed

The study will be conducted at two tertiary care hospitals of Karachi, Pakistan, i.e. AKU Hospital and Jinnah post graduate Medical Centre (JPMC).

Typhoid conjugate vaccine: a pre-post roll out effectiveness study

PhD student: Rozina Thobani

Supervisors: Farah Qamar, Andreas Mårtensson, Nick Brown

As in many LMIC settings, typhoid and paratyphoid are endemic in Pakistan, the result of water and sanitation issues, antibacterial resistance, a susceptible population and, until recently the lack of an effective vaccination

The hope is that the new typhoid conjugate vaccination (introduced in 2019) will change the epidemiology for the better. It has not been tested before in Pakistan, but the large collaborative infectious disease database in Karachi, Hyderabad, Lahore and Islamabad will, given its size, enable a pre-post roll out evaluation of change in incidence, blood culture positivity, antimicrobial resistance patterns and indirect vaccine effects. In addition, the parental views on the new vaccine (essential for long term uptake) will be addressed in a qualitative study

Funding
Global Alliance Vaccine Initiative (GAVI)

Responsible researcher/contact person for all collaborative projects with AKU
Nick Brown, nick.brown@uu.se