Investments in tuberculosis research - what are the gaps?

Through decades of research, numerous studies have generated robust evidence about effective interventions for tuberculosis control. Yet, the global annual decline in incidence of approximately 1 % is evidence that current approaches and investment strategies are not sufficient. In this article, we assess recent tuberculosis research funding and discuss two critical gaps in funding and in scientific evidence from topics that have been left off the research priority agenda.We first examine research and development funding goals in the 2011-2015 Global Plan to Stop Tuberculosis and analyze disbursements to different research areas by funders worldwide in 2014. We then summarize, through a compilation of published literature and consultation with 35 researchers across multiple disciplines in the London School of Hygiene and Tropical Medicine TB Centre, priorities identified by the tuberculosis research community. Finally, we compare researchers' priority areas to the global funding agendas and activities.Our analysis shows that, among the five key research areas defined in the 2011-2015 Global Plan - namely drugs, basic science, vaccines, diagnostics and operational research - drug discovery and basic science on Mycobacterium tuberculosis accounted for 60 % of the $2 billion annual funding target. None of the research areas received the recommended level of funding. Operational research, which had the lowest target, received 66 % of its target funding, whereas new diagnostics received only 19 %. Although many of the priority research questions identified by researchers fell within the Global Plan categories, our analysis highlights important areas that are not explicitly mentioned in the current plan. These priority research areas included improved understanding of tuberculosis transmission dynamics, the role of social protection and social determinants, and health systems and policy research.While research priorities are increasingly important in light of the limited funding for tuberculosis, there is a risk that we neglect important research areas and encourage the formation of research silos. To ensure that funding priorities, researchers' agendas and national tuberculosis control policies are better coordinated, there should be more, and wider, dialogue between stakeholders in high tuberculosis burden countries, researchers, international policymakers and funders

Guidance Brief: How to maximise the use of social sciences evidence for public health emergencies in humanitarian settings

In humanitarian settings, public health emergencies (PHE) are often one of many crises facing communities, governments and response actors. Evidence from the social sciences and other disciplines can inform decisions about effective actions and interventions in response to these events. To maximise the chance that evidence during PHE impacts those affected, it must be useful and usable to those involved. These “end users” of evidence may include government or non-governmental actors, UN or academic researchers, civil society groups, and communities. Aim of this brief This brief draws on the collective experience of social scientists with experience in operational and implementation research for public health emergencies in humanitarian settings to highlight some practical guidelines and suggestions for ensuring that evidence can influence change. Through concrete examples and links to tools, this brief is designed to support teams in generating and presenting robust, credible, and reliable social sciences evidence to inform public health responses in humanitarian contexts. Audience: The target audience for this brief is field teams working in humanitarian settings who conduct social science research that aims to improve the operational response to public health emergencies

“What matters to someone who matters to me”: using media campaigns with young people to prevent interpersonal violence and abuse

Background: While media campaigns are increasingly advocated as a strategy for preventing interpersonal violence and abuse, there is little evidence available regarding their effectiveness. Setting and design: Consultation with experts and young people was used as part of a UK scoping review to capture current thinking and practice on the use of media campaigns to address interpersonal violence and abuse among young people. Three focus groups and 16 interviews were undertaken with UK and international experts, and three focus groups were held with young people. Main results: Participants argued that, although campaigns initially needed to target whole populations of young people, subsequently, messages should be “granulated” for subgroups including young people already exposed to interpersonal violence and lesbian, gay, bisexual and transgender young people. It was suggested that boys, as the most likely perpetrators of interpersonal violence and abuse, should be the primary target for campaigns. Young people and experts emphasized that drama and narrative could be used to evoke an emotional response that assisted learning. Authenticity emerged as important for young people and could be achieved by delivering messages through familiar characters and relevant stories. Involving young people themselves in creating and delivering campaigns strengthened authenticity. Conclusions: Practice is developing rapidly, and robust research is required to identify the key conditions for effective campaigns in this field. The emotional impact of campaigns in this field appears to be as important as the transmission of learning

Childhood disability in Turkana, Kenya:Understanding how carers cope in a complex humanitarian setting

Background: Although the consequences of disability are magnified in humanitarian contexts, research into the difficulties of caring for children with a disability in such settings has received limited attention.Methods: Based on in-depth interviews with 31 families, key informants and focus group discussions in Turkana, Kenya, this article explores the lives of families caring for children with a range of impairments (hearing, vision, physical and intellectual) in a complex humanitarian context characterised by drought, flooding, armed conflict, poverty and historical marginalisation.Results: The challenging environmental and social conditions of Turkana magnified not only the impact of impairment on children, but also the burden of caregiving. The remoteness of Turkana, along with the paucity and fragmentation of health, rehabilitation and social services, posed major challenges and created opportunity costs for families. Disability-related stigma isolated mothers of children with disabilities, especially, increasing their burden of care and further limiting their access to services and humanitarian programmes. In a context where social systems are already stressed, the combination of these factors compounded the vulnerabilities faced by children with disabilities and their families.Conclusion: The needs of children with disabilities and their carers in Turkana are not being met by either community social support systems or humanitarian aid programmes. There is an urgent need to mainstream disability into Turkana services and programmes.</jats:p

Suffering in silence: consequences of sexual violence within marriage among young women in Nepal

<p>Abstract</p> <p>Background</p> <p>Despite the grave consequences of sexual violence, and it's persistence both within and outside marriages, this subject has received relatively little attention from researchers, policy makers, and programme managers in Nepal. This paper explores the definition of sexual violence and its various forms and consequences as reported by young married women in Nepal. In addition, it describes the coping mechanisms used by young married women to avoid sexual violence perpetrated against them by their husbands.</p> <p>Methods</p> <p>This paper analyzes data collected during the qualitative study on "Sexual violence among young couples in Nepal", conducted amongst two major ethnic groups - Brahmin/Chhetri and Tharu - between 2006 and 2007. The data is comprised of 39 free-lists and 15 in-depth case histories with married women aged 15-24 years. The average rank and Smith's Salience were calculated from the free-listing data. The thematic analysis approach was used for the analysis of information from the case histories.</p> <p>Results</p> <p>Approximately three-quarters (74%) of the young women mentioned 'sex against one's wishes' as sexual violence within marriage (SVWM). Sixty-two percent of respondents described 'forced sex during illness' and 'forced sex after consumption of alcohol' as SVWM. About half of young women (48.7%) who participated in the free-listing exercise reported having experienced SVWM. The types of SVWM ranged from unwanted sexual touch to forced sex. Backache, headache, lower abdominal pain, vaginal bleeding and thoughts of suicide were the most commonly reported negative physical and psychological health consequences of SVWM. Women reported various coping strategies including 'trying to convince husbands', 'sleeping in a separate room', 'visiting maternal home', 'waking up the children', and 'using pretexts such as being ill or menstruating', to avoid SVWM. However, in most cases, women reported that these coping strategies were unsuccessful. Almost all women experiencing SVWM were socially isolated and did not turn to institutions, relatives or friends for advice and support.</p> <p>Conclusions</p> <p>Sexual violence within marriage is common in Nepal. Findings provide circumstantial evidence of links between sexual violence and negative general and reproductive health outcomes for women. Various actions are required to prevent SVWM and provide immediate support to the victims.</p

Improving health in the UK

At a time of great change and challenge in the NHS and public health systems in the UK, researchers at the London School of Hygiene & Tropical Medicine are engaged in a wide range of programmes and projects which are making vital contributions to health outcomes, policy and practice. Partnership is key to this work, and the School is working closely with partners in government, the NHS and its executive agencies, local authorities, Royal Colleges, universities, health policy think-tanks, charities and funders to innovate and improve health systems and services. This publication includes Forewords by Chief Medical Officer Dame Sally Davies and Lord Crisp, Former Chief Executive of the NHS and Permanent Secretary of the UK Department of Health, and contributions from David Heymann and Duncan Selbie, Chair and Chief Executive of Public Health England

Early analysis of the Australian COVID-19 epidemic

As of 1 May 2020, there had been 6808 confirmed cases of COVID-19 in Australia. Of these, 98 had died from the disease. The epidemic had been in decline since mid-March, with 308 cases confirmed nationally since 14 April. This suggests that the collective actions of the Australian public and government authorities in response to COVID-19 were sufficiently early and assiduous to avert a public health crisis – for now. Analysing factors that contribute to individual country experiences of COVID-19, such as the intensity and timing of public health interventions, will assist in the next stage of response planning globally. We describe how the epidemic and public health response unfolded in Australia up to 13 April. We estimate that the effective reproduction number was likely below one in each Australian state since mid-March and forecast that clinical demand would remain below capacity thresholds over the forecast period (from mid-to-late April)

Implementing the United Kingdom's ten-year teenage pregnancy strategy for England (1999-2010): how was this done and what did it achieve?

In 1999, the UK Labour Government launched a 10-year Teenage Pregnancy Strategy for England to address the country's historically high rates and reduce social exclusion. The goal was to halve the under-18 conception rate. This study explores how the strategy was designed and implemented, and the features that contributed to its success. This study was informed by examination of the detailed documentation of the strategy, published throughout its 10-year implementation. The strategy involved a comprehensive programme of action across four themes: joined up action at national and local level; better prevention through improved sex and relationships education and access to effective contraception; a communications campaign to reach young people and parents; and coordinated support for young parents (The support programme for young parents was an important contribution to the strategy. In the short term by helping young parents prevent further unplanned pregnancies and, in the long term, by breaking intergenerational cycles of disadvantage and lowering the risk of teenage pregnancy.). It was implemented through national, regional and local structures with dedicated funding for the 10-year duration. The under-18 conception rate reduced steadily over the strategy's lifespan. The 2014 under-18 conception rate was 51% lower than the 1998 baseline and there have been significant reductions in areas of high deprivation. One leading social commentator described the strategy as 'The success story of our time' (Toynbee, The drop in teenage pregnancies is the success story of our time, 2013). As rates of teenage pregnancy are influenced by a web of inter-connected factors, the strategy was necessarily multi-faceted in its approach. As such, it is not possible to identify causative pathways or estimate the relative contributions of each constituent part. However, we conclude that six key features contributed to the success: creating an opportunity for action; developing an evidence based strategy; effective implementation; regularly reviewing progress; embedding the strategy in wider government programmes; and providing leadership throughout the programme. The learning remains relevant for the UK as England's teenage birth rate remains higher than in other Western European countries. It also provides important lessons for governments and policy makers in other countries seeking to reduce teenage pregnancy rates. BACKGROUND METHODS RESULTS CONCLUSION