Africa

Predicting and Preventing Post-Discharge Mortality Among Children (Monrovia, Liberia, and Dar es Salaam, Tanzania)

Challenge

As many as 18 percent of children die in the period after being discharged from hospitals in sub-Saharan Africa. Despite the large burden of mortality in this vulnerable time, few studies have developed models to predict and prevent such deaths.

Where We Started

Chris A. Rees, MD, MPH, a Pediatric Emergency Medicine and Global Health fellow from Boston Children’s Hospital, partnered with collaborators from John F. Kennedy Medical Center in Monrovia, Liberia, and Muhimbili National Hospital in Dar es Salaam, Tanzania, to conduct parallel, prospective observational studies to identify children at risk of mortality in the post-discharge period, which includes close home monitoring for two months after discharge.

Moving Forward

We aim to derive and validate two population-specific, clinical prediction rules to predict mortality, hospital readmission, and emergency department revisits less than 2 months after discharge among children younger than 5 years old at two sites in Monrovia, Liberia, and Dar es Salaam, Tanzania, to help identify ways hospital care, discharge teaching, and follow up can reduce unnecessary child deaths.

Contact

Chris Rees, Pediatric Emergency Medicine and Global Health Fellow

Where There is No Local Author: An Analysis of Authorship in Research Conducted in sub-Saharan Africa

Challenge

Research conducted in sub-Saharan Africa often involves collaboration between researchers from the study country and high-income countries. However, imbalances in power, opportunities for funding, and research priorities in these collaborations can make the benefits of doing research unequal, with high-income country investigators traditionally benefitting more. Authorship in research articles is one manifestation of such imbalances.

Where We Started

Partnering with collaborators in Tanzania, Malawi, and Liberia, Chris A. Rees, MD, MPH, and Michelle Niescierenko, MD, MPH, are conducting an analysis of more than 45,000 articles reporting research conducted in sub-Saharan Africa. The aim of this study is to understand trends and characteristics in articles reporting research conducted in sub-Saharan Africa that have no authors from sub-Saharan African authors. Our prior work has identified this type of research parasitism.

Moving Forward

Understanding commonalities among published articles from sub-Saharan Africa exhibiting authorship parasitism can draw attention to such unintentionally detrimental work and may reduce it in the future, empowering researches from the countries where the studies originate.

Contact

Chris Rees, Pediatric Emergency Medicine and Global Health Fellow

Examining the Consequences of Environmental Enteric Dysfunction (East Africa)

Challenge

Infants and young children living in environments with poor water and sanitation often experience environmental enteric dysfunction (EED), a condition that causes poor intestinal health. 

Where We Started

Christopher Duggan, MD, MPH, and Jacqueline Lauer, PhD, MPH, partnered with the Muhimbili University of Health and Allied Sciences in Tanzania and Makerere University in Uganda to determine the nutritional and developmental effects of poor intestinal health on infants and young children in the regions.

Our Impact

Results from these studies have helped advance our understanding of the consequences of EED in East Africa, with widespread implications for infants and children across resource-limited settings. We have established links between EED and a number of nutritional and developmental concerns including poor birth outcomes, stunted growth, and micronutrient deficiencies.

Moving Forward

In the coming year, we will continue to examine the consequences of EED using data collected by our partners at Harvard T.H. Chan School of Public Health. We also plan to partner with PATH in Seattle to improve the biomarkers used for the assessment of EED in the field.

Contact

Jacqueline Lauer, PhD, MPH

National Surgical, Obstetric, and Anesthesia Strategic Plans (Zambia, Rwanda)

Challenge

Surgical care is not prioritized on the global health agenda despite accounting for one-third of disability adjusted life years. To address this, our Program in Global Surgery and Social Change (PGSSC) led the Lancet Commission on Global Surgery 2030 to outline worldwide surgical priorities. One challenge of global health policy work, however, is moving from abstract resolutions to concrete plans.

Where We Started

In May 2015, the Zambian Ministry of Health (MOH) approached the PGSSC to help move surgery forward. Drawing on the research and policy framework of the Lancet Commission, the PGSSC supported Zambian stakeholders including the MOH, clinicians, and policy experts to pioneer the process of writing the world’s first National Surgical, Obstetric, and Anesthesia Strategic Plan (NSOAP).

Our Impact

In two years, the visionary resolution from the Lancet Commission became a written, detailed, and tangible plan for improving surgical care, championed first by Zambia. In May 2017, the Zambian NSOAP for 2017-21 was signed into effect by the Minister of Health and has now been integrated into the National Health Plan. Today, there are six African countries with NSOAPs, six are actively developing NSOAPs, and several other countries are committed to the process.

Moving Forward

The Southern African Development Community (SADC) — an inter-governmental organization with a goal to further socioeconomic cooperation and integration as well as political and security cooperation among 16 southern African countries — created a mandate to develop NSOAPs for each member country. The PGSSC works with governments to facilitate NSOAPS in SADC, collaborate with local partners in research, and develop tools that can be used across the region.

Contact

Che Len Reddy, Global Surgery Fellow

Sickle Cell Research in Africa

Drs. Venee Tubman, Alexandra Coria, and Dr. Catherine Taylor researched sickle cell patient outcomes in Tanzania, Liberia, and Ghana.

Drs. Venee Tubman, Alexandra Coria, and Dr. Catherine Taylor researched sickle cell patient outcomes in Tanzania, Liberia, and Ghana. More than 240,000 infants are born with sickle cell disease — an inherited red blood cell disorder causing chronic anemia, pain, and increased susceptibility to infections — in sub-Saharan Africa annually. While survival rates of children to age 5 in high-income countries is 95 percent, the number in of children who live with sickle cell disease to age 5 in low- and middle-income countries is 10 to 50 percent. Early diagnosis of sickle cell disease through newborn screening, preventative care, parental education, and long-term follow-up decreases mortality. These high-impact, low-cost interventions have shown to have a huge impact on sickle cell patient outcomes.