566 Projects, page 1 of 114
Study in Senegal. Motivation: Nearly US$ 40 billion are disbursed annually as Development Assistance for Health (DAH) to Low- and Middle-Income Countries (LMICs). At the same time, LMIC governments repay nearly US$ 300 billion of public debt annually to High-Income Country (HIC) creditors. It is poorly understood how these positive and negative funding flows in LMICs affect countries' own public health investments. It is further nearly an unexplored question, how these flows affect the composition of health financing in LMICs, i.e. the reliance on public vs. private health financing. In order for the UK's and other OECD countries' international development policies to achieve their objectives in tackling global health threats and challenges and promoting the health and wellbeing of the world's poorest through strong domestic health systems, a deeper understanding of the health financing effects of these funding flows is needed. Objectives: Objective 1: To explore the effects of DAH and public external debt on domestic government health expenditure (GHE-S) in LMICs. Objective 2: To explore the effects of DAH and public external debt on out-of-pocket payments (OOP) for health services and voluntary health care payment scheme (VHPS) expenditures in LMICs. Objective 3: To explore how international official donors and creditors, and the funds received from and paid to them, have influenced domestic health financing in Senegal. Methods: My methodological approach to the above questions will be both quantitative and qualitative. I will combine a number of large publicly available multi-country datasets and analyse them using advanced econometric methods including panel data analysis performed in STATA. To inform this analysis and explore potential underlying causative mechanisms, I will also conduct interviews with stakeholders and perform a document review at stakeholder institutions in Senegal. Expected Impact: With this research I aim to increase our understanding of how international official funding flows affect domestic health financing in LMICs. I aim to be able to propose evidence-based suggestions for how to avoid or mitigate any identified effects that may hamper the transition of developing economies towards strengthened, equitable domestic health financing. This will be a key step towards achieving the health Sustainable Development Goals (SDGs), Universal Health Coverage (UHC) and the development objectives of donor countries: A healthier, safer and more prosperous world for all. Skills gained during studentship: -I have completed a three-week full-time course in advanced econometrics at the London School of Economics and Political Science (LSE). This has equipped me with state-of-the-art techniques for analysing large country-level datasets. -I have completed a one-day course in semi-structured interviews. -I have audited the 8-week course in qualitative methodologies at LSHTM. - I have reviewed the 10-week ESRC DTP "Core Skills for Doctoral Researchers" course material online. -The topic areas studied throughout my studentship will span health and development economics predominantly at the macroeconomic level, econometrics, global governance, health systems and -policy, statistics, interview- and document review methodology. -I have assessed the ethical aspects of my research and been granted ethics approval. - I have obtained key data collection and management skills. -The case study conducted in Senegal has improved my understanding of public health and development policy mechanisms in these countries, and it has develop my communication and intercultural skills, which has better equipped me for a career in public health and international development (including French language skills). I will disseminate the results of my research in academic journals and at international conferences.
Like other ethnic minority groups, Jewish communities have been particularly badly affected by COVID-19. This may be because they have much larger families than the UK average and because members of this community mix more frequently or in different ways than in other parts of the UK population. In addition members of these communities often obtain information about health related issues from different sources. In this study we will survey households in a UK Jewish community and collect samples to test for evidence of COVID-19 infection. We will interview members of the community to understand people's understanding of risks from COVID-19 and how acceptable different future control strategies might be. We will use this data to understand how transmission spread in this community and in particular whether the larger households and higher number of children in this community played an important role in driving the high rates of COVID-19 seen. Locally information will be disseminated in collaboration with local community groups. Overall this information will help us better understand transmission in high-risk communities and the role of children in transmission of COVID-19.
Malaria remains a disease of global concern, with over 200 million people infected worldwide annually. The disease is caused by protozoan parasites of the Plasmodium genus, which includes the zoonotic parasite Plasmodium knowlesi that infects macaques and humans. Although P. knowlesi is currently not a significant contributor to the incidence of human malaria, it is closely related to P. vivax - the second most prevalent malaria-causing species, which has a huge burden of disease - and therefore merits investigation. The focus of my research project is to investigate the proteins used by malaria parasites to invade red blood cells (RBCs), using a P. knowlesi parasite model. In particular, the aim is to examine how allelic variation of these proteins in the natural population affects the efficiency of parasite invasion. We also want to test how well human antibodies generated against these invasion proteins can inhibit the binding of the different variants, and ultimately determine which antibodies are capable of blocking the majority of, if not all, malaria parasites from invading RBCs; this research should help to inform the design of vaccines that confer protection against blood-stage malaria. To answer these research questions, we are developing a high-throughput system to generate transgenic parasites harbouring different alleles of a gene and to subsequently measure their relative growth efficiency. Our laboratory has developed an in vitro culture system for P. knowlesi, in which the parasites are maintained in flasks of blood and they repeatedly replicate through the asexual stage of their life cycle. Currently, there is not an equivalent in vitro culture system for P. vivax but due to their close similarity we are using P. knowlesi as a model for P. vivax, inserting invasion genes from the latter into our cultured parasites. We are using CRISPR-Cas9 technology to genetically modify our parasites so they express different naturally-occurring alleles of the P. vivax invasion gene, Duffy Binding Protein (PvDBP), which has shown to be crucial for parasite invasion into RBCs. The system has been designed such that each PvDBP allele incorporates a unique DNA sequence, described as a "barcode". This enables the identification of the PvDBP allele within each transgenic parasite by targeted DNA sequencing of their barcode. The relative growth rates of different variants within a pooled population can be measured by barcode sequencing ("barseq") at time intervals. The number of sequence reads per barcode indicates the relative abundance of each transgenic parasite variant. We will also adapt this growth assay by including human antibodies against PvDBP - provided by collaborators involved in human clinical trials - to evaluate the efficiency of inhibition of the different antibodies. In the long-term, by determining the binding sites of those antibodies that are most effective at blocking invasion, we hope to inform the rational design of the recombinant PvDBP vaccine candidate. Skills gained during the project: * Culturing, manipulation and transfection of malaria parasites in a containment level 3 (CL3) laboratory. * Molecular cloning of plasmid constructs designed for gene editing of malaria parasites by the CRISPR-Cas9 system. * Preparation of parasite samples for next-generation DNA sequencing and computational analysis of the data to determine the relative abundance of different allelic variants. * Development and optimisation of a high-throughput system for generating and phenotyping multiple allelic variants within a parasite population - which, once refined, can be readily applied to other genes of interest. * Collaboration and combining expertise with research groups involved in vaccine design against P. vivax. Our in vitro system provides a valuable platform to test potential vaccine candidates before progressing to costly human clinical trials
Nature of proposed research A multi-stage study aimed at describing and explaining seasonal variation in sexual health risk, involving analysis of routine data on GUM clinic attendance, HIV testing; STI returns, births, termination of pregnancy; survey data on sexual beahviour and in depth and quantitative research with service attenders aimed at exploring the possible reasons for the variation, i.e. in terms of risk behaviour and risk reduction practice; health-seeking behaviour and availability of services. Prospective outcomes The expected outcome will be a body of rigorous and reliable data on seasonal patterns of sexual health. Expected benefits We will provide information which those working directly on the implementation of the Sexual Health Strategy may use to deliver more effective and better tailored and targeted sexual health promotion and service provision, and which those concerned with the training and professional development of health care professionals may use to ensure enhanced practice.
Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.