Everything you wanted to know about literature searching and were afraid to ask !!

Stop press, stop press !!! Everything you wanted to know about literature searching and were afraid to ask !!
Fear no more, lunch time help is now available in the Library for MSc students throughout most of May, June and July.
These sessions will help you with constructing a search strategy for your summer project and assist you with understanding database subject headings.
Sessions will be held on most Tuesdays, Wednesdays and Thursdays between 1-2pm.  Additionally you can also retrieve training on :

  • Accessing data via the library, including finding full text resources and managing search results
  • Using grey literature

To to book a place on a class, please click here  http://bit.do/infoskills

Also on Wednesday lunch times, during June and July there will be drop-in sessions to help with general information skills. Details are available via the above link

So come along and get prepared !

[gview file=”http://blogs.lshtm.ac.uk/library/files/2017/05/Lunchtime-Poster.pdf”]

“Implementing the Option B+ PMTCT Guidelines in the Kilimanjaro Region”: symposium organised by PSG’s new SHAPE project

On 26th May, 2017, the SHAPE project (see below for details) is co-organsing a scientific symposium in partnership with Kilimanjaro Christian Medical Centre (KCMC) and the Global health institute, Duke. The meeting will take place in Moshi, Tanzania.  The symposium entitled “Implementing the Option B+ PMTCT Guidelines in the Kilimanjaro Region” aims to bring together scientist and health practioners working on PMTCT related activities to share experiences, to discuss preliminary research findings and new upcoming studies as well as to identify areas of synergy and opportunities for strengthening collaborations.  Within the KCMC community various research groups, students and implementers are involved in aspects related to PMTCT, in particular Option B+.  It is our hope that this symposium provides a platform from which we can foster collaborations and learn lessons in order to strengthen PMTCT research and implementation within the Region.  We are planning a full morning of activities convening current and potential local, national and international researchers, implementers and policy makers.

Background on SHAPE: The Strengthening Health Systems for the Application of Policy to Enable Universal Test and Treat (SHAPE UTT) Study was funded by the MRC/Wellcome and began in January 2017- December 2020.  This project aims to address a critical evidence gap by ascertaining heath systems preparedness for delivering UTT in Tanzania, Malawi and South Africa.  Alison Wringe (PI), Jenny Renju (Co-PI) and Jim Todd (Co-PI) will be working alongside Alpha network partners in Karonga (Mia Crampin), Ifakara (Eveline Geubbels) and uMhanyakude (Mosa Moshabela).

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NIHR SPHR challenges for public health research: reflections and ways forward

Understanding complex systems and context, while retaining generalisability of findings, are key issues, as the next stage of our research tries to genuinely involve the public.

By Matt Egan
SPHR at the London School of Hygiene & Tropical Medicine (SPHR@L) has dealt with a lot of different topics and subject areas: the use of evidence in local government; the use of internet platforms to encourage knowledge transfer; community empowerment; e-cigarettes; healthy ageing – for example. Here we focus on some of the alcohol work we have done, and discuss how local approaches to tacking problems related to alcohol illustrate many of the wider challenges facing researchers interested in informing public health decision-making.he NIHR School for Public Health Research has reached the end of its first five year programme.  This is a good time to reflect on some of the work that has taken place, and consider some of the challenges and opportunities ahead, as a new programme is developed for the next five years.

Our study of local drinking – just one of SPHR@L’s many projects – helps to illustrate three major challenges that we’re addressing so that the School really makes a difference.

Three challenges

First, it’s shown to us how our work needs to think about systems that people fit into. Promoting healthy drinking isn’t simply about informing people about the dangers of alcohol. Camden’s drinkers are part of a wider system comprising, among others, retailers, licensing laws, producers, local and central governments, residents and visitors.  Each part influences the others. As public health researchers, we must understand complexity, interconnectedness and how whole systems operate.

Second, good public health research should have meaning beyond its specific context: any findings we produce should resonate beyond Camden. It’s no good us getting to grips with the complexities of drinking in north London if we don’t also have something useful to say from it to help folk south of the river. In short, we must avoid sacrificing generalisability in pursuit of complexity and context.

Our third challenge is to work out how the “public” should be involved in public health research. That’s not just so the “public involvement” box is ticked in funding applications. It’s to hold a mirror up to our work and spot what’s missing. When we hosted a forum for Camden residents last summer, we recognised how very differently people see what’s going on. One person might be speaking about a great night out in Camden. But that could be the flipside of some others experiencing outsiders urinating in the street, drunken people making the streets unsafe and leaving a mess that council taxpayers pay to clean up.

  1. Complex systems

Let’s take each of our three challenges, one by one. First, there’s researching complex systems. One of our projects, “Reducing the Strength” examines the efficacy of voluntary restrictions on the alcohol content of beer sold in shops. The initiative in Camden and Islington impacts on street and homeless drinkers, on service providers and on retailers. But each of these groups also impacts on the others, as well as people beyond. That raises the question of how the whole system operates and the interconnectedness of different elements that are potentially affected by the intervention.

This is just one example of how we are stepping away from a tendency in public health research to fashion a grand, linear narrative in which a single magic bullet is responsible for a clear and quantifiable outcome. We find ourselves increasingly trying to map systems, to embrace complexity, even if that process is messy, troublesome and awkward.

Why does embracing complexity matter?  Partly because this approach fits much better the landscape in which public health policy and practice now operates. Historically, the evidence culture among public health academics has been based on scientific methodology and epidemiology. We’ve focussed on quality and demonstrating singularity of cause and effects, rather than complexity.  This approach remains important. However, it can mean setting aside a lot of findings and may lead to a selective understanding of a full range of findings. Some rich research, showing how an intervention can have a host of impacts, can easily be lost.

In contrast, public health policy makers and practitioners, sitting in local authorities, are often more concerned with feasibility, and with whether insights have relevance in their geographical area, whether they address problems that require solutions in that area, whether findings are relevant to what they, as practitioners – as people working in local government – can actually do. We’ve realised that the public health research culture has needed some updating so that it is useful to all the people who need it for their work.

How does this work in practice? Rather than assuming that practitioners and policy makers simply need enhanced methods/more magic bullets, we’ve tried to understand better the constraints under which they work. To that end, we’ve shadowed local government practitioners, observing them, running consultations with them, and holding focus groups. As a result, we recognise that the options open to public health practitioners are limited by many factors, including statute, finance, local and national politics and, sometimes, by the unexpected. They are required to perform certain actions but they also have choices about whether to do others, in intensive or non-intensive ways. One of our tasks is to offer them evidence highlighting possibilities that they can act upon.

For example, local authorities are empowered to define areas known as Cumulative Impact Zones (CIZ) within which licensing regulations can be more rigorous. CIZs tend to be created in areas where alcohol problems are particularly acute. Local authorities then have many options – how large the area should be; which premises to apply regulations to; whether to use the rules to reject as many premises as possible or use them to negotiate the types of premises wanted. It helps them if we can provide evidence of how other local authorities have used these powers, to highlight how someone in a similar job in a similar area has successfully taken a certain action.

  1. Generalisability

All of this leads to our second challenge, that good public health research should have meaning beyond its specific context. This is clearly more difficult when research is also tackling complexity. However, even if precise findings are not generalisable because of the specificity of the context, some of the key theories that underpin those findings may be still be generalisable. For example, in our “Reducing the Strength” project, we found evidence to support the theory that the closer area approached 100 per cent of retailers cutting the alcohol in super strength beers, the less likely it was that drinkers would circumvent the initiative by going to a different shop for alcohol. This might be a more useful, generalisable finding than one, for example, that precisely measured impacts on crime rates in one specific locality where ‘Reducing the Strength’ was implemented – given that there is no reason to assume those precise impacts will be replicated in other, different, places.

  1. Involving the public

Our third challenge is to work out how the “public” should be involved in public health research. It builds on work we have already done on partnered research with public health practitioners. This “co-production” has already led to co-authorship of an academic paper on “Reducing the Strength” on which Colin Sumpter, who was Public Health Strategist for Camden and Islington, was lead author.

Our work in Camden shows the value of our focus on involving the public. Academics have a voice in alcohol use research. So does industry and the media. But the public voice is often missing. That’s a problem, because, ultimately, it’s the public’s health that matters to us and they can sometimes highlight what’s missing in our research agenda.

The experience of bringing members of the public together into a free forum and asking them open-ended questions has been that people hold strong, diverse views that they will share respectfully. Getting these events right – reaching out to people, briefing them and encouraging them to think about the issues in advance – is rewarding but takes time and resources.  Our consultation confirmed that the public are not homogeneous and showed how alcohol policy can have many different kinds of winners and losers. Also, it demonstrated that, if researchers are going to involve people, we should be ready for surprising messages.

We will be doing more public consultation in the future. It will be an important element in the second stage our NIHR SPHR work, as we continue to grapple with researching complexity, context, relevance and usefulness for the people we serve.

Dr Matt Egan is an Associate Professor at London School of Hygiene and Tropical Medicine, with an interest in evaluating the health impacts of complex social interventions.


29 April – 5 May 2017

James Logan speaks to The Times (£) about a recent rise in the number of Lyme disease cases: “The cause is likely to be a number of factors […] there is also an increased awareness of the disease which means that we could just be seeing more of it because it is being diagnosed more.” James is also interviewed for BBC Two’s Trust Me I’m a Vet (from 15m20s) on the best way to tackle fleas.

Ngozi Erondu writes for The Conversation on the need for African governments to collaborate to secure a lower cost vaccine for meningitis: “[African governments] need to start funding and developing sufficient amounts of vaccines instead of bartering with large-scale pharmaceutical companies.”  

John Edmunds provides comment to Reuters on the importance of having more than one type of Ebola vaccine, following a World Health Organization event held in Guinea: “It will not only change the way that we control future Ebola outbreaks, but has shown how we might go about developing vaccines for similar epidemic-prone diseases.” 

Liam Smeeth provides comment for The Guardian about a study that suggests that the common side effects of statins are not down to the drugs but a result of patients’ negative expectations. On the warnings about side effects listed by the Medicines and Healthcare Products Regulatory Agency, Liam says: “I do think the MHRA advice could be toned down.”

There is further coverage of the WOMAN Trial results including articles in the Dhaka Tribune, Daily Star and News Hour (all Bangladesh), Business Insider, 20minutes (France), Global Citizen and Eastern Eye.

There is also continued coverage of Ajay Aggarwal’s study which found that the Cancer Drugs Fund failed to deliver meaningful value to patients and society, including the Financial Times (£).

Martin McKee and Lucinda Hiam are interviewed by News-Medical on their recent study that suggested an increase in mortality in England and Wales could be linked to failures in health and social care. Martin also writes for BMJ blogs on the importance of health in UK-EU discussions.


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International Day of the Midwife

By Ninha Silva, MARCH Centre Blog Editor (MSc Public Health Candidate)

To celebrate this year’s International Day of the Midwife, we wanted to hear the voices of the profession, so we spoke with two midwives, currently MSc students at LSHTM.

Maria compressedMaria Garcia de Frutos moved from Spain to UK nearly 14 years ago and has been practicing midwifery for 5 years. She started working in a deprived area of East London and since then she has been working with vulnerable women. Maria worked with the NGO Doctors of the World with undocumented migrants in London and also in a refugee camp in Greece. Maria is currently doing her MSc in Public Health.

Maura compreMaura Daly completed her midwifery training in the birth center and school Maternidad la Luz, located in the U.S.-Mexico border, where she also worked as a midwife for 3 years after completing her training. After that, Maura moved to California and started her own homebirth practice whilst working as a clinician at Planned Parenthood. Maura has been working with the Doctors Without Borders (MSF) since 2013 and has been in missions in South Sudan, Yemen, Nepal and Sierra Leone. Maura is currently pursuing her MSc in Public Health for Development.


Midwifery is one of the oldest professions in the world, dedicated to the wellbeing of the woman, however, its history is marked by neglect, ambiguous laws and fascinating transitions through time and across the world.

In the last decades, the profession started gaining attention in the fore of reproductive health and since then it has been increasingly considered as one of the pillars in the efforts to decrease poor maternal and child outcomes around the world. This started when the Millennium Development Goals (MDG) focus towards maternal and child health, together with the ambition to increase universal health coverage and access to reproductive health, led to a sudden realisation that there was a huge international deficiency of healthcare force.

In 2006, the World Health Organisation (WHO) published the report Working Together for Health that alerted not only for the shortage of healthcare workforce, but also to the uneven distribution of health workers within regions, inside countries and around the world. Data arising in the years following WHO’s report, showed that there was a global shortage of 350,000 midwives around the world.

When asked to share her thoughts on these numbers, Maria says “it is part of the process, first we identify that we need to have a qualified person to attend births, then we start qualifying people and the numbers will start increasing”. Speaking more specifically about NHS, Maria adds that “the real problem is retaining midwives. I think that it is important to train and provide midwifes, it is important that every woman has access to a midwife, but it is also important to deal with the retention problem”.

For Maura, context plays an important role in the shortage of midwifes. She explains that in the United States “there is not enough midwives because people don’t know what a midwife is. It’s just not a career that is obvious to people. In the low and middle income countries, I think there are just not enough midwives because there is not investment in it”.

Despite the decrease of global maternal mortality rates and neonatal mortality, from 1990 to 2015, the number of mothers and newborns dying from preventable causes are still alarming. Most of the deaths could be prevented with the presence of a midwife, however, WHO data shows that in some regions nearly 40% of the births are not attended by a skilled professional and approximately 13% of these women do not receive postnatal care in the first 24 hours after birth.

The UNFPA’s State of the World’s Midwifery 2014 reports that a committed investment in quality of midwifery services could prevent approximately two thirds of maternal and newborns’ deaths around the world. “I hope that the large funders can see the importance of it. This is a solution that will last beyond a five years’ cycle. It will last for the length of the career of that midwife and all the women she will touch”, says Maura.

Beyond catching babies

The International Day of Midwife, 5th of May, was launched in 1992 by the International Confederation of Midwives (ICM) with the aim to bring awareness about the work of midwives and the challenges around this profession. The yearly call for action is usually celebrated with a theme that the ICM brings forward. This year’s theme “Midwives, Mothers, Families” intends to reinforce the importance of working in partnership to improve health outcomes and ensure quality of care.

The ICM definition of midwife leaves much space for interpretation on what constitutes the role of a midwife. Midwives normally provide a range of support services to the pregnant woman, to her family and at community level too. Maria explains that as part of her job with vulnerable pregnant women, she was required to follow the women antenatally and postnatally and work with the social services, psychiatric services, children centres and legal agencies when necessary.

Maria believes that midwives also have a social responsibility. “Midwifery has such a privileged position in the political arena, in the community level, national and international level. We have a privileged position because we have access to so many women’s life and their families and we get to see how they live, the inequalities. Midwives have an opportunity to advocate for women, so we should use that power we have to influence political will. Women’s reproductive health should be even more in the political agenda and with our privileged position we should be doing more”.

The challenge now, says Maura, is “being able to translate the power of midwives and the ability of midwives to policy makers for them to understand that well trained midwives have the ability to make a dramatic improvement in the lives of women, particularly those more vulnerable”.  

It is precisely this sense of social responsibility that motivated these two midwives to go back to studies. After years practicing midwifery, Maria realised that she needed “more tools to make a bigger impact in the lives of women. I hope to be able to make bigger impact than what I make at the clinical level. It [the MSc] has already enabled me to have a broader picture in so many areas.”

For Maura, there was a need to explore the interaction between public health and midwifery. She explains: “the lessons I have learned as a midwife about that interaction, how valuable that could be and how midwives are so important all over the world, does not necessarily translate to the higher level, so I wanted to be able to talk about that to more people and I thought that Public Health could help me doing that”.

In this day, it also seems imperative to discuss the work culture of midwifery and how that impacts the wellbeing of these healthcare professionals. A 2015 NHS Staff Survey showed that approximately 50% of midwives in England were affected by work related stress and 69% felt pressure to attend work despite not feeling well to fulfil their jobs. The weight of these numbers are certainly dependent on context, however, it is symptom of a much bigger problem of the health systems and affects midwives around the world.

Maria shares: “This is a stressful job, with a lot of responsibility. Sometimes the outcomes are not so good and they create stress, and working in shifts takes you to a complete different world. So, there are many different points from where stress builds up and I don’t feel that there is anything in place to relive it. You go through a lot of emotions…and it would be helpful to have support of a specialist. It would be helpful if the maternity department had in-house support not only for midwives, but for doctors too”.

Maura adds that “when you get started you just think about the happy parts and you don’t really think about the terrible parts. As a clinician you are just taught to be stoic but there isn’t a lot of support. But that is the case for all medical providers. We are just not allowed to be humans or vulnerable.”

When asked what the most important factor to deliver good quality of care is for her, Maria answers: “time and flexibility”. She continues: “Women have different needs. Also, you are sharing a very important moment of a women’s life, a very intimate moment, and you need to build a rapport. You need time. If you have time, you have the resources and the money. Because if you have time to do your job properly, it means that there are many midwives around you, and you don’t have shortage of staff.”

Maura’s message for this year’s International Midwife Day is that: “in countries, such as the UK, it is important that they take care of their midwives. These are the women and men that receive whole generations of a country, so they should be taken care of. For countries where midwifery it is not seen as a very strong craft, I would suggest taking a second look at how midwives have the ability to reach so many women and improve the lives of women and children everywhere.”

I would like to say thank you to Maria and Maura for taking time to discuss with me and contaminating and inspiring me with their passion for midwifery.

Happy International Day of the Midwife.

May 2017 Newsletter

Dear all,

Happy May!

This month ICED is hosting or taking part in three seminars at LSHTM, and we hope to see you there.

  • Today! Islay Mactaggart will be presenting the results of the national survey of disability in Guatemala (5:30 in the Rose Room at LSHTM).
  • On May 11, Hannah Kuper will be taking part in the LSHTM “Think Zika” event, and presenting on “Addressing the needs of children with congenital Zika syndrome and their families.”
  • On May 30, Morgon Banks and Stephen Kidd (Development Pathways) will be presenting the results of different studies under the banner of “Social Protection and Disability”.

Details of all the seminars are given below. Recordings will be made available online for those who cannot attend.

A key focus of our research is investigating access to health and rehabilitation services among people with disabilities. This month, Tess Bright and colleagues published a systematic review of interventions to improve access to healthcare services in low and middle income countries. We are looking forward to adapting these techniques and testing them in Malawi to improve uptake of rehabilitation services by children later this year.

Other than that, we are busy preparing for fieldwork and travel, with trips to the Maldives, Guatemala and Geneva, planned for the next month.

Best wishes,

Hannah Kuper
International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine

We have reached more than 1100 followers on Twitter – please follow us @ICED_LSHTM.

Publications and Presentations

Tess Bright and colleagues published “A systematic review of strategies to increase access to health services among children in low and middle income countries” in BMC Health Services Research last month. This review identified 57 studies, investigating effective interventions to improve health uptake by children, though none addressed children with disabilities. The most effective strategies in improving health service access were found to be delivering interventions closer to home and the use of text messages as reminders. Read Here

Upcoming Seminars and Events at LSHTM

ICED Disability Seminar Series 2016 – 2017

Thursday 4th May, 5:30pm in the Rose Room at LSHTM. “The Guatemala National Disability Survey – Findings and Implications”. Presentation by Islay Mactaggart, followed by a Drinks Reception.

Tuesday 30th May, 5:30-7:30 pm at Manson Lecture Theatre, LSHTM. “Social Protection and Disability”. Presentations by Morgon Banks and Stephen Kidd (Development Pathways), followed by a Drinks Reception.

The audio with power-point of past seminars are available on our website: Read Here

Other Events at LSHTM

Title: Think Zika

Date: Thursday 11 May 2017
Time: 4:00 pm – 7:00 pm
Venue: Manson Lecture Theatre, LSHTM, Keppel Street, London, WC1E 7HT, UK
Type of Event:Lecture

Within this event, Hannah Kuper will be speaking on “Addressing the Needs of Children with Congenital Zika Syndrome and of their FamiliesRead Here

Work Experience Programme at ICED

We have launched our work experience programme for people with disabilities seeking experience in research. Please contact us if you would like to find out more about joining our team in this capacity: .

Upcoming Conferences

  • Nordic Network on Disability Research 14th Research Conference. Örebro, Sweden, May 3-5, 2017.Read Here
  • Global Disability Innovation Summit. London, UK, 13-14 July, 2017.  Read Here
  • Second International Developmental Pediatrics Association Congress. Mumbai, India, 7-10 December 2017. Read Here

We are making every effort to make all our research findings widely available, and have launched a Resource Webpage where you can find our key reports and manuals. Resource Website Here

Have you seen this?

Internship opportunity in the WHO country office in Tajikistan for rehabilitation related professionals in Public Health Studies. Read Here

Also, UNICEF has launched the new Module on Child Functioning. This module covers children between 2 and 17 years of age and assesses functional difficulties in different domains including hearing, vision, communication/comprehension, learning, mobility and emotions. Watch a video to Learn more about the module

Posted in News | Comments Off on May 2017 Newsletter

Selection models

Quick summary

Selection model is one of the most famous classical statistical methods to handle missing data analyses under MNAR assumption (Diggle and kenward 1994). It is based on factorizations of joint likelihood of both measurement process and missingness process. A marginal density of the measurement process describes the complete data generation while the density of the missingness process conditional on the outcomes describes the missing data “selection” based on the complete data. Therefore, similar to shared parameter model, this is a joint modelling approach: two process linked through response variable. Please note that in selection models, it is the response values that directly model the missingness process and/or dropout probability, in contrast to some latent random effects as in shared parameter models. Users need to make their judgement and choice according to their project details.

Classic selection model assumes Non-Future Dependence (NFD). That is, dropout probability only depends on the previously last observed and current missing responses. This is a reasonable assumption but can significantly simplify the analysis. It’s also very popular to see different treatment arms with different dropout performance which can be specified in selection model approach.

The current macro models the response using a standard repeated measure model and models the dropout using a logistic regression.


Selection model fitting in the current macro involves integration and the code uses SAS built-in nonlinear optimization function which can be very slow. Convergence may not be achieved for extreme cases. Please always check log files.

Alternatively, selection models can be implemented via proc mcmc. The model specifications and computations may be more straightforward.


Macros can be downloaded here Selection Model_20120726

A new initiative to map a little known disease brings hope of elimination

Map showing the environmental suitability and probability of podoconiosis infections in Ethiopia. Areas in red indicate regions with high levels of podoconiosis infection
Even amongst public health professionals podoconiosis (or endemic non-filarial elephantiasis) is one of the more neglected of the neglected tropical diseases (NTDs).  But much like the better-known polio or guinea-worm disease, the elimination of this debilitating condition is within sight. This eradication is only possible if proper clinical management and preventative
measures can be effectively targeted at the communities affected.

To enable this targeting, researchers from LASER are part of an international effort to develop the first Global Atlas of Podoconiosis.

Podoconiosis is a non-infectious geochemical disease caused by chronic exposure to red clay soils derived from volcanic rock. Irritant particles are absorbed through the feet and collect in the lymphatic vessels and nodes of the lower legs, causing swelling, pain, immobility and disfigurement. Sufferers are often misdiagnosed with lymphatic filarias which though caused by parasitic worms results in similar disfigurements.

It isn’t currently known exactly how many people suffer from podoconiosis, estimates put it at around 4 million people mainly in tropical countries of Africa, Central and South America, and southeast Asia.

In Ethiopia and north-west Cameroon podoconiosis is endemic affecting 4-8% of the population. At these levels of infection, alongside the debilitated clinical effects, the disease poses an immense economic burden, with estimated costs to Ethiopia’s economy of US$208 million per year.

Podoconiosis is one of the NTDs with a clear potential for elimination: it is easily preventable if shoes are consistently worn and early stages can be successfully treated. Currently, control efforts are hampered by a lack of information on geographical distribution. Maps have long been crucial in the planning of disease control. They help in identifying those populations most at risk from NTDs, ensuring they receive treatment, and helping track progress in control.

With funding from the Wellcome Trust, researchers from Ethiopia, Kenya, UK and the US will be pooling their expertise to develop the Global Atlas of Podoconiosis to better enable policy makers and public health implementers to target their control and elimination efforts.

Lead researcher for the atlas is Dr Kebede Deribe from Brighton & Sussex Medical School, “This collaborative effort will lead to an end to the neglect of podoconiosis. The much needed atlas will be used as an advocacy tool to develop an evidence-based global strategy and case for investment. I believe the atlas will provide an important basis for expanding prevention and treatment services of podoconiosis and complement the global elimination of lymphatic filariasis.”

Over the course of the next 5 years the atlas will define the epidemiology and distribution of podoconiosis globally. Working closely with endemic countries, the WHO and development partners, the project will collate all globally available epidemiological data. Through the application of cutting geostatistical models and machine learning approaches the global limits of the disease
will be defined and the population at risk and burden of the disease estimated for the first time.

In-line with the WHO’s call for integration of NTD control efforts the project is integrating podoconiosis mapping with the ongoing mapping of other NTDs.

The benefit of this mapping on the diagnosis and treatment of other NTDs is emphasised by LASER’s Dr Jorge Cano, “Until very recently, most elephantiasis cases in Ethiopia were wrongly attributed to lymphatic filariasis. Analysis by Dr. Kebede Deribe , in collaboration with LASER , identified podoconiosis as the main cause. An open access map which enables users to identify disease hotspots will be an invaluable resource for the targeting of both podoconiosis and LF treatment and prevention programmes. ”

Once completed the atlas will provide vital evidence of the geographical distribution and burden of podoconiosis globally, and provide an important basis for expanding prevention and treatment services on the path towards a world without podoconiosis.

Further resources


Francis Peel, 03/05/2017

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Outbreak simulation exercise

MSc Epidemiology student Emaline Laney shares her account of an outbreak simulation exercise, conducted as part of the Epidemiology and Control of Communicable Diseases module.

I looked around the table. The seven of us, representing six countries – South Africa, Cameroon, Italy, England, Wales and USA – included clinicians, NGO-workers, biomedical scientists, and soon-to-be epidemiologists. We came together that afternoon with one task at hand: to investigate an ongoing outbreak that struck Niolo Jattaba, a rural village in Guinea. According to our briefing, many villagers fell ill with watery diarrhea and/or vomiting, leading to three deaths. The cases took place after the funeral of a resident, Bertha Mboge, a few days earlier. In just over forty-eight hours, we aimed to identify the source of infection and the vehicle of transmission, with hopes of preventing further spread. Aside from the fact that this was part of our Epidemiology and Control of Communicable Diseases course, and the outbreak, village and villagers fictional, it wouldn’t be too far of a stretch to imagine what an outbreak team might look and feel like based on ours.

Conducting interviews

While skills can be taught in a classroom, experience can enrich and hone those skills. To that end, this exercise allowed us to take skills from class to practice. We designed a survey, piloted the survey, and implemented the survey, interviewing forty-five individuals altogether. The interviewees were mainly students, given a character script for the purpose of the outbreak simulation. Walking into the canteen, students buzzed every which way, running to find a certain interviewee or their teammate to share some newfound information. It was as if the whole School pressed pause. Used to the yearly occurrence, professors knew what was going on – several even participated by staging as residents of Niolo Jattaba.

For some students, this was the first time carrying out interviews or entering and cleaning data, essential skills in this field. By compiling our calculated attack rates, interview data, the village map, and even simulated lab results, we pieced together the outbreak. As the sun began to set on the Friday afternoon, we rushed to complete the outbreak report and policy recommendations for the local and national government of Guinea.

Outbreak 2

The School has, I believe, a unique ethos to higher education. Recognizing the School’s role in training tomorrow’s global public health practitioners, it strikes a balance between theory and application. Of course, a simulation can never capture the real world; however, the exercise highlighted the importance of teamwork and collaboration and helped prepare us for the moment when we leave the doors of the School into the communities in which we hope to serve.

What can be done to improve hygiene programming in Humanitarian Emergencies?

The Environmental Health Group has recently embarked on a new project with Action Against Hunger (ACF) and the Centre for Affordable Water and Sanitation Technology (CAWST) to improve the way hygiene programs are designed in humanitarian crises.

At LSHTM this work is being led by Sian White  we spoke with her to find out more about the importance of the project.

Why is this study important?

Well we now have good evidence that diarrhoeal diseases and respiratory infections remain the largest cause of preventable death among children under five. We also know that that the simple act of handwashing with soap has the greatest potential to reduce the burden of these diseases as well as a range of other pathogens that spread via the faecal-oral route. Over the last decade substantial research and programmatic investment have gone into better understanding the determinants of people’s handwashing behaviour. This body of literature has highlighted determinants such as social norms; the physical environment where handwashing takes place; the availability of soap and water; disgust associated with visible dirt; the influence of social networks; and many more. However, this research base is derived entirely from work conducted in stable (non-emergency) settings. When a humanitarian crisis occurs, whether it be a disease outbreak, a natural disaster or an armed conflict, the social and physical environments of the affected population are disrupted. At the same time, disease risk related to faecal-oral pathogens substantially increases. This research starts with the hypothesis that under such exceptional circumstances the determinants of handwashing will also change. The partners involved in this grant feel that exploring the determinants of handwashing behaviour in different types of emergencies is an essential first step for improving the quality of hygiene programming in emergencies. In the long term we hope to use the findings from this research to develop an application-based, decision-making tool that will go one step further in aiding humanitarian actors to design rapid but evidence-based hygiene programs tailored to specific humanitarian contexts.

What will be involved in the research?

The study will involve a multi-stage literature review that will help to generate hypotheses to test in the field research. The field research will involve interviews with humanitarian actors to understand the way hygiene programs are currently designed and the constraints actors have to operate within. The second part of the field work will involve two mixed-method case studies. The first of these will be in the Kurdistan Region of Iraq, which has been selected as an example of an armed conflict. The second case study will take place in the Democratic Republic of Congo and this has been chosen since it is a nation which experiences regular cholera outbreaks.

What has been done so far?

To date I have been working on two literature reviews. The first brings together evidence about the determinants of hygiene in stable settings. A summary of the results from this review can be found here:Systematic qualitative literature review. The second review is of grey literature and includes the documents that humanitarian actors commonly use to design hygiene programs.

I have also just returned from my first visit to the Kurdistan Region of Iraq where I finalised the camps and communities where we will be working and conducted interviews with actors in WASH Cluster.


This research is being funded by United States Agency for International Development (USAID).

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