Arthur Webster completed a Diploma in Bacteriology at LSHTM, graduating in 1970. He is now retired and has shared with us some stories from his time at LSHTM 50 years ago!
“I was a graduate veterinarian from the University of Queensland, and I was working in the veterinary vaccine division of pharmaceutical company Glaxo Ltd in Greenford and LSHTM was recommended to me, to complete the diploma course.
“The standout memory for me from LSHTM was attending the few lectures presented by Sir Graham Wilson, who was well into his 70s, and having ridden his bicycle to LSHTM would literally enthral the class with his stories about discoveries of causes of nasty human diseases such as brucellosis and salmonellosis in earlier times. Professor Arie Zuckerman’s lectures on his hepatitis research progressively unravelling the mysteries of the virus utilising the laboratory techniques of the newly emerging genetic technologies have also stayed with me throughout my career.
“I returned to Australia in late 1970 to join Websters the family-owned veterinary vaccines company as Technical Director. In 1981, I was promoted to Managing Director a position held until 1995. In 1997 I joined Australian human blood products company CSL Ltd Board as a non-executive director a position held until 2006.”
Below are photos of Arthur, his classmates and their partners from their time at LSHTM.
If you would like to share your ‘years since graduating’ story, please email email@example.com for more details.
The results of a dual-purpose field survey in a tribal area of India have shown a high level of avoidable blindness and a reluctance to pay for subsequent cataract surgery.
The new paper, published in Ophthalmic Epidemiology, shares the results of a Rapid Assessment of Avoidable Blindness (RAAB) survey conducted in the Tribal Region of Surat District of Gujarat State, India, along with results of a willingness to pay (WTP) survey conducted at the same time.
Tribal communities in India are a minority group making up about 8% of the overall Indian population. They have distinct cultural, socio-economic structure, often inhabiting forested areas with limited relationships with wider society. Eye health for this group has been previously provided through fully subsidised outreach services such as local NGOs. The population of the Surat district are 90% tribal peoples.
Gujarat state itself has a relatively high rate of cataract surgery (at >10,000/ million/ year) but accessibility for tribal groups has been limited. For instance, there are no dedicated eye care facilities available within a 60-mile radius of the district. This study was undertaken to assess the magnitude of blindness and visual impairment in this specific group, as well as their willingness to pay for services and sustainability.
RAAB is a verified population-based survey methodology (developed at ICEH) which targets people ≥50 years, assessing them for avoidable blindness such as cataract. For this study, the survey tested 44 ‘clusters’ of 50 people within the age bracket. A total of 2137 people were examined using the RAAB protocol (97.1% of people who were asked to be involved participated). Ophthalmic examinations were undertaken by the field team along with a specific questionnaire designed to assess Willingness To Pay (WTP) for surgery amongst those with cataracts.
The results showed that the prevalence of blindness within the population was 2.23%, with cataract as the main cause (67.3% of cases). WTP for surgery was 36.4% amongst those affected and half of whom were willing to pay the full amount of 750INR (approximately £8) for the surgery. There was a strong association between literacy (13.7 times) and WTP. The main barrier to people fully blind from cataract was a lack of escort to the surgical facility, at just over a third.
The effect of blindness was also particularly pronounced in women, who were shown to experience the condition at three times the rate of men. This may be partly due to women not being the financial decision makers of their households, and more dependent of an escort to take them to a health facility.
Interestingly, despite the relatively high rate of blindness, there is a high rate of coverage for cataract surgery within the area (92% of people with cataract receive surgery for it), suggesting people who are fully blind people are not being prioritised.
Furthermore, the quality of services was also an important factor for WTP. People who had good vision in their one operated eye were 4.2 times more likely to be willing to pay for other eye cataract surgery than those whose had poor vision following previous cataract surgery.
This information can be used to guide programme development, for instance increasing free transport facilities, developing regular outreach activities and increasing affordability of services through a tiered system. The WTP information can help to create a cross-subsidising system for payment, increasing access to care.
(04/08) Rashida explains how the COVID-19 crisis in Zimbabwe is being aggravated by the strike of healthcare workers on Euronews. Rashida said:“We barely have any doctors or nurses providing any services for coronavirus or any other acute or chronic healthcare services.”
(03/08) Rashida tells BBC World Service (from 27:04) that Zimbabwe is facing a “disaster” from a shortage of staff and inadequate PPE, amid rising COVID-19 infections. Rashida said: “Many neighbouring countries may be facing challenges such as lack of beds, but where Zimbabwe stands out is that we do not have healthcare workers.”
(04/08) Chris is quoted in The Independent about a new modelling study that suggests effective contact tracing measures are essential for the safe opening of schools during COVID-19. Chris said: “Our study should not be used to keep schools shut because of a fear of a second wave but as a loud call to action to improve the infection control measures and test and trace system so we can get children back to school.”
(04/08) Chris highlights the importance of public trust for an effective test and trace system on Sky News. Chris said: “I think test and trace requires people to trust in the system and that’s something that needs to be worked at in order for people to report their contacts, but also for people then to isolate when they’re requested to do so.”
(04/08) John expresses concern over the UK’s “clunky” test and trace system and tells BBC Newsnight (from 26:33) that it is failing to give epidemiologists the data that they need. John said: “I couldn’t care less whether it’s world beating or not. I just want it to be virus beating – and it’s not.”
(03/08) John is quoted in Bloomberg about the need for more research on the role of children in COVID-19 transmission. John said:“We urgently need large-scale research programs to carefully monitor the impact of schools reopening. Many questions remain, including whether there are age-related differences in susceptibility and the likelihood of transmission between children and adolescents.”
(03/08) Martin discusses the possibility of achieving a ‘zero COVID’ strategy in the UK, in iNews. Martin said:“New Zealand has shown what is possible and, although not there yet, Scotland and Ireland are heading that way. We need much more ambition, but there are also a series of practical steps.”
(03/08) Martin talks to Euronews about the resurgence of COVID-19 cases in Europe. Martin said: “I think we need to be careful about the language around second waves and second surges. I think what we’re seeing is a resurgence of a number of countries that perhaps opened up before they really got the levels of circulating virus down to a very low level.”
(30/08) Martin comments on whether monitoring excess deaths in the UK provides an accurate understanding of the impact of COVID-19 on Sky News. Martin said:“Across Europe, it’s clear that there are variations in the extent to which deaths are being coded due to COVID-19. So we should be looking at the overall adjusted excess mortality and now that we have those figures, I think they give us a very good picture.”
Other LSHTM experts
(05/08) James Logan tells The Telegraph that the risk to dogs is low in a trial to find out whether they could be used as a rapid testing measure for COVID-19. James said:“The dogs won’t have to come into contact with any infected person. They can detect them from a distance.”
(05/08) Annelies Wilder-Smith is quoted in The Metro about the number of infected arrivals in the UK in mid-March. Annelies said: “If you say there were about one million people arriving between March 13 and March 23, I think that there would have been at least 1,000 infected people — probably up to 10,000 — who brought it in.”
(04/08) Pauline Paterson explains how negative online information can impact vaccine confidence on BBC World Service (from 02:05). Pauline said: “On social media, anyone can be an ‘expert’ and concerns can spread quickly and far.”
(04/08) Heidi Larson outlines the need for better communication on how novel technologies and funding programmes have accelerated COVID-19 vaccine trials in the Financial Times. Heidi said:“There was this hope in the public health community that COVID-19 will finally wake up the anti-vaccine people. But it’s done almost the opposite.”
(04/08) Alex Bowmer outlines his experience of taking part in the Oxford vaccine trial on Channel 4 (from 33:07). Alex said:“I’m feeling excited, a sense of doing something which is good.”
(04/08) Peter Smith highlights the scientific standards required before a vaccine is approved for use in Quartz. Peter said:“I think it unlikely that regulatory authorities in the EU or the US would authorise widespread use of a COVID-19 vaccine without first having evidence of both efficacy and safety.”
(03/08) Kathleen O’Reilly emphasises the importance of safe and effective vaccines for COVID-19 elimination in iNews. Kathleen said: “As a country we are barely six months into experiencing Covid-19, vaccines are being trialled but the safety and efficacy of the vaccines still need to be assessed. It is still too early in this pandemic to know whether the UK could eliminate the virus.”
(03/08) Adam Kucharski is quoted in The Sun about the role of indoor gatherings in COVID-19 transmission. Adam said: “If you look at where these super-spreading events occur, it’s often at family gatherings, and meals and weddings and parties.”
(02/08) Anna Vassall tells The Wall Street Journal that it is difficult to measure how social behaviour has changed in Pakistan to reduce COVID-19 transmissibility. Anna said:“The decline in Pakistan is promising. But we are not yet certain as to the cause, nor how long it will last.”
(02/08) Mark Jit cautions that there is no guarantee that a potential COVID-19 vaccine will provide long-term immunity on BBC World Service (from from 38:28). Mark said: “The ideal vaccine will be one where you give it to somebody and they are guaranteed to be protected from infection for life but that might not be the case. We might have a vaccine that wanes so people only have short-term protection.”
(01/08) Graham Medley tells BBC Radio 4’s Today programme (from 1:15:35) that a “trade-off” may be needed in the UK, amid a rising number of COVID-19 cases. Graham said:“I think we’re in a situation whereby most people think that opening schools is a priority for the health and wellbeing of children and that when we do that we are going to reconnect lots of households. And so actually, closing some of the other networks may well be required to enable us to open schools.”
(31/07) Neil Pearce discusses the rise in COVID-19 cases across Europe and the implementation of local lockdown measures in the North West on BBC News. Neil said:“This week we have had two crises: the crisis of foreign travel and the crisis of what is happening in the North. What they both have in common is confusion … things keep changing all the time and nobody really knows the rules now. The government needs a plan, not about what it will do this week but about what it will do in the next two to three months.”
(30/07) David Heymann discusses whether COVID-19 cases are headed in a upward trajectory on BBC News. David said:“There is a resurgence of the virus, especially so where people are grouped together in a social situation and let down their guard. This causes a resurgence which can then spread out into the community if trace and track is not done.”
On social media
This week’s social media highlight comes from Twitter, where we celebrated reaching 50,000 followers! Follow us @LSHTM.
By Felicity L Brown (War Child Holland) and Wietse A Tol (University of Copenhagen)
In this blog series we are giving a voice to practitioners, implementers and policy-makers involved in national COVID-19 responses in low- and middle-income countries. These posts seek to facilitate timely cross- learning by sharing opinions, insights and lessons on the challenges and actions taken by those on the COVID-19 front line.
The COVID-19 pandemic will have a significant impact on the mental health of the global population. We expect an increase in general distress, greater incidence of various mental health conditions, and therefore heightened demand and need for mental health services. The mental health burden is worsened by the disruption of mental health services, often due to re-prioritization of health resources. This can impede treatment for people with existing conditions, and for people with re-emergence or exacerbation of symptoms that had previously been well managed. We also expect increased distress among specific groups of individuals, including frontline workers, individuals who have experienced COVID-19, and individuals who have lost loved ones, or lost livelihoods. We can liken this to our experiences working in populations affected by armed conflict or other emergencies- we see an increased risk of distress and disorders, either related to direct exposure to the crisis, or via resultant social, occupational, or financial stressors. Similarly, we see both the emergence of new conditions, and exacerbation of existing ones. These contexts also have another characteristic in common: the dilemma of equitably meeting the dramatically increased need for mental health services at scale, where existing health care systems and resources were not designed to meet this challenge. We briefly outline three innovations from low resource humanitarian settings, including those outlined in a recent Lancet Commission on Global Mental Health, that can be applied globally in responding to the COVID-19 pandemic.
Lesson one: the need to take an integrated, public mental health approach
Within the context of stretched health resources, and greater demand for mental health services, we need to shift towards a public mental health approach. In humanitarian settings, much work has been done to integrate mental health prevention and promotion activities through other sectors. For example, to stem the tide of an increased mental health burden, mental health practitioners can collaborate with gender-based violence and child protection services to understand how the determinants of mental health (e.g., increased intimate partner violence and child abuse) can be addressed in an integrated manner. Another example is the integration of mental health services with infectious disease health services, such has been successfully implemented in relation to HIV treatment in many global settings.
Lesson two: the need to explore low-intensity interventions
We will not have the capacity to provide specialized psychotherapeutic interventions for the vast numbers of people requiring support. Like in low-resource humanitarian settings, we expect to see increased mental health needs, alongside a limited mental health workforce. In the contexts where we work, the scarcity of trained specialists to meet demand has driven innovation in service delivery, towards scalable interventions and stepped care approaches to use resources efficiently. These often involve ‘task-sharing’, whereby non-specialists with limited or no prior mental health training, such as teachers, general practitioners, nurses, or community health workers, can be trained and supervised to deliver psychotherapies in contexts where the limited number and unequal distribution of specialists would otherwise prevent adequate population-level impact. Furthermore, the context demands less resource-intensive treatments, including briefer treatments compared to typical individual psychotherapies. Focus has necessarily shifted towards interventions comprised of the most active therapeutic ingredients, delivered in group or self-help format, sometimes via online or other remote delivery mechanisms, and with an emphasis specifically on building generalizable skills. There is mounting evidence for the acceptability, feasibility, and effectiveness of such treatments in contexts where the limited number and unequal distribution of specialists would otherwise prevent adequate population-level impact. As an example, the Mental Health Gap Action Programme (MhGAP) Intervention Guide has been used in various global settings to briefly train non-specialists, such as primary care physicians, to assess and treat a variety of mental health symptoms in their practice, and refer cases as needed.
Lesson three: the need to explore innovative training and supervision methods
In order to boost the global mental health workforce to meet the expected increased demand for services, it will be infeasible to increase the number of university-trained professionals within limited timelines. With the growing evidence for task-sharing approaches in low-resource humanitarian settings, attention has turned to the best ways for specialists to train and supervise these non-specialist providers. Innovative mental health apprenticeship models have been promoted, whereby discrete, brief, training sessions are supplemented by ‘on the job’ training, and continuous supervision and skills development through mutual problem solving. Experiences from Ghana have indicated that community health workers indicate also the importance of comprehensive, ongoing supervision and support, beyond the training phase. Additionally, advances have been made in practical methods to train and assess competence of non-specialist providers’ core therapeutic skills through brief role-play observations. Such methods have the potential to expand our trained workforces to meet global needs, while ensuring quality.
In order to meet the global demand for mental health support during the COVID-19 pandemic, and into recovery phases, we will need to develop more sustainable and smarter mental health systems. While it is promising that the mental health aspects of COVID-19 have so-far been prominently highlighted, it is essential that this continues and that we take a public health approach towards the response in order to support mental health and wellbeing at a global scale. Innovations from the humanitarian field are highly relevant to global responses, including attention to prevention and promotion, and thinking through structural changes in the ways that mental health treatments are conceptualized and delivered.
Felicity Brown is a clinical psychologist and senior researcher at War Child Holland, where her work focuses on developing and evaluating effective interventions and implementation models for addressing the mental health and wellbeing of children affected by armed conflict and other adversities.
Wietse A Tol
Wietse Tol is Professor of Global Mental Health at the Section of Global Health, Department of Public Health, University of Copenhagen and Director of the Peter C. Alderman Program for Global Mental Health at HealthRight International. His work focuses on integrated interventions that can address both mental health and its social determinants (e.g., gender-based violence, poverty) in populations affected by adversity.
Chlamydia Trachomatis (Ct), the bacterium that causes trachoma, can survive on surfaces such as plastic, skin and cloth long enough to be transmitted, a first-of-its-kind study from ICEH has found.
Trachoma is the leading infectious cause of blindness worldwide. The disease, which is caused by repeated infection with Ct, affects around seven million people a year, primarily in low-income countries. The condition can be very painful before eventually leading to blindness.
Trachoma elimination efforts are hampered by a lack of understanding about the transmission of Ct between people. Previous studies have shown that Ct DNA can be found on surfaces within households of infected individuals. Although this DNA showed the presence of the bacterium, it did not however assess whether the bacteria were alive and viable to infect others.
This study, published in PLOS Neglected Tropical Diseases, used a new technique, known as ‘viability PCR’, to detect whether bacteria placed on common surfaces in a laboratory were alive at later time intervals. The materials tested were plastic, woven mat, cotton cloth and pig skin (chosen for its biological similarity to human skin).
After assessing the levels of viable bacteria at certain time points, the study found that viable Ct DNA remained detectable up to 24 hours on plastic, pig skin and cotton cloth.
For the first time within trachoma control, these results suggest that these surfaces may contribute to the transmission of the Ct strains that cause trachoma, by acting as reservoirs of bacteria that are later transferred into uninfected people.
Although so far only seen in laboratory conditions, these results provide good evidence for future efforts to combat the development of trachoma and improve eye health for endemic communities.
Dr Stephen Hoffmann is an alumnus of our class of 1979. He has previously been profiled in our alumni magazine in Autumn 2017, talking primarily about his early work fighting Typhoid Fever in Sumatra, which can be found here. This interview with Thomas Weir, Philanthropy Officer at LSHTM, aimed to cover some of his work since 2017 and discuss the recent impact of COVID-19.
What are you doing for work now?
Me and my wife run two biotechnology companies: Sanaria and Protein Potential, that have been primarily working on vaccinations for Malaria and enteric diseases for the last 25 years. This has come from partnering research in the USA and Equatorial Guinea, where we are a key part of the Bioko Island Malaria elimination project. Looking at Malaria particularly this has had quite a lot of success. Over the course of 35 trials, we’ve seen that it can be proven highly protective against Plasmodium falciparum infection in humans. We were about to run phase three trials on a new vaccine, but these have been delayed by the onset of COVID-19. One other major success has been our research into ‘E-Tec’ or ‘travellers diarrhoea’, which has also provided an effective vaccine. It’s not glamorous but absolutely vital for saving lives given the continued problems faced by faecal borne illness. For all of our vaccines we also seek licencing by the USDA and ECDC, to ensure the highest standards have been met. After all, morally, why should something not deemed acceptable in the USA and Europe be seen as ok for use in Africa?
How has the COVID-19 outbreak affected your work?
We have managed to minimise some effects: for example, we are proud of the fact we’ve not laid off any staff, and we have made staff safety and wellbeing our primary consideration; but it has had a big toll in other ways. We have three infectious disease specialist doctors on staff, including myself, leading these efforts. We found the most effective way to track COVID-19 in our staff members, and we have had one case who was able to self-isolate, has been through getting them to complete a very detailed ‘contact tracing’ for themselves. Taking temperatures or other measures when on-site simply wouldn’t work, would be a risk for the person taking it and also act as a potential vector for COVID-19 if not done entirely correctly.
Our Research lab in Equatorial-Guinea has been converted to running testing for COVID-19, and given the lack of national infrastructure otherwise had been the only place in the country doing testing, so far there have been 300 cases diagnosed. We are also supporting efforts at the Swiss Tropical and Health Institute in Tanzania and sharing knowledge across the region.
A direct effect has been its much harder to recruit people for testing and trials, due to both lockdowns reducing the ability of travel and also to find people who are healthy volunteers, as we simply don’t know the potential issues around interaction between Plasmodium and Sars-COVID yet. It’s vital though that we don’t forget about running these clinical trials and continuing to work toward vaccines for Malaria and other illnesses. Even if COVID-19 remains highly infectious and dangerous, it will still be the case that for every two cases of COVID-19 you would still get three with Malaria. This then remains a more pressing, tangible and deadly problem for people and one that we can’t allow to get worse because we’re distracted by this outbreak.
Could Anti-Malarial Drugs work against COVID-19?
There’s simply a lack of evidence on this still. What a lot of those advocates for using malaria medicine miss- when they site the low numbers of cases in Africa as ‘proof’ – is that the medicines they are pedalling simply aren’t used in Africa as they don’t work!
How has your time at LSHTM helped you?
It has provided some vital connections with people we still work closely with. We have collaborated with the MRC in The Gambia on a paper produced last year, and academics at LSHTM such as Professor Brian Greenwood continue to lead the field in their research.
Sathish Kumar (MSc Infectious Diseases, 2017) works as an Infectious disease and General Physician in Dr Ramanathan Hospital, Thanjavur, India. Here, he describes how the outbreak has affected his work and how India’s response to the pandemic has changed his role.
How has the COVID-19 outbreak affected your work?
In India, COVID-19 started more gradually than most other countries. After a surge of cases in March, the whole nation was put under lockdown. Being a clinician, I continued my clinical duties without interruption even during the lockdown. Regular outpatient and inpatient services continued with strict infection control precautions and social distancing practices. We had to maintain distancing from our family members, especially our children and parents during this time.
Also, we created designated rooms where we disposed of our PPE and hospital clothing and washed completely before entering our homes. As the pandemic got stronger, further restrictions on goods and services led to drug shortages and unavailability of referral laboratory services for certain investigations.
How have you been responding to the outbreak?
Because of transportation disruptions and movement restrictions, patients from the villages in the surrounding areas suffered from delayed or interrupted access to our health services. Therefore, almost all clinicians had to make a quick jump to telemedicine so that patients on follow-up can still consult with us remotely. Thankfully, since we have strong telecommunications networks, we are able to connect with patients during this time.
How has your country’s response to the outbreak affected your work?
The Health Ministry advised all health facilities to function with separate fever OPDs segregated from non-fever patients. In case that was not possible, we had to divert our patients to designated fever centres in town.
For patients visiting clinics, we have been instructed to undertake screening at the entrance which included non-contact temperature monitoring, hand washing basins with running water and issuing face-masks. This meant we had to quickly set up these facilities to continue our regular services.
Additionally, all clinic staff had to perform duties with PPEs. Making visitors and patients adhere to the regulations was a challenge, but as the news spread and awareness grew, we saw positive changes.
How has LSHTM’s training helped you during this outbreak?
My training at LSHTM has fundamentally changed my approach to patients. It has taught me to look into the broader context of why and how patients manage their health problems in a certain way. In a low- and middle-income country like India, ever so often the socio-economic factors play a major role in people’s decisions and as clinicians we need to understand that too.
Furthermore, my learnings on infection control and the importance of hygiene have been very helpful in my practice. The training on tropical diseases has made me more vigilant on the common infections (TB, Dengue, Scrub typhus, etc) which by themselves are a major concern in our country. Even though the pandemic has diverted much of our time and resources to COVID-19, we should not forget these common but potentially severe infections.
My course at LSHTM made me really interested in public health and hygiene. Therefore, after completing my course, I began working on a school hygiene project in our town with the help of my wife who is a health counsellor. We have completed two years of the school hygiene programme where we teach kids of all grades about hygiene, infection control and antimicrobial resistance through fun interactive activities. We also plan to start community awareness programs on hygiene and AMR in the future through our newly setup NGO.
For many the quintessential image of the academic library is perhaps something from a bygone era. Dusty shelves with rows upon rows of books, academic journals in rolling stacks, silence broken up by the odd cough and pencil dropping from a desk as a fastidious librarian tells you off for every minor indiscretion with a sharp toned ‘shh’ from across the room.
Obviously, this image is terribly outdated, that is if it even existed in the first place. As someone who went to university in the late 2000s It is not something I ever experienced, but I had the library assistants at hand to help, the quiet study spaces to cram last minute in and rows upon rows of books to turn to.
For many people though, if we were to play some form of word association game, the word library would bring about the reply of books, but imagine a library with no physical books, no physical space to study and no staff members to turn in person to get help from. Lockdown and the ongoing pandemic have brought about huge challenges for academic libraries with regards to the service we are able to provide.
Times have been changing for a long while, eBooks and electronic journals are not a new thing by any stretch of the imagination, but library collections teams have had to think fast and act quickly to ensure students have access to as many items as possible without being able to obtain physical items form the library. Even today, many prefer using hard copies of books, rather than reading a computer screen for everything (I know I do) relying more on e-books is going to be new for some.
We have expanded our e-book collection over the last few months, making more titles available and ready to be accessed by students and staff without even having to access a physical library. Finding items which are available electronically couldn’t be easier using the library catalogue Discover
After searching Discover, results can be refined on the left hand side of the screen, in the image below, after searching for epidemiology I have filtered the results to show eBooks only. We have a number of new titles now available to access on the subject of epidemiology.
All core texts for courses are available as eBooks (where possible), in the image above we can see that if books are available electronically, they will have a link which reads as “Click here to access online”. Once this link has been clicked, you will then be taken to hosting platform where the books can be accessed.
Once we have clicked through to the eBook platform, books can be read online, or can be downloaded and read offline for a limited amount of time, like if you were borrowing a book from the library, or you can download the chapter you may need to access.
If you are having any problems accessing eBooks or have any queries or questions with regards to accessing materials for your studies, do not hesitate to get in contact with the Library, we are always here to help… physical library or not!
A new paper published in the Journal of Clinical Epidemiology has found that systematic reviews and primary research in cataract, the leading cause of avoidable blindness globally, do not take into account factors that could make them more equitable for the most vulnerable people affected.
The study, undertaken by researchers from the International Centre for Eye Health, looked at Cochrane Eyes and Vision systematic reviews and the recent primary research studies they are based on. Systematic reviews aim to collate existing studies within a healthcare topic to provide summaries and compare findings, and Cochrane are a leading provider of these reviews.
Vision impairment from cataract is distributed unequally, with disadvantaged populations disproportionately affected. Looking at factors associated with disadvantage in healthcare, such as location, socioeconomic status and disability, the team found that the majority of reviews and primary papers did not assess these factors when choosing the question to be studied, the populations to study, or the effects of interventions on subgroups within populations.
Considering equity in healthcare is extremely important to ensure that all groups affected by an illness receive the benefits of a healthcare intervention. In some cases, healthcare interventions may have a negative impact on equity. While gender/sex was often taken into account when describing participants of the studies, the effect on differences in these groups was not assessed further. Specific sub-analyses that could assess the effect of the studies on other population groups, such as race/ethnicity, were very rarely or never done.
Despite the burden of cataract being predominantly experienced by people in low and middle-income countries (LMICs), an LMIC author led only two of the sixty-two primary studies and one of the twenty-three reviews assessed by the team.
The study highlights the need for improved inclusion of LMIC authors in research teams and the consideration of equity factors when undertaking research to improve the effectiveness of cataract interventions for all.