01 merlin wilcox_research as a route in to global health_personal reflections
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Transcript of 01 merlin wilcox_research as a route in to global health_personal reflections
DEPARTMENT OF PRIMARY HEALTH CARE
Research as a route in to Global Health - personal reflections
Dr Merlin Willcox MRCGP DTM&H
GP and Clinical ResearcherDepartment of Primary Care Health SciencesUniversity of Oxford
Plan
� Why research global health?
� How I got involved in Global Health research
� Opportunities
� Challenges
Why research global health?
� It’s interesting!� It’s fun!� You can make a real difference� More than just by working in the UK� Not just to your own patients but to others� You can learn new ideas and skills which can
benefit your patients wherever you work� You can leverage funding
Scenario
� You’re on an aeroplane� Call for a doctor� Patient collapsed in the central aisle� Airway OK, breathing OK, circulation OK� Unresponsive to pain or voice, GCS = 3� No fit witnessed� Nearest airport / hospital is 90 minutes away.� What would you do?
Blood sugar level
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80
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0 5 15 20 30 40 50 60 80 100 120
Time (minutes)
Gly
cem
ie (
mg/
dL)
sugar
Is sublingual sugar effective for the treatment of hypoglycaemia?
Is sublingual sugar equivalent to i-v glucose for the treatment of hypoglycaemia?
� 151 children with severe malaria screened at hospital
� Definition of hypoglycaemia?� 26 had glucose <3.3mmol/l� Randomised to sublingual sugar or i-v
glucose� Outcome measure?
Impact
� Personal: Useful emergency first-aid measure� Global: Sublingual sugar is now included in
MSF guidelines for the treatment of suspected hypoglycaemia, e.g. in patients with severe malaria
How I got involved in global health research …
Elective in Uganda
Parasite counts in patients taking “AM”
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0 2 7 14Days of Treatment
Parasite Count
(geometric means, 95% CI)
Madagascar trial of chloroquine resistance-reverser� CQ + SM extract vs
CQ + placebo� SM is safe� No significant
difference� ? Insufficient dose� Increasing levels of
CQ resistance
Literature reviews
Do the DTM&H!
Plasmodium falciparumPlasmodium vivax
Research Assistant at Liverpool / WHO
� Literature review of measures to prevent HIV in young people
� Contacting NGOs to obtain reports
� Helping to coordinate a meeting
Mali
� Using local resources to improve management of malaria
� Collaborating with traditional healers
� Aiming for sustainable results
Village level
� Understanding life in a rural African village
� Primary care with few resources
� Prospective study of patients using herbal decoction for malaria
� RCT of herbal vs ACT
Hospital level
� Improvement in quality of care for children with severe malaria
� Aim to encourage referrals by traditional healers
0
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25
Jun Jul Aug Sep Oct Nov Dec
Month
All-
caus
e in
patie
nt m
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Average 2002 - 2005
All-cause inpatient mortality (Hospital statistics)
Pre-hospital risk factors for inpatient death from severe malaria
� a wide variety of pre-hospital treatments were used, both modern and traditional.
� None had a consistent impact on the risk of death
� Girls were twice as likely to die as boys (AOR 2.00, 95% CI 1.08-3.70)
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1.0
Number of Hours After Hospital Admission
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viva
l Pro
babi
lity
MaleFemale
P<0.01
Health system level
� Pilot of Confidential Enquiry on Maternal and Child Deaths in Mali and Uganda
� Adapting UK methods to African context
� Identifying avoidable factors at every level
� Making recommendations
� Designing intervention(s)
Lessons learnt
� The longer you are involved in one area or project, � The more you will learn
� The more ideas you will have
� the more you will achieve
� You will become an “expert” in your area
� Good working relationship with local staff is probably THE most important factor
� Aim for sustainability – what will happen when you leave?
How to get involved
� Training opportunities:
� Volunteering for an NGO
� DTM&H
� MSc courses, some can be distance-learning e.g. MSc in Clinical
Trials at LSHTM
� PhD
� Network
� Conferences
� http://tghn.org/
� Join a team!
Opportunities for GPs in Global Health Research
� Most health problems are most efficiently dealt with in primary care
� Most research on global health is done by ID / hospital specialists or public health specialists
� There is very little research done in primary care
� A GP perspective is important� Simple interventions can make a big difference
We know what diseases are killing children …
We know which interventions will prevent most childhood deaths…
But how to deliver those interventions…?
SS Africa N&S America
% of world’s pop 11 14
% of global disease burden
25 10
% of global health workers
3 37
% of world health spending
1 50
Where are children dying…?
Example: Effect of training TBAs on perinatal mortality
� Wilson et al 2011, BMJ 343
Challenges
� Finding funding
� Finding good collaborators
� Understanding local culture and traditions
� Bureaucracy
� Logistics
� Communication
� Local politics