When to Give or Not Give Incentives: A Researcher’s Reflection on Incentives in the Field

By Irene Honam Tsey

[Irene is a Research Officer & Institutional Review Board Administrator at the Dodowa Health Research Centre. She is currently a researcher on the COUNTDOWN Project].

As researchers in the field, we are very concerned with ensuring positive community relations and conducting ethical research. But my experiences from the field show how challenging this can be. We are very careful to say “thank you” to study participants for taking part in our study and being respectful of their time. For qualitative research when a participant takes part in a focus group discussion or in-depth interview, we provide an incentive as a token of our appreciation or gratitude.  In my organization, this has tended to come after we have conducted the method so participants do not feel pressure to participate. Yet, a dictionary definition of incentive is “a thing that motivates or encourages someone to do something”.

We were left with mixed feelings after the last COUNTDOWN research trip to the field.  There was a sense of guilt and disappointment following various experiences with “incentives”. Throughout our data collection experiences, timing remained an important factor. We ensure we are in the field at times that suit the community. For example, in fishing and farming communities, we would arrive very early or much later to accommodate their activities. We also try to persuade community members to participate by telling them it will not take very long. However, despite our best efforts delays happen which can be very time consuming and frustrating. If we are undertaking in-depth interviews, we try to ensure we meet participants at the right time. But if we have made a few appointments and participants are not available at the agreed time, this can have an impact on the next appointment. If people have agreed to attend a focus group discussion and then turn up late, this can mean other people who were there on time must wait. In communities where people do not have sufficient food, asking people to wait longer can leave them feeling hungry and frustrated. This frustration can spill into the interview or focus group discussions.

I have noticed a pattern with participants. In the morning participants are often hungry and unhappy to wait. Sometimes we give them snacks. However, it has been agreed those snacks (incentives) be given at the end of the interview. We make sure they are hidden from their sight until the end of a discussion. Yet, once participants get the incentives they tell you “Oh we didn’t know you were going to give us anything, or we would not have pushed you and given our best”.

News of incentives does spread and there have been instances where an entire community troops to the venue of the meeting. They then tell us: “You should have told us you would give something!” One community surprised us when its members asked why survey participants were not given incentives. This is because the norm has always been not to give them incentives.

After one such community, a thought occurred to me: why do we not use advertisements for our recruitments? For example: “12men/women needed for an FGD” and spell out what our study is about, including “incentives”. The advert could also add that admission of participants will be based on first come, first serve basis. Interestingly, advertisement is an ethically acceptable tool for recruiting research participants but we barely talk about it or consider it in the context of our research.

In my seven years at the research centre, it took my involvement on the COUNTDOWN project to realise this.  Advertisement should however be done with the best interest of participants at heart, and in a clear, transparent and accountable manner. After all, they are volunteers and must not be forced or coerced in any way.

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COUNTDOWN Launched at 9th Mano River Union Meeting on Neglected Tropical Diseases

19th-21st October 2016, Monrovia, Liberia

Prof. Russ Stothard

Originally created in 1973, the Manu River Union (MRU) is an intergovernmental institution comprising of Sierra Leone, Liberia, Guinea and Cote d’Ivoire. Primarily, the MRU was formed to promote local trade and economic development. Since 2006 its scope has expanded. Today this includes issues related to health policies and practices, specifically in the harmonization of ongoing interventions against neglected tropical diseases (NTDs) as several NTDs cross-borders. A very pertinent example of when cross-border collaboration was crucial was evidenced by management of the Ebola Virus Disease (EVD) epidemic. Without a cross-country response in Liberia, Sierra Leone and Guinea the epidemic would not have been curtailed. Nonetheless, the EVD crisis severely shocked the health system and suspended many ongoing interventions against NTDs. Thus for Liberia to host the 9th MRU on NTDs is a testimony to reinstatement of routine activities.

In Liberia, the COUNTDOWN team is a collaboration between the Ministry of Health and University of Liberia-Pacific Institute of Research and Evaluation (UL-PIRE). Each partner was very busy this week in preparations to host the 9th MRU meeting. This brought together just over 90 Anglophone and Francophone delegates, inclusive of the MRU secretariat and many representatives of those practicing NTD control in West Africa and elsewhere beyond. We were delighted to represent COUNTDOWN as part of the international partners and were well-placed to assist the Liberian team. In addition to the standing MRU agenda, this 9th MRU meeting was especially significant for it marked the formal launches of the Liberian COUNTDOWN programme and the Integrated NTDs Case Management Programme as well as the inauguration of the first Liberian NTD Ambassador Dr Everlyn Kandakai.

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Prof. Russell Stothard – COUNTDOWN Director & Dr Evelyn Kandakai – Liberia NTD Ambassador

The strategic plan for integrated case management of NTDs is the first of its kind in sub-Saharan Africa. Clearly Liberia is forging ahead and should be much congratulated in its efforts. Alongside patient management of Buruli ulcer, leprosy and yaws, detection and surgical-interventions against hydrocele, a complication of lymphatic filariasis, were reported. Over the years the LSTM-FPSU, as supported by DFID-UK, has played a major role in assisting Liberia to develop an action plan for management of hydrocele. This was reported at the meeting by Brent Thomas.

At the start of the MRU meeting we were all very touched by a personal testimony given to us by Annie Toweh, a young girl who had had a very extensive Buruli ulcer lesion. She much benefited from the closer attention to this condition and had undergone treatment with skin-grafting; we were happy to see that she was well on the road to recovery and gaining a normal life.

The role of the NTD ambassador is primarily to promote activities of the NTD programme, especially in supporting the interface between ministries and promoting appropriate communications and messaging to and from disease-endemic communities. Dr Kandakai has had an outstanding career in shaping education in Liberia from tertiary to primary levels and wished to bring her skills to ensure that the education sector fully embraces the activities of the NTD programme.

A key channel of communication is the weekly 45-minutes health promotion slot on national radio. This is broadcast across the nation on 99.9 FM and on Tuesday, I took part in a radio interview with Karsor Kollie (MoH COUNTDOWN) and Miatta Sonkarlay Sonkarley, (Map International). During discussions I was able to highlight Laura Dean’s recent work with UL-PIRE which is now ready to start fieldwork this coming month in Bong and Maryland Counties, respectively and we look forward to their findings.

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R-L: Prof. Stothard, Karsor Kollie – COUNTDOWN Liberia Country Director, Miatta Sonkarley – Liberia Programme Manager MAPs International (Medical Assistance Programmes), Talk Show Host – Sabbah

As Kate Hawkins once told us, in COUNTDOWN communications should be everyone’s business. Team Liberia has now established a twitter account @COUNTDOWNLR and was active throughout the MRU meeting tweeting and taking notes. This helped to provide two recap sessions at the start of each day as well as drafting the 12 formal recommendations forthcoming the deliberations from the meeting. With regards to the recommendation of establishing an effective communication strategy to address NTDs implementation programme, it is therefore very fitting that COUNTDOWN is helping Liberia to develop an inclusive strategy. This will also be adopted in due course by other MRU countries so we have a lot to expect from the 10th MRU meeting to be held in Guinea.

 

 

COUNTDOWN goes Down Under for ICTMM 2016

By Prof. Russ Stothard, COUNTDOWN

Efforts to control NTDs typically require advice, support and coordination from several international networks. Like tropical medicine in general, the need to bring scientists and clinicians together regularly and discuss their findings is crucial to ensure that the best research is disseminated internationally and eventually translated into optimal control strategies. The International Congress for Tropical Medicine and Malaria (ICTMM) provides such a forum.

This year the 19th ICTMM took place from 18th to 22nd September in Brisbane, Australia. This brought together just over 1,500 delegates. The meeting was jointly organised by the Australian Society for Parasitology (ASP) and the Australasian Society for Infectious Diseases (ASID). I was especially honoured to be awarded a travelling lectureship from the ASP to present and also visit research groups in Australia to instigate future collaboration. This I did by visiting the laboratories of Robin Gasser and Don McManus at the University of Melbourne and Queens Institute of Medical Research (QIMR), Brisbane. Robin and Don each have a tremendous stature in veterinary and medical parasitology, respectively. Both seamlessly blend state-of-the-art molecular studies with field studies and have had significant research programmes advancing the health and well-being of those living in the tropics.

In Melbourne, I gave a departmental seminar and was able to discuss with Robin and his team our ongoing and future work in Ghana and Cameroon. The Gasser lab has been pioneering molecular surveillance of helminth diseases for over thirty years and one of their recent milestones was made by Dr Neil Young in publishing the genome of Schistosoma haematobium.  This Nature publication was a tremendous achievement bringing new focus to the control of urogenital schistosomiasis in Africa. Better knowledge of this genome has opened up new ways to study the population biology of this parasite, often revealing how it is able to cause such ill-health across the continent. Furthermore, a precise knowledge of this genome allows us to monitor significant evolutionary changes which may occur to mitigate our efforts to control it with preventive chemotherapy.

In Brisbane, I attended the ICTMM meeting and gave a keynote presentation on schistosomiasis, reporting our recent findings in Cameroon at Barombi Kotto and Mbo, as well as, two other presentations on treatment of pre-school-aged children with intestinal schistosomiasis and management of co-infections of schistosomiasis and giardiasis. Whilst at the conference our viewpoint article in was published which was a timely reminder of how much future work is needed to expand access of praziquantel to those children currently overlooked within control programmes.

Suzy Campbell gave a presentation on the focus of her PhD studies on WASH (Water, Sanitation and Hygiene) for Soil-Transmitted Helminthiasis (STH). It was also a great honour for me to be invited to serve on the IFTM expanded board so we can look forward to 20th ICTMM in 2020 hosted by the Parasitology and Tropical Medicine Association of Thailand.

A particular highlight was learning from Don the steps that his group had taken to develop and evaluate public health education materials used for control of soil-transmitted helminthiasis in China. I recommend that you view the ‘Magic Glasses’ animation and its associated impact has been reported in the New England Journal of Medicine. More broadly, we do not have adequate nor sufficient health education materials presently for use in African schools for several other NTDs. My own previous research on schistosomiasis in Zanzibar has shown that innovative approaches are very much needed to addressing this aspect of influencing positive behavioural change.

Learning from the Neglected Tropical Disease NGDO Network

By Suzy Campbell,

Over the past few years it has been exciting to see momentum building to address integration and health systems strengthening beyond the traditional vertical approaches of funding and delivery of single disease strategies. A recent supplementary issue of International Health, a journal of the Royal Society of Tropical Medicine and Hygiene has a strong focus on health systems strengthening, and should be essential reading for anyone with interest in addressing NTDs.

The supplement has been largely coordinated by the Neglected Tropical Disease (NTD) Non-governmental Development Organisations Network (NNN), and is refreshingly dedicated to partnering across the entire sector to continue addressing the challenging issues pertaining to prevention, treatment and management of NTDs.

Intersectoral and transdisciplinary cooperation and learning

Of particular note is the article by Hopkins who describes the new project framework developed by the World Health Organization (WHO) Africa Region to replace the African Programme for Onchocerciasis Control (APOC). APOC ceased in 2015 yet has been widely recognised for its contributions towards health systems strengthening, as it has enabled infrastructure development and mobilisation via community health workers, thereby facilitating access to chemotherapeutic drugs by people who have otherwise been truly unable to reach them. The new framework, the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), will be introduced throughout 2016 and will extend beyond onchocerciasis to coordinate all NTD activities in the African region. Together with the current focus on intersectoral, transdisciplinary cooperation and learning, ESPEN will provide an unprecedented opportunity to drive impetus for integrated health system strengthening activities. This does set a new support structure for integrated NTD control and elimination, and we look forward to its further development with great interest.

NTD morbidity

Much valuable work has been done over the last 15 years to map various NTDs and enable resource prioritisation via chemotherapy. Yet the sheer scale, and varying morbidity, of NTDs means that, in addition to the important prevalence and treatment coverage statistics, it is equally important to capture data on additional morbidity measures. Having sound knowledge of the disease burden from these diseases does facilitate advocacy for their control. There are several articles in the supplement that highlight the importance of capturing data on NTD morbidity, including the importance and measurement of coverage statistics, and a research agenda for the NNN to identify common indicators that can be shared across NTDs.

Integration

Integration, as it is directly influenced by NTD control and elimination strategies, needs to be strengthened with inclusion of structural system enhancements delivered as part of the universal health coverage agenda. For many NTDs, this does require consideration beyond chemotherapy to include “multi-component integration”. However, it is clearly acknowledged that more evidence is required, that it is expensive and logistically challenging, and that it requires strong cross-sectoral collaboration. In the supplement, Waite et al. provide a comprehensive review of the progress that has been achieved in, and opportunities to prioritise, integrating water, sanitation and hygiene (WASH) with NTD programmes. Integrated WASH and NTD control contributes simultaneously to several Sustainable Development Goals and every opportunity needs to be taken to further promulgate this.

What’s next?

The international health community does need to determine what a truly integrated universal health coverage agenda should encompass. The NNN has contributed heavily to driving this agenda, as have other organisations. Looking beyond NTDs, this is in direct alignment with macro-political strategies as set by the World Bank, the WHO and other parties. By necessity, a universal health coverage agenda must be broader than NTDs, however NTDs are a major part of this (having been referred to by the WHO as a “litmus test”). As NTD practitioners and researchers we therefore have a major opportunity to collectively share knowledge and in so doing propose critical requirements of integrated health care.

We at COUNTDOWN are delighted to see this supplement published and are wholehearted in our support of its messages.

 

Launch of the Ross Fund at LSTM

By Russell Stothard
This Monday LSTM hosted The UK Chancellor of the Exchequer, the Rt Hon George Osborne MP and the philanthropist Bill Gates who came to announce the launch of the Ross Fund.

Named in Honour of Sir Ronald Ross, The Ross Fund is a new international initiative to stem the spread of antimicrobial resistance, move towards elimination of malaria and control several Neglected Tropical Diseases. The Fund is a portfolio of programmes led by the Department for International Development (DFID) or the UK Department of Health.

At the launch, they both gave their opinions about the importance of the Ross Fund and discussed key challenges in global health. They also drew attention to the importance of existing international research networks and how these are set to expand and respond. The discussions were captured on video and illustrate how interventions against malaria and Neglected Tropical Diseases (NTDs) are top priorities.

The Rt Hon Justine Greening, the Secretary of State for Department for DFID, who joined George Osborne and Bill Gates on a tour of the LSTM laboratories, discussing NTD research with Professor Mark Taylor and Dr Joe Turner, from the COUNTDOWN team.
In short, the 25th January was an excellent opportunity to demonstrate to the world the importance of translating the best laboratory findings into the most appropriate public health policies, to transform the lives of those with NTDs by supporting better health for all.

A Scottish encounter with tropical diseases

By Russell Stothard,

I was delighted to be asked to speak at a symposium which formed part of the public engagement activities of the Wellcome Trust Centre for Molecular Parasitology (WTCMP), at the University of Glasgow. There were nine speakers and just over 245 people attended, bringing together a wide audience, from interested sixth form students to keen emeritus professors, all wishing to learn something new about tropical parasites and their associated diseases. If you were unable to attend you can catch up on conversations on Twitter using #GlasgowNTD. Manuscripts inspired from this meeting will form a special issue of the Cambridge University Press journal Parasitology.

Just over 100 years ago R.T Leiper (1881-1969), an alumnus of the University of Glasgow, clarified and revealed key aspects of the schistosome lifecycle. Today, it is still important to remember and promote his special contribution, and those of others, in advancing disease control and alleviation of the suffering of millions throughout the world. Indeed, there is a grand heritage and tradition of pioneering Scots in parasitology and tropical medicine, David Livingstone (1813-1873) and Patrick Manson (1844-1922) to name but a few. They were each introduced to us by Frank Cox (London School of Hygiene and Tropical Medicine) who went on to describe the ‘golden age’ of parasitology, to set the scene for this meeting.

Leiper’s contribution to and influence on helminthology (the study of worms) has been truly immense. His research in China, Japan and Egypt during 1914-1916, enabled him to devise simple measures of control of schistosomiasis. For example, he devised and established water hygiene measures then relevant to disease control in British troops stationed in Egypt. Even today, more detailed study of these measures form key topics in COUNTDOWN’s research agenda. Other speakers addressing aspects of contemporary schistosomiasis control included Alan Fenwick (Imperial College London) who highlighted problems in the scale-up of praziquantel treatment and drew attention to current intervention gaps: poor access to treatment beyond school-aged children, a lack of focus on female genital schistosomiasis and weak health systems.

2015 marked 150 years since the birth of W. B. Leishman (1865-1926), another influential parasitologist in the Royal Army Medical Corps. Leishman described parasites in a patient with ‘Dum Dum’ fever which was to become later known as leishmaniasis as caused by the protozoan parasite Leishmania donovani. Mike Barrett (WTCMP) explained that during WW1 Leishman also pioneered the use of vaccines against typhoid-fevers, saving thousands of lives in the British forces, lives that would have been otherwise lost to disease like their enemy counterparts who had no effective vaccination programme. In terms of available treatments for this disease, Jorge Alvar (DNDi) drew attention to today’s drug armamentarium and the importance of developing effective alternatives. All important issues especially given the havoc that this disease is now causing in Syria.

The third person to be remembered at the symposium was Muriel Roberston (1883-1973) who was influential in the creation of the British Section of the Society of Protozoologists. She played a key role describing aspects of the lifecyle of African trypanosomiasis, another tremendously important neglected tropical disease. As discussed by Tansy Hammarton, WTCMP, this NTD is caused by Trypanosoma brucei and the biology of which has been a longstanding research theme of the WTCMP. Robertson’s early contributions in revealing its lifecycle, and her other pioneering research using the microscope, is even more remarkable when placed within a male-dominated society. Tansy highlighted Roberston’s quote when asked what it was like working in Uganda “…it compares nothing to suffering one has to endure upon the horror of the modern cocktail party”.

There was ample time for general questions at the end of the meeting. The most pertinent of which from a local sixth-form teacher who was leading a group of her students “How can you work towards a career in tropical medicine?” No doubt this was firmly inspired John Kusel’s (University of Glasgow) presentation where he demonstrated fluorescent microscopy and his joy in its application leading to several discoveries in the biology of schistosomes. John mentioned that to advance scientific and medical research we often stand upon the shoulders of scientists, like Leiper, Leishman and Robertson, but harness our human creativity which bridges science, art and religion. In closing the meeting, Mike Barrett’s answer and final words were particularly guiding for we had clearly achieved our goal, perhaps best summed by Tennyson “To strive, to seek, to find, and not to yield”.

Come see COUNTDOWN at the Prince Mahidol Award Conference

We’re delighted to be attending this year’s Prince Mahidol Award Conference which is focussed on the theme of Universal Health Coverage. We’ll be represented by Kate Hawkins, Sally Theobald and Louis-Albert Tchuem Tchuenté.

At the conference we’ll be presenting our poster on progress on control and elimination of Neglected Tropical Diseases (NTDs) as the ‘litmus test’ for Universal Health Coverage (UHC). Mass Drug Administration (MDA) has been successful in reaching high numbers of people affected by NTDs resulting in progress toward the control and elimination of NTDs in many contexts. However, numerous bottlenecks still remain for the scale-up of MDA if the WHO 2020 targets are to be met. If UHC is to be achieved these aspects need to be addressed and the health system strengthened. We outline the challenges that are being faced under the six health systems building blocks – financing, workforce, information and research, service delivery, leadership and governance, and medical products and technologies – and suggest some ways forward.

If you are attending the conference do come and find us. It would be good to connect.

4th Angolan Conference on Science and Technology

‘Together for strengthening the insertion of science, technology and innovation in the country development strategy’ was the motto of the 4th National Conference on Science and Technology in Angola. The conference is a bi-annual event to encourage the presentation and discussion of scientific works among the Angolan community. The conference assessed the successful experiences of other countries such as South Africa, Botswana, Brazil, Canada, Cuba, Spain, USA, France, Mozambique, Portugal and Zimbabwe.

The event took place simultaneously with the Seventh Fair of Inventors and Creators of Angola (FEICA 2015), the International Fair of Ideas, Inventions and Products Valorisation, and the Science and Technology Fair.

About 300 people attended and included government officials, national and foreign experts, representatives of the United Nations and European Union, teachers, students and potential investors.

Among them was Mr Getachew Engida, the UNESCO Deputy Director-General, who gave a keynote on the Sustainable Development Goals. These goals are universal and will be applied to the North and the South. One of the driving forces behind them is the imperative of the need to act on climate change understanding that we cannot continue to consume energy in the manner that we currently do.

Science, technology, innovation and health

Science, technology and innovation – including information and communication technology – will be central to the achievement of all of the seventeen goals. There is a need to ensure that the benefits of science, technology and innovation are spread throughout society.

The diseases which are a priority in the Africa region – such as Neglected Tropical Diseases, malaria and TB – haven’t been appropriately tackled by research. One of the reasons for this is that they have never impacted significantly on high-income countries. The capacity of people affected by diseases of poverty to pay for prevention and treatment is often constrained by poverty. As a result they do not receive adequate private sector investment.

Yet it is clear that this is a situation that could change. The rush to develop an Ebola vaccine when it became clear that the outbreaks could effect rich Northern countries is testament to this. Previous outbreaks were relatively localised and did not attract the interest and investment that we have seen in West Africa. Although the effects of the outbreak were equally devastating for those who were impacted.

Growing local capacity for science technology and innovation

At the conference I had the opportunity to present a poster presentation on the on-going work from my PhD on the mapping of Neglected Tropical Diseases using RAPLOA and REMO in Bengo province, Angola.

I was one of many national scientists who are working to increase local capacity through research that focuses on Angola’s development priorities. For science, technology and innovation to benefit those most in need we must reorientate investment and capacity to those researchers and scientists who are able to reflect the needs of their nations in the issues that they focus on and the potential beneficiaries of their scientific discoveries.

How can we make Universal Health Coverage truly universal? Equity, gender, disability, and NTDs

By Russell Stothard and Kate Hawkins

Equity is a weak spot in Neglected Tropical Disease (NTD) policy and practice; often aspired to but rarely realised. At the recent COR-NTDs meeting we hosted a session which brought together experts who have been struggling to address equity issues with regard to overlooked and under-prioritised populations. It provided examples of current work on equity and NTDs from multilateral, bilateral, national and community level perspectives. The objectives of the session were: (1) To explore how equity is being addressed in relation to NTDs at different levels of the health system; and (2) To identify key research questions for equity and NTD programming and make recommendations for equity and NTDs policies and programmes.

The session began with a presentation by Margaret Gyapong who provided case studies on Onchocerciasis and schistosomiasis that highlighted inequity in access to treatment and morbidity management. A panel including Charles MacKenzie (LSTM) who chaired the session, Samantha Page (LSTM), Camilla Ducker (DFID), and Elizabeth El-Hassan (SightSavers) provided expert reflection on the issues.

What issues came up?

Small group work enabled us to get detailed feedback on research priorities and areas where there are evidence gaps.

Community and District levels: Participants felt that more research was needed into the social benefits of disease control (for example, less stigmatization in key groups, improved family planning and reproductive health).There were also concerns that there is little formal documentation of resources among Community Drug Distributors – a group that has a great deal of potential to act on equity and the social determinants of health.  There were felt to be gaps in our understanding of gender-specific issues in the need and delivery of interventions. For example, the way that current programmes for schistosomiasis and soil transmitted helminths mostly target school aged children meaning that particular groups – such as adults and children who do not attend school – fail to benefit from them.

National level: Participants mentioned weaknesses within current methods of data collection, and that transgender issues were of growing importance. The need for gender-specific messaging within health interventions was recognized and that there is a need to test alternative programme strategies to maximize programmatic impact among people of all genders. More clarity is needed on exactly what data is collected and harmonization with other interventions for example on Malaria and HIV may be needed. Participants wondered whether all the data included in the NTD master plans took account of gender related issues for example, sex disaggregated data on community drug distributors. How these master plans relate to broader health strategies and plans was considered to be important as was how Ministries of Gender and the Family understood and supported work on NTDs.

International level: Participants felt that there could be more clarity on the use of Preventive Chemotherapy medicines in pregnancy and antenatal care. More could be done to elaborate what universal health coverage might look like in relation to the Preventive Chemotherapy amenable NTDs and understanding and aligning the reporting indicators that national governments will use. More could be done to understand how gender and other inequities potentially act as a barrier to treatment and perhaps this could be the topic of a systematic review.

We are thankful to all participants for engaging so thoroughly and we look forward to continuing this discussion and taking forward some of the suggestions.

Photo courtesy of the World Bank.

From PK-PD to COUNTDOWN: Multidisciplinary studies on schistosomiasis in Africa

On Friday the 20 November Russell Stothard will be presenting at the London School of Hygiene and Tropical Medicine in one of the regular seminars of the Department of Immunology and Infection.

Russell will discuss contemporary research on schistosomiasis and draw attention to the pioneering early role of the London School’s first helminthologist, Robert Leiper, who uncovered the lifecycle of the African schistosome 100 years ago. Russell’s recent work in Uganda has drawn attention to a significant burden of disease in pre-school children, and he will present the case as to why expanded access to praziquantel treatment is needed now. Ongoing pharmacokinetic and pharmacodynamic (PK-PD) suggests that higher doses of praziquantel may be required.  Russ will close showing how implementation research, as framed within the DFID-funded COUNTDOWN consortium, is playing an important role in accelerating towards WHO 2020 NTD targets.