• Start Date: July 2023
• Duration: June 2028
• Funder: NIH
• Principal Investigator: Dr Oghenebrume Wariri
• Collaborators:  Prof Beate Kampmann (MRC Unit The Gambia at LSHTM) and Prof Jessica Metcalf (Princeton University, USA)

In this NIH-funded project, we will apply novel spatiotemporal modelling approaches to map the subpopulation with untimely measles vaccination and zero-dose at fine-spatial scale and examine potential links with suboptimal herd immunity and risk of measles outbreaks. We will also examine how geographic accessibility shapes the uptake and delivery of routine vaccination in The Gambia.

The project will leverage longitudinal cohort data from health and demographic surveillance systems in The Gambia and serological samples covering rural populations in the Basse health and demographic surveillance system.

There are four specific aims for this K43 award:

1. To determine the spatiotemporal pattern of untimely MCV1 and zero-dose children at high-spatial resolution in The Gambia.
2. To determine if there is a spatiotemporal relationship between cluster location of untimely MCV1 and measles population immunity in The Gambia.
3. To investigate the contribution of geographic accessibility (between households and vaccination posts; and between fixed and outreach vaccination posts) to zero-dose prevalence and delayed MCV1.
4. To model geographic access to routine vaccination services to understand the utility of the current vaccine delivery channels and potentially identify optimal locations of vaccination clinics and posts.

• Start Date: August 2023
• Duration: 18 months
• Funder: Bill & Melinda Gates Foundation
• Principal Investigator: Beate Kampmann, Oluwatosin Nkereuwem 
• Co-Investigators: Dr Uduak Okomo (MRCG at LSHTM), Rachel Ford (LSHTM), Ugochukwu Madubueze (National Obstetric Fistula Centre, Abakiliki), Agnes Msoka (Kilimanjaro Christian Medical Centre), Dr Dan Kajungu (Makerere University Centre for Health and Population Research, Uganda), Suraj Bhattarai (Siddhi Memorial hospital, Nepal), Dr Mir Mobarak Hossain (Directorate of General Health Services, Bangladesh),
• Collaborators:  MoH The Gambia, NOFC, KCMC, MUCHAP, SMH, DGHS

While vaccinating pregnant women to prevent infections in them and their newborns is a proven strategy to reduce maternal and neonatal morbidity and mortality, challenges persist. These challenges include vaccine acceptability among pregnant women and healthcare workers and logistical issues like access, affordability, availability, and timing of vaccine administration. The timing is crucial to minimize risks and ensure optimal antibody transfer to the baby. With new vaccines for RSV and GBS on the horizon, it is important to investigate real-world implementation in low- and middle-income countries (LMICs). These settings may face different challenges compared to controlled clinical trials, potentially impacting vaccine effectiveness. Understanding gestational age at antenatal care visits and the number of women attending within the 24 - 36 week window is essential. This multi-country project (The Gambia, Nigeria, Uganda, Tanzania, Nepal, Bangladesh) aims to gather detailed data from representative LMIC antenatal services to optimise new vaccine implementation.

• Start Date: March 2023
• Duration: 12 Months
• Funder: Belmont Forum
• Principal Investigator: Dr Sari Kovats
• Co-Investigators: Dr Uduak Okomo (MRCG at LSHTM), Dr Cherie Part (LSHTM), Dr Oghenebrume Wariri (MRCG at LSHTM), Dr Ana Bonel (MRCG at LSHTM), Professor Kris Murray (MRCG at LSHTM), Professor Veronique Filippi (LSHTM), Dr Shakoor Hajat (LSHTM)
• Collaborators:  MoH The Gambia; CHAMNHA

High environmental temperatures can overwhelm pregnant women's thermoregulatory capacity, leading to adverse birth outcomes. Despite growing interest in the effects of ambient heat on maternal and neonatal health (MNH), few studies have been conducted in sub-Saharan Africa (SSA), where foetal and maternal deaths are frequent, health systems have low adaptive capacity, and extreme weather events increasingly disrupt access to health services. Temperatures across Africa are rising rapidly and are expected to exceed 50°C in the Sahel region by the end of the century. The CHAMNHA (Climate, Heat, and Maternal and Neonatal Health in Africa) project aims to understand and mitigate the impacts of heat stress on MNH, enhance healthcare system resilience, and provide evidence-based interventions to protect against heat-related stillbirths. This secondary analysis of facility-based stillbirth data specifically aims to assess the burden of heat-related stillbirth in The Gambia.

• Start Date: July 2022  
• Duration: 26 months
• Funder: US Centers for Disease Control
• Principal Investigator: Professor Beate Kampmann
• Co-Investigators: Dr Uduak Okomo (MRCG at LSHTM), Oluwatosin Nkereuwem (MRCG at LSHTM), Ashley Longley (CDC/GHC/GID), Jane Gidudu (CDC/GHC/GID), Dr Mustapha Bittaye (MoH The Gambia), Dr Momodou T. Nyassi (MoH The Gambia), Sonali Kochhar (University of Washington, Seattle)

The SARS-CoV-2 pandemic has highlighted that pregnant women are particularly vulnerable to poor outcomes, prompting specific vaccination recommendations during pregnancy. However, initial clinical trials excluded pregnant women, so most safety data come from post-implementation studies in high-income countries, focusing on mRNA vaccines. No alarming safety signals have emerged, but it is crucial to expand safety data to pregnant women in low- and middle-income countries and include other COVID-19 vaccines, such as those available in The Gambia. This active vaccine safety surveillance program aims to generate data on adverse events of special interest (AESI) among vaccinated pregnant women and compare them with unvaccinated cohorts. The observational study will address potential confounders and strengthen pregnancy outcome reporting with active participation from the Ministry of Health and the Medicines Control Agency, contributing valuable data to global safety surveillance efforts.

• Start Date: January 1, 2018
• Duration: 93 months
• Funder: BMGF
• Principal Investigator: Prof Grant Mackenzie
• Collaborator: MCRI, LSHTM, THL FINDLAND, MOH, SGUL

A cluster-randomized non-inferiority trial of the effect of a two-dose schedule compared to a three-dose. The purpose is to evaluate whether a two-dose schedule of pneumococcal conjugate vaccine (PCV) is as effective as a three-dose schedule, thereby enhancing the prevention of pneumonia and other pneumococcal diseases in low- and middle-income countries through the schedule of the pneumococcal conjugate vaccine.

• Start Date: January 1, 2024
• Duration: 18 months
• Funder: BMGF
• Principal Investigator: Prof Grant Mackenzie
• Collaborator: LSHTM

K. pneumoniae and E. coli are major pathogens causing neonatal and infant sepsis. The burden of infant sepsis is highest in low-income countries in Africa. Antimicrobial resistance in invasive K. pneumoniae and E. coli is common, particularly among the former, and this greatly complicates therapy. Neonatal and infant sepsis with these pathogens is often associated with nosocomial outbreaks. Outbreaks and antimicrobial therapy are particularly problematic in low-resource settings, where microbiology services are commonly non-existent and second-line antimicrobials are generally unavailable. Development of vaccines against these pathogens is a priority and a range of different vaccine development platforms are being pursued. Vaccines against K. pneumoniae are likely to be based on O-antigen and other conserved capsular antigens. Vaccines against E. coli are likely to focus on toxin types, O-antigen types, and other conserved capsular antigens. There are limited data on the distribution of K. pneumoniae and E. coli antigenic proteins and polysaccharides from isolates causing invasive disease in Africa.

• Start Date: November 2022
• Duration: 2 years
• Funder: Medical Research Foundation 
• Principal Investigator: Dr Toyin Togun 
• Co-Principal Investigator: Dr Esin Nkereuwem
• Co-Investigators: Dr Schadrac Agbla (University of Liverpool), Dr Muyiwa Owolabi (MRCG at LSHTM), Mrs. Monica Davis (MRCG at LSHTM), Dr Sheila A. Owusu (MRCG at LSHTM), Dr Victory F. Edem (MRCG at LSHTM/University of Ibadan, Nigeria)

Spirometry is the standard method most widely used to assess pulmonary function. However, its interpretation relies on comparison with reference ranges derived from extensive studies from different parts of the world. The currently-used Global Lung Initiative (GLI) race-based and race-neutral reference ranges are deficient as they do not capture data of diverse African populations, with none from West Africa in particular. 

The RANGE study aims to generate locally-appropriate spirometry data, which can serve as a reference point for assessment of chronic lung disease among Gambian children. Healthy children from randomly selected primary and secondary schools within the Greater Banjul Area (GBA) will be recruited, and they will have lung functions tests performed by portable spirometry. We will use the Lambda-Mu-Sigma (LMS) model to generate z-scores for the age- and height-standardized reference curves for each lung function parameter stratified by sex.

The findings from this study are intended to be generalizable to other TB-endemic settings in West Africa.

• Start Date: December 2022
• Duration: 3 years
• Funder: EDCTP via the West Africa Networks of Excellence for TB, AIDS and Malaria
• Principal Investigator: Dr Toyin Togun 
• Co-Investigators: Dr Victory F Edem (MRCG at LSHTM/University of Ibadan, Nigeria), Dr Kwabena A Osman (KBTH, Ghana), Dr. Audrey G Forson (KBTH, Accra, Ghana), Dr Arnauld Fiogbe (CNHU-PPc, Cotonou, Benin), Prof Dissou Affolabi (CNHU-PPC, Cotonou, Benin)
• Collaborators:  West Africa Paediatric TB Network (WApTBNet); WANETAM TB Network

Diagnosis of pulmonary tuberculosis (TB) in children is challenging for several reasons including difficulties in obtaining good quality sputum samples and the paucibacillary nature of the disease in children. As such, sensitivity of the conventional TB diagnostic tests is considerably lower in children relative to adults.

The aim of this multi-country project is to pragmatically investigate the utility and added-value of non-sputum based approaches, including computer-aided diagnosis of TB (CAD4TB) and stool testing by Xpert Ultra, for diagnosis of pulmonary TB in children. Children with clinical suspicion of TB disease will be consecutively recruited for detailed evaluation at study sites in The Gambia (MRCG at LSHTM), Ghana (Korle-Bu Teaching Hospital [KBTH]), and Benin Republic (National Teaching Hospital for TB and Respiratory Diseases [CNHU-PPC]).

This study will provide valuable information on how many additional childhood TB cases could be detected when these non-sputum based approaches are used in combination with conventional diagnostic tests within national health systems in West Africa.

• Start Date: January 21, 2024
• Duration: 24 months
• Funder: Science for Africa (SFA) Foundation
• Principal Investigator: Dr Zakari Ali
• Co-Investigators: Prof Kris Murray (MRCG), Dr Tony Carr (LSHTM), Prof Andrew Prentice (MRCG), Prof Rosemary Green (LSHTM) 
• Collaborators: Dr Amat Bah (National Nutrition Agency - NaNA), Mr Abdou Aziz Ceesay (NaNA), Dr Alcade Segnon (Alliance of Bioversity and CIAT - Senegal)

The DiGES project aims to identify and promote the consumption and production of underutilized crops that are more resilient to climate change, reduce environmental impacts, and have positive health attributes. Studies have investigated different ways to produce enough food under climate change – with diverse evidence of success. This project examines how populations can demand and consume foods that are more climate resilient.

The project uses population diet as the entry point to agricultural adaption to climate change by identifying the barriers and opportunities for populations to demand and consume locally available and climate resilient foods. The study team will also model different food system scenarios under climate change – engage food system stakeholders, policymakers and local farmers, and use social behaviour change communication (SBCC) strategies to promote the demand, consumption, and production of climate resilient crops.

Contacts: Carla Cerami, Andrew Prentice
Funding: MRC

This project seeks to identify the sources of persistent low-grade inflammation in well and sick Gambian children. It will additionally try to understand the complex interacting mechanisms linking iron absorption, distribution and erythropoiesis to the effects of inflammation mediated through hepcidin, erythropoietin (EPO) and the newly discovered hormone erythroferrone (ERFE) which signals to the liver that the bone marrow requires iron. Finally we will conduct a randomised controlled trial to test whether it is possible to circumvent the hepcidin-induced blockade of iron absorption by administering iron in the form of haem. Another arm of this trial will be a proof-of-principle trial to assess the impact of reducing inflammation by co-administering azithromycin and galacto-oligosaccharides with iron. These studies, if successful, would suggest the need for a radical revision of current policies to combat IDA.