My research spans three main areas:

1. Digital health interventions for contraception
2. Tropical medicine
3. COVID-19

My work has mostly had a clinical epidemiological focus often in Southeast Asia, particularly Cambodia and the Philippines. I have experience conducting randomised controlled trials, observational studies, systematic reviews, qualitative, and cost-effectiveness studies.

Digital health interventions for contraception

I became interested in family planning when I worked for the Maddox Jolie-Pitt Foundation and the UK National Health Service on a health project in rural Cambodia which involved establishing family planning services at the health centres. We learned that there was demand for family planning but at the same time contraceptive discontinuation was common, mainly due to fear or experience of side-effects. It was the concept that additional support could be provided by mobile phone that led me to the topic of my PhD research.

My PhD, which was funded by the UK Medical Research Council (2014-17) focussed on understanding the effectiveness of digital health interventions delivered by mobile phone to increase contraception use. I was the lead investigator of the Marie Stopes International funded MObile Technology for Improved Family Planning (MOTIF) trial of an intervention comprising automated voice messages +/- counsellor support for contraception in Cambodia. The intervention increased use of post-abortion contraception, was acceptable and cost-effective, and subsequently included as a case study of digital technology high-impact practice in family planning for social and behavior change.

Our 2015 Cochrane review of Mobile phone-based interventions to improve contraception use identified five randomised controlled trials. For our update of this review published in 2023 we identified 23 trials indicating significant activity in this area. We were able to conduct a meta-analysis demonstrating evidence to support mobile phone-based interventions in improving the use of contraception, compare unidirectional and interactive interactions, and code behaviour change techniques in the interventions.

I was the principal investigator of a project funded by the Arts & Humanities Research Council (AHRC) from 2018 to 2020 to develop interventions (edutainment videos) to support reproductive health of garment factory workers in Cambodia.

I have provided support to related projects at LSHTM (trials in Bangladesh and Zimbabwe) and Oxford University (investigating side effects in Ethiopia).

Tropical medicine

Since 2017 I have been supporting the research programme of the San-Lazaro hospital-Nagasaki University (SLH-NU) collaborative research office and laboratory. Research themes of the collaboration have included aetiology of fever, and diseases such as leptospirosis, diphtheria, measles, HIV, tuberculosis, rabies, dengue, and typhoid.

Aetiology of fever: Nagasaki University and SLH have been running a Community-Acquired Bacteraemia (CAB) study since 2015. We are conducting additional in-depth analysis on diseases such as typhoid fever, diphtheria, and dengue. We are currently redesigning the CAB study as a platform study able to enrol patients with a broader range of conditions.

Leptospirosis: A major area of work is on leptospirosis, through epidemiology, pathophysiology, diagnosis and management. With colleagues at Nagasaki University we have published Cochrane reviews to establish the evidence base for antibiotic prophylaxis, antibiotic treatment, and corticosteroid treatment (protocol) for the condition. We reported leptospirosis as an important cause of fever and jaundice in the Democratic Republic of the Congo. A PhD student is developing a Core Outcome Set for Leptospirosis trials with view to developing a core trial protocol for a multi-site trial of treatments. 

Measles: We conducted a descriptive analysis of over 5,000 children hospitalised with measles in San Lazaro Hospital during the 2018-19 outbreak. The analysis reconfirmed the protective efficacy of measles vaccination and Vitamin A supplementation. Over one-third of deaths occurred in children aged <9 months, prior to routine administration of the first dose of measles-containing vaccine (MCV-1). A Master's student has conducted a systematic review comparing effectiveness of standard vs. early timing of MCV-1.

Rabies: San Lazaro Hospital admits around 50 patients with rabies each year and has an animal bite treatment centre (ABTC) conducting around 800 consultations per day. With colleagues, a retrospective analysis of rabies cases in Metro Manila from 2006-2015 was conducted. A PhD recent completed an analysis of post-exposure prophylaxis adherence at the ABTC. 

Snakebite: With colleagues in the Eastern Visayas Medical Centre (Leyte, Philippines), a Master's student reported the first case series of Samar cobra, Naja Samarensis, bite, a snake for which there is no currently available antivenom. Future work will explore the possibility of the development of novel antivenoms and diagnostic tests for snakebite in the Philippines.

COVID-19

Philippines: We published the report of the first COVID-19 cases in the Philippines, including the first death outside of China. We have published several other analyses including characteristics of suspected cases, confirmed cases, paediatric cases, and population seroprevalence over time.

Brazil: Along with collaborators at the Oswaldo-Cruz Institute, I was the UK PI of a UKRI GECO-funded project examining COVID-19 infection and immunity amongst a paediatric cohort and household contacts in a favela in Rio de Janeiro, Brazil. Outputs include infection dynamics, SARS-CoV-2 incidence over four epidemic waves, and the role of children across successive waves of the pandemic.

Vaccine effectiveness: A PhD student analysed risk factors for COVID-19 infection and vaccine effectiveness in Japan and the Philippines.

Experience of COVID restrictions: We collaborated with Roehampton University in the UK on a British Academy-funded project on the public response to public health and social measures. I am currently PI of a project funded by the Japanese Society for the Promotion of Science to document the international travel experience (particularly hotel quarantine) during the COVID-19 pandemic.

Other activities

I undertake peer review for various journals and am an editor for the Tropical Medicine and Health journal. Details of grants and work I have been involved in are also available on ORCID and ResearchMap.