Introduction from Professor Amaya Bustinduy, infectious diseases specialist and Child theme co-lead at the MARCH Centre.

"World Neglected Tropical Diseases Day, on 30^th January, acts as a rally point to focus efforts on better control of Neglected Tropical Diseases (NTDs)."

World Neglected Tropical Diseases Day, on 30^th January, acts as a rally point to focus efforts on better control of Neglected Tropical Diseases (NTDs). The Schistosomiasis Clinical Research Group, based in the Faculty of Infectious Tropical Diseases at the London School of Hygiene & Tropical Medicine, pays specific attention to NTDs that are amenable to preventive chemotherapy. Working in partnership with Zambart in Zambia and the MRC Unit in Uganda, we have a wide portfolio addressing the impact on the health of preschool children living with schistosomiasis and the best way to treat them.

The group’s research interests also include improving detection of female genital schistosomiasis (FGS), a neglected gynaecological disease caused by the Schistosoma parasite often confused with sexually transmitted infections. We are using a novel combination of home-based sampling with genital self-swabbing packs and development of point-of-contact molecular diagnostics to increase surveillance at scale. Our innovative Schista! study plans to integrate FGS detection within the wider sexual and reproductive health landscape.

Our research aligns closely with the Adolescent and Child themes of the MARCH Centre and our findings are shedding new light on NTDs. It’s so important to have a day dedicated to NTDs and we are delighted that one of our former students has gone on to support their elimination through her work.

 

Former MSc student, Sarit Baum, now works as Communications & Donor Relations Officer at NALA, a foundation working to eliminate Neglected Tropical Diseases (NTDs) and prevent the cycle of poverty. We caught up with her to learn more about their work and how her time at LSHTM has shaped her career so far.

 

Tell us how you came to study at LSHTM…

I grew up in Northwest London and opted to study Biomedical Sciences at UCL because I wasn't sure exactly what I wanted to do. During the long university summers, I travelled a lot, and one of the places that I visited was the Dharavi slums in Mumbai, India, which really inspired me to pursue Global Health.

I later took an opportunity to go on a social justice trip back to India, called the ‘Ben Azzai’ programme, which is targeted at Jewish students from UK universities. I went to the West Bengal region and met with an organisation called the ‘Economic Rural Development Society (ERDS)’ who work on small scale community projects, specifically those that empower women. My experience with them confirmed for me that Global Health was the route I wished to pursue.

At the same time, I was having my own gut health and digestion issues, so I was considering specialising in nutrition. I went to LSHTM's Open Day in 2019 and discovered the MSc Nutrition for Global Health course. I applied, got in, and studied at the School from 2019 to 2020. I really enjoyed it.

 

Did COVID-19 affect your studies?

It was the first year of COVID-19 so we were able to go in to the School in person until around March. I had my summer project lined up to go to the Philippines for three months with Professor Sharon Cox to research Tuberculosis (TB) and malnutrition, which tied into my undergraduate degree of Biomedical Sciences. But then coronavirus came around, we moved online, and I couldn’t visit the Philippines.

 

What did you end up doing instead?

I originally planned to explore the acceptance of nutritional supplements for patients with TB in the Philippines. So instead, I conducted a secondary data analysis using the same cohort: patients with TB in the Philippines who were malnourished. I wrote a paper on whether the mid-upper arm circumference (MUAC), was a good indicator for the outcome of TB versus body mass index (BMI).

It was a really interesting paper to write, and my supervisor, Sharon Cox, was fantastic and incredibly supportive. She went through the data analysis with me and guided me well. I was really happy with my final paper.

 

What were the main findings of the analysis?

I found that the lower MUAC someone had, the more likely they were to have an adverse outcome – which means death. It was as expected, if you are malnourished, you're more likely to die from TB.

Often people can't stand when they're too weak due to TB or malnutrition which makes it difficult to measure BMI accurately. MUAC on the other hand can be measured in whatever position you're in. The chances are, if those collecting the data couldn’t get a BMI, the patient had a very low MUAC anyway, meaning the outcome was likely to be adverse. 

"The point of my MSc was not just to focus on nutrition, but to prepare me for any public health intervention."

That's really interesting. Have you gone on to work on similar topics in your current role?

After my MSc, I emigrated to Israel. My family lives here and it was time for a change. I spent 6 months learning Hebrew whilst interning at an international development organisation - OLAM. Through them I met the CEO of NALA, Michal Bruck. NALA is a public health organisation that works to combat NTDs in Ethiopia. We partner with lots of different organisations, including LSHTM, and are looking to expand into other countries.

Although NALA’s work is not specifically malnutrition focused, I'm utilising a lot of the skills that I gained through my MSc degree such as project planning and analysis. My role here is in Communications and Operations so I’m exposed to various aspects of our work. Infectious diseases are so closely linked with malnutrition, that I can see it linking up in some upcoming projects which is great, but I feel that the point of my MSc was not just to focus on nutrition, but to prepare me for any sort of public health intervention. There's a lot of water, sanitation, and hygiene (WASH) that comes up in my work too and we also work on educational and national policies.

I’ve really benefitted from the way that LSHTM taught me to be forward thinking and to avoid being a ‘white saviour’. They emphasise working with local people, utilising what's already in the environment and producing context specific materials. This has really guided me well into my first job working with communities in low-income countries.

"I’ve really benefitted from the way that LSHTM taught me to be forward thinking and to avoid being a ‘white saviour’. They emphasise working with local people, utilising what's already in the environment and producing context specific materials. This has really guided me well into my first job working with communities in low-income countries."

Are you working remotely?

The NALA headquarters are based in Tel Aviv, which is where I am. We then have a team of 70 local staff members in Ethiopia, who are based within the local health and education offices. We also have offices in Addis Ababa and Bench Maji. The headquarters here focus on grant applications, donor relations, programme planning and communications but the team in Ethiopia runs the project from start to finish.

Normally the staff at headquarters visit the country teams regularly but due to COVID-19 we haven’t been able to visit as often as we like. I travelled to Ethiopia in October 2021 and once we can we will travel more, to provide support, technical expertise, and to gather content for communications, but it's very important for us to employ and work local.

 

When you were out in Ethiopia, what did you do?

I was there for 10 days, meeting the team and visiting the offices and projects. We have a lot of projects in the South, mainly with Sightsavers, the END Fund and the Merck group, who together with the UK-based Pears Foundation are our biggest partners. I was also able to visit healthcare centres and the rivers and streams that are used by the community. It helped me to understand the context of our work better and reinforced why we do what we do. It was my first time in sub-Saharan Africa and it was an incredible trip.

The projects we implement through NALA are community focused and community led, so before we implement anything we talk to the religious and community leaders, mothers, government officials, zonal WASH and health officers, and the NTD team. We ask them what the situation is like in the area, what needs to be improved, as well as gather an understanding of the community’s attitude and practices associated with NTDs.

It’s very encouraging to see that small changes can make a massive difference. Monitoring and Evaluation (M&E) is very important to us, and we collect baseline, midline and endline data for all our projects. We also conduct Knowledge Attitudes & Practices (KAP) surveys. We’ve been able to see a reduction in intestinal worms in the stool samples of schoolchildren for example, and positive changes in their knowledge of diseases, their attitude towards the use of rivers and streams, and their hand washing habits – all things that are directed at raising awareness of NTDs.

NALA is an incredibly progressive organisation, they really echo everything that LSHTM has taught me in terms sustainability, appropriate language and employing locals. We're making a video for our 10-year anniversary and it’s really important to me to ensure we are not portrayed as the heroes of the story.

"I felt like I was part of something bigger and I always feel like I can go back to anyone LSHTM."

What three words sum up your time at LSHTM?

Enlightening. Then I want to say community/family, I felt like I was part of something bigger and I always feel like I can go back to anyone LSHTM. Our course WhatsApp group is still active. Then learning, I learnt a huge amount.

 

Do you have any advice for new MSc students?

Utilise the LSHTM name, faculty, and community because there's so much to offer. They have connections all around the world so don't be afraid to say “Yes, I went to LSHTM, and I studied this, and I learned this, and these are my connections, this was my head of course.”