Liverpool School Of Tropical Medicine Research Articles

Cross sectional survey of maternal and newborn quality of care in Niger: Selected findings, lessons learned and recommendations.

Comprehensive assessments of quality of care (QoC) are essential for monitoring progress towards meeting global and national maternal and newborn health (MNH) targets. Liverpool School of Tropical Medicine (LSTM) and the Niger Ministry of Public Health adapted a 2014 WHO QoC tool to cover antenatal care (ANC) and postnatal care (PNC) and include client voices through exit interviews. The objectives of the study were to assess quality of MNH care in Niger and to document lessons learnt from implementing the LSTM QoC tool. Quality of Care (QoC) was assessed using five tools: health facility survey (using register and official record data), partograph reviews, healthcare provider knowledge assessment, exit interviews with clients, and observation of antenatal and postnatal care. A nationally representative sample of 110 public healthcare facilities at three levels (integrated health centres, district hospitals and mother-child hospitals) and 2153 women were included. Descriptive analysis with 95% confidence intervals was presented. The health facility survey showed variable access to electricity (63% [53-72]), water (72% [62-81]), and transportation (40% [31-50]). Tests and treatment for HIV, TB, and malaria were found in more than 90% of relevant facilities. During observation of first ANC visit, 62% [48-74] women were tested for HIV; 13% [5-30] for pre-eclampsia and 22% [12-36] for anaemia. Observation of PNC showed much lower rates of screening (15% [7-27] tested for HIV and 4% [0;11] for malaria). Partographs were used in 86% of deliveries with inconsistent completion. At client interviews, respectful care indicators were variable, with providers not always explaining results to clients (59% [50-67]). Targeted allocation of resources and training could impact on QoC and reduce missed opportunities for prevention, screening and management of diseases among pregnant women and babies. The QoC assessment tool proved capable of offering a comprehensive overview of priorities in MNH, while maintaining feasibility in the Nigerien context.

A combined tropical medicine and psychiatry approach to patients with possible delusional infestation.

Delusional infestation (DI) is a well-recognized delusional disorder presenting as the persisting belief of being infested. Combined clinics have been run by dermatology and psychiatry in a small number of centres. In this article we focus on our Liverpool University Hospitals NHS Foundation Trust clinic hosted at the Liverpool School of Tropical Medicine, UK, where we run a specialist clinic for DI. We describe the specific set-up and approach of our clinic as a guide for clinicians working in specialties likely to see patients with DI (including tropical medicine, infectious diseases and dermatology) who may either want to set up similar clinics or be better equipped to manage DI patients promptly within existing practice. We describe the details of the clinic's approach. Between 2018 and 2023, the service saw 208 patients, of which 82.7% could be assessed and 55.7% had DI. The female:male ratio was 2:1. Interdisciplinary combined clinics with medical and psychiatry consultants working together offer an approach to managing this rare, challenging and high-consequence condition.

Mosquitoes reared in distinct insectaries within an institution in close spatial proximity possess significantly divergent microbiomes.

The microbiome affects important aspects of mosquito biology and differences in microbial composition can affect the outcomes of laboratory studies. To determine how the biotic and abiotic conditions in an insectary affect the composition of the bacterial microbiome of mosquitoes we reared mosquitoes from a single cohort of eggs from one genetically homogeneous inbred Aedes aegypti colony, which were split into three batches, and transferred to each of three different insectaries located within the Liverpool School of Tropical Medicine. Using three replicate trays per insectary, we assessed and compared the bacterial microbiome composition as mosquitoes developed from these eggs. We also characterised the microbiome of the mosquitoes' food sources, measured environmental conditions over time in each climate-controlled insectary, and recorded development and survival of mosquitoes. While mosquito development was overall similar between all three insectaries, we saw differences in microbiome composition between mosquitoes from each insectary. Furthermore, bacterial input via food sources, potentially followed by selective pressure of temperature stability and range, did affect the microbiome composition. At both adult and larval stages, specific members of the mosquito microbiome were associated with particular insectaries; and the insectary with less stable and cooler conditions resulted in slower pupation rate and higher diversity of the larval microbiome. Tray and cage effects were also seen in all insectaries, with different bacterial taxa implicated between insectaries. These results highlight the necessity of considering the variability and effects of different microbiome composition even in experiments carried out in a laboratory environment starting with eggs from one batch; and highlights the impact of even minor inconsistencies in rearing conditions due to variation of temperature and humidity.

A feasibility study of controlled human infection with intradermal Bacillus Calmette-Guérin (BCG) injection: Pilot BCG controlled human infection model.

Tuberculosis (TB) caused 1.5 million deaths in 2020, making it the leading infectious killer after COVID-19. Bacille Calmette-Guerin (BCG) is the only licensed vaccine against TB but has sub-optimal efficacy against pulmonary TB and reduced effectiveness in regions close to the equator with high burden. Efforts to find novel vaccines are hampered due to the need for large-scale, prolonged, and costly clinical trials. Controlled human infection models (CHIMs) for TB may be used to accelerate vaccine development by ensuring only the most promising vaccine candidates are selected for phase 3 trials, but it is not currently possible to give participants Mycobacterium tuberculosis as a challenge agent. This study aims to replicate and refine an established BCG CHIM at the Liverpool School of Tropical Medicine. Participants will receive an intradermal injection with licensed BCG vaccine (Statens Serum Institut strain). In phase A, participants will undergo punch biopsy two weeks after administration, paired with minimally invasive methods of skin sampling (skin swab, microbiopsy, skin scrape). BCG detection by classical culture and molecular methods will be compared between these techniques and gold standard punch biopsy. Techniques meeting our pre-defined sensitivity and specificity criteria will be applied in Phase B to longitudinally assess intradermal BCG growth two, seven and fourteen days after administration. We will also measure compartmental immune responses in skin, blood and respiratory mucosa in Phase B. This feasibility study will transfer and refine an existing and safe model of BCG controlled human infection. Longitudinal BCG quantification has the potential to increase model sensitivity to detect vaccine and therapeutic responses. If successful, we aim to transfer the model to Malawi in future studies, a setting with endemic TB disease, to accelerate development of vaccines and therapeutics relevant for underserved populations who stand to benefit the most. Registration: ISRCTN: ISRCTN94098600 and ClinicalTrials.gov: NCT05820594.

A multi-step analysis and co-produced principles to support equitable partnership with Liverpool School of Tropical Medicine, 125 years on.

Transboundary health partnerships are shaped by global inequities. Perspectives from the "global South" are critical to understand and redress power asymmetries in research partnerships yet are not often included in current guidelines. We undertook research with partners working with the Liverpool School of Tropical Medicine (LSTM) to inform LSTM's equitable partnership strategy and co-develop principles for equitable partnerships as an entry point towards broader transformative action on research partnerships. We applied mixed-methods and participatory approaches. An online survey (n = 21) was conducted with LSTM's transboundary partners on fairness of opportunity, fair process, and fair sharing of benefits, triangulated with key informant interviews (n = 12). Qualitative narratives were analysed using the thematic framework approach. Findings were presented in a participatory workshop (n = 11) with partners to co-develop principles, which were refined and checked with stakeholders. Early inclusion emerged as fundamental to equitable partnerships, reflected in principle one: all partners to input into research design, agenda-setting and outputs to reflect priorities. Transparency is highlighted in principle two to guide all stages including agenda-setting, budgeting, data ownership and authorship. Principle three underscores the importance of contextually embedded knowledge for relevant and impactful research. Multi-directional capacity strengthening across all cadres is highlighted in principle four. Principle five includes LSTM leveraging their position for strategic and deliberate promotion of transboundary partners in international forums. A multi-centric model of partnership with no centralised power is promoted in principle six. Finally, principle seven emphasises commitment to the principles and Global Code of Conduct values: Fairness, Respect, Care, Honesty. The co-developed principles are part of ongoing reflections and dialogue to improve and undo harmful power structures that perpetuate coloniality within global health. While this process was conducted with LSTM-Liverpool's existing partners, the principles to strengthen equity are applicable to other institutions engaged in transboundary research partnerships and relevant for funders.

Uneasy bedfellows: Public-Private partnerships for malaria control.

It is argued that reducing poverty is likely to alleviate malaria transmission and that the way to do this is by reducing inequality. The present capitalist system (as opposed to a straightforward market) tends to erode equality and promote profit over product. This may extend to the manufacture of bednets, bought by agencies rather than individual consumers, whose products may suffer from built in obsolescence. It is argued that better quality nets that can be re-impregnated locally are both desired and required. Derek Charlwood (aka Mzshensy#1) started his career as a medical entomologist in 1974 as a Research Assistant in the laboratory of the legendary Mick Gillies. By 2012 he had risen to become a Senior Research Assistant working for the Liverpool School of Tropical Medicine and so he is definitely ascending the career ladder. He has worked in numerous malaria endemic countries including Brazil, Papua New Guinea, Tanzania, Cambodia, São Tomé and Príncipe, Mozambique and Eritrea.

A feasibility study of controlled human infection with intradermal Bacillus Calmette–Guérin (BCG) injection: Pilot BCG controlled human infection model

Tuberculosis (TB) caused 1.5 million deaths in 2020, making it the leading infectious killer after COVID-19. Bacille Calmette-Guerin (BCG) is the only licensed vaccine against TB but has sub-optimal efficacy against pulmonary TB and reduced effectiveness in regions close to the equator with high burden. Efforts to find novel vaccines are hampered due to the need for large-scale, prolonged, and costly clinical trials. Controlled human infection models (CHIMs) for TB may be used to accelerate vaccine development by ensuring only the most promising vaccine candidates are selected for phase 3 trials, but it is not currently possible to give participants Mycobacterium tuberculosis as a challenge agent. This study aims to replicate and refine an established BCG CHIM at the Liverpool School of Tropical Medicine. Participants will receive an intradermal injection with licensed BCG vaccine (Statens Serum Institut strain). In phase A, participants will undergo punch biopsy two weeks after administration, paired with minimally invasive methods of skin sampling (skin swab, microbiopsy, skin scrape). BCG detection by classical culture and molecular methods will be compared between these techniques and gold standard punch biopsy. Techniques meeting our pre-defined sensitivity and specificity criteria will be applied in Phase B to longitudinally assess intradermal BCG growth two, seven and fourteen days after administration. We will also measure compartmental immune responses in skin, blood and respiratory mucosa in Phase B. This feasibility study will transfer and refine an existing and safe model of BCG controlled human infection. Longitudinal BCG quantification has the potential to increase model sensitivity to detect vaccine and therapeutic responses. If successful, we aim to transfer the model to Malawi in future studies, a setting with endemic TB disease, to accelerate development of vaccines and therapeutics relevant for underserved populations who stand to benefit the most. Registration: ISRCTN: ISRCTN94098600 and ClinicalTrials.gov: NCT0582059

Confirmation of the presence of Anopheles stephensi among internally displaced people’s camps and host communities in Aden city, Yemen

BackgroundDeclines in global malaria cases and deaths since the millennium are currently challenged by multiple factors including funding limitations, limits of, and resistance to vector control tools, and also recent spread of the invasive vector species, Anopheles stephensi—especially into novel urban settings where malaria rates are typically low. Coupled with general increases in urbanization and escalations in the number of conflicts creating rapid and unplanned population displacement into temporary shelter camps within host urban areas, particularly in the Middle East and sub-Saharan Africa, increased urban malaria is a major threat to control and elimination.MethodsEntomological monitoring surveys (targeting Aedes aegypti) of water containers across urban areas hosting internally displaced people (IDP) communities in Aden city, Yemen, were performed by The MENTOR Initiative, a non-governmental organisation. As part of these surveys in 2021 23 larvae collected and raised to adults were morphologically identified as An. stephensi. Twelve of the samples were sent to Liverpool School of Tropical Medicine for independent morphological assessment and genetic analysis by sequencing the ribosomal ITS2 region and the mitochondrial COI gene.ResultsAll twelve samples were confirmed morphologically and by sequence comparison of the single ITS2 and COI haplotype detected to the NCBI BLAST database as An. stephensi. Phylogenetic analysis with comparable COI sequences indicated close relationship to haplotypes found in Djibouti and Ethiopia.ConclusionThe study results confirm the presence of An. stephensi in Yemen. Confirmation of the species in multiple urban communities hosting thousands of IDPs living in temporary shelters with widescale dependency on open water containers is of particular concern due to the vulnerability of the population and abundance of favourable breeding sites for the vector. Proactive monitoring and targeted integrated vector management are required to limit impacts in this area of typically low malaria transmission, and to prevent further the spread of An. stephensi within the region.

Development and evaluation of TaqMan-based, one-step, real-time RT-PCR assays for pepper mild mottle virus detection for near source tracking and wastewater-based epidemiology validation.

Emergence of novel human pathogens pose significant challenges to human health as highlighted by the SARS-CoV-2 pandemic. Wastewater based epidemiology (WBE) has previously been employed to identify viral pathogens and outbreaks by testing samples from regional wastewater treatment plants. Near source tracking (NST) allows for more targeted WBE by analysing samples from individual buildings such as schools or even individual floors such as in multi-floor office buildings. Despite the public health advantages of WBE, few strategies exist for optimising NST sampling methodologies. Therefore, we developed a protocol to evaluate virus detection in NST sampling using Pepper Mild Mottle Virus (PMMoV) as a proxy for RNA viruses. PMMoV is the most abundant enteric human associated RNA virus and is present in peppers/pepper-containing foods. Two bespoke TaqMan RT-PCR assays were developed to detect a PMMoV genomic 5' region and a capsid associated gene. To evaluate the protocol against field samples, pepper homogenates were flushed down an in-use toilet (Liverpool School of Tropical Medicine, UK) to spike wastewater with PMMoV on multiple days, and samples collected from two sewage access points to validate NST samplers. These wastewater samples were assessed for PMMoV based on Ct values and results compared to pepper and Tabasco derived PMMoV positive controls. Positive detection of PMMoV was comparable and consistent in ten independent samples across two NST samplers regardless of pepper homogenate spiking. We have developed two novel one step TaqMan assays that amplify both PMMoV targets in viral RNA extractions from peppers, Tabasco, and wastewater samples with cDNA synthesis through to RT-PCR results taking approximately 30 minutes. Pepper homogenate flushing was not required to detect PMMoV in our wastewater samples, however this strategy of flushing PMMoV containing materials outlined here could be valuable in assessing and validating NST in buildings with no previous or current sewage flow.

Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke

HomeStrokeVol. 53, No. 9Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextScreening for Aspiration Risk Associated With Dysphagia in Acute Stroke Elizabeth Boaden, PhD, Jane Burnell, MSc, Lucy Hives, MSc, Paola Dey, MD, Andrew Clegg, PhD, Mary W. Lyons, MPH, C. Elizabeth Lightbody, PhD, Margaret A. Hurley, PhD, Hazel Roddam, PhD, Elizabeth McInnes, PhD, Anne W. Alexandrov, PhD and Caroline L. Watkins, PhD Elizabeth BoadenElizabeth Boaden Correspondence to: Elizabeth Boaden, PhD, Senior Research Fellow, Stroke Research Team, Brook Building 247, University of Central Lancashire, Preston, PR1 2HE. Email E-mail Address: [email protected] https://orcid.org/0000-0002-4647-6392 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Jane BurnellJane Burnell https://orcid.org/0000-0002-4601-1632 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Lucy HivesLucy Hives https://orcid.org/0000-0003-4125-4034 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Paola DeyPaola Dey https://orcid.org/0000-0003-4555-1917 Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom (P.D.). Search for more papers by this author , Andrew CleggAndrew Clegg https://orcid.org/0000-0001-8938-7819 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Mary W. LyonsMary W. Lyons https://orcid.org/0000-0001-7532-2301 Liverpool School of Tropical Medicine, United Kingdom (M.W.L.). Search for more papers by this author , C. Elizabeth LightbodyC. Elizabeth Lightbody https://orcid.org/0000-0001-5016-3471 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom (C.E.L.). Search for more papers by this author , Margaret A. HurleyMargaret A. Hurley https://orcid.org/0000-0002-2502-432X Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Hazel RoddamHazel Roddam https://orcid.org/0000-0002-0637-1801 Faculty of Allied Health and Well-being (H.R.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Elizabeth McInnesElizabeth McInnes https://orcid.org/0000-0002-0567-9679 Nursing Research Institute, Australian Catholic University, Sydney, Australia (E.M.). Search for more papers by this author , Anne W. AlexandrovAnne W. Alexandrov https://orcid.org/0000-0002-4060-6766 Department of Acute and Tertiary Care, University of Tennessee Health Science Center (UTHSC), Memphis (A.W.A.). Search for more papers by this author and Caroline L. WatkinsCaroline L. Watkins https://orcid.org/0000-0002-9403-3772 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author Originally published22 Aug 2022https://doi.org/10.1161/STROKEAHA.122.037998Stroke. 2022;53:e424–e425"Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke." Stroke, 53(9), pp. e424–e425FootnotesFor Sources of Funding and Disclosures, see page e425.Correspondence to: Elizabeth Boaden, PhD, Senior Research Fellow, Stroke Research Team, Brook Building 247, University of Central Lancashire, Preston, PR1 2HE. Email [email protected]ac.uk

`Bump It Forward`: How a campaign challenged our fundraising status quo

This paper describes the development and implementation of the Liverpool School of Tropical Medicine's (LSTM) Bump It Forward campaign, which was launched in January 2021 to provide personal protective equipment (PPE) and protect health workers in African countries until the COVID-19 vaccine reached them. As a specialist and small institution with an embryonic fundraising operation, it was assumed that LSTM would never be successful as a public fundraising charity. However, this campaign challenged these beliefs and LSTM's existing approach to fundraising, resulting in more than five times the original target being raised, and increasing donor numbers seven-fold. This paper considers some of the elements that made the campaign so successful, which shattered the previous misconceptions of fundraising ability and challenged what constitutes best practice, particularly for donor acquisition strategies. The paper concludes with a summary of the lessons learned, which can be applied to fundraising practice in any size of organisation.

Risk Factors for Nonattendance in Delusional Infestation: A Multicenter Observational Study

Background: Nonattendance is common among patients suffering from delusional infestation (DI) with a risk factor for poorer patient outcomes. Objective: The aim of this study was to determine the incidence rate and predictors of nonattendance among patients presenting to a psychodermatology department with DI and the subsequent effect on the success of prescribing new antipsychotics. Methods: Data of 265 patients were reviewed of the Amsterdam UMC, the Erasmus University Medical Center, the Royal London Hospital, and the Liverpool School of Tropical Medicine between January 2008 and October 2019. Results: We observed that among the patients who attended the first consultation, 57% (n = 144) did not attend their second visit. Recreational drug use was significantly higher in the nonattendance group compared to the attendance group (25% against 18%). Patients who had a history of previously prescribed antipsychotics at the time of the first consultation were less likely to get prescribed antipsychotics from the psychodermatology departments for DI; however, prescribing antipsychotic drugs by the psychodermatology department did not influence nonattendance significantly. Conclusions: People suffering from DI are at high risk of nonattendance, even in specialist settings. Patients with current illicit drug use and younger patients are particularly at risk of this.

The influence of pneumococcal conjugate vaccine-13 on nasal colonisation in a controlled human infection model of pneumococcal carriage in Malawi: a double-blinded randomised controlled trial protocol.

Streptococcus pneumoniae is the leading cause of morbidity and mortality due to community acquired pneumonia, bacterial meningitis and bacteraemia worldwide. Pneumococcal conjugate vaccines protect against invasive disease, but are expensive to manufacture, limited in serotype coverage, associated with serotype replacement, and demonstrate reduced effectiveness against mucosal colonisation. For Malawi, nasopharyngeal carriage of vaccine-type pneumococci is common in vaccinated children despite national roll-out of 13-valent pneumococcal conjugate vaccine (PCV13) since 2011. Our team has safely transferred an established experimental human pneumococcal carriage method from Liverpool School of Tropical Medicine to the Malawi-Liverpool Wellcome Trust Clinical Research Programme, Malawi. This study will determine potential immunological mechanisms for the differential effects of PCV13 on nasal carriage between healthy Malawian and UK populations. We will conduct a double-blinded randomised controlled trial to vaccinate (1:1) participants with either PCV13 or control (normal saline). After a period of one month, participants will be inoculated with S. pneumoniae serotype 6B to experimentally induce nasal carriage using the EHPC method. Subsequently, participants will be invited for a second inoculation after one year to determine longer-term vaccine-induced immunological effects. Primary endpoint: detection of inoculated pneumococci by classical culture from nasal wash recovered from the participants after pneumococcal challenge. Secondary endpoints: local and systemic innate, humoral and cellular responses to PCV-13 with and without pneumococcal nasal carriage The primary objective of this controlled human infection model study is to determine if PCV-13 vaccination is protective against pneumococcal carriage in healthy adult Malawian volunteers. This study will help us to understand the observed differences in PCV-13 efficacy between populations and inform the design of future vaccines relevant to the Malawian population. Trial Registration: Pan African Clinical Trial Registry (REF: PACTR202008503507113).

The influence of pneumococcal conjugate vaccine-13 on nasal colonisation in a controlled human infection model of pneumococcal carriage in Malawi: a double-blinded randomised controlled trial protocol

Streptococcus pneumoniae is the leading cause of morbidity and mortality due to community acquired pneumonia, bacterial meningitis and bacteraemia worldwide. Pneumococcal conjugate vaccines protect against invasive disease, but are expensive to manufacture, limited in serotype coverage, associated with serotype replacement, and demonstrate reduced effectiveness against mucosal colonisation. For Malawi, nasopharyngeal carriage of vaccine-type pneumococci is common in vaccinated children despite national roll-out of 13-valent pneumococcal conjugate vaccine (PCV13) since 2011. Our team has safely transferred an established experimental human pneumococcal carriage method from Liverpool School of Tropical Medicine to the Malawi-Liverpool Wellcome Trust Clinical Research Programme, Malawi. This study will determine potential immunological mechanisms for the differential effects of PCV13 on nasal carriage between healthy Malawian and UK populations. We will conduct a double-blinded randomised controlled trial to vaccinate (1:1) participants with either PCV13 or control (normal saline). After a period of one month, participants will be inoculated with S. pneumoniae serotype 6B to experimentally induce nasal carriage using the EHPC method. Subsequently, participants will be invited for a second inoculation after one year to determine longer-term vaccine-induced immunological effects. Primary endpoint: detection of inoculated pneumococci by classical culture from nasal wash recovered from the participants after pneumococcal challenge. Secondary endpoints: local and systemic innate, humoral and cellular responses to PCV-13 with and without pneumococcal nasal carriage The primary objective of this controlled human infection model study is to determine if PCV-13 vaccination is protective against pneumococcal carriage in healthy adult Malawian volunteers. This study will help us to understand the observed differences in PCV-13 efficacy between populations and inform the design of future vaccines relevant to the Malawian population. Trial Registration: Pan African Clinical Trial Registry (REF: PACTR202008503507113)

Racism in two UK global health institutions

Many people have been shocked by the racism evidenced in the February, 2022 independent review 1 Arday J Equity and inclusion at LSTM: improving racial equity in global medicine—an independent report. https://www.lstmed.ac.uk/sites/default/files/LSTM%20Race%20Equality%20Review%20-%20Arday%20%28February%202022%29%20FINAL.pdfDate: February, 2022 Date accessed: February 24, 2022 Google Scholar , 2 Wolfe-Robinson M Race report delivers damning verdict on Liverpool School of Tropical Medicine. The Guardian. Feb 17, 2022; Google Scholar of the Liverpool School of Tropical Medicine (LSTM), Liverpool, UK, the oldest institute of global health in the world. The LSTM findings are strikingly similar to those of a 2021 independent review 3 Nous GroupIndependent review to address discrimination and advance anti-racism: London School of Hygiene and Tropical Medicine. https://www.lshtm.ac.uk/media/56316Date: Dec 8, 2021 Date accessed: February 24, 2022 Google Scholar , 4 Weale S Structural racism at London School of Hygiene & Tropical Medicine, finds report. The Guardian. Dec 13, 2021; Google Scholar of the London School of Hygiene & Tropical Medicine (LSHTM), London, UK, a marginally younger, but substantially larger institute of global health. Dedicated almost exclusively to research in low-income and middle-income countries and related teaching, the institutes annually receive about £115 million (LSTM) and £180 million (LSHTM) in research grant income from various funding bodies, including UK Research and Innovation (UKRI), the Bill & Melinda Gates Foundation, and the Wellcome Trust. 5 Liverpool School of Tropical MedicineThe Liverpool School of Tropical Medicine 2020/21 annual report. Liverpool School of Tropical Medicine, Liverpool2021 Google Scholar , 6 Liverpool School of Tropical MedicineFinancial statements 2020/2021. Liverpool School of Tropical Medicine, Liverpool2021 Google Scholar , 7 London School of Hygiene & Tropical MedicineAnnual report 2020: the London School of Hygiene & Tropical Medicine. London School of Hygiene & Tropical Medicine, London2020 Google Scholar

Household food insecurity, maternal nutrition, environmental risks and infants’ health outcomes: protocol of the IMPALA birth cohort study in Uganda

IntroductionIn low- and middle-income countries (LMICs), food insecurity and undernutrition disproportionately affect women of reproductive age, infants and young children. The disease burden from undernutrition in these vulnerable sections of...

Adolescent mental health research in Tanzania: a study protocol for a priority setting exercise and the development of an interinstitutional capacity strengthening programme

IntroductionPoor adolescent mental health is a barrier to achieving several sustainable development goals in Tanzania, where adolescent mental health infrastructure is weak. This is compounded by a lack of community...

Prisoner of War Medical Ingenuity in Far East Captivity.

Research into British perspectives of the medical history of Far East prisoners of war (FEPOWs) has been conducted by the Liverpool School of Tropical Medicine (United Kingdom), resulting from decades of treating FEPOW veterans that began after their repatriation in late 1945. This paper examines some of the ingenious ways that British medical officers, medical orderlies, and volunteers fought to save the lives of thousands of FEPOWs during captivity in the Second World War. It highlights some of the key medical challenges, together with the resourcefulness of a "citizen's army" of conscripts and volunteers who used their civilian knowledge, skills, and ingenuity in many ways to support Allied medical staff. Using the most basic of materials, they were able to produce a vast array of medical support equipment and even drugs, undoubtedly saving many lives.

The noble mission of Nobel Laureate Sir Ronald Ross

The noble mission of Nobel Laureate Sir Ronald Ross

Chemistry that delighted us in 2021

Snakes spitting pain Most of the venomous snakes in the Liverpool School of Tropical Medicine’s collection immobilize and kill prey by injecting venom through their fangs. But some snakes protect themselves from predators by spitting venom —potentially causing pain, inflammation, and blindness. This year, a team of researchers at the school’s Centre for Snakebite Research and Interventions uncovered how the venom packs such a punch: the molecular cocktail in spitting snakes’ venom contains high levels of proteins that increase the sensation of pain ( Science 2021, DOI: 10.1126/science.abb9303 ). The team found that, while each snake’s venom had a unique concoction of toxins, all the spitting snakes had higher levels of phospholipase A 2 (PLA 2 ) enzymes in their venom than nonspitting snakes. In tests on mouse nerve cells, mixtures of venom components including PLA 2 triggered more cell activity than cocktails without it, a sign of a greater