New global health research to reduce the impacts of COVID-19 across low and middle income countries
The NIHR, in partnership with UK Research and Innovation (UKRI), has announced 12 new research projects specifically aimed at tackling the multiple health consequences of the COVID-19 pandemic in low and middle income countries (LMICs).
The new research spans more than 18 countries across Africa, South America and South East Asia and covers topics such as transmission and infection control, and how people are affected by the disease in different settings and their long-term outcomes, including the risk of neurological problems. Other projects focus on the indirect consequences of the pandemic, for example on mental health, tuberculosis, and provision of HIV care and other health services.
The new projects include:
- Developing optimal critical care pathways for COVID-19 patients across seven African countries by establishing networks to rapidly share successful intervention
- Understanding the mental health needs of older people in Peru, and how they are being impacted by restrictive measures intended to protect them from COVID-19
- Preventing the spread of COVID-19 across different communities in Malawi by better understanding the impact of living conditions on infection rates between crowded and less crowded urban settings
The projects, which have received nearly £7.6 million of funding, focus on four priority COVID-19 research topics highlighted by the World Health Organization COVID-19 Global Research Roadmap: epidemiology; clinical management; infection prevention and control; and health system responses.
Dr Lesong Conteh, chair of the funding committee for the Global Effort on COVID-19 (GECO) Health Research funding call and deputy chair of the Independent Scientific Advisory Group for NIHR's Global Health Research Portfolio, said: “Coronavirus does not respect borders, and the impact of the pandemic is being felt across the globe. These varied multidisciplinary new research projects will directly benefit people in low and middle income countries, provide learning opportunities globally, and complement NIHR and UKRI’s cross government approach to funding COVID-19 research in the UK."
Professor Andrew Thompson, UKRI’s International Champion, said: “COVID-19 is having devastating consequences across the world. Through these projects researchers from across developing countries and the UK will combine their skills, experience and expertise to find urgently needed solutions across different healthcare systems and settings, to support the lives and livelihoods of people across the globe in the most appropriate ways for the situations in which they are living.”
One such project is looking at how the spread of COVID-19 is impacting differently on people depending on how crowded their households are.
Professor Victor Mwapasa, University of Malawi’s College of Medicine who is leading the project, explains: “The study will assess the intensity of COVID-19 transmission and the social and economic impact of the infection in medium- and high-density Malawian households. Findings will inform the design of COVID-19 care programs and social safety nets for resource-constrained households. The UK-Malawi collaboration is essential as it will promote sharing of lessons, across countries, on strategies to combat the infection.”
These new projects are funded by cross UK Government aid funds through the NIHR and UKRI GECO Health Research funding call.
Understanding the impact of COVID-19 on the mental health of Peruvian older adults
Partners: University College London (UK), AB PRISMA (Peru), Universidad de San Martin de Porres (Peru), Johns Hopkins Center for Global Non-Communicable Disease Research and Training (EEUU)
The COVID-19 pandemic has disproportionately affected older adults worldwide, with this age group having the highest morbidity and mortality. Measures such as quarantine and social distancing aim to reduce viral transmission and protect the most vulnerable. However, there are likely unintended consequences of such restrictive measures on the mental and physical health of older adults, including increasing feelings of loneliness, reduced physical activity, depression and anxiety. This study will explore the direct and indirect impacts of COVID-19 on the mental wellbeing of older adults in Peru. It aims to generate data to inform interventions and policy to mitigate the effects of restrictive mobility measures on the physical and mental wellbeing of older adults from low resource settings.
"COVID-19 'lock-down' policies can significantly impact vulnerable older adults' mental health. Our Lima based study makes visible older adults' quarantine experiences in low-resource settings to inform local policy adaptations." Dr Oscar Flores-Flores, Research Associate, AB PRISMA, Peru
COVID-19 neurological disease: a global meta-analysis and prospective case control study in Brazil, India and Malawi
Partners: University of Liverpool (UK), University of Malawi College of Medicine (Malawi), Malawi-Liverpool-Wellcome Trust Clinical Research Programme (Malawi), Oswaldo Cruz Foundation (Fiocruz; Brazil), National Institute for Mental Health & Neurosciences (India), Christian Medical College Vellore (India) and The Encephalitis Society (UK)
This project will look at why and how the virus affects the brain, to help improve patient management and save lives. Working as part of a global network, researchers will pull together data from all patients to make a single large report of the full range of neurological disease in COVID-19. To understand why some COVID-19 patients get neurological disease, the researchers will compare patients with and without neurological disease in hospitals in Brazil, India and Malawi. They will look for risk factors, especially those which can be treated, such as lack of oxygen in the blood. They will also look at outcomes for neurological patients, to help better understand what might predict a poor outcome.
“This programme will help us make a difference for patients with COVID-19 across the world. Importantly for countries like Malawi, it should tell us simple, low-cost ways of predicting who is at highest risk of brain disease with COVID-19, and hopefully ways of preventing it.” Dr Tamara Phiri, Queen Elizabeth Central Hospital and College of Medicine, Malawi
The DOMINO Study: measuring and mitigating the indirect effects of COVID-19 on tuberculosis and HIV care in Indonesia
Partners: The London School of Hygiene & Tropical Medicine (UK), University of Gadjah Mada (Indonesia), University of Sebelas Maret (Indonesia), University of New South Wales Sydney (Australia), Indonesian Ministry of Health (Indonesia), University of Indonesia (Indonesia), USAID Indonesia (Indonesia)
Indonesia has recently strengthened efforts to control HIV and tuberculosis (TB), but the diversion of resources to the current pandemic combined with social distancing policies is creating new vulnerabilities and exacerbating existing ones for people who rely on TB and HIV services. Indonesia urgently needs to understand the wider impact of the pandemic on TB and HIV care to inform mitigation strategies. This project will build on strong, existing collaborative research relationships to rapidly assess the impact of COVID-19, and policy responses to it, on the delivery of, and access to, TB and HIV care, with a particular emphasis on highly vulnerable populations. Findings will be used to design strategies to safeguard the continuity of care for TB and HIV patients in the near and medium term, thereby ensuring the country does not lose ground on the major advances it has made towards the control of these diseases.
“This project will provide directions to strengthen the tuberculosis and HIV program's resilience in Indonesia that has been challenged by the COVID-19 pandemic.” Professor Ari Probandari, Universitas Sebelas Maret and the Center of Tropical Medicine, Universitas Gadjah Mada, Indonesia
Household transmission and immunity to SARS-CoV-2 among paediatric clients of a primary care centre in a low-resource community in Rio de Janeiro
Partners: Oswaldo Cruz Foundation (Fiocruz; Brazil), The London School of Hygiene & Tropical Medicine (UK), University of Exeter (UK)
Understanding SARS-CoV-2 in children is important for their health, as well as for their families and communities, particularly in crowded living conditions such as slums, where households are very small and it is almost impossible to keep children within their homes.The aim of this project is to study the household transmission dynamics of the COVID-19 in a favela in Rio de Janeiro, Brazil. The researchers will examine and test for COVID-19 in a sample of children and their families from one of the poorest neighborhoods of the city, with regular follow-up visits over two years. The study expects to bring more evidence to the role of children in disease transmission, answering questions such as whether adults catch the virus at work, then transmit it to their children or do children catch the virus from neighbours, then bring it back to their families.
“The risk of catching SARS-CoV-2 comes down to a variety of factors, from genetics, to behaviour, to the environment in the home. We’re hoping to tease variables apart with statistical models and figure out which ones are the most important.” Leonard Bastos, Associate Researcher, FIOCRUZ, Brazil
African critical care registry network for pandemic surveillance, clinical management and research (CRIT Care Africa)
Partners: University of Oxford (UK) African Coalition for Epidemic Research, Response and Training (ALERRT; international), Aga Khan University (Kenya), Debre Berhan University (Ethiopia), Doctors with Africa (CUAMM; Ethiopia, Sierra Leone and South Sudan), D’OR Institute for Research and Education (IDOR; Brazil), Intermediate Hospital (Namibia), International Forum for Acute Care Trialists (InFACT; international), International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC; international), Mahidol Oxford Tropical Medicine Research Unit (MORU; Thailand), Makerere University College of Health Sciences (Uganda), Monash University (Australia), Muhimbili University of Health & Allied Sciences (Tanzania), NICS-MORU (Sri Lanka), University of British Columbia (Canada), University College London (UK), University of Edinburgh (UK), World Health Organization (international) Ziauddin University (Pakistan)
Bringing together the expertise of researchers and clinicians based across low- and middle-income countries and partners from established critical care and pandemic networks internationally, this project aims to address the knowledge gaps that exist in the natural history and clinical course of COVID-19 related critical illness in Africa. Knowledge gaps and underlying operational gaps will be identified by implementing a setting-adapted registry for service evaluation and pandemic research in seven countries across Africa. Leveraging the registry data, and led by healthcare stakeholders, the researchers will identify priorities for improving processes of care for the sickest patients. Once established, the same registry platform will support trials to identify strategies for optimal supportive care and interventions in the management of critically ill patients.
“Without data we cannot engage in research, and without research we have no voice.” Prof Madiha Hashmi, co-investigator, Ziauddin University, Pakistan
Promoting health and safety in traditional food markets to fight COVID-19 in Peru and Bolivia
Partners: The Royal Veterinary College (UK), The London School of Hygiene & Tropical Medicine (UK), Universidad Peruana Cayetano Heredia (Peru), Universidad Nacional Mayor de San Marcos (Peru), Universidad Mayor de San Simon (Bolivia)
This project will design bespoke plans to reduce COVID-19 transmission in two markets in Sacaba, Bolivia, and two in Huancayo, Peru, and will support similar plans elsewhere through the development of a user-friendly tool that will be made available online. In collaboration with health services in these two localities, the researchers will pilot a health promotion plan for market sellers and their families that will include early detection and follow-up of COVID-19 infections. Data from the follow-up of a high-risk population will be valuable to answer questions in relation to COVID-19 infection. Enhanced local capacity resulting from the project will not only help facing the current pandemic but also future public health emergencies.
Measuring unanticipated opportunity costs of South Africa's COVID-19 response for children, mothers and people living with non-communicable diseases
Partners: University of Witwatersrand (South Africa), MRC/Wits Rural Public Health and Health Transitions Research Unit (South Africa), Ezintsha research group (South Africa)
Health systems across the world have had to pivot suddenly and with great speed in order to address COVID-19. Although this may have been effective in containing the pandemic, it has not been without consequence to the burden of disease and the health services that existed pre-pandemic. Through a mixed-method, multidisciplinary study, these researchers will investigate how COVID-19 has impacted the supply and demand of routine health services, specifically those related to non-communicable diseases, as well as maternal and child health, in both urban and rural settings. The project will quantitatively measure the impact of COVID-19 on routine preventive and curative health services, from supply and demand side perspectives, through a time series analysis of health service data. The researchers will also qualitatively evaluate the views of the community and healthcare workers on health service access and delivery. These results will enable policymakers to make evidence-based decisions regarding resource allocation that are also responsive to community needs and priorities.
“We will focus our analyses on the critically important area of missed opportunities of healthcare access in South Africa – a country with the majority of COVID-19 cases on the continent. This research will influence policy in future epidemic outbreaks, ensuring the best health care for all.” Professor Karen Hofman, Director, PRICELESS SA, SAMRC Centre for Health Economics and Decision Science, University of Witwatersrand
Spectrum, determinants and long term outcome of SARS-CoV2 infection and disease in African children
Partners: University of Cape Town (South Africa), University of Western Australia (Australia), University of Southampton (UK)
Children in LMICs experience a very high burden of pneumonia, which continues to be the major single killer of children under five years of age. Risk factors such as malnutrition, pollution, crowded living conditions and the high burden of infectious diseases all contribute to the vulnerability of children to developing severe pneumonia in these settings. However, surprisingly children in LMICs and globally are only mildly affected by COVID-19, with very few severe cases or deaths occurring in young children. This project will investigate what factors protect children against developing infection or severe disease from COVID-19 across LMICs and whether prior infection with other organisms, including seasonal coronaviruses, protects children against severe disease through development of immunity. This project will provide new information on COVID-19 in childhood, protective factors, immune responses and the long term impact on child health.
“This funding provides a wonderful opportunity to better understand COVID-19 in African children in a low and middle income country context. Children are usually very vulnerable to developing severe pneumonia, however this hasn’t occurred with COVID-19. Understanding why children are only mildly affected may be key to develop new strategies to prevent or ameliorate illness.” Professor Heather Zar, University of Cape Town, South Africa
The impact of COVID-19 on primary health care service provision and utilisation in Tanzania, Sierra Leone and the Democratic Republic of Congo
Partners: The London School of Hygiene & Tropical Medicine (UK), Institut National de Recherche Biomédicale (Democratic Republic of the Congo), University of Sierra Leone (Sierra Leone), National Institute for Medical Research (Tanzania)
The impact and implications of the COVID-19 pandemic on routine primary health care provision and utilisation in resource-poor settings is unknown. Initial reports suggest that the capacity to provide services has been reduced as health care workers with comorbidities or pre-existing conditions are taken off the ‘frontline’, absenteeism increases through fear of COVID-19 exposure and social distancing measures are put in place in health facilities. Fear among patients, misconceptions that services are shut, and financial and transport issues have also affected use of healthcare services. This multidisciplinary project aims to investigate the impact that the COVID-19 pandemic is having on primary healthcare providers and patients in three distinct settings in Democratic Republic of the Congo, Tanzania and Sierra Leone, and look to find solutions to maximise health care provision.
SARS-CoV-2 infection, transmission dynamics and household impact in Malawi (SCATHIM)
Partners: University of Malawi College of Medicine (Malawi), Malawi-Liverpool-Wellcome Trust Clinical Research Programme (Malawi), University of Oxford (UK), University of Liverpool (UK)
Sub-Saharan African countries have adopted prevention measures similar to those used in developed countries to combat COVID-19, despite having very different social, cultural and economic contexts. Currently limited empirical data exists on SARS-CoV-2 transmission dynamics and the feasibility of prevention measures in diverse African households, to guide the adaptation of more appropriate preventive measures. This project will seek to determine the transmission dynamics, determinants and socioeconomic impact of COVID-19 infection in households located in urban medium-density, urban high-density and rural-high density locations in Malawi. The researchers will generate contextually-relevant empirical data for identifying high risk individuals. The project will also predict the intensity of transmission and the impact of preventive measures, and design appropriate social safety nets for households affected by COVID-19.
“I am thrilled that this research project is led by scientists from the University of Malawi College of Medicine and will provide data for developing home-grown strategies to reduce the intensity of COVID-19 transmission and mitigate against other impacts of the infection.” Professor Victor Mwapasa, University of Malawi’s College of Medicine
The impact of the COVID-19 pandemic on people with severe mental illness and on mental health service provision in South Asia (IMPASS)
Partners: Rawalpindi Medical University (Pakistan), ARK Foundation (Bangladesh), University of York (UK), Keele University (UK), London School of Economics and Political Science (UK), University of Dundee (UK), National Institute of Mental Health & Neuro Sciences (India), National Institute of Mental Health (Bangladesh)
The COVID-19 pandemic has adversely affected lives and challenged healthcare provision and people with severe mental illness such as schizophrenia and bipolar disorder are likely to be disproportionately affected. This project will look at the impact of the pandemic on people with severe mental illness and on mental health care provision in Bangladesh and Pakistan. The project will specifically look at how individuals with severe mental illness have received and responded to advice about preventing spread of COVID-19, their well-being, health risk behaviors, quality of life and access to healthcare as well as housing issues, food security, domestic violence, employment and income. Using this evidence, the researchers will then work to inform strategies to mitigate the impact of the pandemic on people with severe mental illness and healthcare services.
“IMPASS creates a platform for generating evidence and influencing policy for providing better health care of people with severe mental illness and improving their wellbeing during the pandemic and beyond.” Professor Rumana Huque, ARK Foundation, Bangladesh
Development and pilot testing of an m-health intervention to reduce COVID-19 associated psychosocial distress among Nigerian healthcare workers
Partners: Obafemi Awolowo University Teaching Hospitals Complex (Nigeria), Lagos State University Teaching Hospital (Nigeria)
The emergence of COVID-19 across the globe has brought severe disproportionate distress on individuals, communities, health resources and nations. The distress is increasingly eroding mental health and wellbeing of patients and caregivers in contexts with precariously fragile health resources. Nigeria, with all health parameters below the World Health Organization standard, is no exception.COVID-19 associated psychosocial distress in Nigeria is rapidly jeopardising mental health and wellbeing of healthcare workers, especially doctors and nurses. Healthcare workers are besieged by long working hours, psychological distress, fatigue and occupational burnout. However, m-health intervention is increasingly seen by some experts as a game changer in the context of solutions to mental health and wellbeing challenges. This project will investigate COVID-19 associated psychosocial distress and evaluate the feasibility and pilot testing of a guided m-health intervention among Nigeria’s healthcare workers. Findings of this project would provide useful information on the feasibility of using such intervention for improving psychosocial health of Nigerian healthcare workers.
“This funding provides a great opportunity to better understand COVID-19 associated psychosocial distress among healthcare workers in a low and middle income country context. Healthcare workers are under great stress and providing a culturally relevant m-health based psychological intervention may be a key to reducing this great suffering.” Professor Victor Adetiloye, Obafemi Awolowo University Teaching Hospitals Complex, Nigeria