Friday Newsletter
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Dear Centre Leaders,
In today's newsletter:
  • Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS)
  • Five keys to improving research costing in low- and middle- income countries
  • Could drug resistant malaria be on the rise in Africa?
  • Interesting grant opportunity for young researchers
  • Kintampo HDSS:The risk of STI and its influence on condom use among pregnant women
  • Ouagadougou HDSS:Monitoring adult mortality by type of residence
  • Nairobi HDSS in The Lancet:Health in slums: understanding the unseen
1. Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS)
Two of the authors of this paper Prof. Don de Savigny and Dr. Raj Mitra (in the background).
Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death.
Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. The paper "Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations" identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems. Read more
2. Five keys to improving research costing in low- and middle- income countries
Research institutions in low- and middle-income countries (LMICs) are critical to the pursuit of country-led research agendas. It is essential that these institutions both develop and maintain their research environments to sustain high-quality research. Access to adequate funding is clearly essential. While access to funds is a huge challenge for research institutions all over the world, it is even more critical in LMICs where governments are often not in a position to prioritize and fund research. Certainly, much of the financing for health research that takes place in LMICs is derived from foreign sources. There are a multiplicity of sources of funding within sustained research environments such as governments, councils, funders and philanthropists. In the current global context, in which competition for a finite pool of research funding is constantly increasing, improving access to funding is ever more relevant for LMICs and for the donors that wish to support them. Read more
3. Could drug resistant malaria be on the rise in Africa?
Following four recent resistant cases, a team at the London School of Hygiene and Tropical Medicine says though it is too early to panic, things could suddenly get worse and is demanding an urgent appraisal of drug-resistance levels in Africa. The BBC reports: “Two of the cases were associated with travel to Uganda, one with Angola and one with Liberia - suggesting drug-resistant malaria could be emerging over wide regions of the continent.” Read more
4. Interesting grant opportunity for young researchers
The purpose of the Fogarty Emerging Global Leader Award is to provide research support and protected time to a research scientist from a low- or middle-income country (LMIC) with a junior faculty position at an LMIC academic or research institution.  This intensive, mentored research career development experience is expected to lead to an independently funded research career.  This Funding Opportunity Announcement (FOA) invites applications from LMIC scientists from any health related discipline that propose career development activities and a research project that is relevant to the health priorities of their country. Read more:  
News from Centres
1. Kintampo HDSS:
   The risk of STI and its influence on condom use among pregnant women
Kintampo Centre Leader, Dr Seth Owusu-Agyei.
Sexually transmitted infection (STI) affects the reproductive health of both men and women worldwide. Condoms are important part of the available preventive strategies for STI control. The lack of proper risk-perception continues to impede women’s ability to negotiate condom use with their partners. The paper "The Risk of Sexually Transmitted Infection and Its Influence on Condom Use among Pregnant Women in the Kintampo North Municipality of Ghana" is the outcome of secondary analysis of data collected in a cross-sectional survey that explored the perception of risk of STI and its influence on condom use among 504 pregnant women attending antenatal clinic at two health facilities in the Kintampo North Municipality. Read more
2. Ouagadougou HDSS:
    Monitoring adult mortality by type of residence
A street scene in Ouagadougou, Burkina Faso.
In the context of the post 2015 agenda, disaggregation of mortality indicators is needed to assess health inequalities within populations. However, producing sub-national estimates of adult mortality is notably difficult in the absence of death registration. Using Burkina Faso as a case study, this paper revisits the main avenues to quantify differences in adult mortality between the ages of 15 and 60 according to urban/rural residence. Estimates are based on reports on the survival of parents and siblings collected in surveys and in the 2006 census, and compared to levels inferred from recent household deaths or inferences based on child mortality.
Results indicate that in Burkina Faso, adults living in urban areas still benefit from a health advantage compared to their rural counterparts. Thus, efforts made in reducing adult mortality in rural settings should be intensified. In terms of methods, this analysis shows the value of asking additional questions about the place of residence of close relatives to avoid misclassification errors. The approach adopted here could be implemented in other countries to facilitate the measurement of spatial inequalities in health indicators for all ages when monitoring Sustainable Development Goals (SDGs). Read more
3. Nairobi HDSS in The Lancet:
Health in slums: understanding the unseen
Dr. Alex  Ezeh
Massive urbanisation, outpacing urban planning and infrastructure, within low-income and middle-income countries over the past 50 years has resulted in urban slums. Around 881 million people worldwide already live in slums according to UN Habitat, a number estimated to double to almost 2 billion within the next 30 years due to continuing urbanisation and natural population growth. In The Lancet a two part Series addresses the health of the people living in slums. In the first paper, Alex Ezeh and colleagues describe how the shared physical and social environment in slums creates a unique combination of health threats distinct to those found in non-slum urban or rural areas. Inadequate sanitation and water supply predispose to diarrhoeal diseases, reservoirs and vectors for infectious diseases such as dengue and leishmaniasis flourish, and the physical environment leaves the population vulnerable to fire, extreme weather, and violence. Overcrowding contributes to a high prevalence of tuberculosis and food insecurity.

The Series "The history, geography, and sociology of slums and the health problems of people who live in slums" and "Improving the health and welfare of people who live in slums, also covers interventions to improve the health of people in slums", explaining that while the neighbourhood conditions in slums create challenges, they can offer some benefits, including economy of scale for health improvement measures. Richard Lilford and colleagues show that the unique environment requires a distinct set of interventions to yield effective change. Research data on interventions to improve infrastructure and health services from other settings cannot be assumed to apply to slums (pit latrines, for example, are unsuitable for use in slums due to the high population density).
Further reading A.
Further reading B 
Policy Engagement and Communications