Professor Sharon Brownie explains her research on nursing in LMICs Nurses are the largest part of the health care workforce an millions more will be needed in LMIC if high quality care is to be available to everyone. Research that addresses the consequences of the shortage of nurses but also helps generate ideas on solutions is important and should be conducted in partnership with the nursing profession.

Nursing research in a global context 

Researcher Jalemba Aluvaala tells us about his work concerning newborn care in LMICs. Care for even the sickest newborns in many countries is limited by the resources available but there are some key interventions that can save lives. Delivering these interventions requires doctors and nurses to work together and often it is the continuous care provided by the nursing team together with families that is critical. Despite this a number of babies die and understanding risks is important to help provide information to families, to help plan care and should help us design better systems of care.

The treatment and outcomes of care for sick newborns 

Jacob McKnight tells us about the challenges faced by nurses caring for newborns in Kenya. Caring for sick newborns in a poorly resourced hospital is a very challenging job. Yet this is not the only challenge many nurses face as they juggle supporting families and lives in a busy city. Some nurses have developed ways to cope in these difficult circumstances but for many the relentless pressure may cause them harm while upholding the ideals of nursing may seem impossible.

Under pressure, the challenges of neonatal nursing 

David Gathara tells us about his work leading nursing research Sick newborns require large amounts of nursing time, so what happens when nurses have to care for too many babies? By making direct observations of the care that is given this important new research identified how much care is missed. More care is missed when nurses have more babies to care for showing the direct consequences of health care worker shortages.

Quantifying nursing care done (or left undone) 

Social Scientist Jacinta Nzinga tell us about her research on the care of sick newborns. To really understand the work of nurses in very busy wards where care for sick newborns is provided, you have to be there. Using detailed observations, day, night and weekends, linked to narrative interviews, the routines, compromises and coping strategies that characterise the delivery of hospital care for newborns are brought to light providing critical information to understand why care is missed and to guide improvement efforts.

Understanding nurses' work to care for sick newborns 

Professor Mike English tells us about the research project Health Services that Deliver for Newborns. Basic hospital care may be key to saving newborn lives. Professor Mike English, University of Oxford, outlines a multidisciplinary project engaging policy-makers and practitioners in Kenya. This project demonstrated poor coverage of Nairobi's 4.25 million population if a sick newborn baby needs quality hospital care. Using novel research approaches the team also identified how severe shortages of nurses contribute to poor quality of care for patients and negatively affect nurses themselves.

Health services that deliver for newborns. 

Professor Tran Hien, founder member of our OUCRU unit in Vietnam tells us about the development of this very successful Clinical Research Unit. Although incidence of malaria has decreased in Vietnam, the burden of infectious diseases remains high and weighs heavily on the health care system. Clinical research aims to allow investments to go further: findings in the laboratory, tested in clinical trials and then applied to the community, help improve diagnosis and management.

Infectious diseases in the tropics 

Professor Ronald Geskus from our OUCRU unit in Ho Chi Minh City, Vietnam, tells us about the contribution of biostatisticians to complex clinical research. The role of biostatisticians in clinical research is to contribute to trial design, by calculating sample size for example, and to help draw correct conclusions from the data, discriminating important information from noise. They are instrumental in the translation of a practical problem into a statistical model, and the translation of the result into practice.

Sophisticated biostatistics for complex clinical research 

Dr Audrey Dubot-Peres from our LOMWRU unit in Laos and IRD (Institut de Recherche pour le Développement, Marseille, France) tells us about her research on viral infections in Laos. Infections such as dengue and Japanese encephalitis are important problems in Laos but confirmed data are lacking, particularly from outside the capital Vientiane. Rapid diagnostic tests that can be kept at tropical room temperature help better diagnosis and treatment, and also inform policy to implement vaccination programmes.

Viral infections in Laos 

Dr Juan Carrique-Mas from OUCRU, our Clinical Research Unit in Ho Chi Minh City, Vietnam, tell us about his research in the development of antimicrobial resistance in small-scale poultry production. Many households in Vietnam raise animals for food production, particularly chickens, using large amounts of antimicrobials with no veterinary support, and those antimicrobials find their way into the food chain. The ViParc project conducts intervention trials similar to human clinical trials, to help farmers reduce the level of antimicrobials used when raising chickens.

Antimicrobial resistance in poultry production 

Translational research in NDM has a truly worldwide impact, with scientists and clinicians investigating epidemiology, treatment, and prevention of disease on a global scale. Our podcasts on Global Health illuminate this work, and discuss research conducted in Oxford and around the world to better understand and manage emerging and endemic diseases.

Global Health

Dr Jay Berkley tells us about his work on childhood nutrition and immunity in East Africa. Malnutrition is responsible for almost a third of childhood mortality worldwide. A better understanding of the bacteria in a child's gut will assist researchers in developing better treatment options. Dr Jay Berkley works in the KEMRI/Wellcome Trust Collaborative Research Programme in Kilifi, Kenya. His research interests include tackling the infection and inflammation of the gut to prevent mortality in malnourished children. He is also an expert advisor on severe acute malnutrition to the Ministries of Health, and the World Health Organisation.

Childhood Nutrition and Immunity 

Dr Janjira Thaipadungpanit from our MORU unit in Bangkok, Thailand, tells us about her research on molecular diagnosis and bacterial genotyping A molecular microbiologist, Dr Janjira’s research focusses on using bacterial typing based on genome to confirm which disease is present in a patient. She aims to develop a single whole genome sequence type test using mutliple-PCR assays that can determine from a single sample of blood what bacteria or viruses are present in a patient’s blood – thereby speeding up diagnosis and potentially saving lives in resource-limited settings. Head of Molecular Microbiology at MORU, Dr Janjira Thaipadungpanit’s research interests include the molecular epidemiology of leptospirosis and melioidosis using multilocus sequence typing or genome data and molecular diagnosis to identify the causes of acute febrile illness and sepsis in patients.

Dr Janjira Thaipadungpanit from our MORU unit in Bangkok, Thailand, tells us about her research on molecular diagnosis and bacterial genotyping A molecular microbiologist, Dr Janjira’s research focusses on using bacterial typing based on genome to confirm which disease is present in a patient. She aims to develop a single whole genome sequence type test using mutliple-PCR assays that can determine from a single sample of blood what bacteria or viruses are present in a patient’s blood – thereby speeding up diagnosis and potentially saving lives in resource-limited settings. Head of Molecular Microbiology at MORU, Dr Janjira Thaipadungpanit’s research interests include the molecular epidemiology of leptospirosis and melioidosis using multilocus sequence typing or genome data and molecular diagnosis to identify the causes of acute febrile illness and sepsis in patients.

Molecular diagnosis and bacterial genotyping 

Dr George Warimwe talks about his research on Rift Valley Fever. Rift Valley Fever is a mosquito-borne virus, which affects both livestock and humans in Africa and parts of the Middle East. There is currently no licensed vaccine for use in humans. Amid fears that the virus may spread to Europe, Dr George Warimwe is working with the International Livestock Research Institute (ILRI) in Africa, and the Jenner Institute to develop a vaccine against Rift Valley Fever for both humans and livestock.

Rift Valley Fever 

Dr Claudia Turner heads the clinical research program at the Cambodia Oxford Medical Research Unit (COMRU), in collaboration with the Angkor Hospital for Children. Whereas children mortality has dramatically decreased over the past 15 years, almost half the remaining mortality still occurs during the first 4 weeks of age. Neonatology, or care of newborns, doesn't need to be difficult or expensive. Low cost intervertions involving communities, such as keeping babies warm, save lives.

Tropical neonatology 

Dr Markus Winterbert from our MORU unit in Bangkok, Thailand, tells us about his research on biomarkers for tropical diseases Having a background in malaria physiology and biochemistry, Markus Winterberg’s research focus is on the interaction between host, pathogen and drug, the metabolism of antimalarial drugs and discovering biomarkers for tropical diseases. Markus aims to use these biomarkers to develop non-invasive, field-based rapid diagnostic tests for tropical diseases that quickly identify pathogens, thereby improving diagnostics and the treatment of patients. Dr Markus Winterberg is Head of Laboratory and a Principal Investigator in MORU’s Department of Clinical Pharmacology. The key aspect of his research is ‘trop-med-omics’, the application of mass spectrometry-based bioanalysis in tropical medicine, particularly using proteomics and metabolomics to identify a disease in a patient.

Dr Markus Winterbert from our MORU unit in Bangkok, Thailand, tells us about his research on biomarkers for tropical diseases Having a background in malaria physiology and biochemistry, Markus Winterberg’s research focus is on the interaction between host, pathogen and drug, the metabolism of antimalarial drugs and discovering biomarkers for tropical diseases. Markus aims to use these biomarkers to develop non-invasive, field-based rapid diagnostic tests for tropical diseases that quickly identify pathogens, thereby improving diagnostics and the treatment of patients. Dr Markus Winterberg is Head of Laboratory and a Principal Investigator in MORU’s Department of Clinical Pharmacology. The key aspect of his research is ‘trop-med-omics’, the application of mass spectrometry-based bioanalysis in tropical medicine, particularly using proteomics and metabolomics to identify a disease in a patient.

Biomarkers for tropical diseases 

Identifying and addressing ethical issues are key to the success of any clinical trials, particularly when working with vulnerable populations. Dr Phaik Yeong Cheah leads the Department of Bioethics &amp; Engagement at the Mahidol Oxford Tropical Medicine Research Unit (MORU) in Thailand. She is particularly interested in ethical issues in community engagement, data sharing, consent and assent in paediatric research.

The ethics of research 

Naomi’s work focuses on supporting researchers to collect, clean and store research data. PRESERVING EVIDENCE FOR THE FUTUREResearch is only as good as the evidence it generates, and data management is a critical part of this process since it supports findings. High quality data must be preserved for long term use and available to the research community. Ultimately, data is not about numbers, but about people's lives and health.

Naomi’s work focuses on supporting researchers to collect, clean and store research data. PRESERVING EVIDENCE FOR THE FUTURE Research is only as good as the evidence it generates, and data management is a critical part of this process since it supports findings. High quality data must be preserved for long term use and available to the research community. Ultimately, data is not about numbers, but about people's lives and health.

Why data management matters 

Dr Olga Tosas-Auguet from our unit in Kenya tells us about her research on mapping bacterial antibiotic resistance Dr Olga Tosas-Auguet aims to develop ad evaluate a new approach to large scale surveillance of bacterial antibiotic resistance in low income settings. This approach can then be taken forward to a testing stage, initially in partnership with an emerging network of policy makers and healthcare practitioners in Africa.Resistance to antibiotics is a growing issue worldwide. Mapping where the resistance is as well as its distribution and diversity is hampered by the lack of laboratory facilities in many parts of the world. New technologies allow the characterisation of whole pathogen communities, giving us clues where multi-drug resistant organisms come from. This can help set up a better public health perspective surveillance.

Dr Olga Tosas-Auguet from our unit in Kenya tells us about her research on mapping bacterial antibiotic resistance Dr Olga Tosas-Auguet aims to develop ad evaluate a new approach to large scale surveillance of bacterial antibiotic resistance in low income settings. This approach can then be taken forward to a testing stage, initially in partnership with an emerging network of policy makers and healthcare practitioners in Africa. Resistance to antibiotics is a growing issue worldwide. Mapping where the resistance is as well as its distribution and diversity is hampered by the lack of laboratory facilities in many parts of the world. New technologies allow the characterisation of whole pathogen communities, giving us clues where multi-drug resistant organisms come from. This can help set up a better public health perspective surveillance.

Mapping bacterial antibiotic resistance 

Rickettsial Disease Rickettsial diseases such as scrub typhus are important causes of fever in southeast Asia especially in rural communities. Discovered quite recently and not big killers, these diseases are among the most under-reported and under-diagnosed illnesses that are both treatable and preventable.Rickettsial studies at he Mahidol Oxford Tropical Medicine Research Unit (MORU) focus on the epidemiology and incidence of the disease using hospital-based fever studies in Thailand and Laos. Our research unit has developed highly improved acute diagnosis of rickettsial illness. MORU also has ongoing studies to determine the pathophysiological mechanisms of scrub typhus infection.

Rickettsial Disease Rickettsial diseases such as scrub typhus are important causes of fever in southeast Asia especially in rural communities. Discovered quite recently and not big killers, these diseases are among the most under-reported and under-diagnosed illnesses that are both treatable and preventable. Rickettsial studies at he Mahidol Oxford Tropical Medicine Research Unit (MORU) focus on the epidemiology and incidence of the disease using hospital-based fever studies in Thailand and Laos. Our research unit has developed highly improved acute diagnosis of rickettsial illness. MORU also has ongoing studies to determine the pathophysiological mechanisms of scrub typhus infection.

Rickettsial Disease 

Dr Kesinee Chotivanich's laboratory provides facilities and resources to researchers, students, and collaborators who are interested in tropical diseases, with the aim to improve patients’ care. More effective diagnosis and treatments are needed to reduce the morbidity and mortality affecting malaria patients. Researchers at the Malaria Laboratory at MORU study the pathophysiology of the disease, and test new compound drugs for anti-malarial activity. In the context of growing artemisinin resistance, this research will have a global impact.

Malaria laboratory at MORU 

Professor Ben Cooper from MORU in Thailand uses mathematical modelling and statistical techniques to help understand the dynamics of infectious disease and evaluate potential control measures. Antibiotic resistance is one of today's major global health problems. Mathematical models help us answer what if questions and evaluate the impact of specific interventions such as hands hygiene on the spread of bacterial drug resistance. Effective solutions are then translated into policy changes or changes in practice at national or international level.

Modelling bacterial drug resistance 

The Cambodia Oxford Medical Research Unit (COMRU) is based in Siem Reap, northern Cambodia, which remains one of the poorest countries in South East Asia with extremely limited health services. PNEUMONIA IN CAMBODIAInfectious diseases are prevalent in Cambodia, a country that is struggling with poor infrastructure. Streptococcus pneumoniae causes the most severe form of pneumonia and is now targeted by the pneumococcal conjugate vaccine. Dr Paul Turner is studying the effect of this vaccine in field conditions in SE Asia, as well as other direct applications such as the evaluation of a new diagnostic test for Typhoid and interventions to reduce the burden of infections acquired within hospitals.

The Cambodia Oxford Medical Research Unit (COMRU) is based in Siem Reap, northern Cambodia, which remains one of the poorest countries in South East Asia with extremely limited health services. PNEUMONIA IN CAMBODIA Infectious diseases are prevalent in Cambodia, a country that is struggling with poor infrastructure. Streptococcus pneumoniae causes the most severe form of pneumonia and is now targeted by the pneumococcal conjugate vaccine. Dr Paul Turner is studying the effect of this vaccine in field conditions in SE Asia, as well as other direct applications such as the evaluation of a new diagnostic test for Typhoid and interventions to reduce the burden of infections acquired within hospitals.

Microbiology in the tropics 

Professor Heiman Wertheim from our OUCRU unit in Hanoi, Vietnam, tells us about his research on drug resistant infections in low and middle-income countries. Drug resistant infections are a global crisis and we cannot focus on our own country only. Clinical trials in low and middle income countries where the burden is highest, as well as work with local communities and engagement with policy makers help influence public health policies.

Clinical research in low and middle-income countries  

LOMWRU researchers conduct clinical research to help improve global, regional and Lao public health. They focus on infectious diseases, and also investigate diseases of nutrition and poverty. Poor quality medicines are a serious threat to our health. Falsified medicines and substandards medicines are a problem for all countries, but particularly for low and middle income countries where we see, for example, a large epidemic of fake anti-malarial drugs. Globally, better medicine regulatory authorities will help improve the quality of our medicines.

Poor quality medicines 

Governance in practice Dr Sassy Molyneux's main interests reside in Social science and Ethics in Public Health. Over the years, social scientists have developed a programme of empirical work on research ethics. This work is based on an understanding that while the ethics of human subjects research may be universal, there can be big differences across contexts and circumstances in key ethical issues or principles.

Health systems research 

Professor Rogier van Doorn, director of our OUCRU unit in Hanoi, Vietnam, tells us about his research on antimicrobial resistance and avian influenza. Antibiotics are widely used in Vietnam, leading to widespread antimicrobial resistance. Monitoring antibiotic use helps inform the government to change treatment guidelines and implement antibiotic stewardship programmes. This may also prevent the transmission of resistant bacteria outside the country.

Research at OUCRU Hanoi 

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