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The disease is classified as a neglected tropical disease despite being described in over 30 countries including Ghana, Togo, Benin, Côte d'Ivoire, Cameroon, Mexico, Papua New Guinea, South East Asia and Australia, and mostly affects individuals in rural communities living in infected areas. The World Health Organisation's Global Buruli Ulcer Initiative has identified the development of simple diagnostic tools as one of the priority areas in the control of the disease. Metabolomics is a growing field in analytical science and biology which seeks to identify novel biomarkers that can distinguish between diseased and non-diseased individuals. In a pilot study, funded under the Cambridge-Africa Partnership for Research Excellence (CAPREx), we sought to determine the best types of sample for the identification of metabolites from the bacteria that can be found only in Buruli ulcer patients. We collected tissue biopsy, swabs and fine needle aspirates from 28 Buruli ulcer confirmed patents and 21 patients with tropical ulcers that were not Buruli ulcer. The samples were pre-processed at the Department of Biochemistry, Cell and Molecular Biology at the University of Ghana, to extract the required components for gas chromatography-mass spectrometry (GC-MS) at the University of Cambridge. We identified tissue biopsy and fine needle aspirates as the best specimen for the identification of metabolites in preference to lesion swabs. Interestingly, metabolites identified in both groups of patients included cadaverine, putrescine, pinitol, palmitate, naphthalene, chlopyrifos and oxaspiro. The former two metabolites are interesting because they classify all the samples as containing degenerating tissue. The fatty acid palmitate is a common metabolite present in human tissue. Pinitol and the later three identifies metabolites are chemical residues that may have been present in the treatment poultice used as unorthodox remedies by the patients. In this proposal, we are seeking to further this pilot study, building on our observations and collecting the tissue biopsies and fine needle aspirates from a larger patient sample group to allow us to perform a more detailed analysis of the compounds found within the bacteria and also within infected tissue. We also intend to expand the scope of the biological samples from affected individuals by including urine samples in our analysis which may provide a more convenient biofluid to sample. To gain more insight into the novelty of the biomarkers we identify, we will include another phase of experimentation which involves the characterization of the compounds found in M. ulcerans and other similar bacteria strains that infect people in Ghana including M. pseudishottsii, M. liflandii and M. marinum DL. Data generated from this project will be important in the identification of new diagnostics and also give us insight to the biology of the mycobacterium during infection which may lead to better prospects for future treatments.","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. 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This is particularly true in low-income countries where treatments such as chemotherapy or radiotherapy may not be available. It is important that surgery goes well. When complications occur, longer term outcomes are worse, and some patients will die. It is increasingly recognised that boosting the health of patients before surgery can greatly improve the chances of success. Of course, a balance must be struck between the urgency to operate and remove the cancer and a desire to take time and improve a patient's health. Cancer often causes extreme weight loss and, in many countries, this occurs on top of pre-existing malnutrition. THE QUESTION: Would it be of benefit to intensively treat patients with nutritional supplements prior to surgery? Studies from high income countries suggest it could be, and the benefit may be even greater in low-income countries. THE TEAM: We are a well-established team working to improve surgical care worldwide. Surgeons from low- and middle-income countries are supported in Research Hubs and set their own research agenda. Nutrition in cancer surgery has been identified as an area of high priority. Our team has the broad set of skills required to make this work. OUR CURRENT WORK: We are gathering data on patients undergoing cancer surgery worldwide. It is the largest study of its kind and is taking place in 100 countries. This information will allow us to work out the relationship between malnutrition and the results of surgery in a way that hasn't been possible before. But what we really want to do is come up with a solution. This grant application is for funding to bridge the gap between our current observational study and a trial to treat patients prior to surgery. We have broad experience and are currently launching the FALCON trial, looking at steps to reduce wound infection after surgery in low-income countries. FUTURE PROPOSED TRIAL: We want to perform a large study in low- and middle-income countries giving a nutritional supplement (sometimes called ready-to-use therapeutic food) to patients undergoing cancer surgery. We will then measure whether it results in fewer complications and better outcomes after surgery. Before we can do that, we need to do three things. NEED FOR THIS PUMP PRIMING GRANT: First, we need to find a good way of screening patients for malnutrition in low-income countries. This is to identify those who may benefit most from a treatment. One would have thought that this would be easy and well-established, but it is not. Simple but accurate screening methods for malnutrition, which can be used by a nurse or a doctor for patients undergoing surgery, need to be developed or adapted. Second, we need to find an appropriate product. This needs to fulfil specific nutritional requirements but must be inexpensive, sustainable and ideally locally sourced. We will work with companies, experts, patients, and clinicians to find what is best. Third, we then need to make sure that a trial can actually be run. We will ask pragmatic questions such as, will there be a sufficient number of patients in our partner hospitals who can take part? Will they be able to take the nutritional supplement? Is the hospital in contact with patients after discharge to ensure we know what happens to them etc.? Determining the practicalities and planning for any problems identified is essential in ensuring the success of a study such as this. THE BENEFIT: We propose to perform this preliminary work in a small area of our network (Ghana, Zambia, Pakistan and the Philippines), but the research promises great benefits beyond this. Focusing on fitness prior to surgery and issues such as malnutrition will be essential in improving the outcomes of cancer surgery worldwide.","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. 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Cryptosporidiosis is caused by a single-celled protozoan parasite; the predominant species infecting humans are called Cryptosporidium hominis and Cryptosporidium parvum. This parasite mainly lives in the cells in the gut wall and has a complex life-cycle. Infection occurs due to consumption of water or food contaminated with the parasites. Parasites are spread from an infected individual through their faeces. In people who are healthy and well nourished, the disease clears naturally within a couple of weeks. However, in people who are malnourished (particularly in young children) and people with an immune system that is not functioning properly (for example HIV/AIDS victims), the disease can have a much more significant impact. It is the major contributor to life-threatening diarrhea in young children, with 2.9-4.7 million cases in children under 24 months in sub-Saharan Africa and the Indian sub-continent, leading to more than 200,000 deaths per year. Cryptosporidiosis is also associated with malnutrition and stunted growth in children and probably causes chronic infections, which last for weeks or months. The only drug registered for the treatment of this disease is nitazoxanide, which is not very effective, especially in those patients who are most severely affected due to a weak immune system and/ or malnutrition. Therefore there is an urgent need for the development of new drugs to treat: (1) children <24 months, especially those that are malnourished and with chronic diarrhea; and (2) immunocompromised children and adults with advanced AIDS and chronic diarrhea. Cryptosporidium may be the cause of as much as 75% of chronic diarrhea in this patient cohort. We have discovered some chemical starting points that can be used for a drug discovery programme. We have a series of compounds that kill the parasites and also are very effective in clearing the parasites from rodent models of cryptosporidiosis. The compounds are thought to work through preventing the parasite making proteins. The aim of this project is to take these starting points and optimise them to make a molecule which has the potential to be a drug. This will require us to optimise multiple features of the molecule: its ability to kill the parasite, its ability to reach the sites in the body where the parasite resides without being broken down, and its safety. At the end of this project we hope to have a \"preclinical candidate\". This is a compound that we think should be suitable to enter human clinical trials. The steps after this project, prior to human clinical trials will be to make the compound on a larger scale under properly defined conditions and to carry out formal safety testing.","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world."], "participating_org_ref":["GB-GOV-13","GB-COH-RC000346","GB-COH-RC000346","GB-SC-015096"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","UNIVERSITY OF DUNDEE"], "activity_status_code":"4", "activity_date_iso_date":["2018-12-01T00:00:00Z","2019-05-01T00:00:00Z","2021-07-31T00:00:00Z","2023-01-31T00:00:00Z"], "activity_date_type":["1","2","3","4"], "contact_info_organisation_narrative":["Department of Business Energy and Industrial Strategy"], "contact_info_department_narrative":["General enquiries"], "contact_info_email":["enquiries@odamanagement.org"], "contact_info_website":["https://www.gov.uk/government/publications/beis-official-development-assistance-research-and-innovation"], "contact_info_mailing_address_narrative":["Department of Business, Energy and Industrial Strategy, 4th Floor, 1 Victoria Street, SW1H 0ET"], "activity_scope_code":"2", "recipient_country_code":["BI","KM","ET","KE","MG","MW","MU","MZ","ZW","RW","ER","SO","DJ","SD","SS","TZ","UG","ZM","AO","CM","CF","TD","CG","CD","GA","GQ","ST","ZA","BW","LS","NA","SZ","CV","BJ","GM","GH","GN","GW","CI","LR","ML","MR","NE","NG","SN","SL","SH","TG","BF"], "recipient_country_percentage":[2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123,2.0408163265306123], "sector_code":["12182"], "sector_vocabulary":["1"], "policy_marker_code":["1","5","6","7","8","10","11","12"], "policy_marker_significance":["0","0","0","0","0","0","0","2"], "policy_marker_vocabulary":["1","1","1","1","1","1","1","1"], "collaboration_type_code":"1", "default_flow_type_code":"10", "default_finance_type_code":"110", "default_aid_type_code":["D02"], "default_tied_status_code":"5", "budget_status":["1","1"], "budget_type":["1","1"], "budget_period_start_iso_date":["2019-04-01T00:00:00Z","2020-04-01T00:00:00Z"], "budget_period_end_iso_date":["2020-03-31T00:00:00Z","2021-03-31T00:00:00Z"], "budget_value":[943848.8,885292.5], "budget_value_currency":["GBP","GBP"], "capital_spend_percentage":0.0, "transaction_type":["3","3","3","3","3","3","3","3","2"], "transaction_date_iso_date":["2021-03-31T00:00:00Z","2020-12-31T00:00:00Z","2020-09-30T00:00:00Z","2020-06-30T00:00:00Z","2020-03-31T00:00:00Z","2019-12-31T00:00:00Z","2019-09-30T00:00:00Z","2019-06-30T00:00:00Z","2018-12-01T00:00:00Z"], "transaction_value":[179651.53,229893.98,237873.51,237873.53,235962.24,235962.24,235962.24,235962.24,2165959.19], "transaction_value_currency":["GBP","GBP","GBP","GBP","GBP","GBP","GBP","GBP"], "transaction_value_date":["2021-03-31T00:00:00Z","2020-12-31T00:00:00Z","2020-09-30T00:00:00Z","2020-06-30T00:00:00Z","2020-03-31T00:00:00Z","2019-12-31T00:00:00Z","2019-09-30T00:00:00Z","2019-06-30T00:00:00Z","2018-12-01T00:00:00Z"], "hierarchy":1, "transaction_value_usd":[248939.80718950738,307480.5939836779,308177.97882575076,297858.9725431336,292014.99550130573,309817.65593052306,291672.5464242103,299125.1818581239,2745736.269544861] },{ "default_currency":"GBP", "default_lang":"en", "iati_identifier":"GB-GOV-13-FUND--GCRF-MR_T016124_1", "reporting_org_ref":"GB-GOV-13", "reporting_org_type_code":"10", "reporting_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY"], "title_narrative":["Evaluating multiple loci modulating susceptibility of African malaria parasites to artemisinin"], "description_narrative":["Combination drugs for treatment of malaria deployed globally since the start of the 21st century have provided a substantial public health benefit. Malaria deaths across Africa in particular have plummeted since a peak in the 1990s, when failure of the drugs chloroquine and sulphadoxine-pyrimethamine precipitated a rise in infant and child deaths. A key component in all the currently effective drug combinations is the plant-derived chemical called artemisinin. The parasite-killing ability of artemisinin has recently been threatened by the emergence of reduced susceptibility in the Mekong region: this is manifest as a slowing of artemisinin clearance of P. falciparum from the blood of treated malaria patients. Although under combination treatments these patients should eventually experience a full cure in most cases, in this region the combination partner drugs are also failing in some patients. Careful monitoring and vigilance of malaria drug resistance is therefore needed. A parasite gene has been identified in Cambodia and the surrounding region which contributes to the loss of effectiveness of the artemisinin drug - this gene, which encodes a kelch-domain protein and is called K13, has accumulated a variety of mutations. These are strongly associated with the loss of effectiveness of artemisinin against these parasites. However, this same phenomenon has not yet been observed in African malaria parasites - in the small number of cases where drug treatment does not work, K13 mutations are not implicated as the cause. In the past 2 years, gene-editing studies by ourselves and others have successfully demonstrated a direct effect of 3 genes in reducing susceptibility to artemisinin : pfap2mu, pfubp1 and pfcoronin. Variants of these genes elicit increased parasite survival in vitro in the ring-stage artemisinin survival assay (RSA). In the case of trafficking adaptor potein subunit AP-2mu, we have shown that the role of this protein in P. falciparum is unlike in other organisms as it does not interact with clathrin, but is associated with an as yet unknown compartment in the cell that appears to also contain K13, although we found no evidence of direct interaction between AP-2mu and the K13 protein. There is, however, good evidence of direct interaction of AP-2mu with a different kelch protein , K10. Polymorphisms in the gene encoding the K10 protein have been previously identified as a genetic component of parasites from the Mekong region in which the K13-dependent reduced artemisinin susceptibility originally arose. This work was carried out by PhD student Ryan Henrici, who completed his doctoral studies in 2018 and has moved on. We now request support to extend this work, using gene editing to test the effect of new mutations. In preliminary studies of both field samples and UK isolates, we have already identified a number of such new mutations in our current five genes of interest - pfk13, pfap2mu, pfubp1, pfcoronin and pfk10 (see Case for Support). For each new isolate (either from the UK or from our collaborator Dr Bismarck Dinko in Ho, Ghana) that is adapted to culture, we will fully test drug susceptibility, and genetically characterise them using genome sequencing. In gene-editing experiments we will then directly measure the impact of each candidate gene variant in both established laboratory lines and in our new cultures from UK and Ghanaian patients; any variant proven to generate a drug susceptibility phenotype may therefore be contributing to changing patterns of drug susceptibility, and could be developed as a surveillance marker for use in malaria endemic areas. Our work will thus assist our understanding of resistance to our current combination drugs, and help us to devise strategies for deploying these drugs carefully in both the UK and Africa, to maximise their useful life in curing malaria patients.","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world."], "participating_org_ref":["GB-GOV-13","GB-COH-RC000346","GB-COH-RC000346"], "participating_org_role":["1","2","3"], "participating_org_type":["10","15","15"], "participating_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL"], "activity_status_code":"4", "activity_date_iso_date":["2020-01-01T00:00:00Z","2020-07-01T00:00:00Z","2023-12-31T00:00:00Z","2021-03-31T00:00:00Z"], "activity_date_type":["1","2","3","4"], "contact_info_organisation_narrative":["Department of Business Energy and Industrial Strategy"], "contact_info_department_narrative":["General enquiries"], "contact_info_email":["enquiries@odamanagement.org"], "contact_info_website":["https://www.gov.uk/government/publications/beis-official-development-assistance-research-and-innovation"], "contact_info_mailing_address_narrative":["Department of Business, Energy and Industrial Strategy, 4th Floor, 1 Victoria Street, SW1H 0ET"], "activity_scope_code":"3", "recipient_country_code":["KH","CN","GH","LA","MM","TH","VN"], "recipient_country_percentage":[14.285714285714286,14.285714285714286,14.285714285714286,14.285714285714286,14.285714285714286,14.285714285714286,14.285714285714286], "sector_code":["12182"], "sector_vocabulary":["1"], "policy_marker_code":["1","5","6","7","8","10","11","12"], "policy_marker_significance":["0","0","0","0","0","0","0","0"], "policy_marker_vocabulary":["1","1","1","1","1","1","1","1"], "collaboration_type_code":"1", "default_flow_type_code":"10", "default_finance_type_code":"110", "default_aid_type_code":["D02"], "default_tied_status_code":"5", "budget_status":["1"], "budget_type":["1"], "budget_period_start_iso_date":["2020-04-01T00:00:00Z"], "budget_period_end_iso_date":["2021-03-31T00:00:00Z"], "budget_value":[123952.9], "budget_value_currency":["GBP"], "capital_spend_percentage":0.0, "transaction_type":["3","3","2"], "transaction_date_iso_date":["2021-03-31T00:00:00Z","2020-12-31T00:00:00Z","2020-01-01T00:00:00Z"], "transaction_value":[44557.89,79395.01,697687.56], "transaction_value_currency":["GBP","GBP"], "transaction_value_date":["2021-03-31T00:00:00Z","2020-12-31T00:00:00Z","2020-01-01T00:00:00Z"], "hierarchy":1, "transaction_value_usd":[61743.04524637936,106189.92647889275,912027.187790218] },{ "default_currency":"GBP", "default_lang":"en", "iati_identifier":"GB-GOV-13-FUND--GCRF-MR_T022132_1", "reporting_org_ref":"GB-GOV-13", "reporting_org_type_code":"10", "reporting_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY"], "title_narrative":["Strengthening private-sector medicine systems to tackle the persistence of poor-quality medicines in Africa: a proof-of-concept study"], "description_narrative":["Poor-quality medicines, containing little or no active ingredient - whether through deliberate fraud, poor manufacturing practice or post-manufacture deterioration - represent a major public health threat in low/middle-income countries (LMICs): responsible for more than 200,000 under-5 deaths each year in Africa and contributing to antimicrobial drug resistance. Efforts by governments and international agencies to curb the problem through improving detection rates, tightening regulation and public education have been hampered by the economic realities of medicine supply in resource-poor, high-need contexts, but also - we suggest - by a failure to apprehend fully the complex workings of medicine supply systems, particularly beyond the public sector. Private-sector medicine systems can be characterised as 'complex systems' involving multiple dispersed actors with no central organising authority. Recent developments in the study of complex systems have revealed how the actions of individuals can combine to have non-intuitive effects on the system as whole. This has significant implications for well-intentioned policy interventions based on 'common sense' intuition, which may have unwelcome unanticipated consequences. Our ultimate goal is to understand - and predict - the workings of complex medicine systems in order to inform effective interventions to minimise the penetration of poor-quality products in LMICs. This will require: mapping complete medicine supply chains; understanding the motivations/behaviours of buyers, sellers and regulators; developing sophisticated computational models to simulate the system; and engaging stake-holders to co-design evidence-based interventions. This is an ambitious project which needs careful groundwork through a proof-of-concept study with the following objectives and activities: (1) To assess fieldwork feasibility in these contexts and validate research instruments: Very few people have attempted to trace a full medicine supply chain in an under-regulated context. In order to assess feasibility, safety and ethical issues, we will map a limited number of medicine supply chains starting at retail outlets across Ghana and Tanzania and moving upwards to point of manufacture, obtaining as much relevant information as possible at each stage. Research instruments will be validated in each local context, and re-validated across contexts to ensure consistency. (2) To develop our understandings of the structure and operation of private-sector medicine systems: Geographically weighted analysis will be employed to describe the structure/organization of supply systems (length, number of transaction points, degree/level of vertical 'collapse', etc.) and investigate spatial dependencies in the data. Thematic analysis of ethnographic data and secondary sources will be used to understand actors' decision-making and behaviour at each point. (3) To build Agent-Based Models (ABMs) simulating medicine systems, based on empirical data: We will build a sequence of ABMs simulating medicine supply systems in Ghana and Tanzania as 'complex systems'. These models will allow us to understand, and ultimately predict, how individual behaviours might affect the system as a whole. We will develop 'user-friendly' models to use with policy-makers, highlighting potential unintended consequences of interventions. (4) To develop and evaluate strategies for engaging relevant actors (market, regulatory, political) in the research and intervention design: In each country, we will convene National Stake-holder Groups (NSGs), with policy, regulatory and high-level market actors and Project Working Groups (PWGs), comprising 'on-the-ground' supply-chain actors (buyers, sellers and regulators). Through a series of collaborative workshops, we will work with 'user-friendly' models to identify potential 'bottlenecks' or problematic behavioural logics that might underpin interventions.","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world."], "participating_org_ref":["GB-GOV-13","GB-COH-RC000346","GB-COH-RC000346"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","DURHAM UNIVERSITY"], "activity_status_code":"4", "activity_date_iso_date":["2020-03-01T00:00:00Z","2020-03-01T00:00:00Z","2022-02-28T00:00:00Z","2021-03-31T00:00:00Z"], "activity_date_type":["1","2","3","4"], "contact_info_organisation_narrative":["Department of Business Energy and Industrial Strategy"], "contact_info_department_narrative":["General enquiries"], "contact_info_email":["enquiries@odamanagement.org"], "contact_info_website":["https://www.gov.uk/government/publications/beis-official-development-assistance-research-and-innovation"], "contact_info_mailing_address_narrative":["Department of Business, Energy and Industrial Strategy, 4th Floor, 1 Victoria Street, SW1H 0ET"], "activity_scope_code":"2", "recipient_country_code":["GH","TZ"], "recipient_country_percentage":[50.0,50.0], "sector_code":["12182"], "sector_vocabulary":["1"], "policy_marker_code":["1","5","6","7","8","10","11","12"], "policy_marker_significance":["0","0","0","0","0","0","0","0"], "policy_marker_vocabulary":["1","1","1","1","1","1","1","1"], "collaboration_type_code":"1", "default_flow_type_code":"10", "default_finance_type_code":"110", "default_aid_type_code":["D02"], "default_tied_status_code":"5", "budget_status":["1"], "budget_type":["1"], "budget_period_start_iso_date":["2020-04-01T00:00:00Z"], "budget_period_end_iso_date":["2021-03-31T00:00:00Z"], "budget_value":[89893.92], "budget_value_currency":["GBP"], "capital_spend_percentage":0.0, "transaction_type":["3","3","3","3","2"], "transaction_date_iso_date":["2021-03-31T00:00:00Z","2020-12-31T00:00:00Z","2020-09-30T00:00:00Z","2020-06-30T00:00:00Z","2020-03-01T00:00:00Z"], "transaction_value":[22473.48,22473.48,22473.48,22473.48,180516.02], "transaction_value_currency":["GBP","GBP","GBP","GBP"], "transaction_value_date":["2021-03-31T00:00:00Z","2020-12-31T00:00:00Z","2020-09-30T00:00:00Z","2020-06-30T00:00:00Z","2020-03-01T00:00:00Z"], "hierarchy":1, "transaction_value_usd":[31141.086179879738,30058.024917748196,29115.607045025456,28140.700069775154,223397.54347226745] },{ "default_currency":"GBP", "default_lang":"en", "iati_identifier":"GB-GOV-13-FUND--GCRF-MR_T022787_1", "reporting_org_ref":"GB-GOV-13", "reporting_org_type_code":"10", "reporting_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY"], "title_narrative":["Adapting the health system in Ghana to reach the urban poor"], "description_narrative":["In rural areas, Ghana has a well-established programme of community-based nurses, community health officers and volunteers working with rural communities to improve maternal and child health. The approach is called Community Health Planning and Services (CHPS) and evaluations in rural areas have shown that the approach has halved all maternal deaths and with increased access to family planning, reducing by one the number of children a woman gives birth to. While successful in rural areas, the approach has not yet been extended to urban areas. Ghana is urbanising rapidly and inequalities between the rich and poor are unacceptably high, with children under the age of 14 in poor urban communities five times more likely to die than the general urban population. Extending CHPS to poor urban communities is now a top government priority. This proposal has been put together by health systems researchers and policy makers embedded within Ghana's health services (GHS) and the national CHPS programme. Our aim is to conduct the foundation work needed to scale-up CHPS so that the poorest, marginalised urban residents can benefit from the approach. We will engage closely with three urban communities, each with different variations of urban poverty, for example informal settlements or more mixed, well-established neighbourhoods. Our team includes senior GHS staff, including the head of CHPS, head of nursing research and a strong team of health systems researchers. Ghanaian public health registrars who have worked throughout GHS, with expertise in research methods, will work alongside UK public health registrars (at no salary cost to the project). They will conduct two focus groups in each of the 3 areas. Participants will include women with children facing a variety of challenges to accessing health care. We will conduct approx. 24 interviews with marginalised groups and also community leaders. The registrars will conduct a desk review of urban community health initiatives. We will collect details of current services provided in the 3 areas and their costs. Key decision makers from within the CHPS programme and GHS will come together for a workshop to design a prototype urban CHPS model and identify all materials, guidelines and training that need to be developed. Our team will develop the practical tools and revise them based on learning throughout the project. CHPS staff and volunteers will be trained to deliver the new model and will begin implementation in the three areas. Our team will facilitate participatory action research groups with the CHPS staff, community members in each of the areas. The groups will identify issues, agree on and implement solutions and then observe the results. This will lead to a continual cycle of learning and development. The registrars will document this process, collect cost and service data to estimate cost and increase in utilisation and qualitative data with marginalised groups to inform improvement. This will provide valuable new knowledge on how to engage communities and develop an urban health system to reach the most vulnerable. We will draw on a theoretical framework that spells out different components to consider in community engagement. This will ensure that the model we develop considers all aspects of creating a successful and sustainable community engagement model. Our findings will also allow us to propose modifications to the framework which is currently based on evidence from high income countries. A final workshop with CHPS and CHS decision makers will enable the detailed development of a plan to scale-up the model across urban Ghana. It will also enable us to plan for future large scale evaluation. By the end of the project, a full suite of policy and practice documents will be available to enable scale-up across urban areas. We will establish a centre of excellence for Urban CHPS to maintain the culture of research to continually evaluate and improve urban CHPS as it is scaled up.","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world."], "participating_org_ref":["GB-GOV-13","GB-COH-RC000346","GB-COH-RC000346","GB-COH-RC000679"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","UNIVERSITY OF YORK"], "activity_status_code":"4", "activity_date_iso_date":["2019-12-01T00:00:00Z","2020-09-01T00:00:00Z","2021-11-30T00:00:00Z","2021-03-31T00:00:00Z"], "activity_date_type":["1","2","3","4"], "contact_info_organisation_narrative":["Department of Business Energy and Industrial Strategy"], "contact_info_department_narrative":["General enquiries"], "contact_info_email":["enquiries@odamanagement.org"], "contact_info_website":["https://www.gov.uk/government/publications/beis-official-development-assistance-research-and-innovation"], "contact_info_mailing_address_narrative":["Department of Business, Energy and Industrial Strategy, 4th Floor, 1 Victoria Street, SW1H 0ET"], "activity_scope_code":"4", "recipient_country_code":["GH"], "recipient_country_percentage":[100.0], "sector_code":["12182"], "sector_vocabulary":["1"], "policy_marker_code":["1","5","6","7","8","10","11","12"], "policy_marker_significance":["0","0","0","0","0","0","0","0"], "policy_marker_vocabulary":["1","1","1","1","1","1","1","1"], "collaboration_type_code":"1", "default_flow_type_code":"10", "default_finance_type_code":"110", "default_aid_type_code":["D02"], "default_tied_status_code":"5", "budget_status":["1","1"], "budget_type":["1","1"], "budget_period_start_iso_date":["2019-04-01T00:00:00Z","2020-04-01T00:00:00Z"], "budget_period_end_iso_date":["2020-03-31T00:00:00Z","2021-03-31T00:00:00Z"], "budget_value":[24639.0,24639.0], "budget_value_currency":["GBP","GBP"], "capital_spend_percentage":0.0, "transaction_type":["3","3","2"], "transaction_date_iso_date":["2021-03-31T00:00:00Z","2020-03-31T00:00:00Z","2019-12-01T00:00:00Z"], "transaction_value":[24639.0,24639.0,197910.44], "transaction_value_currency":["GBP","GBP"], "transaction_value_date":["2021-03-31T00:00:00Z","2020-03-31T00:00:00Z","2019-12-01T00:00:00Z"], "hierarchy":1, "transaction_value_usd":[34141.807249525074,30491.986659207305,259855.76592669415] },{ "default_currency":"GBP", "default_lang":"en", "iati_identifier":"GB-GOV-13-FUND--GCRF-MR_P025226_1", "reporting_org_ref":"GB-GOV-13", "reporting_org_type_code":"10", "reporting_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY"], "title_narrative":["The Dynamics of Filovirus Infection in bats in Ghana"], "description_narrative":["GCRF Foundation Infections 2016 to determine key aspects of the dynamics of filovirus infections in reservoir bat species in Ghana, to identify the optimal local means of avoiding spill over of infection into humans, or into 'bridging' domestic animals or\n","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world."], "participating_org_ref":["GB-GOV-13","GB-COH-RC000346","GB-COH-RC000346","GB-CHC-222655"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","LIVERPOOL SCHOOL OF TROPICAL MEDICINE"], "activity_status_code":"4", "activity_date_iso_date":["2017-04-01T00:00:00Z","2017-04-01T00:00:00Z","2019-03-31T00:00:00Z","2019-03-31T00:00:00Z"], "activity_date_type":["1","2","3","4"], "contact_info_organisation_narrative":["Department of Business Energy and Industrial Strategy"], "contact_info_department_narrative":["General enquiries"], "contact_info_email":["enquiries@odamanagement.org"], "contact_info_website":["https://www.gov.uk/government/publications/beis-official-development-assistance-research-and-innovation"], "contact_info_mailing_address_narrative":["Department of Business, Energy and Industrial Strategy, 4th Floor, 1 Victoria Street, SW1H 0ET"], "activity_scope_code":"4", "recipient_country_code":["GH"], "recipient_country_percentage":[100.0], "sector_code":["12182"], "sector_vocabulary":["1"], "policy_marker_code":["1","5","6","7","8","10","11","12"], "policy_marker_significance":["0","2","0","0","0","0","0","0"], "policy_marker_vocabulary":["1","1","1","1","1","1","1","1"], "collaboration_type_code":"1", "default_flow_type_code":"10", "default_finance_type_code":"110", "default_aid_type_code":["D02"], "default_tied_status_code":"5", "budget_status":["1","1"], "budget_type":["1","1"], "budget_period_start_iso_date":["2017-04-01T00:00:00Z","2018-04-01T00:00:00Z"], "budget_period_end_iso_date":["2018-03-31T00:00:00Z","2019-03-31T00:00:00Z"], "budget_value":[300598.24,227171.58], "budget_value_currency":["GBP","GBP"], "capital_spend_percentage":0.0, "transaction_type":["3","3","3","3","3","3","3","3","2"], "transaction_date_iso_date":["2019-09-30T00:00:00Z","2018-12-31T00:00:00Z","2018-09-30T00:00:00Z","2018-06-30T00:00:00Z","2018-03-31T00:00:00Z","2017-12-31T00:00:00Z","2017-09-30T00:00:00Z","2017-06-30T00:00:00Z","2017-04-01T00:00:00Z"], "transaction_value":[74490.05,75723.86,75723.86,75723.86,75149.56,75149.56,75149.56,75149.56,603493.64], "transaction_value_currency":["GBP","GBP","GBP","GBP","GBP","GBP","GBP","GBP"], "transaction_value_date":["2019-09-30T00:00:00Z","2018-12-31T00:00:00Z","2018-09-30T00:00:00Z","2018-06-30T00:00:00Z","2018-03-31T00:00:00Z","2017-12-31T00:00:00Z","2017-09-30T00:00:00Z","2017-06-30T00:00:00Z","2017-04-01T00:00:00Z"], "hierarchy":1, "transaction_value_usd":[92077.03133673739,95993.38243853861,98907.77401856861,100647.0908077591,104984.5444983428,100732.32863497494,100159.85878550728,96203.99053609611,762803.7529730478] },{ "default_currency":"GBP", "default_lang":"en", "iati_identifier":"GB-GOV-13-GCRF-MR-C-JGHT-C4-1314MR-M009211-1", "reporting_org_ref":"GB-GOV-13", "reporting_org_type_code":"10", "reporting_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY"], "title_narrative":["The CRASH-3 Trial: Tranexamic acid for the treatment of significant traumatic brain injury."], "description_narrative":["There are more deaths each year from injuries than from HIV, TB and malaria combined. Worldwide, about ten million people are killed or hospitalised because of a head injury every year. Most head injuries are caused by road traffic crashes, and because car use is increasing, the number of people suffering a head injury is increasing. Amongst those who survive a head injury, many are left severely disabled for the rest of their lives. For example, there is a high likelihood that Michael Schumacher will be permanently disabled as a result of his recent head injury. Most victims of head injury are young adults living in low and middle income countries. Because many of the victims are also breadwinners for their families, head injuries can also result in loss of income which, along with medical costs, can increase household debt and lead to a fall in living standards for the whole family. When the head is injured there is often bleeding inside the brain, which can continue for some time and worsen after hospital admission. This bleeding increases pressure inside the skull causing further damage to the brain, which can be fatal or result in serious disability for the patient. We think that we can prevent some of these deaths and disability by reducing the amount of bleeding in the brain after head injury. Tranexamic acid is a cheap drug that reduces bleeding in other conditions. A large trial in accident victims (other than those with head injury) found that it reduces the chances of bleeding to death. If this drug also works in patients with head injury and bleeding into the brain, this would be important to know because it could save lives at a very low cost. We have already done two preparatory studies to see if tranexamic acid can help people who have bleeding inside the brain because of a head injury. Together, the results of the studies suggest that tranexamic acid should reduce the amount of bleeding inside the brain and could reduce their chances of dying or being disabled. However, because these studies were small, we are not very certain about the accuracy of their results. Also, they were not designed to find out whether tranexamic acid reduces disability. Because doctors are still unsure about whether tranexamic acid works, it is not given to patients with traumatic brain injury. But if a new clinical trial showed that it worked, this would change very quickly. We want to find out if tranexamic acid saves lives and reduces disability in people with traumatic brain injury. We plan to study 10,000 patients with traumatic brain injury in countries throughout the world. We will give half of them tranexamic acid and the other half a dummy medicine called a placebo. To make sure that the two groups are the same apart from tranexamic acid, we will decide who gets tranexamic acid and who gets placebo using the modern equivalent of the toss of a coin (this is called randomisation). Everyone will of course get all the treatments that doctors usually give to traumatically brain injured patients. At the end of the trial we will see if giving tranexamic acid on top of all the usual treatments improves survival and other patient outcomes. The study will be carried out by a team of researchers with lots of experience in doing clinical trials. In fact, it will be the same team that did the successful study of tranexamic acid in accident victims. The trial will cost several million pounds but if it shows (as we hope it will) that tranexamic acid works, we will have a very cheap way of reducing the number of people who die and are disabled after a head injury. The start up phase of trial is underway and over a thousand patients have been recruited. The trial procedures work well. This application is for funds to continue recruitment to 10,000 patients.","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world."], "participating_org_ref":["GB-GOV-13","GB-COH-RC000346","GB-COH-RC000346"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE"], "activity_status_code":"4", "activity_date_iso_date":["2014-10-01T00:00:00Z","2014-11-01T00:00:00Z","2018-06-30T00:00:00Z","2021-01-31T00:00:00Z"], "activity_date_type":["1","2","3","4"], "contact_info_organisation_narrative":["Department of Business Energy and Industrial Strategy"], "contact_info_department_narrative":["General enquiries"], "contact_info_email":["enquiries@odamanagement.org"], 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"reporting_org_type_code":"10", "reporting_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY"], "title_narrative":["InterTxt2Heart pilot: A trial to evaluate efficacy of text message to improve adherence to cardiovascular medications in secondary prevention."], "description_narrative":["In less developed countries cardiovascular diseases (heart diseases and stroke) have a vast deleterious impact at individual and society level. Patients with cardiovascular diseases can benefit from affordable and effective medications, but only a minority of patients takes the medications, and strategies tested in the past to improve taking of these medications have failed. Mobile phones are becoming an essential instrument in daily life of people living in less developed countries and therefore have become an ideal \"instrument\" to deliver interventions to change behaviours, such as taking medications. Previous successes of studies using mobile text messages to improve adherence to HIV-medications provides a strong precedent that this success could be translated to cardiovascular diseases. However, to achieve this, it requires a carefully work on understanding the reasons why people stop taking medications that also considers the local-context. To date, there are no studies in cardiovascular disease that full fill these criteria. Our long-term aim is to conduct the largest study to evaluate if mobile text messages can be helpful to increase adherence to life-saving cardiovascular medications. As a first step (current proposal), we will be studying reasons for poor adherence to cardiovascular medications using \"state of art\" psychological strategies co-developed by some of the co-applicants. Then, we will convert this knowledge, on reasons for poor adherence, into short-text messages tailor to the specific needs of patients in order to increase adherence of cardiovascular medications. In a second step (not included in this proposal) we will test under controlled experimental conditions (known as randomized trial) if mobile text messages are useful to increase adherence to cardiovascular medications that decrease blood pressure and the bad-cholesterol as well as making the blood thinner to avoid occlusion of arteries in the heart, brain and extremities. The study will take place in Colombia, Ghana, and India, representing major geographical areas with different stage of economic development and health care systems. We expect that our wide-coverage of less-developed countries will facilitate a rapid adoption of our intervention (if successful) to other less-developed countries. Our study will inform the World Health Organization initiative on uses of mobile text phone interventions to improve management of chronic conditions such as cardiovascular diseases","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world."], "participating_org_ref":["GB-GOV-13","GB-COH-RC000346","GB-COH-RC000346"], "participating_org_role":["1","2","3"], "participating_org_type":["10","15","15"], "participating_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL"], "activity_status_code":"4", "activity_date_iso_date":["2016-01-01T00:00:00Z","2016-05-01T00:00:00Z","2017-06-30T00:00:00Z","2017-10-31T00:00:00Z"], "activity_date_type":["1","2","3","4"], "contact_info_organisation_narrative":["Department of Business Energy and Industrial Strategy"], "contact_info_department_narrative":["General enquiries"], "contact_info_email":["enquiries@odamanagement.org"], "contact_info_website":["https://www.gov.uk/government/publications/beis-official-development-assistance-research-and-innovation"], "contact_info_mailing_address_narrative":["Department of Business, Energy and Industrial Strategy, 4th Floor, 1 Victoria Street, SW1H 0ET"], "activity_scope_code":"3", "recipient_country_code":["CO","GH","IN"], "recipient_country_percentage":[33.333333333333336,33.333333333333336,33.333333333333336], "sector_code":["12182"], "sector_vocabulary":["1"], "policy_marker_code":["1","5","6","7","8","10","11","12"], "policy_marker_significance":["0","0","0","0","0","0","0","0"], "policy_marker_vocabulary":["1","1","1","1","1","1","1","1"], "collaboration_type_code":"1", "default_flow_type_code":"10", "default_finance_type_code":"110", "default_aid_type_code":["D02"], "default_tied_status_code":"5", "budget_status":["1","1"], "budget_type":["1","1"], "budget_period_start_iso_date":["2016-04-01T00:00:00Z","2017-04-01T00:00:00Z"], "budget_period_end_iso_date":["2017-03-31T00:00:00Z","2018-03-31T00:00:00Z"], "budget_value":[100810.36,25406.72], "budget_value_currency":["GBP","GBP"], "capital_spend_percentage":0.0, "transaction_type":["3","3","3","3","3","3","3","3","2"], "transaction_date_iso_date":["2018-03-31T00:00:00Z","2017-12-31T00:00:00Z","2017-09-30T00:00:00Z","2017-06-30T00:00:00Z","2017-03-31T00:00:00Z","2016-12-31T00:00:00Z","2016-09-30T00:00:00Z","2016-06-30T00:00:00Z","2016-01-01T00:00:00Z"], "transaction_value":[3566.02,-5081.37,5081.37,5081.34,5040.52,5040.52,5040.52,5040.52,151623.95], "transaction_value_currency":["GBP","GBP","GBP","GBP","GBP","GBP","GBP","GBP"], "transaction_value_date":["2018-03-31T00:00:00Z","2017-12-31T00:00:00Z","2017-09-30T00:00:00Z","2017-06-30T00:00:00Z","2017-03-31T00:00:00Z","2016-12-31T00:00:00Z","2016-09-30T00:00:00Z","2016-06-30T00:00:00Z","2016-01-01T00:00:00Z"], "hierarchy":1, "transaction_value_usd":[4981.758846917805,-6811.194007734744,6772.485449507797,6504.964037988868,6216.6808018558095,6298.696619469467,6623.434124650562,7163.846125975703,218381.6621929571] },{ "default_currency":"GBP", "default_lang":"en", "iati_identifier":"GB-GOV-13-FUND--GCRF-MR_N029984_1", "reporting_org_ref":"GB-GOV-13", "reporting_org_type_code":"10", "reporting_org_narrative":["DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY"], "title_narrative":["Development grant for a multicentre, randomised trial to reduce surgical site infection following emergency gastrointestinal surgery in LMICs"], "description_narrative":["THE PROBLEM: Infections in wounds after bowel surgery are common in all countries. They have adverse effects for patients, doctors and health systems. For patients, they are painful, smelly, reduce quality of life and reduce time taken to return to normal activities. They are hard to treat and require prescriptions of long courses of antibiotics and return trips to the operating theatre, increasing antibiotic resistance and reducing future available treatments. They are extremely costly and require long lengths of stay in hospital and lots of nursing time. In low and middle-income countries, they are at least twice as common as they are in high-income countries. Rates of antibiotic resistance are also higher, meaning they are even harder to treat. Wound infections affect both adults and children and since people of working age can't return quickly to work, their families and communities are also adversely affected. FUTURE PROPOSED TRIAL: We aim to perform a large, multi-country randomised controlled trial looking at two simple interventions to reduce wound infections after emergency bowel surgery. Emergency surgery is the most common, demanding and burdensome type of bowel surgery in low and middle income countries (LMICs). Since the burden of wound infections is highest in these countries compared to other places in the world, this research proposal if timely and focussed toward a clinical need in LMICs. Wound infections are complex and testing two interventions at the same time may show even greater effect than just testing one, and it also improves value for money. The trial will be large and require around 2000 patients. NEED FOR A DEVELOPMENT GRANT: Before we can submit a highly competitive, world-class grant proposal, we need to perform some development work to ensure that we are prepared. This work will develop a final, tangible plan for that application, and engage local doctors and research staff into the process. We aim to: 1. Hold on site meetings in participating countries, led by local surgeons, to engage a range of staff and shortlist interventions which could be tested in their units. 2. Deliver on-site research skills training that will increase local research capacity and leadership. 3. Perform small observational studies to ensure that sites have a strategy to follow-up patients during the main trial. 4. Hold our first face-to-face collaborator group meeting, to develop a finalised protocol based on the selected interventions, that can be used for a main trial application. This meeting will also allow us to foster the strongest possible relationships between our new collaborative and improve team working. NEED FOR MORE SURGICAL RESEARCH: There is a lack of surgical research across the world, partly driven by a lack of doctors regularly performing surgical research. This initial proposal will allow is to form a collaborative that could last for many decades. We predict that this network will enable us to deliver more trials into the future, of larger sizes and complexity. In the UK, we have developed hub and spoke research networks to deliver similar trials. We aim to transfer these research skills from the NHS to LMICs to help disseminate best surgical research practice widely. This will also speed recruitment to trials and maximise generalizability. We aim that this development grant and subsequent main grant will produce a generation of surgical researchers focused on testing cost-effective interventions internationally.","The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. 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