devinitorg/iati-policy-markers huggingface dataset:
How is the current crisis reshaping Brazil's health system? Strengthening health workforce and provision of services in São Paulo and Maranhão Economic crises are very common worldwide, and they have been shown to carry multiple effects on national health systems; they can increase the burden of disease from specific mental health and poverty-related conditions, but also drive health workers away from the public sector and the country in search of better working conditions. Some scholars have suggested that it is often the associated policy responses - the so-called austerity measures - that carry a negative impact on health systems and workforces.  In Brazil, the health system effects of the economic crisis that has affected the country since 2015 have not been fully understood, with press reports and anecdotal evidence suggesting that services are being shut down and physicians are abandoning the public sector, particularly in rural areas. As part of its policy response to the crisis, the Government is introducing measures to limit public health spending, promote the growth of private health insurance plans, and fill the gaps in the workforce through international recruitment. However, an objective assessment of the health systems effects of Brazil's crisis is lacking, and so is the evidence base to elaborate policies to address them.  The present study aims at exploring the impact of the current economic crisis and of the associated austerity measures on the health system and workforce in Brazil, with a specific focus on public sector physicians - an essential pillar of any health system-, and on how to foster the debate on suitable health policy options. We will look specifically at the cases of São Paulo and Maranhão states, two very diverse settings where we expect the diverse effects of the crisis to be felt differently because of their uneven economic development. We will do so by analysing the existing data on the effects of the crisis from available health financing and medical workforce datasets, and by conducting interviews and surveys among phsycians in the two states. The study findings will be presented in facilitated policy dialogues workshops in São Paulo and Maranhão, where health policy-makers will be invited to review the fresh evidence produced, and to consider examples of health policy responses from other countries.   It is hoped that this study will help identify suitable policies to alleviate the effects of the crisis on the health system, health workforce and provision of services in Brazil, particularly for the most vulnerable populations in São Paulo and Maranhão. The study findings will also contribute to the growing body of knowledge on economic crises and health systems world-wide. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
Newton001-THE EFFICACY AND SAFETY OF STEM CELL THERAPIES IN MOUSE MODELS OF KIDNEY DISEASE It is now recognized that renal disease is a global public health problem, with the incidence of end stage renal disease (ESRD) rising annually. Current treatment options for ESRD are dialysis or renal transplantation, which apart from their significant drawbacks in terms of increased morbidity and mortality, are also placing an increasing economic burden on society. ESRD usually develops from a progressive worsening of chronic renal disease. In most cases, however, there is a time-window of several years from the onset of mild/moderate kidney disease to the development of ESRD, which could present an opportunity to design therapies aimed at preventing disease progression by repairing or replacing damaged renal tissue. Over recent years, stem cells have been identified in the kidneys of mice and humans that are able to generate some of the specialised cells that are essential for the kidneys to function. Studies have shown that if these kidney-derived stem cells (KSCs) are injected into mice with kidney disease, they populate the damaged tissue and in some cases, can even improve kidney function. Furthermore, mesenchymal stem cells (MSCs) derived from bone marrow or adipose tissue have also been shown to ameliorate kidney disease in rodents. However, no studies have directly compared the therapeutic efficacy of these two stem cell types, nor investigated whether they remain in the kidneys and are able to benefit the recipient over the long-term, or if their presence is only short-lived.  There are also a number of safety issues surrounding such therapies that need to be addressed; for instance, the possibility that the stem cells populate other tissues besides the kidney has not been thoroughly investigated. This information is important because if the stem cells end up in the wrong environment, they could generate inappropriate cell types, or could potentially from tumours, which would be detrimental to the recipient.  In this project, we will compare the therapeutic efficacy of human KSCs and MSCs in mice with kidney disease. To check if the stem cells populate tissues other than the kidney, in some experiments, we will label the cells so that they can be monitored non-invasively using various imaging techniques, such as magnetic resonance imaging, photoacoustic imaging and bioluminescence imaging. We will also follow some animals over the long-term to investigate if they develop tumours. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
Evaluation of effect of social determinants and of impact of social programs on incidence, frequency of disability and treatment outcomes of leprosy Leprosy continues to be a disease of public health importance in Brazil and many other low and middle income countries. Not much is known about the social epidemiology of leprosy nor the effectiveness of social policies on this poverty-related disease.  We propose a new way to investigate wich aspects of poverty increase the risk of leprosy, and how much Bolsa Familia ( a conditional cash transfer programme) introduced by the Brazilian government helped to decrease the risk of leprosy, reduced the risk of disability, and increased the proportion of cases of leprosy that completed treatment.   We are going to do this by using data already collected for administrative purposes. The main database is "Cadastro Único para Programas Sociais" (CadÚnico), used for screening applications for social programmes, which contains data on a range of socioeconomic indicators for 100 million people. We will link  this to two databases:  of benefits received, and to notification of leprosy. This will be done protecting the identification of individual data with strict security measures approved by the ethical committee. The unprecedented size of this cohort will allow the investigation of effects of social conditions (education, income, housing, family structure, ethnicity, water supply, sanitation) and  of impact of interventions (income received, duration of support) on different aspects of leprosy in  subpopulations defined by type of disease, age, geography, income, gender, housing, etc..     The project will produce evidence of the impact of social interventions and social deprivation on leprosy. The study will advance our understanding of leprosy and will strengthen the case for implementation of social interventions- in addition to biomedical interventions-to promote effective  control of leprosy and pave the way for evaluation of impact on other poverty related diseases. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
Newton001 Maternal nutritional status, mental health and childhood health: a prospective cohort study in Rio de Janeiro. The improvement of maternal and child health is one of the aims of the Millennium Development Goals of the United Nations Development Programme. Maternal mental health and obesity are global issues and risk factors for adverse pregnancy and perinatal outcomes. This partnership will undertake the necessary background work and training to achieve the final goal of developing a protocol for a prospective mother child cohort study in Rio de Janeiro, Brazil. The aim of the cohort is to improve the understanding of the complex relationship between maternal nutrition, mental health in pregnancy and adverse pregnancy outcomes. This objective will be achieved through workshops, web based communication and exchange visits. King's College London (KCL) has many links with Universities in Brazil, facilitated by the KCL Brazil Institute including a college wide co-operation agreement with the Federal University of Rio de Janeiro (UFRJ). The proposed collaboration with the KCL Division of Women's Health and UFRJ Nutritional Epidemiology Observatory has developed from a mutual research interest in maternal nutritional status and women and children's health outcomes, with a particular focus on mental health during pregnancy and childhood cognitive development. This potential partnership relates both areas of expertise (maternal and child health and nutrition), and in this way, will contribute to reach the Millennium Development Goals and reduce the global burden of chronic diseases. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
The dynamic of anti-dengue antibodies over time. Dengue virus is transmitted to man by the bite of an infected mosquito. Infection is usually not life threatening either causing no symptoms, resulting in a mild flu-like syndrome or leading to an unpleasant but limited disease called dengue fever. However the infection can have more serious consequences with a significant number of infected individuals developing what is called dengue haemorrhagic fever (DHF), which can be fatal in up to 20% of patients unless they receive expert medical care. This disease is common in tropical and subtropical countries where around 2.5 billion people are at risk of infection. It is estimated that 390 million infections occur per year of which around 25% develop into dengue disease. In Thailand millions of people become infectioned each year and in some years hundreds of thousands of those infected go on to develop life-threatening DHF. Dengue circulates as four related viruses. Infection with one serotype will not provide protection against other serotypes. Therefore it is common to get a dengue infection on more than one occasion. In fact, those experiencing a second infection with a different serotype are more likely to develop DHF. This suggests that pre-existing immunity can have a detrimental effect. This feature is an obstacle to vaccine development. Because of the scale of the problem, there is an urgent need for a vaccine. However it has proved an enormous challenge. After almost 50 years of effort two phase III trials showed limited protection. In this study, we will interrogate the development of acute antibody responses as well as memory B cell responses. We will also study the antibody response in dengue-infected individuals who do not develop the disease. The antibody profiles will be compared with the responses found in dengue-infected patients. In addition, the contribution of antibodies recognizing the dengue non-structural protein 1 in the pathogenesis and protection will be studied. The study will provide useful information to direct vaccine design and monitoring. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
Using whole genome sequencing to characterise drug resistant Mycobacterium tuberculosis in Thailand Tuberculosis is an infectious disease that causes a high public health burden. The World Health Organisation estimates that there are ten million new cases and nearly two million deaths each year. Thailand is classified by WHO as one of the 22 countries in the world with the highest TB burden, with 93,000 new cases each year and an overall estimated TB prevalence of nearly 130,000 cases, 16 percent of whom are also HIV positive. Establishing who transmits to whom and where is fundamental to disease control. By comparing the genetic profiles of tuberculosis-causing bacteria within large population-based studies we can identify likely transmissions based on the similarity of the strains. Our work will focus on the Kanchanaburi province of Thailand, where there have been outbreaks of multi-drug resistant TB bacterial strains. This is a province where tuberculosis disease prevalence has been high compared other to regions in Thailand. Tuberculosis samples from patients (n=2,000) attending the largest hospital (Makarak Hospital), spanning a period from 2003 to 2019, will be genetically characterized, and important meta data (e.g. HIV status) curated. The inferred genetic profiles will use a higher proportion of the genome than used previously, allowing more accurate reconstructions of transmission chains. Factors influencing transmissibility will then be assessed directly by looking at the patterns of data within each transmission chain. These factors may be genetic variations within the bacteria themselves, and we will seek to identify those associated with drug resistance and transmissibility. Non-genetic factors affecting transmission, such as differences in the human hosts, including age, sex, diabetes, HIV infection and treatment, and contact patterns, will be investigated. We will attempt to confirm any insights into these factors using data collected and generated from other populations in Thailand and globally. Ultimately, an improved understanding of the genetic and other processes underlying transmissibility could lead to the development of improved control measures. These measures could include novel drug or vaccine targets, or identification of geographical or socially determined hotspots of transmission; thereby assisting the Thailand Ministry of Public Health with control strategies, as well as benefiting the Kanchanaburi province and wider Thailand. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
Investigating anti-tumour T cell responses in nasopharyngeal carcinoma to refine vaccine-based immunotherapies Nasopharyngeal carcinoma (NPC) is a type of cancer that occurs at the back of the nose. It is unusually common in some parts of the world, including countries like Malaysia where it constitutes a very significant health problem. NPC can be cured, but in many cases the cancer comes back and this is usually fatal. Furthermore, patients who do survive are often left with significant long-term side effects caused by the toxic treatments. Therefore, new treatments are needed to reduce deaths from NPC and improve the quality of life for survivors. All patients with NPC have a virus, known as the Epstein-Barr virus, or EBV for short, in their tumour cells. We have developed a vaccine that can recognise EBV with the aim of boosting the patients' own immune response to the tumour. Early tests of our vaccine in people show that it is safe and that it can boost immunity against the virus. In this proposal we want to understand more about immunity to EBV in patients with NPC so that we can modify how we deliver our vaccine and eventually combine it with other drugs to improve its therapeutic effects. To do this we will be using new sequencing technologies to probe how patient's T cells, the body's main weapon against virus-infected cells, respond to EBV, for example before and after treatment, enabling us to 'track' individual T cell responses over time. At the same time, we will explore the nature of potential inhibitory pathways present in the tumour so that we might eventually target these in combination with our vaccine making it more effective. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
Newton001: Targeting the surface proteome of Trypanosoma cruzi The surface of protozoan parasites represent the interface with the host, with many roles in invasion, immune evasion, signalling, and environmental sensing. We recently identified a conserved ubiquitylation pathway in trypanosomes that controls the surface copy number of important trans-membrane domain proteins, and which provides a means for the first time to manipulate trans-membrane domain protein abundance in these parasites in a rational manor, and to assess their importance to host cell invasion and virulence.   This application seeks to assess the significance of the surface protein ubiquitylation pathway in Trypanosoma cruzi for:  1. Parasite viability, host cell invasion and life cycle progression, 2. Maintenance of the surface coat, specificallycopy number of trans-membrane domain proteins and their impact on the global surface proteome,  3. Possible value as a therapeutic target, by assessment of viability in vitro. The work will combine state of the art genome editing using CRISPR/Cas9 approaches, together with SILAC proteomics for unbiased analysis of the surface/cellular proteome. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
Using host-responses and pathogen genomics to improve diagnostics for tuberculosis in Bandung, Indonesia Tuberculosis disease (TB) is a major public health issue in Indonesia with over one million cases and 123,000 deaths in 2016 alone. Worldwide, the World Health Organisation estimates that there are nine million new TB cases and nearly two million deaths each year. The increasing prevalence of multi-drug resistance strains is making disease control difficult. Until today, diagnosing active TB, especially in the early stages, is difficult and requires a sputum sample. In addition, current treatment takes more than 6 months of therapy, with diagnostics unable to help identify early treatment failure. An eventual diagnosis of drug resistance may mean extended further treatment for 2 years.  This project seeks to identify a new diagnostic assay that uses a small blood sample to measure the patient's response to the tuberculosis infection, instead of looking for the tuberculosis bacterium directly. This assay could be able to identify patients earlier and monitor their treatment response. This would allow earlier treatment and more rapid ability to alter therapy to a more appropriate regimen.  This project will link the Dr. Hasan Sadikin Hospital, Faculty of Medicine Universitas Padjadjaran (DHSH-UNPAD), with the Eijkman Institute for Molecular Biology and the London School of Hygiene and Tropical Medicine - three institutions at the forefront of infectious disease research - to enable world class research. The project will also allow for the training of Indonesian researchers in genomic technologies and analysis to allow local capacity building. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
Innovating behaviour and health surveillance for cardiovascular disease prevention in Malaysia In Malaysia the prevalence of obesity among adolescents is increasing and non-communicable diseases, like type 2 diabetes and cardiovascular disease, account for two out of three deaths. While research in European and US-based populations has found that particular lifestyle factors might cause adolescents to be fatter and less fit we do not have a complete picture of what causes these problems in Malaysia. In this study we are going to look at how different lifestyle factors, like foods eaten, timing or frequency of eating, physical activity, sedentary behaviours and their timing or location, relate to whether adolescents have good health.  We plan to use a reproducible laboratory technique, known as metabolomics, to measure 150 different components of blood that indicate a range of metabolic processes. This will help us find out in much more detail than ever before how behaviour leads to better cardiovascular health via metabolic pathways. When we know more about the pathway that leads from lifestyle to disease we will be better able to predict who will stay healthy and who will not.  This research is possible because of an ongoing large community study including over 6000 adolescents, called SEACO, in Segamat, Malaysia. The aim of SEACO is to monitor changes in population health using annual surveys. Data collection started in 2012 and is repeated yearly from over 13000 households. The participants have already had measurements of their height and weight at two previous times, which we will use to look at how body size changes in different groups. We will approach children in the cohort at school to collect samples of blood and urine and ask them to wear an activity monitor on their wrist for 7 days. In a smaller selection of the sample we'll measure metabolic components in urine and see if they can tell us about what foods have been eaten recently. We also give a small group of children a smartwatch to ask them regular questions about eating so we can explore the possibility of measuring eating behaviour using the activity monitors without have to ask in future. We are interested to see whether lifestyle behaviours are associated with changes in the blood chemical profile of participants before they develop clear symptoms of cardiovascular disease or diabetes. Finally, within this project we will lay the foundations for improving the measurement of food intake to make methods passive, rather than relying on participants to tell you every time they eat. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.