NIHR Global Health Research Group on Introduction and evaluation of vaccines to reduce childhood diarrhoea in sub-Saharan Africa The NIHR Global Health Research Group in Gastrointestinal Infections will apply world leading infection and vaccine research to improve health outcomes from childhood diarrhoea in Eastern and Southern Africa. Diarrhoea kills about half a million children under 5 years of age each year, and most of these deaths occur in Africa and Asia. The highest rates of diarrhoea deaths occur in sub-Saharan Africa. In children who survive a diarrhoeal illness, malnutrition, poor growth and impaired brain development commonly follow. 

Vaccines represent a critical public health tool to reduce this disease burden. Informed by a longstanding research programme in Malawi undertaken by the Lead Investigator, vaccination against a virus called rotavirus has helped to reduce diarrhoeal illness and deaths in African children. But the benefit has not been equal across countries. In some populations, vaccination does not work well, or vaccination is not administered at the optimum age or not at all. Vaccines being developed against other organisms causing diarrhoea, including a bacterium called Shigella, offer hope that suffering and death can be further reduced. 

More research is required to enable current and future vaccines to bring improved and equitable benefit to all children. The Global Health Research Group in Gastrointestinal Infections will address inequalities in diarrhoea burden by combining expertise in epidemiology, laboratory science, 
social science, mathematical modelling, statistics, health economics and policy. This multidisciplinary programme, jointly led by the University of Liverpool and the Kamuzu University of Health Sciences, will extend the scientific depth and the geographical scope of our research beyond Malawi. New partnerships will be developed in Kenya (Kenya Medical Research Institute) and Ethiopia (Addis Ababa University), countries in which childhood diarrhoeal morbidity and mortality is high and where vaccination to reduce this burden is a priority. Responding to input from key stakeholders including Ministries of Health and Community Leaders, research will be undertaken in each of Malawi, Kenya and Ethiopia in order to: 
 
• develop sustained engagement with communities and key stakeholders to provide greater national and regional visibility of gastrointestinal infection research;
• estimate the burden of vaccine preventable diarrhoeal diseases; 
• predict the clinical impact and cost-effectiveness of vaccination; 
• work with policy makers to inform vaccine introduction and evaluation;
• build capacity in gastrointestinal infection and vaccine research through Masters training programmes run by the partner organisations. 

Through close links with each Ministry of Health and ongoing community engagement, the Global Health Research Group in Gastrointestinal Infections will ensure its research findings are translated into policy for public benefit. Development of a cohort of researchers and public health practitioners with expertise in gastrointestinal infections will sustain this work in the years ahead. The Group’s impact will include enhanced and more equitable use of current and future vaccines to prevent diarrhoea and its consequences, particularly among disadvantaged children in sub-Saharan Africa. 1. To facilitate sustained engagement between regional and national authorities and local communities together with other key stakeholders, to provide greater visibility of gastrointestinal infection research in Malawi, Kenya and Ethiopia. This will create increased awareness of gastrointestinal infections among clinicians, policymakers and the public. 
2. To estimate the clinical and cost burden of diarrhoeal diseases presenting to health facilities. This will inform national estimates of disease burden attributed to key, vaccine-preventable diarrhoeal diseases.
3. To predict the clinical impact and cost-effectiveness of vaccines against leading causes of childhood diarrhoea. These data will be shared with Ministries of Health to inform policy.
4. To create sustainable systems to measure the burden of gastrointestinal infections and the outcome of vaccine interventions. This policy framework will inform population-wide vaccine introduction and evaluation against diarrhoeal diseases.
5. To develop a cohort of African scientists with expertise in gastrointestinal infection research. This cohort of trained staff and students will help to sustain this work in the years ahead.