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Podoconiosis - Subsistence Farmers
Brighton & Sussex Medical School

NIHR work packages

NIHR work packages

To achieve our long term research aims we have developed seven work packages.

BACKGROUND IMAGE FOR PANEL

Integration and scale up of care package – the EnDPoINT Consortium

Work package 1.

This work package aims to integrate the different foot care and psychosocial care interventions for NTDs which cause lymphoedema (including lymphatic filariasis, podoconiosis and leprosy) into a holistic care package, that is embedded into routine health care services in selected districts in Ethiopia. An implementation research approach will allow the research team (the 'Excellence in Disability Prevention Integrated across NTDs' (EnDPoINT) Consortium, drawn from UK based researchers and Ethiopia based researchers, policy makers and practitioners), to document the processes and outcomes of the integration efforts, in 'real-time'.

We will explore the factors that influence the integration process by focusing on the nature of the diseases and their perception amongst the target communities (disease narrative), the nature of the intervention, the type of policy actors involved and their interrelationships (adoption systems), the health systems' characteristics, and other pertinent factors related to the wider social, political, economic, cultural and technological context. 

This work package will inform existing plans on the part of the Ministry of Health in Ethiopia to scale up integrated foot care and psychosocial support for lymphoedema patients, nationally. This will in turn enable the research team to extend its involvement into evaluation of these national scale-up efforts. The research team intends to transfer the insights gained through this work package beyond Ethiopia to inform further research, policy and action in similar low income settings. Active involvement of local researchers, policy makers and practitioners, will also ensure that the work contributes toward building critical capacity in implementation research within Ethiopia.

Team

Prof Gail Davey >
Dr Stephen Bremner >
Dr Kebede Deribe > 
Dr Maya Semrau >
Dr Natalia Hounsome >
Prof Abebaw Fekadu > 

 

Watch Abraham Tesfaye, a researcher at CDT Africa, discuss his research in relation to this work package.

 

BACKGROUND IMAGE FOR PANEL

Volume measurement and diagnostic devices

Work package 2.

There is a pressing need for a diagnostic test that will reliably distinguish the two main forms of lymphoedema found in the tropics: lymphatic filariasis (LF) and podoconiosis. These two conditions result in similar lower limb changes, but require different public health approaches. Measuring lower limb volume is important in establishing the extent (severity) and stage of lymphoedema and to measure treatment and self-management outcomes over time.  However, there is no fully validated and reliable method for establishing lower limb lymphoedema volume in podoconiosis patients. The water displacement method is viewed as the gold standard for limb volume determination but it is time consuming, not easily portable and unhygienic if (for example) wounds are present. 

The aim of this work package is to validate and check field feasibility of a simple, non-invasive method to measure lower limb volume in podoconiosis patients - Lymphatech®. A second device will be piloted on the same patient population – the Texas Instruments DLP (Digital Light Processing) NIRscan Nano, a portable spectrometer that measures variation in absorption of near-infra red (NIR - 900 to 1700nm) wavelengths. We hope that this device may eventually allow us to distinguish between lymphoedema related to superficial lymph vessel blockage (podoconiosis) and oedema due to more central lymph vessel blockage (lymphatic filariasis, LF). 

Team

Prof Gail Davey >
Dr Stephen Bremner >
Prof Abebaw Fekadu >
Prof Chris Chatwin > 
Dr David Bell >
Dr Brandon Dixon > 


Watch Abdi Samuel and Dr Brandon Dixon discuss their research in relation to this work package.

Immuno-pathogenic studies 

Work package 3.

The aim of this work package is to understand the pathogenesis of podoconiosis, and its immunological basis. Genetically susceptible individuals develop painful swelling of the lower limbs leading to irreversible fibrosis. Our previous research has identified a strong association between podoconiosis and the HLA region on chromosome 6 suggesting that the immune system plays a critical role in the development of podoconiosis.  This work package will investigate the immunogenetic basis of this condition using a range of cellular and molecular techniques. This work will be undertaken in partnership with the Analytical Genomics of Complex Traits group at the Wellcome Trust Sanger Institute where further genetic analyses are ongoing and with our research team based in Addis Ababa, Ethiopia.

Team 

Prof Melanie Newport >
Dr Simon Waddell >
Dr Abraham Aseffa >
Prof Eleftheria Zeggini >
Prof Danny Altmann > 

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Identification of endemic plant extracts for limb care 

Work package 4.

The aim of this work package is to identify endemic plant extracts for use in the care of lymphoedema in Ethiopia. The work will have three stages:

  1. Identification stage: Plants with potential benefits as topical anti-infective agents will be identified from published and grey literature as well as from information from local traditional healers.
  2. Pre-clinical discovery stage: Tests for safety and potential efficacy in animal models on up to 10 plant products prioritised on the basis of their safety and efficacy profile.
  3. Development stage: Products with the best safety and efficacy profile will be further developed. The hope is that this work will lead eventually to the design of protocols for pragmatic trials for external use.

This work will be undertaken in collaboration with CDT-Africa. The work package supports a PhD student and Post-doctoral research fellow.

Team

Prof Gail Davey >
Prof Abebaw Fekadu > 

 

Watch Belete Adefris Legesse, a researcher at PDRF, and Dereje Negussie, a PhD student, discuss their research in relation to this work package.

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Epidemiological mapping of mycetoma in Sudan 

Work package 5.

This work package to create an epidemiological map of mycetoma in Sudan will involve the development of a case definition algorithm in the first two years of the programme, involving nationwide fieldwork. Geospatial modelling will take place from the second year along with an economic analysis of the burden of disease. The work will aim to ascertain environmental risk factors for Mycetoma. This work will be undertaken in collaboration with the Mycetoma Research Centre at the University of Khartoum and the London School of Tropical Medicine and Hygiene.

Team

Prof Melanie Newport >
Dr Natalia Hounsome >
Dr Kebede Deribe >
Prof Ahmed Hassan Fahal >
Dr Stephen Bremner > 

 

Watch Dr Kebede Deribe, Research Fellow at BSMS, and Rowa Fathelrahman, a NIHR PhD student, discuss their research in relation to this work package.

Development of community prevention programme 

Work package 6.

This work package aims to increase our understanding of mycetoma – the disease, its aetiology, and possible prevention. A prevention package will be developed during the first phase of the programme, and community based feasibility studies will then be conducted to trial this prevention package throughout the final years of the programme.

Team

Prof Melanie Newport >
Dr Natalia Hounsome >
Dr Shahaduz Zaman >
Prof Ahmed Hassan Fahal > 

 

Watch Mohamed Elsheikh, a PhD student, discuss his research in relation to this work package.

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Impact evaluation – MDA with IVM for scabies 

Work package 7.

The aim of this work package is to refine the public response to scabies outbreaks in Ethiopia. In 2016 a sharp drop in the availability of water due to the worst drought the country had faced in decades led to a widespread outbreak of scabies. This work package will work closely with the MOH in Ethiopia and will involve a physical and physcosocial impact assessment of MDA with ivermectin, followed by the development and testing of outbreak responses, including economic resource planning.

Team

Prof Gail Davey >
Dr Natalia Hounsome >
Dr Stephen Bremner >
Prof Jackie Cassell > 

 

Watch Abdi Samuel, a lecturer at Wollega University, discuss his research in relation to this work package.

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