Available Research Projects 2017
For a description of the three theme’s, please click HERE
Theme I: Addressing Ethical Challenges in Global Health Research
Project 1: Ethical Implications of the Process of Decision-Making for Participation in Clinical and Biomedical Research in Vulnerable Settings: a Transdisciplinary Study
(Host Institute: ITM)
This mixed-methods transdisciplinary study, ancillary to on-going clinical trials in the Gambia and Burkina Faso, aims at improving ethical research conduct in vulnerable populations by increasing our understanding of the decision-making process that defines participation in biomedical and clinical trial research. Ensuring free decision-making when deciding to be part of medical research is a complex subject, particularly in socio-economically vulnerable communities where numerous factors may limit the effectiveness of the informed consent process. Research has shown that trial participants generally take the decision of participating in a clinical trial before attending the informed consent process. Their individual decision is therefore based on information that informally spreads through the community in combination with pre-conceived incentives. Decision-making largely independent of and often prior to the consent procedure arguably invalidates the process itself and questions how informed and “voluntary” participants’ “free” decision is. Questions such as the timing of the decision-making process; the content of the information provided to potential participants; how this information spreads at community level; who are the people beyond the individual that actually shape the decision; in what socio-cultural setting; following what kinds of local norms, illustrate that there is a gap in our knowledge on how exactly the “social” decision to participate is formed. In addition, researching this decision-making requires us to move beyond the assessment of individual participant factors and focus on the social context in which the decision is embedded and the processes and negotiations at their core.
Project 2: Clinical Trials for Outbreaks: Contribution of Ethics and Anthropology in a Transdisciplinary Approach
(Host Institute: Université de Bordeaux)
In 2013, the world began to witness an unprecedented Ebola epidemic in West Africa that was smoldering by early 2016, when raised the Zika virus outbreak as public health emergency of international concern. Under these urgent circumstances, the global scientific community organizes and makes progress in identifying potential preventive countermeasures and therapeutics and accelerated the development of those promising interventions. During the 2014-2015 Ebola outbreak, trials of experimental interventions soon emerged as a key component of the global response. Hence, a global interdisciplinary issue ensues concerning how best to assess clinical safety and effectiveness of potential interventions prior to or concurrent with their broad use in humans. Both in the course of the response and during inter epidemic period, comprehensive review and analysis of clinical research experience is to be produced that analyses scientific and ethical issues related to clinical design, conduct and reporting. Thus, best practices will be informed and addressed for all future clinical trials to be conducted in response to an ongoing or a future outbreak, toward contribution of mutualized inputs from clinical sciences, experimental medicine, biometrics, epidemiology, human and social sciences, public health and ethics. In this context, ethical questions raise about the implementation of trials (producing scientific evidence) and the quality of care, with a shift from a collective emergency perspective to an individual care perspective. We hypothesize that the appropriate implementation and success of a clinical trial in a situation of emergency is more conditioned by contextual environment than by scientific constraints. The aim of the thesis project is to rethink and adapt clinical trials perspective and application (in terms of both practical methodology and ethics) to the emergency circumstances. Major endpoints of the project rely to delineate and analyse the conditions (constraints, opportunities and impact) of clinical trial implementation in emergency concern. An ethno-historical project will be set based on the experience and background from i) three clinical trials run during the 2014 West Africa Ebola outbreak in Guinea by the Bordeaux and Antwerp teams (ie. Favipiravir, ZMapp and convalescent plasma clinical trials) and ii) previous or ongoing arboviral disorders outbreaks. The programme offers a 3-year doctorate project hosted by Bordeaux University, supported by Lyon ENS, in partnership with Antwerp and Barcelona sites, and with study fields in West Africa and Indian ocean.
Theme II: Systemic Approaches Towards Sustainable Development Goals
Project 3: Researching Human Resource Management Capacities of Facility Managers to Improve Health Worker Performance in Sub-Saharan Africa
(Host Institute: VU)
Improving health and reducing the burden of disease requires a functional health system, that provides quality care services. Well-performing services are particularly important in poverty pockets in Low-and Middle Income Countries (LMIC), where often the most poor and vulnerable populations live. Health care provision is dependent on the performance of health workers. Research on factors influencing performance of health workers has identified the importance of the role of health managers at facility and district level. Their ability to act depends among others on their leadership and management competencies, decision-making space and tools and support they have to manage their staff. At the same time, human resource management in many Sub-Saharan African countries is challenging, as often health facility managers are clinical professionals with little or no management training. To date, little research has been conducted on the leadership and HRM practices of facility managers in Sub-Saharan Africa. Given the importance of leadership and HRM to motivate health workers and support them in their performance, thus improving health services, such evidence is crucial. It will inform policy makers how to better prepare and support health facility managers in their HRM tasks in resource-constraint settings. This study aims to provide insight in leadership and Human Resource Management capacities and practices of facility- managers in rural and urban districts in a Sub-Saharan country, and in the cultural context within which these take place. The study will use mixed methods and includes social and management sciences. It has a transdisciplinary approach by involving practitioners and policy makers from the start in the study. It applies a realist perspective so as to better understand in which context which leadership and management practices work and for whom.
Project 4: Pregnant Women as Sentinel Group for Malaria Surveillance in Elimination Contexts
(Host Institute: ISGlobal)
According to the Global Strategy for Malaria 2016-2030 of the World Health Organization, all countries can accelerate efforts towards elimination through combinations of interventions adapted to local contexts. Such efforts require precise metrics to monitor trends in malaria transmission, resistance levels and clinical impact of residual infections. Pregnant women are a potential sentinel surveillance group because of their susceptibility to malaria and easy access through antenatal clinics. The aim of the doctoral research offered here is to provide epidemiological and molecular evidences of the value of pregnant women attending health centers to generate estimates of the burden of malaria and its adverse consequences in situations of different transmission levels. To do this, the candidate will participate in prospective observational studies among pregnant women attending health centres in southern Mozambique, apply molecular techniques to describe the epidemiology of malaria infections and the pattern of antimalarial resistance, and analyze antibody-based serological measures of malaria exposure during pregnancy that can be used as surrogates for malaria transmission. The PhD candidate will also investigate the perceptions and uses of antenatal care services in African countries, with the objective of assessing the value of a pregnancy-based surveillance approach and correcting for any bias in the representativeness of the pregnant women captured through hospital services. Finally, we plan to compare the cost of such a surveillance approach with current systems to monitor the intensity of malaria transmission in elimination settings. In summary, this study will combine research on molecular and immunological epidemiology of malaria in pregnancy with social and economic research on the use of prenatal services by pregnant women. By this way, the project will contribute to apply the knowledge gained on malaria during pregnancy to the development of new tools for the epidemiological surveillance of malaria as well as to malaria elimination activities currently being deployed in Southern Mozambique.
Project 5: Implementation Constraints in the Scale-up of Early ART Programmes
(Host Institute: AMC)
Extensive clinical research and modelling studies suggest that new interventions such as early antiretroviral treatment (early ART) could play a significant role in achieving elimination of the HIV epidemic. However, the planning and implementation of early ART programmes at scale remain a challenge for the majority of countries. Early ART is a complex intervention, and as such, supply- and demand-side barriers play an important role in an effective and equitable scale-up. However, the definition and inclusion of these constraints in current cost-effectiveness analyses and, further downstream, in decision making processes, have been hindered by a lack of empirical data and appropriate analysis techniques. This project aims to develop a framework to explain how both supply- and demand-side constraints influence the equitable and successful scale-up of an early ART programme in Tanzania. A winning application will use a multidisciplinary approach to explore the definition of locally-relevant barriers in demand- and supply-side of service delivery and use, and develop methods to characterize and analyse the impact of these barriers on cost-effectiveness studies and subsequent policy recommendations.
Project 6: Intersectionality of Inclusion
(Host Institute: VU)
Health-related stigma is an important area of research in the field of global health because it hampers the management and control of the diseases like HIV/AIDS, tuberculosis and neglected tropical diseases, but also because it negatively impacts on the lives of the persons affected. By focusing only on exclusion researchers, policy makers and health practitioners are missing out on positive attitudes and experiences in the daily lives of people affected (e.g. individuals that are not ashamed of their disease, understanding families, respectful behavior of health workers, supportive colleagues or teachers). The objective of this PhD-project is to gain insights in the intersectionality of inclusion of different stigmatized health conditions in Indonesia and to provide recommendations for specific interventions and future implementation. The guiding methodology for this PhD project will be based on the Interactive Learning and Action (ILA) approach. The project will comprise of the following studies: (1) two desk studies, one on theories of inclusion in the daily lives of people affected by stigmatized conditions from different scientific disciplines and another on the characteristics of the stigmatized conditions of interest in this study; (2) an in-depth study to explore the factors of inclusion in relation to health-related stigma in the Indonesian context, (3) an in-depth study on perspectives of people with a stigmatized condition towards other stigmatized conditions and (4) a study to investigate opportunities for context-specific interventions and prioritize these interventions for future implementation.
Project 7: Comprehensive, Multi-sectoral, System Approach to Food and Nutrition Security
(Host Institute: VU)
More efficient approaches are needed to advance in reducing the burden of disease and mortality rates of most vulnerable populations in resource-limited settings in order to achieve SDG3. Health-in-All policies – taking an inter-sectorial and society-wide approach – are increasingly seen as a promising mechanism to tackle health determinants and inequities in a systemic way. One of the most important determinants of poor health is food and nutrition insecurity. While underlying causes of poor nutrition have been well understood for decades, the design, testing and scaling of more holistic multi-sectoral programs that combine child care and disease control interventions with food/nutrition system and livelihood-based approaches has been limited in their development and implementation. Building upon existing interventions in Vietnam and Lao PDR, this project will generate evidence on the effectiveness of, and best way to scale-up, a food/nutrition systems approach amongst ethnic minorities in mountainous areas. The project will use Complex Adaptive System Theory and Transition Management to analyse processes of embedding interventions in food/nutrition systems. A transdisciplinary research methodology is applied to assess effectiveness and enhance adaptive capacities of studied interventions. Comparative case study analysis will result in a generic framework to develop and scale-up NSA interventions in different contexts. This PhD research focuses mainly on the latter comparative case study of the overall project, which includes three other PhD students (who are funded by the Dutch national science foundation).
Theme III: Urbanisation, Migration, and Environmental Impacts on Health in a Globalised World
Project 8: What Does it Mean to be left Behind? Investigation into the Effects of Temporary Labor Migration on Children in the Philippines
(Host Institute: VU)
The Philippines is a country known for its high migration rates. In addition to the migration of complete families, there is also the phenomenon of ‘temporary’ labor migration whereby only the parents depart for a period of several months to a year (and in some cases longer than 2 years) to earn money in support of their children and other dependent family members. It is estimated that 27% of all children in the Philippines find themselves in this situation. Whilst parents depart to secure a better future for their children, their absence negatively affects the development and mental health of their children, as several studies in both the Philippines and elsewhere have shown. This study aims to study these effects in more depth by investigating their origins, the protective and harmful effects of this type of migration on children as well as develop specific interventions and guidance in support of disconnected families. The research will employ a multi-stakeholder, transdisciplinary approach by uniting academia, policy-makers and practitioners to jointly study this phenomenon in the Philippines and involve multiple disciplines, such as psychology, psychiatry, health science, sociology and anthropology. The study is spearheaded by the VU and the Ateneo School of Medicine in the Philippines and uses both qualitative and quantitative methods. The transdisciplinary approach to the study subject of labor migration, its high relevance for the Asian continent and beyond as well as the potential contribution of this research to the health and wellbeing of Phillipino’s youth presents an exciting opportunity for a PhD student.
Project 9: Health Impact Assessment for Healthy Living
(Host Institute: ISGlobal)
Urbanisation is occurring at unprecedented rates worldwide, and will present important challenges to protect and promote population health. The United Nations projects that nearly all global population growth from 2016 -2030 will be absorbed by cities, about 1.1 billion new urbanites over the next 14 years. In the face of rising non-communicable diseases, climate change impacts, potential epidemics, new tools and mechanisms to work across health and urban planning and transport sectors are urgently needed. There is currently a lack of use of quantitative Health Impact Assessment (HIA) models to assess the overall burden of mortality and morbidity related to urban and transport development and planning in cities that can be used by policy makers to mitigate harms and increase health benefits, estimate effects on health equity and economic costs. HIA is a novel approach that combines mixed-methods to systematically judge the potential health effects a proposed policy, programme or particular intervention might have on population health and the distribution of those effects within a population (healthy equity). The aim of the proposed research is to bring health into the agenda of urban and transport planning by developing participatory HIA methods, models and tools for evidence-based decision making whilst involving citizens and other stakeholders to overcome political and cultural barriers of implementation. The hypothesis is that HIA is a method that can be applied to different urban contexts to assess policy scenarios on their health consequences, and create indicators and recommendations that can optimise health and equity in cities. We will construct a framework to identify urban and transport related exposures with health relevance and consider demographic, economic or geographical factors. We will develop a comprehensive quantitative HIA model to assess scenarios of the health benefits and risks. Quantitative sources will be supplemented by qualitative interview, focus groups, and community network assessment techniques to contextualise public health implications across different urban political, socio-economic, and spatial contexts. Estimated health impacts and will be compared to health impacts implied by business as usual. The modeling will include a health equity assessment to help identify and target vulnerable population groups in order to narrow the health gap, and reduce inequities throughout the whole population. The HIA model will be developed in Barcelona, and then be refined for applicability and application in cities worldwide, making this a project with significant potential for global impact. This project is transdisciplinary by nature, and aims to bring health, transport and planning sectors together in collaboration to bridge sectorial gaps methodological approaches, as well as to maximise impact in society.
Project 10: Epigenetics in Cardiovascular Risk Factors in Sub-Saharan African Populations in Europe and Africa
(Host Institute: AMC)
Urbanisation and international migration have been unprecedented in the last few decades and have been associated with the rising levels of cardiovascular disease (CVD) and its risk factors in both urban populations in low- and middle-income countries (LMICs) and migrant populations in high-income countries. Transitioning of societies and resulting changes in lifestyles is thought to be a major driven force, but the key specific factors within these broad categories still need to be determined. An effective response requires better understanding of the key specific factors driving the increasing burden, which will undoubtedly require trans-disciplinary approaches. Gene-environmental interactions (i.e. epigenetics) is currently seen as potential factor driving the increasing burden of CVD and its risk factors in these populations due to the rapid changes in lifestyle in urban centres and upon migration, but data are currently lacking. One of the innovative ways of identifying the key underlying determinants such as epigenetics and other environmental factors driving the rising prevalence of CVD and its risk factors in LMIC and migrant populations is by means of comparing homogenous populations living in rural and urban centres in LMIC and similar source populations that have migrated to high-come countries. This research will take advantage of the European Commission funded multidisciplinary and multi-centre RODAM study (http://rod-am.eu/) data on epigenetics and environmental factors to (i) assess the role of epigenetics on CVD risk factors (i.e. hypertension, dyslipidaemia, and metabolic syndrome) among rural and urban dwellers in Ghana and Ghanaian migrants living in three European countries (Netherlands, Germany and England); (ii) to ascertain relevant lifestyle factors (e.g. nutrition, physical activity, smoking), social and psychosocial factors that are driving the epigenetic processes and subsequent CVD risk factors among these populations. Furthermore, this project aims to investigate social perception and knowledge of CVD and its risk factors among Africa populations. The outcome of this project is expected to inform targeted intervention and prevention, and to provide basis for improving diagnosis and treatment of CVD and its risk factors.