Disease Control in Disadvantaged Populations

Disease Control in Disadvantaged Populations

This multidisciplinary working group consists of specialists working in different areas relevant to disease control in developing countries (e.g. parasitology, epidemiology, pediatrics, reproductive health, anthropology, global health).

Group members are working on projects in partnership with colleagues from a number of countries mainly situated in the south (e. g. Burkina Faso, Ghana, Tanzania, Malawi, Zambia, Yemen, China, Thailand).

The aim of the group is to collaborate on relevant projects and programmes to improve health through applied disease control measures in disadvantaged populations of respective partner countries.

The working group has expertise in a wide range of fields such as infectious diseases (e.g. Covid-19, HIV, malaria, dengue, polio), mother and child health, and non-communicable diseases.

1.1.1 HIV Research

Despite the increasing body of knowledge, the considerable achievement in treatment, progress in access to prevention treatment and care by a multiplicity of interventions, to date the pandemic is still not under control in the predominantly affected regions and populations. Sub-Saharan Africa (SSA), the most heavily affected region, still accounts for the majority of all new HIV infections. Our HIV research group addresses quality of care related to ART provision for adult and pregnant women and ART adherence and retention in care and looks at the integration of addressing co-morbidities in long term treatment and aging HIV cohort.

1.1.2 Malaria Research

Quite a number of malaria research projects were carried out in the research zone of the Centre de Recherche en Santé de Nouna (CRSN) in Nouna Health District in north-western Burkina Faso. Malaria is holoendemic but highly seasonal in this area. Research activities started in 1999 with a WHO-supported randomised controlled trial (RCT) on the effects of zinc supplementation in malaria control, followed by a DFG-supported RCT on the long-term effects of insecticide-treated mosquito nets (ITN) on malaria morbidity and all-cause mortality, a DFG-supported study on operational aspects of ITN programmes in Africa, and a DFG-supported study on the efficacy and effectiveness of alternative first-line treatment regimens compared to artemisinin-based combination therapy (ACT) in Burkina Faso. Moreover, a EU-funded study on malaria home treatment in Burkina Faso as part of a multi-centre study has been conducted. All these clinical studies were implemented in close collaboration with the CRSN and its local partners (e.g. National Malaria Research Centre in Ouagadougou) in rural Burkina Faso. 

Extensive studies on the development of methylene blue (MB)-based combination therapy have been carried out since the year 2003 with funding from various organisations (e.g. DSM Dream Award, DFG through SFB 544, BASF). While phase I studies were mainly carried out at the University Hospital in Heidelberg, most of the phase II studies were conducted in Burkina Faso, but recently also in Mali and in Thailand. Preliminary findings point to MB being safe and effective in the treatment of falciparum malaria in Africa and MB can be combined with ACT for transmission reduction and prevention of artemisinin resistance development.

Further research takes place in the area of malaria surveillance, both in high endemicity countries (such as Burkina Faso and Ghana) and in countries being in the stage of prevention of reintroduction after having achieved elimination (such as China). During the Covid-19 pandemic, extensive research has also addressed the complex associations between the pandemic and malaria in SSA.

1.1.3 Mother & Child Health (MCH)

The MCH projects consist of: 

• Research on public health aspects of routine childhood vaccinations in sub-Saharan Africa (SSA)
• Research on the epidemiology and prevention of childhood malnutrition in SSA
• Research on the effectiveness of Care in Pregnancy and Child Birth with an emphasis on antenatal screening, referral systems, community-based safe motherhood, and related health systems issues, such as quality of care and access in Tanzania, Burkina Faso, Ghana and Germany
• Research on the population-based assessment and monitoring of reproductive morbidity, mortality and use of health services in Europe

Childhood vaccinations are an important tool for reducing morbidity and mortality in developing countries. In recent years, a number of new and costly vaccinations have been included or are proposed to be included into the Extended Programme of Immunization (EPI) schemes, but it is currently not clear how this can be effectively implemented and sustained. Moreover, routine vaccinations can be associated by unspecific and negative effects. A large EU-funded multi-country research project has been looking at these issues in a number of African countries and this research is ongoing in collaboration with the group of Peter Aaby from Denmark/Guinea Bissau.

Childhood malnutrition remains a major public health problem in SSA, causing up to half of the under-five mortality. A number of studies on the development of childhood malnutrition and its determinants has been undertaken in the research zone of the CRSN in Nouna Health District in north-western Burkina Faso, but also in Ghana and in East Africa.

Effective Care in Pregnancy and Child Birth cannot be achieved with a silver bullet approach based on one specific intervention. Rather, it requires a functional health system based from the community to local first level facilities and up to the referral hospital. These levels need to be linked through a referral system, supportive supervision and a bi-directional flow of information. Thus, our research projects in East and West-Africa pursue a system approach, based on a defined and tested health service model.

1.1.4 Non-commmunicable Diseases

The Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases in September 2011 has put NCDs high on the global health agenda. The declaration acknowledges the importance of NCDs in poor and disadvantaged populations who actually carry most of the burden which leads to individual suffering as well as to increasing poverty. Health systems are mainly set up for episodic rather than for chronic care. Our research in NCD targets individual health needs and health system requirements for health promotion, prevention, treatment and disease management, looking at facility and community aspects. The lessons learned from chronic HIV care are integral part of our approach. We cooperate to this regard with epidemiology and health economy groups of our Institute.

 

1.1.5 Harm Reduction

The term harm reduction refers to policies, programs and practices that aim to minimize the negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights. Harm reduction focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that people stop using drugs as a precondition of support. The Harm Reduction Team within the working group of Disease Control in Disadvantaged Populations is actively involved in global, regional and national research projects investigating various aspects of substance use with the ultimate goal of mitigating the burden of substance use and its associated harms. The team is focused on numerous marginalized populations with a focus on people who live in prison settings.