Lawn, Joy; Marchant, Tanya; Ross, David; Marston, Cicely; Fil- ippi, V; Chico, Matthew; Yeung, Shunmay The Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH) at the London School of Hygiene & Tropical Medicine; (2014) The Centre for Mater- nal, Adolsecent, Reporoductive & Child Health (MARCH) Report. Other. London School of Hygiene & Tropical Medicine.

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Available under license: http://creativecommons.org/licenses/by-nc-nd/2.5/ More than 150 public health and research experts working around

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Improving health worldwide September 2014 1 2 Improving Delivering on our promises for About MARCH women and children worldwide

At a time of global concern over emerging infectious The Centre for Maternal, Adolescent, and chronic diseases, it is important to remember Reproductive, and Child Health (MARCH) that millions of women and children continue to is the central hub for women’s and die every year from conditions that are easily children’s health within The London preventable and treatable. School of Hygiene & Tropical Medicine, with over 150 members creating Despite progress on many fronts, this is a major unfinished agenda synergies for inter-disciplinary research from the UN Millennium Development Goals, so it is welcome that and leadership for change. donors, including the UK Department for International Development, are now taking a strong lead on women and girls. This approach MARCH strengthens and promotes innovation, also makes economic sense. According to a recent Lancet evaluation and evidence-based policy making by Commission report, investing in women’s and children’s health, and fostering communication and collaboration particularly in family planning, care at birth, child and adolescent inside and outside the School and between health, can give a nine-fold return, and reduce the burden on researchers and policy makers, across a range of settings in over 100 countries and multiple health systems. disciplines including: Researchers at the London School of Hygiene & Tropical Medicine Description: observational , high-quality have long been active in women’s and children’s health, and in national and global estimates and social science 2009 the School established the MARCH Centre to focus efforts theory and analyses are the foundation for linking in this area, with founding directors Professor Oona Campbell and data to action. Contents Professor Pat Doyle, and now expanding under the leadership of Discovery: understanding infections, genetic and Professor Joy Lawn. Today, the Centre includes more than 150 epigenetic risks, and delineating risks for adverse researchers working on critical issues of adolescence, births, and outcomes especially during the two crucial windows child health, spanning the full spectrum of research expertise of pregnancy and the first two years after birth, and in infectious and non-communicable diseases, mental health, adolescence. evaluation and education. MARCH also provides a coordinated hub Development: innovations in diagnostics, for knowledge translation, to improve policy and decision making, devices and strategies, for example to improve working with a range of government and charitable organisations in quality of care. the UK and worldwide. Delivery: a major strength is in intervention and I hope you will take a few minutes to read this report, which health systems research, with economic and policy highlights the approach of the MARCH Centre and some of its analysis. achievements to date. Please join us in supporting this vital work to Currently we have over 80 multidisciplinary research deliver on the promises of the UN Millennium Development Goals studies, coordinated by world leading scientists for 2015 and beyond. and covering themes along the continuum of care including:

■ young people’s health and behaviours ■ family planning and reproductive health ■ infertility Professor Peter Piot ■ maternal mortality and morbidity Director and Professor of Global Health ■ newborn health, and stillbirths London School of Hygiene & Tropical Medicine ■ nutrition and child health, growth and development ■ diagnosis, prevention and treatment for infectious disease in pregnancy and childhood. 9 million deaths each year of women, babies and children two-

thirds around the time of birth. The Director: largest mortality burden at the end Professor Joy Lawn Courtesy of Bill & Melinda Gates Foundation of the MDG era. [email protected] Twitter: @joylawn

MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health Courtesy of Felicia Webb 1 Unfinished agenda and future delivery post-2015 Delivering solutions through the lifecycle

MARCH through the lifecycle dolescents and ■ When in the lifecycle? Ayoung people Progress in the MDG era Our work is organised around three achieving healthy The Millennium Development Goals (MDGs) era Two thirds of the deaths for women, babies and children happen priority points in the lifecycle: ends in 2015 with remarkable successes and yet an at birth - investing at this time gives a triple return on investment, transitions or even quadruple if counting the lost development potential from unfinished agenda for 9 million maternal, newborn irths that are wanted, and child deaths and stillbirths, linked to HIV, malaria neonatal complications and poor in-utero growth of babies, leading and undernutrition, as well as unmet needs for family to stunting in children. Care at birth and family planning are two B pregnancies that are planning. Adolescent health was missing in the MDG of the most cost-effective health strategies, also contributing to safe, babies alive metrics. economic development. ion and thriving There is also a shifting global health agenda with transitions MARCH focuses on a lifecycle approach, including the key time ept onc P hildren with a healthy from death to disability, and newer risks such as obesity, NCDs, around birth. ec re Pr g Cstart, optimal growth urbanisation, mental health disorders, injuries and climate ■ Who? na change. Infectious diseases, both the old and the new, are not n and development A focus on girls is important throughout the lifecycle and c over yet. The research community needs to be ahead of these y especially when girls and women are disadvantaged. This may s shifts since studies often take two to ten years to influence policy. r be by gender selective abortions, less preference for nutritional a e Data for action to accelerate progress inputs than boys, lower careseeking, female genital mutilation y B i post-2015 (FGM), missing out on education, child marriage, or violence e r v t against women. MARCH includes members working on all these i h t With new and ambitious goals to end preventable maternal issues and also the important linkages for boys and men. c newborn and child mortality and to address universal reproductive

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Around the world, the School has a history of partnerships in over 100 countries (see Investing in women’s and children’s health can give a pages 10 - 13). 9-fold return in economic gains, and lower health system costs. The most effective investment points are family planning, care at birth, child and adolescent health. Courtesy of Molly Miller-Petrie Lancet Commission on Investing in Health

2 MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health 3 Adolescents Worldwide the Aand young Adolescents and young people people... healthy most common transitions achieving healthy transitions causes of death for adolescents What is the A theme about? What does the A theme do? are road traffic This theme focuses on the health of Staff from across the School’s three faculties are injuries, suicide, adolescents and young people. There engaged in research and teaching to improve the interpersonal are four main reasons why public health health and wellbeing of young people, and to help should focus on this group: them realise their potential. Work in the A theme violence, HIV and ranges from descriptive quantitative and qualitative other infections. Neglected group. Young people aged 10-24 are research on the burden of disease in this age often neglected in health interventions, despite range, to in-depth anthropological and sociological both the importance of supporting young adults to enquiries into social aspects of young people’s realise their potential, and the key role of health health and transitions, to development, testing and ■ An epidemiological study in Malawi and health behaviours in young adulthood in evaluation of novel interventions. showed a link between earlier shaping health in later life. age at menarche and age at first Disciplines cover a wide spectrum across the Demographic transition. In most high and sex, age at marriage, and herpes social, behavioural, epidemiological and clinical middle income countries there are more simplex type-2 infection. sciences. Topic areas cover the full range of the key adolescents (10-19 years) than children (0-9 years). ■ A trial in Bulawayo Zimbabwe health issues of young people, including sexual and Low income countries are rapidly approaching of a single session, football- reproductive health, use of tobacco, alcohol and a similar demographic balance, with more than based voluntary medical male other psychoactive drugs, injuries, mental health, one in four of the total population aged 10-19 circumcision promotion intervention nutrition and exercise, and infectious diseases. owing to falling fertility rates and dramatic recent (Make the Cut) showed that improvements in child survival. This provides a The A theme organises seminars and workshops it increased the uptake of one-time potential economic dividend to countries related to the health of adolescents and young circumcision ten-fold over the 4.5 whose populations are replete with young adults people (often jointly with the Child and Adolescent month follow-up period. going through their most productive period of life. Health Centre in University College London) and But to realise this potential, those young adults creates opportunities for staff to develop multi- Examples of outputs: must be healthy, educated and employed. disciplinary collaborations. ■ A Theme members were involved Courtesy of Neil Spicer Epidemiological transition. The burden from in the recent Lancet Series on infectious diseases is decreasing, especially Examples of research: adolescent health, and are also in young children. On the other hand, non- (more examples on pages 10-13) co-leaders for the current Lancet One billion adolescents communicable health conditions with origins in Commission on Adolescent Health ■ A qualitative longitudinal study of young people’s (10-19 yrs) alive today: children and young people such as injuries, mental and Wellbeing. experiences of growing up with HIV in UK, the largest ever youth generation. ill health, cardiovascular disease, diabetes and , Zimbabwe and USA and how this affects ■ Jointly with WHO, the School runs obesity have been increasing dramatically. Are we investing for their future? transitions to adulthood. an annual two-week short course WHO Health for the World’s Adolescents. of adolescent health in low and Effective interventions. We have an increasing ■ Epidemiological studies of individual, family, middle income countries, which has Report 2014 range of effective interventions to prevent these community and school-level factors influencing trained 70 mid-career professionals illnesses through taking action during childhood and school dropout and school absenteeism in Courtesy of Jeff Holt during its first 5 years. The adolescence. Malawi. course has also spawned annual regional courses for Africa run by collaborators in the Obafemi In the UK, 10-19 year olds outnumber 0-9 Awolowo University in Nigeria, and for Asia run by the Public Health year olds. In Europe, mortality rates among young men Foundation of India. aged 15-19 are higher than for 1-4 year-olds. Lancet Adolescent series 2011

4 MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health Courtesy of David Ross 5 Births that are wanted and safe

Births B…Wanted and safe What is the B theme about? For every woman who dies in Every year there are over 200 million childbirth, around 20 more suffer pregnancies in the world, wanted and injury, infection or disease – unwanted, that result in a healthy baby By 2030 one in three births will delivered by a healthy woman, or an approximately 10 million women be in Africa but almost two-thirds of child adverse birth outcome that afflicts mother, each year, along with 5.5 million child, or both. deaths will be African – unless we act babies who die as stillbirths or now to address family planning and child In 2013, an estimated 289,000 women lost their neonatal deaths. mortality. lives in childbirth, 2.9 million babies died in the neonatal period and 2.6 million were stillbirths. One in every four couples in the developing world ■ Development of simple diagnostic tools to has been affected by infertility with global levels be used in primary health care settings with of primary and secondary infertility relatively particular attention to syphilis (Professors unchanged between 1990 and 2010. Rosanna Peeling, David Mabey and colleagues). ■ Conducting clinical trials designed to prevent The ‘Birth’ theme covers issues related to and treat malaria infection during pregnancy preconception, family planning, pregnancy, care (Professors Brian Greenwood, Daniel at birth and the immediate postnatal period. Chandramohan and colleagues). Courtesy of Save the Children Topics covered by MARCH members include infertility, menstrual hygiene, induced abortion ■ Three large evaluations of multi-country and miscarriage, contraceptive needs and unmet intervention projects of maternal and neonatal needs, obstetric complications, maternal mortality, health interventions as well as family planning prevention and treatment of infectious and chronic funded by the Bill and Melinda Gates Foundation diseases during pregnancy, stillbirth, and neonatal (Professor Joanna Schellenberg), Markets morbidity and mortality, particularly preterm birth. Evaluation Team (Professor Oona Campbell), and EVA-PMDUP (Evaluation of Prevention of Maternal What does the B theme do? Mortality and Unwanted Pregnancy) funded by the UK’s Department for International Development. The ‘Birth’ theme includes anthropologists, ■ Work with the Royal College of Obstetricians paediatricians, epidemiologists, lab scientists, and Gynaecologists examining variations in economists, demographers, statisticians as well as maternity care in the UK (Professor Jan van der several other disciplines. Meulen and colleagues). MARCH members play a leading role in quantifying the burden of diseases as well as testing are Examples of outputs: 34 countries interventions or technologies designed to prevent projected to meet the Members of MARCH are involved in several high- and to treat complications of birth and deaths, in Millennium Development profile, policy-relevant initiatives. For example The high- and low-resource countries. MARCH members Goal to halve unmet Lancet Every Newborn Series (2014) provided the also study how maternity, antenatal, postnatal and need for family planning basis for the Every Newborn action plan with post- reproductive health services can be used as a compared to 1990. 2015 targets for reducing neonatal mortality and 9 of these countries are platform to deliver services that prevent and control Courtesy of Save the Children stillbirth rates. Others have played a lead role in the in sub-Saharan Africa, infections such as HIV, malaria, and other public WHO report on violence against women (2013) and 6 in Eastern Africa. health problems such as violence against women. Of 26 countries with the Family Planning 2020 summit (2012) and the >50% unmet need for Examples of research: Nutrition for Growth Summit (2013). family planning all but (more examples on pages 10-13) We have hosted several events with global partners one are in sub-Saharan including, for example, Save the Children’s State Africa, mostly in Central ■ A multi-country randomised controlled trial of of the World’s Mothers report (2013), a recent and Western Africa. tranexamic acid administered to women who have symposium on the effects of obesity on maternal postpartum haemorrhage involving more than Courtesy of Save the Children and neonatal health, and the launch of 15,000 women across 19 countries (Professor Midwifery Series (2014). Ian Roberts, Haleema Shakur and colleagues).

6 MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health 7 Children that survive and thrive Children …SurviveC and thrive

What is the C theme about? and immunologists unpacking the relationship between host immunity and infection, through to 1 in 4 of During the MDG era deaths for children social scientists, epidemiologists, mathematical children under- under five have been halved. Our focus is modellers and health economists, using qualitative five are stunted, on ending preventable child deaths, and and quantitative approaches to describing and improving child development and nutrition. understanding newborn and child health, and to accounting for Despite significant progress in reducing childhood design and evaluate interventions to address key over one third mortality there are still more than 6.7 million challenges. of child deaths deaths of children under five each year (1 child School researchers also lead multidisciplinary plus millions with every 5 seconds), almost half occurring in the first research in collaboration with other sectors, for lost development month of life. example research on injury and violence prevention In 2013 preterm birth complications became the in schools, collaborative research on nutrition and potential. leading cause of child deaths at 1 million per year, agriculture, innovative work on water, sanitation and followed by pneumonia. The causes with the largest hygiene (WASH), and research on the prevalence reductions since 2000 were pneumonia, diarrhoea and impact of disability in childhood. and measles, together accounting for almost half Examples of research include: to promote optimum child care of the overall reduction. Those with the slowest (more examples on pages 10-13) practices, including infant and progress (<3% per year) included preterm birth, young child feeding, mother-child congenital conditions, neonatal sepsis, injury. ■ A mother’s diet and her child’s DNA interaction and play. The evaluation Researchers from the School led by Branwen Courtesy of Molly Miller-Petrie Many of these deaths could be prevented if we is through a cluster randomised Hennig and Andrew Prentice have produced reached every woman and every child with evidence- controlled trials in each site. the first evidence in humans that a mother’s based interventions, particularly care of the diet before conception can lead to epigenetic ■ SuperAmma handwashing newborn and prevention, diagnosis and treatment modifications in her child’s DNA, with the promotion programme in rural India of infections. Evaluating how best to implement, potential to permanently affect lifelong health. represents leadership in behaviour overcoming systems barriers and promoting By utilising a unique ‘experiment of nature’ in change research that also engages behaviour change, is critical. The School excels at rural Gambia, where there is marked seasonal the private sector. Through the use this research as well as more upstream discovery variation in people’s dietary patterns, they of a fictional character (SuperAmma) and delivery research. found that infants from dry season conceptions and emotional motivators the Worldwide, as more children survive, increasing had lower rates of DNA methylation than those intervention was shown to increase attention is focused on healthy childhood: nutrition, conceived during the wet season, altering how handwashing with soap at key times Courtesy of Shunmay Yeung growth, development and the prevention and the genes will be interpreted with potentially life- by 31%. management of injury and disability, maximising long impact. ■ TRAC (Tracking Resistance health in later life. ■ SPRING (Sustainable Program Incorporating to Artemisinin Collaboration) What does the C theme do? Nutrition and Games) is a five year programme Resistance to artemisinins, the in Haryana, India and Rawalpindi, Pakistan first-line treatment for falciparum MARCH is uniquely positioned to address the funded by the Wellcome Trust to develop and malaria, is a major threat to priority challenges in child and newborn health. evaluate an innovative, integrated strategy to children. TRAC is conducting As one of the world’s largest schools of public reduce child deaths and improve child growth research to track and limit the health, London School of Hygiene & Tropical and development. The intervention consists spread of resistance, including Medicine researchers work across a range of of a community worker home visit package assessments of treatment seeking disciplines: from molecular biologists discovering Courtesy of March of Dimes from pregnancy through the first 2 years of life and antimalarial drug use and vaccine targets and biomarkers of infections, quality in Southeast Asia. Donor funding for child health to 75 Countdown countries more than At current rates of progress it will be over a century before doubled during the last decade, with a baby born in Africa has the same chance of surviving their almost all being for immunisation, HIV first month as a baby born in Europe or USA. and malaria. Lancet Every Newborn series

8 MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health Courtesy of Molly Miller-Petrie 9 What young people think about sex and what Healthy transitions to adulthood, Kenya, Health systems and financing RESYST, they do, UK This study is designing a package of adolescent health India, Thailand and Vietnam The sixteen18 project examines a broad range services, and exploring how best to deliver this care to MARCH around the world Resilient and Responsive Health Systems of practices, including oral, vaginal and anal sex. young people. David Ross and Aoife Doyle are working (RESYST) is an international research Based on interviews with 130 young men and with Margaret Gyapong and colleagues at Dodowa The Centre has partnerships in around 100 consortium which aims to enhance the women aged 16-18 in England, the study aims to Health Research Unit of Ghana Health Service, the countries and is involved in more than 80 studies resilience and responsiveness of health understand where, when and with whom young INDEPTH Secretariat in Accra, and the Wellcome Trust- systems to promote health equity. Led by globally. Here are a few examples, in addition to people would expect different practices to occur, KEMRI Unit in Kenya with Hewlett Foundation funding. Kara Hanson, and funded by UKAID, RESYST and what those practices mean to them. The study, those listed throughout this report Contact: [email protected] is working with IHPP THAILAND, the Indian led by Cicely Marston and funded by the ESRC Twitter @LSHTM_MARCH Institute of Technology and the Health Strategy has shown different ways the social environment and Policy Institute, Vietnam. The research Healthy schools- Reducing dengue and diarrheal around young people can influence practices, focuses on the three critical components diseases in primary schools in Columbia including for instance, normalising coercion of of health systems: financing, workforce and women into anal sex. Drinking water may contain the micro-organisms that governance including approaches. Examples cause diarrhoea, and also mosquitoes which transmit Contact: [email protected] of focus include results based financing and dengue need water to lay their eggs in. Funded by the raising and using tax revenues for health Research Council of Norway and the Lazos de Calandaima services. Foundation, this study assesses two sets of interventions Contact: [email protected] to reduce these diseases in children attending schools in Twitter @RESYSTresearch rural Cundinamarca, Columbia. Schools are randomised Soapbox: clean birth practices in reality to receive one or other of the sets of interventions, or Given the opportunity of increasing facility births, the neither, or both. We measure the effect in terms of school Soapbox Collaborative aims to research and improve absences due to diarrhoea, and the occurrence of the clean, safe delivery care to reduce maternal and dengue mosquitoes (Aedes aegypti). newborn infections. In Zanzibar, in collaboration with Contact: [email protected] the Ministry of Health and WaterAid, funded by SHARE, we are undertaking an innovative assessment of water sanitation and hygiene (WASH) in all facilities. In The User-fee free health for mothers and newborns Gambia there is a mixed-methods feasibility study of Burkina Faso, Benin, Mali Clean Birth Kits supply in health centres. FEMHealth (Fee exemption for maternal health care) is Contact: [email protected] a study evaluating the effects on maternal and newborn www.soapboxcollaborative.org outcomes if user fees are removed for emergency care INSIST, community-based interventions for newborn in Mali, Morocco, Benin and Burkina Faso. In addition survival, Tanzania multidisciplinary research is being conducted on the impact of pregnancy on women’s economic activity Maternal and newborn health is an urgent priority in Burkina Faso, investigating how investments in in Africa yet half of births are at home. Joanna reproductive health might contribute to reducing poverty Schellenberg and colleagues are working with Fatuma and fostering economic development and equity. The Manzi at Ifakara Health Institute on Improving Newborn project is coordinated by Aberdeen Univ. The LSHTM team Survival in Southern Tanzania (INSIST), a community- is led by Veronique Filippi and Carine Ronsmans and is based trial funded by the Gates Foundation though funded by the EU. Saving Newborn Lives, Save the Children. A network of over 800 trained local female volunteers visit women Contact: [email protected] and families before and after birth to promote healthy practices including clean birth, breastfeeding and extra care for small babies. Maternal healthcare markets Evaluation Team Contact: [email protected] The School’s Maternal healthcare markets Evaluation Team (MET) is seeking to understand the role of the private sector in providing maternal health care as part of its evaluation of the Merck, Sharpe and Dome (MSD) for Mothers initiative. Projects being evaluated Reducing child mortality through mass media include social franchising for maternal health in Burkina Faso India and Uganda and private operated supply The first robust trial of the impact of mass media on chains for family planning in Senegal. Led by health outcomes in a low-income setting is evaluating HIV, nutrition and childhood infections Zambia Caroline Lynch and Catherine Goodman, the whether 60- second health messages and long format team are also investigating where women seek programmes broadcast on local radio can save lives. Children maternally exposed to HIV in utero have reduced immunity to other care worldwide through analysis of demographic The trial is designed to detect a 20% reduction in child viruses, yet infection outcomes can be reduced by breastfeeding and vitamin/ health surveys and examining the nature of mortality at the end of the radio campaign. Funded by mineral supplements. However, some infections as HIV and human cytomegalovirus, competition where the private sector is providing the Wellcome Trust and Planet Wheeler Foundation, HCMV, can be transmitted in breastmilk. Suzanne Filteau and Ursula Gompels with maternal care. MSD for Mothers is a 10-year, Simon Cousens and Sophie Sarrassat from the School Lackson Kasonka, Mwaka Monze and colleagues have been studying effects of these US $500 million initiative to reduce maternal are working in partnership with Development Media interventions on poliovirus antibodies and effects of HCMV in Zambian children. The mortality around the world. International, Centre Muraz, and the Ministry of Health team is now testing lipid based dietary supplements for HIV patients in the Nutritional Contact: [email protected] of Burkina Faso. Support for Africans Starting Antiretroviral Therapy (NUSTART) trial and following breastmilk infections. Contact: [email protected] Contact: [email protected] and [email protected]

10 MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health 11 ACT for malaria treatment Artemisinin-based combination therapy (ACT) is the MARCH around the world current gold standard of treatment for Plasmodium Examples of multi-country projects and consortia falciparum malaria, a major cause of childhood illness and death. The ACT Consortium aims to improve access to and targeting of ACT drugs, as well as to assess their quality and safety through a range of interdisciplinary approaches including large cluster randomized control trials, qualitative and IDEAS: Evidence to improve economic studies. Funded by the Bill & Melinda Gates maternal and newborn health Foundation, the Consortium is a global research partnership involving over 40 co-investigators from The IDEAS project uses measurement and evaluation to Africa, Asia, Europe and the US working on 25 projects understand which health innovations and programmes across 10 countries. deliver the greatest impact on maternal and newborn survival at scale, as well as why and how they work. Contact: [email protected] Working in Ethiopia, North-Eastern Nigeria and the state Website: www.actconsortium.org of Uttar Pradesh in India, the multidisciplinary team, led by Professor Joanna Schellenberg, aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. The project also hosts the IDEAS Technical Resource Centre which strengthens the measurement, learning and ALPHA network: the power of shared data, East and Southern Africa evaluation capacity of colleagues from collaborating ALPHA network: the power of shared data, East and Southern Africa. The network for Analysis of Longitudinal projects, promotes collaboration, and stimulates Population based HIV data in Africa (ALPHA) links 10 existing community-based HIV cohort studies, to harmonise exchange of expertise. IDEAS is funded by the Bill & data and better inform intervention design, monitoring and epidemiological forecasting for HIV. Using their pooled Melinda Gates Foundation. data set, ALPHA published the first empirical estimates of HIV contribution to pregnancy-related mortality in sub-Saharan Africa. With funding from the Wellcome Trust, and the Bill & Melinda Gates Foundation, ALPHA is co- Contact: [email protected] ordinated by Basia Zaba and Jim Todd from the School, and works closely with partners in Kenya, Malawi, South Website: ideas.lshtm.ac.uk Africa, Tanzania, Uganda and Zimbabwe. Twitter: @LSHTM_IDEAS Contact: [email protected]

MenAfriCar (African Meningococcal Carriage Consortium) This multi-country research is coordinated by the School’s Professor Brian Greenwood, linking with many African institutions and global experts with funding by The Wellcome Trust and The Bill & Melinda Gates Foundation. The study is examining how meningococcal meningitis spreads across the “meningitis belt” in sub-Saharan Africa, and documenting the impact of a new meningitis vaccine. The vaccine was introduced in Burkina Faso, Mali and Niger in 2010. In Chad almost 2 million doses were given and recently shown to be E4A to save mothers and highly effective at preventing invasive meningococcal newborns Africa regional disease and carriage. Evidence for Action (E4A) a five year programme Contact: [email protected] to improve maternal and newborn survival in Website: www.menafricar.org six sub-Saharan countries (Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone and Tanzania) through better use of information, evidence- based advocacy, and effective accountability. The consortium of 6 partners (Options, The London School for Hygiene & Tropical Medicine, University of Aberdeen, UCL, University of Southampton and Advocacy International) is funded by the UKAID. Contact: [email protected] Twitter: @mamaye

12 MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health 13 Leadership for the next generation

Our vision is to identify the next Study at the School Perinatal Health), and Child Health generation of leaders for women’s and (e.g. mother and child nutrition, children’s health and help to skill them The School has nearly 4000 postgraduate students epidemiology and control of by maximising collaborations inside and and provides a stimulating environment, with malaria). The joint LSHTM/World outside the School. state-of-the-art facilities, in which to carry out Health Organization annual short research training. MARCH contributes to teaching course on Adolescent Health in Leadership at the School through short courses, MScs and Low and Middle Income Countries, PhDs. Students learn about the burden, assessing launched in 2010, addresses health As well as formal qualifications in public health, efficacy of new interventions, and analysing policy, needs of the largest ever cohort of MARCH is building on long-term partnerships with costs and implementation strategies for integrating adolescents. academic and research institutions and networks, interventions into large scale programmes. Working particularly in Africa, to strategically identify and with MARCH members based around the world, the strengthen leaders and centres of excellence research degree programme provides opportunities around the MARCH themes of A, B and C. for advanced study leading to the degrees of DrPH (Doctor of Public Health), MPhil (Master of Several of our staff contribute to leadership Philosophy) and PhD (). development whilst based overseas. Recent examples include Professor Carine Ronsmans As part of the School’s Master’s programmes, seconded to Sichuan University (China) from MARCH members deliver world class courses I feel proud to be November 2014, where she is conducting on Reproductive health (e.g. Foundations a London School collaborative research and supervise postgraduate in Reproductive Health and Family Planning students. Programmes), Maternal and Newborn health of Hygiene & (e.g. Current Issues in Safe Motherhood and Tropical Medicine alumnus. The focus on building skills of MARCH team Centre Leadership Team: health professionals Director Professor Joy Lawn A (Adolescents) Professor David Ross throughout the Deputy Dr Tanya Marchant Dr Cicely Marston B (Births) Dr Véronique Filippi world has been Mr Matthew Chico achieved in many C (Children) Professor Andrew Prentice ways. Just look at Dr Shunmay Yeung the number of school Experts drawn from School faculties alumni working in representing a continuum of research in ministries of health women’s and children’s health. in developed and Professor Joy Lawn Dr Tanya Marchant developing countries, international organisations and NGOs. Dr Elizabeth Mason (MSc Community Medicine, 1984) retired Director, Department of Child and Adolescent Health, World Health Organization.

Courtesy of Anna Kagstrom 14 MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health 15 Courtesy of OmPrasad Gautam

Delivering on our future

Delivery priorities The MARCH Centre has strategic collaborations with other Centres in the We cannot rest until these In the short term the most gains will School such as the Centre for Evaluation, problems (for women and come from immediate implementation and those for Malaria, Vaccines, of high impact care, with innovation and Diagnostics, Mental Health, Disability children) are solved, and implementation research to increase and Non Communicable Diseases. We we cannot solve these coverage and close equity and quality also have many alliances with global problems alone. gaps. This focus will be especially and regional partners, particularly in the important for the 30 or so countries that agencies such as WHO, Hillary Clinton, June 2014 at the need to more than double progress to UNICEF and UNFPA. Partner’s Forum reach 2030 targets for ending preventable maternal, newborn and child deaths. In the post-2015 world where health However, it is also crucial to invest fits in the wider context of sustainable Courtesy of Save the Children now in discovery science, ensuring development, greater progress and bigger new solutions whether vaccines, newer breakthroughs occur when “unlike minds” antimicrobials, and other drugs and collaborate - from around the globe, from devices, or innovations in service delivery different disciplines and focusing on and behaviour change. It is particularly different parts of the lifecycle. important to link women’s and children’s MARCH and the School can bring such Courtesy of Ulrika Baker health with new agendas – NCDs mental breakthroughs more and more - in Courtesy of Save the Children health and intersectoral issues such as discovery science, innovation for health Water Sanitation and Hygiene (WASH), system delivery, and a deliberate education, and economic growth. and strategic approach to leadership There are major burdens where solutions development. are lacking notably preterm birth, stunting, and outcomes for HIV exposed but non infected infants where the School has Please join with us to improve world leading scientists. Inter-generational health for women and children impact and epigenetics hold promise around the world. for breakthroughs, with potentially more [email protected] major impact in low and middle income http://march.lshtm.ac.uk countries. Twitter: @MARCH_LSHTM

The world community must unite in a shared vision of healthy women and children at the heart of the Post-2015 Sustainable Development Agenda. Erna Solberg, Prime Minister of Norway

Report written and edited by Joy Lawn, Tanya Marchant and the MARCH team (David Ross, Cicely Marston, Véronique Filipi, Matthew Chico and Shunmay Yeung). Design and layout by Chris Matthews. Cover image by Felicia Webb.

16 MARCH | The Centre for Maternal, Adolescent, Reproductive and Child Health