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LSHTM research led to the development of a computer-based tool known as the Lives Saved Tool (LiST), which has been made available to international organisations, governments and NGOs free of charge. It allows policy-makers and programme managers in the 75 countries with the highest number of child deaths to identify which policy and programme choices are likely to have the greatest impact in cutting neonatal and child mortality. Since its 2008 launch, LiST has been used widely by international agencies, foundations, bilateral agencies, large NGOs and individual countries to determine investment priorities and programme choices.
Every year over 5,000 children and young people in the UK die. Previous research suggests that 20-25% of these deaths may be preventable, and in comparison to many other European countries, the UK has higher child mortality rates. Child Death Review processes, introduced in the USA in the 1970s have been proposed as a means of learning from child deaths and driving prevention initiatives. Prior to 2008, the UK had no national system for reviewing and learning from children's deaths.
From 2006 to 2007, a team from Warwick Medical School led by Dr Peter Sidebotham undertook government-funded research examining a number of Local Authorities across England who had set up pilot Child Death Overview Panels (CDOPs). The findings from this research were instrumental in developing national policy and procedures for child death reviews. The Warwick research emphasised the importance of a multi-agency approach to reviewing all child deaths, with a strong public health focus on learning lessons for prevention, and robust systems for notification and gathering information. This, together with other research by Warwick Medical School on fatal child maltreatment published between 2009 and 2011, has contributed to updated national policy and interagency practice to safeguard children.
Although it is too early in the process to demonstrate any impact on the ultimate goal of reducing preventable child deaths, CDOPs have now been established in every Local Authority in England, as well as an all-Wales panel, and current work in Scotland and Northern Ireland is considering how best to implement such reviews. These panels are reviewing all child deaths in England, resulting in local prevention initiatives, and national returns enabling a clearer picture of the nature of preventable child deaths.
The University of Liverpool (UoL) team at the WHO Collaborating Centre for Policy Research on Social Determinants of Health (Liverpool WHO CC) has made a leading, internationally recognised contribution to addressing the adverse health consequences of household air pollution, a problem responsible for an estimated 4 million premature deaths among 2.8 billion of the world's poorest people. Impacts include (i) generating global awareness of a hitherto poorly recognised problem through defining the disease burden, (ii) leading development of new WHO Guidelines on the issue, (iii) providing key evidence for intervention and policy studies in low-income countries and (iv) helping to formulate strategy for global initiatives to address the problem.
In 2011, largely on the strength of evidence assembled by Southampton based researchers, the Department of Health (DH) recommended that employers offer welders vaccination against pneumococcus, a decision with potential to benefit some 80,000 workers, and to prevent an estimated 130 cases of invasive pneumococcal disease over 10 years, a significant proportion of which would be fatal. The advice has received extensive media attention, and more recently has been extended to other workers exposed to metal fume, offering scope for even greater benefits. It has influenced research and safety practice internationally.
Responding to the crisis in confidence amongst clinicians involved in child protection, Cardiff University developed the world's first research programme to provide the scientific basis for more reliable clinical assessments of child abuse and neglect. The programme, which involves 21 systematic reviews (updated annually) and related primary studies, has directly informed five national clinical guidelines, the National Child Protection training program and the first NICE guidance on child maltreatment. Through the Core-Info website, the evidence base created by the Cardiff team is accessed each year by 100,000 users. Key messages from their research have been published in a series of Core-Info leaflets which have reached more than 250,000 allied professionals nationally. The Cardiff research informs standardised national clinical practice, training and legal decisions, ultimately improving the recognition and protection of children from abuse or neglect.
Research conducted by the Centre for the Study of Poverty and Social Justice (CSPSJ) led to a new way of assessing child poverty in developing countries. This novel method (termed the Bristol Approach) resulted in the United Nations General Assembly's adoption, for the first time, of an international definition of child poverty (2006). It also underpinned UNICEFs Global Study on Child Poverty and Disparities (2008-10), which was run in over 50 countries. In the last ten years, the CSPSJ's work has put child poverty at the centre of international social and public policy debates. Its researchers have advised governments and international agencies on devising anti-poverty strategies and programmes that specifically meet the needs of children, and have significantly influenced the way child poverty is studied around the world. The Centre has developed academic and professional training courses for organisations like UNICEF on the issues of children's rights and child-poverty. Our work has also spurred NGOs such as Save the Children to develop their own child-development indices, and so has had a direct and profound impact on the lives of poor children around the planet.
Impact: Health and welfare, policy and services. By quantifying the high lifetime prevalence of allergy, high costs and sub-optimal NHS care, UoE researchers catalysed international policy change and UK service developments.
Significance: Investment in expanded allergy services and improved standards of care, resulting in a significant drop in global allergy-related mortality rates.
Beneficiaries: People with allergies; GPs and emergency care clinicians; policymakers and professional bodies.
Attribution: The work was led by Sheikh (UoE) with collaborators for national surveys.
Reach: International. 1 in 3 people in the UK have an allergy; World Allergy Organization anaphylaxis guidelines are used in 89 countries.
LSHTM researchers have developed four computer models to help decision-makers make evidence-based choices about new vaccines and vaccine schedules. These models analyse the public health impact and cost-effectiveness of different options under different assumptions and scenarios on a country-by-country basis. They are used by national immunisation managers and key decision-makers, international committees and partner organisations (e.g. the Global Alliance for Vaccines and Immunisation and the Bill & Melinda Gates Foundation). LSHTM's researchers have built on this research for WHO, informing global recommendations on vaccine timing and schedules.
Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries with young children and pregnant women particularly at risk. Over the last 20+ years LSHTM researchers have carried out a series of definitive trials in collaboration with the Ghana Health Service to evaluate the impact of different vitamin A supplementation (VAS) strategies on maternal and/or child survival. Findings have had major impacts on national and global VAS programmes and influenced WHO guidelines on VAS in: infants and children 6-59 months of age; infants 1-5 months of age; postpartum women; and pregnant women.
Research at LSHTM has been central to the introduction of the Hib vaccine in developing countries. School staff were involved in the 1990s Gambia Hib vaccine trial, which demonstrated the impact of Hib vaccine on pneumonia. Through their work on the subsequent Hib Initiative, their research was instrumental in speeding up evidence-based decision-making for Hib vaccine introduction in a number of countries, mainly in Asia and Africa. The project has been an outstanding success, with Hib vaccine now introduced into 71 of the 73 countries eligible for GAVI Alliance support.