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Impact: Health and welfare; raised awareness of childhood pneumonia as the largest single cause of global childhood mortality, which has led to increased investment and action. Global deaths have reduced from 2.01M (in 2002) to 1.58M (2008) and 1.26M (2011).
Significance: Global child pneumonia mortality (2008-2013) showed about 1M deaths fewer than if 2008 levels had persisted throughout this period.
Attribution: Campbell and Rudan (UoE) derived global pneumonia incidence and mortality estimates as the pneumonia technical experts for the WHO / UNICEF Child Health Epidemiology Reference Group.
Beneficiaries: Young children and families, international agencies, Ministries of Health.
Reach: Global (>170 countries on all continents, especially low- and middle-income countries).
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.
A comprehensive body of research into the effectiveness, cost and distribution of long-lasting insecticidal nets (LLINs) by LSHTM has made a major contribution to the reduction of malaria-related mortality between 2008 and 2013, especially among children in Africa. The research formed the basis of a radically altered strategic approach to combating malaria by WHO and other agencies, and led to the roll-out of malaria campaigns based around LLINs in several African countries. LSHTM research into the technology of LLINs, which also contributed to these developments, is described in a separate case study.
Since 2006 the University of East Anglia (UEA) has led a series of Government commissioned studies of all Serious Case Reviews of child death and serious injury in England. This work has provided the largest national database of analyses of child deaths and serious injury where abuse or neglect are known or suspected.
Since 2008, the findings have informed public understanding, practitioner thinking, multi-agency child protection practice, policy and law - in the UK, and internationally. Both key child protection policy and practice reviews commissioned by the UK Government 2008-13, the Laming report (2009) and the Munro Review of Child Protection (2011), drew on this research.
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.
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.
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 York undertaken by Bradshaw, Skinner, Corden and Davidson, directly influenced child support policy throughout the period 2008-2013, informing the radical change that abolished the Child Support Agency and returned child maintenance to the hands of parents to make private agreements under the `Child Maintenance and Other Payments' Act 2008. It also contributed to the decision to disregard child support payments and thus allow child support to increase lone parent incomes and reduce child poverty. More recently our research has contributed to the evolution of policy under the Coalition Government in the 2012 `Welfare Reform' Act, which introduced new `relationship support' services to improve co-parenting relationships, reduce conflict and improve child well-being.