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• Start Date: June 2020
• Duration: 5.5 years
• Funder: NIH
• Principal Investigator: Prof Jayne Sutherland
• Co-Investigators:  Prof Gerhard Walzl, Prof John Belisle, Mr Ismaila Manneh (PhD student)

• Collaborators: Dr Thuong Nguyen, Prof Harriet Majanya-Kizza

   

This project aims to perform head-to-head comparison of novel point-of-care triage, prognostic and diagnostic tests for TB in symptomatic adults, adolescents and children and in exposed household contacts. There are currently four million cases of TB missed each year due to lack of access to currently available diagnostic tests. The ability to screen patients with a low cost rapid test to assess if further high-cost TB tests are required for confirmation of TB would save lives and reduce transmission. This project is recruiting symptomatic adults from four countries, symptomatic children from two countries (The Gambia and Vietnam) and asymptomatic household contacts from four countries. We are assessing the diagnostic performance of two novel fingerstick blood tests for TB alongside routine diagnostic tests. Results are promising and show the utility of immune marker detection as opposed to pathogen detection for triage and diagnostic TB tests. 

• Start Date: January 2023
• Duration: 5 years
• Funder: BMBF (German government)
• Principal Investigator: Prof Jayne Sutherland
• Co-Investigators:  Dr Behzad Nadjm, Dr Matthis Neubock, Dr Olumuyiwa Owolabi, Mr Raphael Kamn’gona (PhD student), Ms Janet Zambezi (PhD student)

• Collaborators: Prof Andrea Rachow, Mr Chrisoph Leschczyk, Prof Bob Wallis

   

Post TB lung disease (PTLD) contributes to the almost 4-fold increase in all-cause mortality in patients who have had prior TB. This project aims to assess the long-term health impact on patients with prior TB including post-TB lung disease exacerbations, lung function, health economics and host immunity. The project follows on from previous funding (TB sequel I) which enrolled and followed TB patients for 5 years. These same patients are included in TB sequel II and will be assessed for lung function and any exacerbations together with host immune profiling the lung and blood. In addition, we will be enrolling 160 newly diagnosed TB patients for an adjunctive host-directed therapy trial with N-acetyl-cysteine (NAC). Previous data has shown a better recovery of lung function in patients who received NAC alongside standard TB therapy in Tanzania. We will analyse lung function by spirometry for up to one year from enrolment, and determine immunological profiles including neutrophil ROS assays, whole Mtb infection assays and microbiome analysis. 

• Start Date: April 2023
• Duration: 4 years
• Funder: European Union
• Principal Investigator: Prof Jayne Sutherland
• Co-Investigators: Ms Haddijatou Jobe (PhD student), Dr Behzad Nadjm
• Collaborators: Prof Hazel Dockrell, Prof Helen McShane

The goal of this project is to define new vaccine candidates for TB. There are 30 partner sites providing analysis of the pathogen and the host from an extensive collection of samples. At MRCG, we will analyse the early protective immune response to Mtb infection using highly exposed but infection resistant contacts. We have recently established bronchoscopy and single-cell RNA sequencing in Prof Sutherland’s lab/team and will utilise these important techniques in order to understand early protective immune events. In addition, antigen-specific cell response, soluble markers and antibody arrays will be determined. These findings will be utilised for development of novel TB vaccines for prevention of infection and for defining surrogate markers for vaccine efficacy studies. 

• Start Date: July 2023
• Duration: June 2028
• Funder: NIH
• Principal Investigator: Dr Oghenebrume Wariri
• Collaborators:  Prof Beate Kampmann (MRC Unit The Gambia at LSHTM) and Prof Jessica Metcalf (Princeton University, USA)

In this NIH-funded project, we will apply novel spatiotemporal modelling approaches to map the subpopulation with untimely measles vaccination and zero-dose at fine-spatial scale and examine potential links with suboptimal herd immunity and risk of measles outbreaks. We will also examine how geographic accessibility shapes the uptake and delivery of routine vaccination in The Gambia.

The project will leverage longitudinal cohort data from health and demographic surveillance systems in The Gambia and serological samples covering rural populations in the Basse health and demographic surveillance system.

There are four specific aims for this K43 award:

1. To determine the spatiotemporal pattern of untimely MCV1 and zero-dose children at high-spatial resolution in The Gambia.
2. To determine if there is a spatiotemporal relationship between cluster location of untimely MCV1 and measles population immunity in The Gambia.
3. To investigate the contribution of geographic accessibility (between households and vaccination posts; and between fixed and outreach vaccination posts) to zero-dose prevalence and delayed MCV1.
4. To model geographic access to routine vaccination services to understand the utility of the current vaccine delivery channels and potentially identify optimal locations of vaccination clinics and posts.

• Start Date: August 2023
• Duration: 18 months
• Funder: Bill & Melinda Gates Foundation
• Principal Investigator: Beate Kampmann, Oluwatosin Nkereuwem 
• Co-Investigators: Dr Uduak Okomo (MRCG at LSHTM), Rachel Ford (LSHTM), Ugochukwu Madubueze (National Obstetric Fistula Centre, Abakiliki), Agnes Msoka (Kilimanjaro Christian Medical Centre), Dr Dan Kajungu (Makerere University Centre for Health and Population Research, Uganda), Suraj Bhattarai (Siddhi Memorial hospital, Nepal), Dr Mir Mobarak Hossain (Directorate of General Health Services, Bangladesh),
• Collaborators:  MoH The Gambia, NOFC, KCMC, MUCHAP, SMH, DGHS

While vaccinating pregnant women to prevent infections in them and their newborns is a proven strategy to reduce maternal and neonatal morbidity and mortality, challenges persist. These challenges include vaccine acceptability among pregnant women and healthcare workers and logistical issues like access, affordability, availability, and timing of vaccine administration. The timing is crucial to minimize risks and ensure optimal antibody transfer to the baby. With new vaccines for RSV and GBS on the horizon, it is important to investigate real-world implementation in low- and middle-income countries (LMICs). These settings may face different challenges compared to controlled clinical trials, potentially impacting vaccine effectiveness. Understanding gestational age at antenatal care visits and the number of women attending within the 24 - 36 week window is essential. This multi-country project (The Gambia, Nigeria, Uganda, Tanzania, Nepal, Bangladesh) aims to gather detailed data from representative LMIC antenatal services to optimise new vaccine implementation.

• Start Date: March 2023
• Duration: 12 Months
• Funder: Belmont Forum
• Principal Investigator: Dr Sari Kovats
• Co-Investigators: Dr Uduak Okomo (MRCG at LSHTM), Dr Cherie Part (LSHTM), Dr Oghenebrume Wariri (MRCG at LSHTM), Dr Ana Bonel (MRCG at LSHTM), Professor Kris Murray (MRCG at LSHTM), Professor Veronique Filippi (LSHTM), Dr Shakoor Hajat (LSHTM)
• Collaborators:  MoH The Gambia; CHAMNHA

High environmental temperatures can overwhelm pregnant women's thermoregulatory capacity, leading to adverse birth outcomes. Despite growing interest in the effects of ambient heat on maternal and neonatal health (MNH), few studies have been conducted in sub-Saharan Africa (SSA), where foetal and maternal deaths are frequent, health systems have low adaptive capacity, and extreme weather events increasingly disrupt access to health services. Temperatures across Africa are rising rapidly and are expected to exceed 50°C in the Sahel region by the end of the century. The CHAMNHA (Climate, Heat, and Maternal and Neonatal Health in Africa) project aims to understand and mitigate the impacts of heat stress on MNH, enhance healthcare system resilience, and provide evidence-based interventions to protect against heat-related stillbirths. This secondary analysis of facility-based stillbirth data specifically aims to assess the burden of heat-related stillbirth in The Gambia.

• Start Date: July 2022  
• Duration: 26 months
• Funder: US Centers for Disease Control
• Principal Investigator: Professor Beate Kampmann
• Co-Investigators: Dr Uduak Okomo (MRCG at LSHTM), Oluwatosin Nkereuwem (MRCG at LSHTM), Ashley Longley (CDC/GHC/GID), Jane Gidudu (CDC/GHC/GID), Dr Mustapha Bittaye (MoH The Gambia), Dr Momodou T. Nyassi (MoH The Gambia), Sonali Kochhar (University of Washington, Seattle)

The SARS-CoV-2 pandemic has highlighted that pregnant women are particularly vulnerable to poor outcomes, prompting specific vaccination recommendations during pregnancy. However, initial clinical trials excluded pregnant women, so most safety data come from post-implementation studies in high-income countries, focusing on mRNA vaccines. No alarming safety signals have emerged, but it is crucial to expand safety data to pregnant women in low- and middle-income countries and include other COVID-19 vaccines, such as those available in The Gambia. This active vaccine safety surveillance program aims to generate data on adverse events of special interest (AESI) among vaccinated pregnant women and compare them with unvaccinated cohorts. The observational study will address potential confounders and strengthen pregnancy outcome reporting with active participation from the Ministry of Health and the Medicines Control Agency, contributing valuable data to global safety surveillance efforts.

• Start Date: January 1, 2018
• Duration: 93 months
• Funder: BMGF
• Principal Investigator: Prof Grant Mackenzie
• Collaborator: MCRI, LSHTM, THL FINDLAND, MOH, SGUL

A cluster-randomized non-inferiority trial of the effect of a two-dose schedule compared to a three-dose. The purpose is to evaluate whether a two-dose schedule of pneumococcal conjugate vaccine (PCV) is as effective as a three-dose schedule, thereby enhancing the prevention of pneumonia and other pneumococcal diseases in low- and middle-income countries through the schedule of the pneumococcal conjugate vaccine.

• Start Date: January 1, 2024
• Duration: 18 months
• Funder: BMGF
• Principal Investigator: Prof Grant Mackenzie
• Collaborator: LSHTM

K. pneumoniae and E. coli are major pathogens causing neonatal and infant sepsis. The burden of infant sepsis is highest in low-income countries in Africa. Antimicrobial resistance in invasive K. pneumoniae and E. coli is common, particularly among the former, and this greatly complicates therapy. Neonatal and infant sepsis with these pathogens is often associated with nosocomial outbreaks. Outbreaks and antimicrobial therapy are particularly problematic in low-resource settings, where microbiology services are commonly non-existent and second-line antimicrobials are generally unavailable. Development of vaccines against these pathogens is a priority and a range of different vaccine development platforms are being pursued. Vaccines against K. pneumoniae are likely to be based on O-antigen and other conserved capsular antigens. Vaccines against E. coli are likely to focus on toxin types, O-antigen types, and other conserved capsular antigens. There are limited data on the distribution of K. pneumoniae and E. coli antigenic proteins and polysaccharides from isolates causing invasive disease in Africa.

• Start Date: November 2022
• Duration: 2 years
• Funder: Medical Research Foundation 
• Principal Investigator: Dr Toyin Togun 
• Co-Principal Investigator: Dr Esin Nkereuwem
• Co-Investigators: Dr Schadrac Agbla (University of Liverpool), Dr Muyiwa Owolabi (MRCG at LSHTM), Mrs. Monica Davis (MRCG at LSHTM), Dr Sheila A. Owusu (MRCG at LSHTM), Dr Victory F. Edem (MRCG at LSHTM/University of Ibadan, Nigeria)

Spirometry is the standard method most widely used to assess pulmonary function. However, its interpretation relies on comparison with reference ranges derived from extensive studies from different parts of the world. The currently-used Global Lung Initiative (GLI) race-based and race-neutral reference ranges are deficient as they do not capture data of diverse African populations, with none from West Africa in particular. 

The RANGE study aims to generate locally-appropriate spirometry data, which can serve as a reference point for assessment of chronic lung disease among Gambian children. Healthy children from randomly selected primary and secondary schools within the Greater Banjul Area (GBA) will be recruited, and they will have lung functions tests performed by portable spirometry. We will use the Lambda-Mu-Sigma (LMS) model to generate z-scores for the age- and height-standardized reference curves for each lung function parameter stratified by sex.

The findings from this study are intended to be generalizable to other TB-endemic settings in West Africa.