Global Health Projects

Project Lead(s): Eric Finkelstein

Description: APPROACH, which stands for Asian Patients Perspective regarding Oncology Awareness, Care and Health, to date has been fielded in 14 hospitals across 10 countries in Asia. It is a cross-sectional survey that systematically captures key dimensions of the end of life experience for patients with advanced illness, including quality of life, levels of pain and distress, use of life-extending treatments, palliative care and non-traditional medicines, treatment decision-making, and multiple dimensions of quality of care. The results provide insights into the challenges that patients with advanced illness face and help identify and advocate for areas for improvement. This study aims to expand our Asia focused APPROACH study to Africa, starting with Moi Teaching and Research Hospital (MTRH).

Project Lead(s): Tazeen Jafar, Zainab Samad

Description: The Aga Khan University-Pakistan Initiative for NCDs (AKUPI-NCDs) is a training program focused on capacity building to generate contextual, integrated and locally relevant research targeting multiple priority NCDs. Non-communicable diseases now represent the top causes of death and disability in low middle income countries particularly Pakistan. An important reason for failure of an adequate response to this NCD epidemic in Pakistan is a dearth of NCD researchers. We plan to fill this gap by training the next generation of leaders in NCD research with a particular focus on cardiovascular and neurovascular diseases and their risk factors. Our program will offer short-medium and long-term training covering research methods such as classic epidemiological cohort studies, clinical trials and computational methods for ‘Big data’. Our program will be the first of its kind in LMICs leveraging an unparalleled large data repository at the Aga Khan University as well as many large historical community cohorts.

Project Lead(s): Chua Yeow Leng, Lim Swee Hia

Description: Supported by Lee Foundation, this nursing training programme aim to create awareness and impart nursing knowledge among Ambon nurses to improve their patient management skills. Through this project, a few medical students can also come to SingHealth for a short-term medical exchange programme.

Project Lead(s): Shenglan Tang

Description: "Indonesia is a high burden country of tuberculosis (TB) and has increased in the prevalence of diabetes mellitus (DM) in recent years. The interaction between TB and DM requires comanagement of TB and DM to addressing the dual challenges. This study aims to explore a model of integrated care for co-management of TB and DM within the primary healthcare setting in DKI Jakarta Province, Indonesia and use the findings to determine the key health system factors in order to identify and develop evidence-based interventions for effective comanagement of TB and DM. This study will adopt a mixed-methods: 1) A critical review will be conducted to map out policies, strategies and practice guidelines for TB and DM control and management by primary and public health systems at national level and the study province. 2) Qualitative interviews will be conducted with decision makers and health administrators at national, provincial and district level; national and international experts in the areas of TB and DM control; head of primary health centers and primary health professionals; as well as TB and DM patients. These aim to understand current policy commitment, collaborative mechanisms for the co-management of TB and DM and health system challenges including governance, health financing and institutional capacity of primary health centers. 3) Secondary analysis of the national basic health survey data will be used to understand prevalence of TB and DM, implementation of TB-DM co-management in primary healthcare setting and factors impacting on access to and use of the service."

Project Lead(s): Andrea Kwa

Description: Training of Radiation Therapists and Support staff to provide Radiation therapy for Cancer Patients

Project Lead(s): Toh Han Chong

Description: Prospective international randomized phase III trial examining the role of aspirin as adjuvant treatment following surgery and adjuvant chemotherapy for high risk stage 2 and stage 3 colorectal cancer - vs placebo - global health angle is that this is the world's first use of aspirin as drug repurposing for reducing colorectal cancer relapse - to complete. over 1550 patients have been recruited for a total of 1587.

Project Lead(s): Cheng Ching-Yu

Description: The Asian Eye Epidemiology Consortium (AEEC) is a collaboration between 21 groups, originating from 13 different Asian countries. It comprises both population-based and other studies (case-control, cases only, randomized trials), providing ophthalmological data on approximately 100,000 Asian participants. Goals of AEEC: Shaping the Future of Epidemiology 1. To derive ‘conclusions’ on risk factors of major eye diseases across Asians 2. To document the prevalence and incidence of eye diseases, in particular relatively uncommon ones, in Asia 3. To develop and validate prediction models for eye diseases 4. To provide a platform for international collaborations in Asia and worldwide 5. To build capacity in ocular epidemiology in Asian and translate expertise to young investigators

Project Lead(s): Eric Finkelstein

Description: Asia has experienced a shift in causes of death from infectious to chronic diseases. This study proposes to understand how the limited resources of and inadequate infrastructure available in low and middle income countries for treatments of chronic diseases and systematic coverage of basic palliative care and home based services influence terminally-ill patients' quality of life and treatment relative to expectations. We propose to conduct a one-time roughly 45-minute survey of hospital-based advanced cancer patients in Asia. The core research domains included in the survey are: A. Patients’ quality of life and perceived quality of care; B. Patients’ perceived roles and preferences for involvement in decision making;C. Patients’ understanding of their illness, prognosis, and treatments received;D. Use of hospice palliative care, mental health services, and complementary and alternative therapy; andE. Self-blame and social stigma . The findings from this study are expected to help policy makers to identify key areas for improvement of end-of-life care within and across countries.

Project Lead(s): Carolyn Lam

Description: This is a prospective observational multinational Asian registry comprising 5,276 patients with symptomatic HF (stage C), LV systolic dysfunction (EF ≤ 40%) and 1,203 patients with HF and preserved ejection fraction (EF ≥50%) enrolled from 46 centres across 11 Asian regions (China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Philippines, Singapore, Taiwan and Thailand). By providing prospective data regarding the demographics, risk factors, and outcomes of Asian patients under treatment for HF, the ASIAN-HF registry is expected to advance fundamental understanding of the Asian HF phenotypes, the burden and predictors of death and hospitalization among these patients.

Project Lead(s): Gayathri Nadarajan, Marcus Ong

Description: The objective of this project is to build upon the existing Global Resuscitation Alliance 10-step tool to develop and test a prehospital emergency care system assessment tool encompassing the domains of cardiovascular, trauma, and perinatal emergencies, for implementation in low resource settings in Southeast Asia.

Project Lead(s): Ian Mendenhall

Description: Emerging infectious diseases pose a continual risk for humans, imparting major health and economic challenges. It is estimated that greater than 70% of these diseases originate in wildlife, demonstrating the importance of understanding the diversity of pathogens that circulate in animals. Bats are important reservoirs of several medically important viruses that have high case fatality rates, including rabies/lyssaviruses, the henipaviruses, SARS-like coronaviruses, and Ebola virus and the related filoviruses. India is one of the most biologically diverse countries in the world, however there are few reports of viruses detected in bats. Diseases outbreaks can begin from a single source, as phylogenetic data from the recent Ebola outbreak in West Africa indicates, signifying the importance of cross-species transmission events. Therefore, studying specific interfaces where humans are more frequently exposed due to their proximity and heightened interactions with wildlife can provide critical information on exposure and risk of zoonotic infection. Bat harvesting for human consumption is a common practice across India, as concentrated efforts can yield high numbers of bats. This contact and processing of bushmeat is an opportune place for zoonotic pathogen transmission to occur. By sampling the bat populations where harvesting occurs before, during and after the trapping, we can determine if bat harvests increase the shedding of viruses and what medically important viruses are circulating in the targeted bat populations. This will allow us to generate risk models and understand which species may be natural virus reservoirs in India.

Project Lead(s): Ashley St. John

Description: Assessment of Flavivirus prevalence in Nepal and evaluation of biomarkers of dengue disease severity.

Project Lead(s): Ashley St. John

Description: Determination of associations of clinical signs of severe dengue with mast cell-derived products in hospitalised patients.

Publication: https://doi.org/10.1038/s41598-020-68844-z

Project Lead(s): Ian Mendenhall

Description: Bats and small mammals are rich reservoirs of zoonotic viruses and bacteria. Studying these host-microbe relationships can better our understanding of disease emergence. Species-habitat relationship models can be used to identify areas where there is a high probability of detecting a disease reservoir (small mammal and bat). However, these models are rarely tested using an independent data set and not one that is country-wide. Laos has similar habitat types, and shares many of the samebat and small mammal species with Cambodia. By implementing this strategy, we will be able to assess the effectiveness and generalizability of the species-habitat models that we have developed in Cambodia. This will enable effective transboundary surveillance efforts and provide informed surveillance efforts.

Project Lead(s): Mark Leong Kwok Fai

Description: The 3-year programme, supported by SIF and led by Dr Mark Leong Kwok Fai managed to enhance and build capabilities in healthcare professionals in Calmette Hospital, Cambodia, in the area of emergency and critical care. More than 900 specialists were trained in this programme.

Project Lead(s): Ian Mendenhall

Description: Camels share a history with humans and are an integral part of the economies and subsistence agricultural practices in parts of Africa and Asia. These animals are a valuable source of transport, hair/wool, milk and meat. There are an estimated 27 million camels globally and the physiology of camels, coupled with the nomadic nature of certain groups of humans, often results in high levels of animal dispersal and migration. With the identification of camels as a reservoir for Middle East respiratory syndrome coronavirus (MERS-CoV), there is increased interest in studying their role in the maintenance of zoonotic pathogens. Camels are reservoirs of several ‘select agents’, including; Crimean Congo haemorrhagic fever virus (CCHF), tick borne encephalitis virus (TBEV), and Coxiella burnetii (the bacterium causing Q fever). Detection of pathogens in acute and latent infections can be challenging owing to the short duration of infection or low levels of the organism in the sample material. Serologic assays can provide retrospective evidence for pathogen exposure. Kazakhstan has a large camel population of close to 200,000 animals and several endemic ‘select agents’ identified in the country. Studying pathogen exposure at the camel-human interface will allow us determine high risk areas for the prevalence of a certain pathogen and therefore potential cross-species transmission. Additionally, by understanding the interactions between camels, livestock, bats and their parasitic communities, we can estimate in which areas and under which circumstances spillover events are likely to occur.