Southampton

The intern will work alongside a team in the UK and Uganda on the collection and analysis of data from the ACCU-2 project. This is an “impact” project funded by FCDO. The abstract for the whole project is below. The precise role of the intern will depend on the needs of the project at the time when the intern is able to join the project. We anticipate this could include involvement in data cleaning and analysis.

Project abstract:

Maternal and perinatal mortality are still high in Uganda, with high unmet need for contraception. Although 86% of women deliver in health facilities, many high-risk women do not deliver in an appropriate hospital. Only 16% receive counselling about family planning after their delivery.

Our FCDO-funded feasibility trial of Antenatal Couples Counselling in Uganda (ACCU) showed that routine antenatal clinics could be used to screen health education films and deliver couples’ counselling about birth planning and post-partum family planning. This was associated with an increased uptake of delivery at an appropriate health facility and of post-partum family planning (PPFP).

We aim to scale this up to all 20 government primary health care facilities in Mbarara city and district (covering a population of 438,464) and in Rwamwanja refugee settlement (covering >100,000 refugees).

Starting in March 2026, our main activities for this project will be: (1) Screening our health education films on family planning in 7 health facilities in Mbarara city and district; (2) Adapting and screening these films in 3 health facilities serving >100,000 disadvantaged Congolese refugees in Rwamwanja settlement; (3) Training health workers in these health facilities on antenatal couples’ counselling and provision of PPFP; (4) Monitoring the impact of these activities on uptake of birth planning and PPFP; (5) Engaging stakeholders in the study sites and at the Ministry of Health Technical Working Group.

The impact will be sustained because health facilities can continue screening films at no cost after the project, and health workers can also continue to deliver couples’ counselling and PPFP

Background: Unintended pregnancy is a serious health concern in low-and-middle income countries (LMICs), because it increases risks of maternal and perinatal mortality. Long-acting reversible contraception (LARC) is the most effective form of contraception but its use in LMICs remains low, despite multiple interventions to increase uptake.

Study aims: To identify facilitators and barriers to LARC use in LMICs.

Methodology: We have started a systematic review of qualitative literature. We searched MEDLINE, EMBASE, CINAHL and Sociological abstracts using terms for LARCs and qualitative studies. The intern will update this search and will screened titles and abstracts to identify studies that met the inclusion criteria (qualitative studies about views/ experiences of LARCs in LMICs). The quality of the included papers will be assessed using the CASP checklist. A coding framework has already been developed and will be used to code data using Nvivo. The intern will update the existing thematic synthesis with new data from the updated search, and will format this for submission to a peer-reviewed journal for publication.

Background: Psidium guajava (guava) leaves are used in traditional medicine worldwide for diarrhoea. With diarrheal disease related mortality hitting 1.53 million in 2019 and the persistent incorrect use of antibiotics in lower-middle income countries when treating diarrhoea; research about effective and safe alternative treatments is imperative.

Objective: To assess the safety and effectiveness of guava leaf preparations in treating acute diarrhoea.

Search Methods: A systematic review has been conducted in 2023 but needs to be updated. Databases (AMED, CINAHL, COCHRANE, EMBASE, MEDLINE, PubMed, ProQuest, Google Scholar, CNKI, VIP and Wangfang Data) will be searched using terms for randomised controlled trials (RCTs), guava and acute diarrhoea.

A draft paper has been written already, but this will be updated with the updated search results, finalised and submitted for publication.
A meta-analysis will be prepared.

The intern will work alongside a team in the UK and Uganda on the analysis of data from the Opti-MaP project. This is a Global Health Group funded by NIHR. The abstract for the whole project is below. The precise role of the intern will depend on the specific interests of the intern, and the needs of the project at the time when the intern is able to join the project. We anticipate this could include involvement in data cleaning and analysis, and preparing manuscripts for publication. This is likely to involve mainly qualitative analysis.

Project abstract:

Research question: Can perinatal and maternal deaths be reduced by implementation of a customised ‘Toolbox’ of interventions to optimise implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR) in LMICs?

Background: When implemented optimally, MPDSR has been shown to reduce maternal mortality by 35% and perinatal mortality by 30%. However, documented barriers to implementation are frequent:

• Lack of community involvement: under-notification of community deaths, infrequent community-level data collection & review
• Fear of blame / litigation among health care providers, deterring engagement / learning
• Poor quality data, hampering identification of modifiable factors
• Insufficient training at all levels
• Inadequate implementation of responses
• Lack of monitoring / accountability and funding for implementation
• Aims
• To develop and optimise intervention components to improve functionality of MPDSR
• To evaluate the effect of a customised intervention (optimising MDPSR) on maternal and perinatal mortality.

Specific objectives

1. To review existing tools, develop and adapt a harmonised toolbox of resources to optimise MPDSR implementation
2. To co-design a customised “intervention package” using the toolbox
3. To evaluate effectiveness and cost-effectiveness of the “customised intervention package” to reduce perinatal and maternal mortality.

Methods and timelines
Community Advisory Boards and Stakeholder Committees will be established and meet regularly to advise on all aspects of the project (WP1.1, months 1-48). Political Economic Analysis will be conducted (WP 1.2, m1-12).
Phase 1 (WP 2-6, m1-12): Co-development of a comprehensive “toolbox” of resources for adaptation to specific country contexts, including tools for:

• Reviewing, then proposing the amendment/development of laws and regulatory frameworks to facilitate an enabling regulatory environment for MPDSR and legal accountability for implementing responses at all levels (WP2)
• Improving data quality (WP3)
• Training and mentoring health workers across specific MPDSR roles (WP4)
• Improving MPDSR response-tracking and budgeting (WP5)
• Community death notification, data collection and review (WP6)
• Counselling bereaved families (WP6)

Phase 2 (WP7, m12-18): Developing customised “intervention packages”. Each country will hold stakeholder workshops to select, adapt and translate “toolbox” components to ensure they align with national policies, capacity, socio-economic context, and the proportion of deaths in health facilities and outside.

Phase 3 (WP8, m18-48): stepped-wedge cluster-randomised trial to assess effectiveness and cost-effectiveness of “customised intervention packages” in 9 districts (3 in each country, implemented at months 18, 24 and 30), with perinatal mortality as the primary outcome. To ensure that mortality data is reported reliably and consistently, we will also implement improved tools for death notification in all sites from month 12. Outcome data will be collected up to month 42.