Clinical Services Department
Lead Research Organisation:
London Sch of Hygiene & Tropic. Medicine
Department Name: UNLISTED
Abstract
The Clinical Services Department serves the Gambian public, providing access to the medical care available at the clinics in Fajara and Keneba, as well as supporting research in the Unit by providing care to staff of the Unit and members of the public who have volunteered to be part of our research. We provide general (internal) medicine and paediatric services in Fajara. In Keneba, we provide primary healthcare services to residents of West Kiang.
We constantly seek to improve the service we offer, using Quality Improvement methods to ensure we are successful. We have training programmes for our staff and for students of the nursing and medical schools in The Gambia and aim to teach healthcare workers to deliver the best quality of care that they can.
We support research more directly by undertaking small studies that answer practical questions we identify in our medical practice, as well as hosting projects undertaken by Unit scientists and supporting the scientists with specific clinical skills and our expertise.
We constantly seek to improve the service we offer, using Quality Improvement methods to ensure we are successful. We have training programmes for our staff and for students of the nursing and medical schools in The Gambia and aim to teach healthcare workers to deliver the best quality of care that they can.
We support research more directly by undertaking small studies that answer practical questions we identify in our medical practice, as well as hosting projects undertaken by Unit scientists and supporting the scientists with specific clinical skills and our expertise.
Technical Summary
The Clinical Services Department exists to support clinical research at the Unit by providing primary health care to staff and their family members, medical care to study participants, primary health care to the population of West Kiang, and access to paediatric and internal medical services to the general public. Both outpatient and inpatient services are offered at the Fajara site.
The Department supports research with specific clinical skills, such as ultrasound, GI endoscopy and bronchoscopy. More intensive studies are hosted in the ward.
Alongside this, the Department supports local healthcare training institutions by providing clinical attachments to all levels of nursing students, medical students and doctors in training.
The department focuses on Quality Improvement in healthcare, with an active programme of projects aimed to improve the care delivered in the department. A suite of guidelines have been developed and are publicly available.
We have developed an electronic medical record system, which enables us to record clinical activity for day-to-day operational reasons, but also gives us access to data that can be used to improve quality and to better understand the conditions seen in the Department.
The Department hosts small research projects which answer questions that arise during clinical practice. Examples have included studies of the relationship between respiratory illness and air quality, validation of a locally produced buffer for a point of care test and a study of antimicrobial usage.
Collaborations are sought with organisations and individuals who can further the objectives of the Department, particularly when they are able to offer skills which are not currently found within the Department.
The Department supports research with specific clinical skills, such as ultrasound, GI endoscopy and bronchoscopy. More intensive studies are hosted in the ward.
Alongside this, the Department supports local healthcare training institutions by providing clinical attachments to all levels of nursing students, medical students and doctors in training.
The department focuses on Quality Improvement in healthcare, with an active programme of projects aimed to improve the care delivered in the department. A suite of guidelines have been developed and are publicly available.
We have developed an electronic medical record system, which enables us to record clinical activity for day-to-day operational reasons, but also gives us access to data that can be used to improve quality and to better understand the conditions seen in the Department.
The Department hosts small research projects which answer questions that arise during clinical practice. Examples have included studies of the relationship between respiratory illness and air quality, validation of a locally produced buffer for a point of care test and a study of antimicrobial usage.
Collaborations are sought with organisations and individuals who can further the objectives of the Department, particularly when they are able to offer skills which are not currently found within the Department.
Organisations
- London Sch of Hygiene & Tropic. Medicine (Lead Research Organisation)
- Medical Research Council (MRC) (Collaboration)
- Muhimbili University of Health and Allied Sciences (Collaboration)
- Newcastle University (Collaboration)
- UNIVERSITY OF BOTSWANA (Collaboration)
- University of California, Los Angeles (UCLA) (Collaboration)
- Gates (Collaboration)
- UNIVERSITY OF OXFORD (Collaboration)
- University of Cape Town (Collaboration)
- University of the Witwatersrand (Collaboration)
- University of Ibadan (Collaboration)
- London School of Hygiene and Tropical Medicine (LSHTM) (Collaboration)
- St Georges Hospital (Collaboration)
- Ludwig Maximilian University of Munich (LMU Munich) (Collaboration)
Publications
Agboghoroma O
(2022)
Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study
in Journal of Endocrinology, Metabolism and Diabetes of South Africa
Antimicrobial Resistance Collaborators
(2022)
Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis.
in Lancet (London, England)
Antimicrobial Resistance Collaborators
(2024)
The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis.
in The Lancet. Global health
Armitage E
(2024)
Streptococcus pyogenes carriage and infection within households in The Gambia: a longitudinal cohort study
in The Lancet Microbe
Bittaye SO
(2022)
Clinical manifestations and outcomes of severe malaria in adult patients admitted to a tertiary hospital in the Gambia.
in Malaria journal
Boté-Casamitjana A
(2024)
Evaluating the sensitivity and specificity of Determine™ HIV-1/2 rapid test using a 0.01M phosphate-buffered saline produced at the Medical Research Council Unit The Gambia for the diagnosis of HIV.
in Transactions of the Royal Society of Tropical Medicine and Hygiene
Brindle HE
(2022)
Aetiology and Potential Animal Exposure in Central Nervous System Infections in Vietnam.
in EcoHealth
Camirand-Lemyre F
(2023)
Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19.
in JAMA network open
Citarella BW
(2024)
Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms.
in Heliyon
| Description | Advice provided to Gambian Medical and Dental Council |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | This has informed the plans that the MDCG are making to improve the regulatory and disciplinary structures for doctors in the UK. |
| Description | CSD Guidelines |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | We have undertaken a number of internal clinical audits showing that we have improved care to the patients we see. For instance, we now provide standardised care to patients with hyperthryoidism and have greater number of our heart failure patients on treatments shown to improve mortality outcomes. |
| Description | Contributing to Knocking Out AMR workshop |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Participation in a guidance/advisory committee |
| URL | https://microbiologysociety.org/our-work/knocking-out-antimicrobial-resistance.html |
| Description | Examining for MDCG |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | We enable the Medical and Dental Council to ensure that practitioners registered in The Gambia have reached the appropriate levels of competence. |
| Description | National Action Plan for AMR - Workshop |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| Impact | This resulted in the development of a National Action Plan which has a coherent section addressing research needs and opportunities. |
| Description | Support to Medical and Dental Council of The Gambia: AIUWA Accreditation Process |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | This was partly a training exercise, in that we were being trained to contribute to the regulatory processes in The Gambia. We will be asked to be involved in future accreditations. Also it has enabled the Council to ensure that all medical practitioners in country are properly trained. |
| Description | Training day for residents |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Title | Electronic Medical Record System |
| Description | This database is the medical record system for the CSD clinics in Fajara and Basse. It is also used for some data collection in Keneba. It contains the clinical details of care provided within the clinics - including all outpatient and inpatient care, lab investigations and prescribing data. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2019 |
| Provided To Others? | No |
| Impact | We have been able contribute data from the system to a number of collaborative papers, as well as publishing our own clinical case series. |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | Muhimbili University of Health and Allied Sciences |
| Department | School of Medicine |
| Country | Tanzania, United Republic of |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. |
| Start Year | 2019 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | University of Botswana |
| Department | School of Medicine |
| Country | Botswana |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. |
| Start Year | 2019 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | University of Cape Town |
| Department | Faculty of Health Sciences |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. |
| Start Year | 2019 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | University of Ibadan |
| Department | Faculty of Medicine |
| Country | Nigeria |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. |
| Start Year | 2019 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | University of the Witwatersrand |
| Department | Medical School Witwatersrand |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. |
| Start Year | 2019 |
| Description | ADILA |
| Organisation | St Georges Hospital |
| Country | United Kingdom |
| Sector | Hospitals |
| PI Contribution | We are working together to contribute our antibiotic prescribing data to this study. |
| Collaborator Contribution | Our partner will analyse the data and return advice and information to us to help us improve our prescribing. |
| Impact | Outputs awaited |
| Start Year | 2023 |
| Description | AMR work with Newcastle Medical school |
| Organisation | Newcastle University |
| Department | Newcastle University Medical School |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We have hosted medical students from Newcastle University in 2022 and again this year. They carry out a co-created project to look at antibiotic use in humans and animals to contribute to the AMR data we have from The Gambia. |
| Collaborator Contribution | They send 2 medical students to carry out a project and provide funding to cover their transport / accommodation / stipend costs and bench fees. |
| Impact | N/A yet. |
| Start Year | 2020 |
| Description | GRAM |
| Organisation | University of Oxford |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We are preparing our the collaboration agreement. We will share microbiology data as well as associated clinical metadata to be included in the Global Burden of Diseases work on AMR. |
| Collaborator Contribution | They will analyse the data as part of the international study. |
| Impact | Sartorius, B. et al., 2023. The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis. The Lancet Global Health 0. https://doi.org/10.1016/S2214-109X(23)00539-9 Murray, C.J.L., et al., 2022. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 399, 629-655. https://doi.org/10.1016/S0140-6736(21)02724-0 |
| Start Year | 2019 |
| Description | ISARIC |
| Organisation | University of Oxford |
| Department | Nuffield Department of Medicine |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We contributed data to the ISARIC database. The data comprised structured extractions of real clinical data from patients who were treated for COVID-19. |
| Collaborator Contribution | They have analysed the data in combination with data from many other centres and have begun to publish papers about the data. Currently about how the data can be used to develop AI systems. |
| Impact | Multi-disciplinary: Clinical medicine, Engineering, Epidemiology The first paper is in preprint: arXiv:2302.04725v1 |
| Start Year | 2021 |
| Description | M72 Epi study |
| Organisation | Gates |
| Country | United States |
| Sector | Private |
| PI Contribution | Site PI for a multi-site epi study |
| Collaborator Contribution | Sponsor for the study |
| Impact | None yet |
| Start Year | 2022 |
| Description | Oxford University Clinical Research Unit Vietnam |
| Organisation | University of Oxford |
| Department | Oxford University Clinical Research Unit Vietnam (OUCRU) |
| Country | Viet Nam |
| Sector | Academic/University |
| PI Contribution | Our team member Behzad Nadjm was formally at OUCRU. He has continued to collaborate, supervising PhD students and finalising papers for publication. |
| Collaborator Contribution | They previously employed Behzad Nadjm. |
| Impact | doi: 10.1016/S2666-5247(22)00338-X doi: 10.1038/s41598-022-27084-z doi: 10.1007/s10393-022-01611-w doi: 10.1016/S2666-5247(22)00181-1 doi: 10.1186/s12936-022-04294-4 doi: 10.3389/fpubh.2022.893200 |
| Start Year | 2019 |
| Description | PaTS / RECOVERY |
| Organisation | Medical Research Council (MRC) |
| Department | MRC Unit, The Gambia |
| Country | Gambia |
| Sector | Public |
| PI Contribution | We have been involved in the discussions around the design and running of the PaTS trial. We have provided clinical care to patients with COVID-19 including those in the study. We have referred patients to join the study as participants. |
| Collaborator Contribution | They have provided staff to the ward as well as clinical time. They have provided equipment, drugs, diagnostics needed to sustain COVID-19 care on the ward. |
| Impact | http://dx.doi.org/10.18203/2349-3259.ijct20230048 |
| Start Year | 2020 |
| Description | Spycats |
| Organisation | Medical Research Council (MRC) |
| Department | MRC Unit, The Gambia |
| Country | Gambia |
| Sector | Public |
| PI Contribution | We have provided clinical care to the participants of the study - this was essential to the safe running of the study. |
| Collaborator Contribution | They designed, obtained funding and ran the study. They have also contributed clinical time to us. |
| Impact | None yet. |
| Start Year | 2020 |
| Description | TB Sequel II |
| Organisation | Ludwig Maximilian University of Munich (LMU Munich) |
| Country | Germany |
| Sector | Academic/University |
| PI Contribution | MRC is one of the clinical sites and Prof Sutherland is the site-PI and work package lead for host immunological analysis |
| Collaborator Contribution | LMU is the lead PI institution |
| Impact | None yet as the project has only just begun |
| Start Year | 2023 |
| Description | TBVAC-HORIZON |
| Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Site PI |
| Collaborator Contribution | 30 other sites contributing to development of novel TB vaccines |
| Impact | None to date |
| Start Year | 2023 |
| Description | UCLA / MRCG quality improvement projects |
| Organisation | University of California, Los Angeles (UCLA) |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | We have worked with the clinical microbiology team from UCLA on a number of quality improvement projects. This year, they have sent us a medical student for 6 months to lead a series of quality improvement projects. We have provided him with support and supervision, as well as the ideas of what our problems are that he can help us with. |
| Collaborator Contribution | The student has been involved in 7 different projects, several have been resolved with successful outcomes. Others are ongoing. We hope to start two audit projects before he leaves that will help us investigate outcomes and should lead to publications. He has also worked with the molecular biology lab to develop a fungal PCR assay and has brought more direct financial support to that project. |
| Impact | N/A |
| Start Year | 2019 |
| Description | Vaccine trials |
| Organisation | Medical Research Council (MRC) |
| Department | MRC Unit, The Gambia |
| Country | Gambia |
| Sector | Public |
| PI Contribution | We have provided clinical care for participants of multiple vaccine trials - including Serum Institute of India Yellow fever licencing trial, Matisse (Pfizer sponsored RSV maternal vaccination study), Microneedle Measles / Rubella phase 1 study, GAPS (Pertussis maternal vaccination study), HPV (Human Papillomavirus vaccine study), Novel Oral poliovirus 2 vaccine licencing study. Without this care, these studies could not have proceeded in our setting. |
| Collaborator Contribution | They obtained designed, obtained funding and ran the studies. |
| Impact | 10.1186/s13063-022-06493-5 |
| Description | Informational videos for clinics - to address how the clinics work and research use of data |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | 2 Videos were created - one for the Keneba clinic and one for the Fajara clinic. The videos describe how the clinics work, what is done with blood samples and why we might take them and what is done with clinical data - particularly how it can be used anonymously for quality improvement or (with ethics permission) for research. These videos are played in the clinic waiting areas in Keneba and Fajara potentially reaching up to 300 people per working day. |
| Year(s) Of Engagement Activity | 2022 |