Clinical Services Department

Lead Research Organisation: London School of Hygiene & Tropical 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.

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.

Publications

10 25 50

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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

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Antimicrobial Resistance Collaborators (2022) Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. in Lancet (London, England)

Related Projects

Project Reference Relationship Related To Start End Award Value
MC_UU_00031/1 01/04/2022 31/03/2027 £2,493,333
MC_UU_00031/2 Transfer MC_UU_00031/1 01/04/2022 31/03/2027 £2,493,333
MC_UU_00031/3 Transfer MC_UU_00031/2 01/04/2022 31/03/2027 £2,493,333
MC_UU_00031/4 Transfer MC_UU_00031/3 01/04/2022 31/03/2027 £2,015,400
MC_UU_00031/5 Transfer MC_UU_00031/4 01/04/2022 31/03/2027 £2,015,400
MC_UU_00031/6 Transfer MC_UU_00031/5 01/04/2022 31/03/2027 £2,015,400
MC_UU_00031/7 Transfer MC_UU_00031/6 01/04/2022 31/03/2027 £2,015,400
MC_UU_00031/8 Transfer MC_UU_00031/7 01/04/2022 31/03/2027 £2,015,400
MC_UU_00031/9 Transfer MC_UU_00031/8 01/04/2022 31/03/2027 £11,247,000
 
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 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.
 
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 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 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