Pilot study: a cluster randomised trial of the provision of alcohol handgel to postpartum mothers to prevent neonatal infective morbidity in the home

Lead Research Organisation: University of Liverpool
Department Name: Institute of Translational Medicine

Abstract

The research question is "Is the provision of alcohol hand gel to pregnant women in rural Uganda a clinically and cost-effective way of preventing early infant infections?". To provide context to this question across the globe, there are an estimated 3 million neonatal deaths annually. In Uganda, with over 1.5 million live births annually, 142,000 newborn infants die every year before reaching their fifth year with 33% of these in the neonatal period. This places Uganda 153rd out of 163 countries in the global rank for frequency of neonatal deaths. Most newborn infections and deaths occur in the community, and are frequently unreported to the health sector. For example, preliminary findings from the Iganga/Mayuge Demographic Surveillance Site showed that 60% of all deaths occur outside a health facility setting and go unreported. African community studies suggest an infection rate of around 30%.

In terms of infection prevention hand washing with soap even when washed with unclean water results in a large reduction in hand contamination. A recent systematic review concluded that there was a lack quality evidence for the effect of clean birth and postnatal newborn care practices on neonatal mortality. However, the need for clean birth and postnatal care is widely accepted. A Delphi expert consensus process judged that clean birth practices at home with no skilled attendant could reduce neonatal sepsis deaths by 15% and tetanus deaths by 30%. The panel judged that postnatal newborn care practices could prevent 40% of neonatal sepsis deaths, but that more research is needed particularly on the content and quality of care during the early postnatal period.

A research priority-setting exercise by World Health Organisation (WHO) on the reduction of newborn infection deaths found that the top ranked question was 'what is the feasibility, effectiveness, and cost of different approaches to promote the home care practices especially hand washing of caregivers?' Despite this being 4 years ago, there are no registered studies addressing the use of alcohol hand gels for mothers in the neonatal period, and local experts know of no similar study. The importance of hand-washing in preventing infective deaths has led WHO to develop guidelines for hand hygiene both within health care settings and in the community and integrate hand hygiene into neonatal community care programmes. For hand hygiene, the current recommended practice at the household level is handwashing with soap. However, studies show widespread non-adherence to the household guidelines, often due to a lack of water. An alternative option could therefore be alcohol based hand gel. This is cheap ($0.6 for 60mls) and active against a broad range of Gram-positive and Gram-negative aerobic bacteria, including staphylococci, streptococci, and enteric Gram-negative bacteria. Although alcohol-based hand rubs effectively prevent acute diarrhoeal diseases.

Technical Summary

A pilot of the full study will be conducted in 10 villages around Busiu Health Centre IV and Lwangoli Health Centre III in the Mbale District of East Uganda. With an average of 3.5 deliveries per month in the study villages - a 3-month pilot will therefore include around 100 births.

Planned Impact

Impact Summary
Study objectives:
1. To determine the effectiveness of providing alcohol hand gel to pregnant women in rural Eastern Uganda as a way of reducing infant infective morbidity in the first 3 months of life
2. To determine the cost-effectiveness of providing alcohol hand gel to pregnant women in rural Eastern Uganda as a way of reducing early infant infections in the first 3 months of life
3. To prevent maternal infection in the first 3 months postnatally


This BabyGel clinical trial will have multiple beneficiaries. Policy-makers nationally and internationally, local government agencies and regulators and the commercial private sector are all likely to benefit from the clinical trial outcomes.

The Department of Women's and Children's Health in the University of Liverpool is a WHO Collaborating Centre and home of the Cochrane Pregnancy and Childbirth Group. Both these facilitate rapid integration of research findings into systematic reviews, as well as having long-established mechanisms for the dissemination of research findings. This will enable the findings to diffuse rapidly to international policy makers.

If the hand-gel is effective at reducing neonatal mortality then we envisage a range of strategies for scale-up including the placement of hand gel into maternal delivery packs, antenatal distribution, postnatal distribution through village health workers, or social marketing with the production of subsidised locally available gels.

Within Uganda itself, the research team includes members of key organisations who need to be aware of the research findings. These include: 1) experienced academic researchers in public health, maternal health and child health; 2) research training institutions (e.g. Makerere and Busitema Universities, Sanyu Africa Research Institute, Mbale Regional Referral Hospital) who will have new teaching and research tools to train researchers; 3) Government of Uganda Ministry of Health; and 3) over 7,000 research participants themselves, who will benefit from this simple self-help technique to improve maternal and neonatal health. The use of hand gel amongst participants will also spread the message directly to neighboring areas about the importance of hand hygiene, thus disseminating the hand hygiene message beyond the immediate study group. This trial will facilitate to reduce health inequity and help to develop sustainable communities throughout Mbale.

The impact summary comprises a range of initiatives aimed at:
1)Dissemination of information and outcomes at a range of levels
2)Research - capacity building
3)Local awareness raising of the importance of hand hygiene
4)Information sharing of individual components of the project

On-going Dissemination of Information and Outcomes
There will be significant opportunities for information sharing and policy transfer throughout the project. The project will be evaluated and the development of the project as a whole and will take place on an on-going basis.

Publications

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Ditai J (2018) Patients' roles in research: where is Africa? in BMJ (Clinical research ed.)

 
Description WHO RP2 Research Assessment Panel
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a advisory committee
Impact The RP2 Panel is an invited group of 10 researchers in maternal and child health who assess all the WHO research projects in this area. They meet formally once a year in Geneva as well as reviewing research proposals via email. The projects all relate to research in low and middle income settings.
 
Description A cluster randomised trial to evaluate the effectiveness of household alcohol-based handrub for the prevention of sepsis, diarrhoea and pneumonia in Ugandan infants.
Amount € 5,977,299 (EUR)
Funding ID RIA2017MC-2029 
Organisation Sixth Framework Programme (FP6) 
Department European and Developing Countries Clinical Trials Partnership
Sector Public
Country European Union (EU)
Start 02/2019 
End 02/2024
 
Description Stars in Reproductive, Maternal, Newborn and Child Health
Amount $100,000 (CAD)
Funding ID R-ST-POC-1807-12800 
Organisation Government of Canada 
Department Grand Challenges Canada
Sector Public
Country Canada
Start 04/2018 
End 10/2019
 
Description Award of the WellBeing of Women / FIGO Fellowship to Professor Julius Wandabwa 
Organisation Busitema University
Country Uganda 
Sector Academic/University 
PI Contribution We are mentoring Prof Wandabwa in evidence-based medicine: the conduct of systematic reviews and clinical trials. He visits the Sanyu Research Unit annually for training and joint preparation of a new Cochrane Review into Mechanical methods for the management of postpartum haemorrhage.
Collaborator Contribution Prof Wandabwa has visited Liverpool once so far for a training course into the preparation of systematic reviews. Prof Weeks has also visited him in Uganda for support and mentorship. Prof Wandabwa is an investigator for a number of ongoing studies in Mbale including BabyGel and studies of the PPH Butterfly (ongoing scoping work to develop a device for low income settings).
Impact None yet.
Start Year 2015
 
Description Babygel Research Group 
Organisation Busitema University
Country Uganda 
Sector Academic/University 
PI Contribution We are collaborating on an EDCTP grant together which follows on from the BabyGel MRC Pilot Study.
Collaborator Contribution We are all part of the trial management group, and lead various workpackages on the study.
Impact There have been multiple outputs from this group which arose from the MRC funded BabyGel pilot study. The full study is now commencing and will produce further outputs in due course.
Start Year 2012
 
Description Babygel Research Group 
Organisation Liverpool School of Tropical Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution We are collaborating on an EDCTP grant together which follows on from the BabyGel MRC Pilot Study.
Collaborator Contribution We are all part of the trial management group, and lead various workpackages on the study.
Impact There have been multiple outputs from this group which arose from the MRC funded BabyGel pilot study. The full study is now commencing and will produce further outputs in due course.
Start Year 2012
 
Description Babygel Research Group 
Organisation Makerere University College of Health Sciences
Country Uganda 
Sector Academic/University 
PI Contribution We are collaborating on an EDCTP grant together which follows on from the BabyGel MRC Pilot Study.
Collaborator Contribution We are all part of the trial management group, and lead various workpackages on the study.
Impact There have been multiple outputs from this group which arose from the MRC funded BabyGel pilot study. The full study is now commencing and will produce further outputs in due course.
Start Year 2012
 
Description Babygel Research Group 
Organisation Mbale Regional Hospital
Country Uganda 
Sector Hospitals 
PI Contribution We are collaborating on an EDCTP grant together which follows on from the BabyGel MRC Pilot Study.
Collaborator Contribution We are all part of the trial management group, and lead various workpackages on the study.
Impact There have been multiple outputs from this group which arose from the MRC funded BabyGel pilot study. The full study is now commencing and will produce further outputs in due course.
Start Year 2012
 
Description Babygel Research Group 
Organisation Ministry of Health, Uganda
Country Uganda 
Sector Public 
PI Contribution We are collaborating on an EDCTP grant together which follows on from the BabyGel MRC Pilot Study.
Collaborator Contribution We are all part of the trial management group, and lead various workpackages on the study.
Impact There have been multiple outputs from this group which arose from the MRC funded BabyGel pilot study. The full study is now commencing and will produce further outputs in due course.
Start Year 2012
 
Description Babygel Research Group 
Organisation University of Bergen
Country Norway 
Sector Academic/University 
PI Contribution We are collaborating on an EDCTP grant together which follows on from the BabyGel MRC Pilot Study.
Collaborator Contribution We are all part of the trial management group, and lead various workpackages on the study.
Impact There have been multiple outputs from this group which arose from the MRC funded BabyGel pilot study. The full study is now commencing and will produce further outputs in due course.
Start Year 2012
 
Description WHO Collaborating Centre for Research and Research Synthesis in Reproductive Health 
Organisation World Health Organization (WHO)
Department Department of Reproductive Health and Research
Country Global 
Sector Academic/University 
PI Contribution The Terms of Reference are: 1. Collaborate in research synthesis to support the translation of evidence-based research findings into WHO policy and services in the area of maternal and newborn health
Collaborator Contribution To advise on research proposals and protocols, contribute to Trial Steering Groups
Impact The WHO officers contribute to all the research proposals within the Sanyu Research Unit by commenting on the protocols. In addition, Julie Storr was a co-investigator on the BabyGel Study and Metin Gulmezoglu chaired the Steering Committee for INFORM study.
Start Year 2012
 
Title The BabySaver Tray: a bedside resuscitation unit for low resource settings 
Description The BabySaver Tray is a low cost version of the LifeStart Trolley which was successfully developed for the bedside resuscitation of newborn babies. Whilst the LifeStart Trolley costs many thousands of pounds, we sought to create a version that costs under $20. This was done in collaboration with Peter Watt of the Department of Clinical Engineering. Initial cardboard structures were shown to colleagues in Uganda for comment and refined. A final version was vacuum formed by the clinical engineering team at Bryn y Neuadd Hospital, Wales. The decision was made to transfer to IP to the Sanyu Africa Research Institute in Mbale, Uganda for development. Together we submitted an funding application to Grand Challenges Canada and were awarded CAD 100,000 to develop the unit. 
Type Support Tool - For Medical Intervention
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2018
Development Status Under active development/distribution
Impact No impacts as yet as it is still in the development phase. 
 
Description A pilot cluster randomised trial of alcohol-based hand rub to prevent community neonatal sepsis in rural Uganda (poster presentation at the Global Women's Health Society conference) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Prof Weeks presented this poster about the BabyGel research. He made himself available to take questions around both his poster and the wider question of consent procedures in low resource settings. The conference is a UK-based Global Maternal Health conference run every 18 months to bring together UK and international researchers exploring maternal health in low resource settings.
Year(s) Of Engagement Activity 2016
 
Description Annual meeting of European WHO Collaborating Centres in Edinburgh 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Annual meeting of European WHO Collaborating Centres at which we each present our ongoing work.
Year(s) Of Engagement Activity 2018
 
Description BabySaver Tray launch 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact We launched the BabySaver Tray at the Uganda Association of Obstetrics and Gynaecologists annual meeting in Kampala (23 Aug 2018), and at a press conference in Liverpool (12th Sept 2018). I gave a talk about it, and we had a stall to demonstrate its use. There was a lot of media coverage with newspaper articles in the Ugandan national press, Ugandan TV, UK BBC regional news coverage (TV and radio) and local Liverpool newspaper coverage.
Year(s) Of Engagement Activity 2018
URL https://www.thebabysaver.org/
 
Description BabySaver Tray poster at ICHG conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I had a poster and demonstration at the RCP International Child Health Group winter meeting at Alder Hey hospital in Liverpool.
Year(s) Of Engagement Activity 2018
 
Description Babygel development group launch meeting in Mbale, Uganda 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Launch meeting of Babygel group to run large cluster randomised trial in Eastern Uganda.
Year(s) Of Engagement Activity 2018
 
Description CONSHA meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact CONSHA is a $8m NIH funded study to examine neonatal hydrocephalus in Uganda run by Prof Steven Schiff of Penn State University. One of my PhD students is funded by this programme.
Year(s) Of Engagement Activity 2018
 
Description Conference e-poster at RCOG World Congress in Birmingham,, UK Workstream 3 "Optimizing informed consent for participants in randomised controlled trials: a comparison of three different methods"; 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The Babygel study is looking at the use of alcohol based hand-rub as a possible means of reducing infant morbidity and mortality due to neo-natal sepsis in a cohort of babies in Mbale, Eastern Uganda. Three posters in total from this study are being presented at RCOG World Congress in 2016.
The third poster represented part of the Babygel pilot study which looked at "Optimizing informed consent for participants in randomised controlled trials: a comparison of three different methods"; an area of investigation looking at different methods of consent. The women were offered patient information sheets in paper-based format, offered them as Power-Point presentations and the third option was in video format. The women were visited 48 hours after each presentation was given and interviewed about their level of understanding from what they had seen. Our results showed that the slide show consent model is the preferred model for recruitment of pregnant women into randomised controlled trials in rural Ugandan settings. Though the study was conducted on a small sample, the slide show was found to enhance communication between researchers and the potential participants.
The RCOG Congress is one of the most prestigious conference for professionals engaged in both maternal health clinical work and research. This study is using a new technology which attempts to address the issue of neo-natal sepsis. Presenting information about this study at this conference will
Year(s) Of Engagement Activity 2016
 
Description GLOW conference debate chair 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I am on the steering committee for the GLOW Society (Global Women's Health) that has a conference every 1-2 years. In this year conference in Cambridge I chaired a round-table discussion with female African scientists about the role of women in science.
Year(s) Of Engagement Activity 2018
 
Description Global Health CSG 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I sit on the RCOG Global Maternal Health Clinical Study Group. This meets 3 times per year to co-ordinate global maternal health activity.
Year(s) Of Engagement Activity 2018
 
Description Innovations in maternity care: achieving success against the odds 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was an invited lecture to the British Journal of Midwifery Annual conference.
Year(s) Of Engagement Activity 2018
 
Description Keynote lecture at a national midwifery conference on research in low income settings 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Keynote lecture on 'The highs and lows of conducting research in low resource settings' at the 13th National Conference on Current Issues in Midwifery: The changing landscape of maternity care. 23rd and 24th March 2015 at the Cavendish Conference Centre, London
Year(s) Of Engagement Activity 2016
 
Description NIHR GCRF Stillbirth Advisory Board 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact I am a member of the advisory group for the University of Manchester Stillbirth project (funded by NIHR Grand Challenges Research Fund). The project seeks to explore the causes of stillbirth in African countries.
Year(s) Of Engagement Activity 2018
 
Description Optimizing informed consent for participants in randomised controlled trials: a comparison of three different methods (poster presentation at the Global Women's Health Society conference) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Prof Weeks presented this poster about the BabyGel research methods research. He made himself available to take questions around both his poster and the wider question of consent procedures in low resource settings. The conference is a UK-based Global Maternal Health conference run every 18 months to bring together UK and international researchers exploring maternal health in low resource settings.
Year(s) Of Engagement Activity 2016
 
Description Preventing neonatal sepsis in rural Uganda: a cross-over study comparing the tolerance and acceptability of 3 alcohol-based hand rub formulations (poster presentation at the Global Women's Health Society conference) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Prof Weeks presented this poster about the BabyGel handrub acceptability research. He made himself available to take questions around both his poster and the wider question of consent procedures in low resource settings. The conference is a UK-based Global Maternal Health conference run every 18 months to bring together UK and international researchers exploring maternal health in low resource settings.
Year(s) Of Engagement Activity 2016
 
Description Public Health Priorities in low resource settings 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Undergraduate students
Results and Impact This was a lecture to medical students at Busitema University Medical School.
Year(s) Of Engagement Activity 2017
 
Description Royal College of Obstetricians and Gynaecologists (RCOG ) Conference e-poster - World Congress - Birmingham UK, June 2016 Babygel Study: Workstream 2 - acceptability of alcohol based hand rub study 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The Babygel study is looking at the use of alcohol based hand-rub as a possible means of reducing infant morbidity and mortality in a cohort of babies in Mbale, Eastern Uganda. Three posters in total from this study were presented at RCOG World Congress in 2016.
The second poster covered activity which took place prior to commencement of the main pilot study in the second work-stream. This workstream was important as it primarily involved mothers in Mbale informing the investigative team of their preferences. The women in Mbale were asked to select the optimal hand rub for use in an open, 2-arm cluster randomised controlled trial (RCT) comparing alcohol hand rub with normal hand hygiene care. This pilot is one of 3 studies being conducted in preparation for the main BabyGel cluster RCT, and will take place in villages around Mbale, Uganda. This workstream will assess whether the addition of bitterants and perfume affects the acceptability of the handgel. This will be done through a randomised cross-over study amongst mothers in the community using 3 handgel formulations: plain alcohol (no bitterant or perfume added), alcohol with added bitterant and alcohol with added perfume.
The women were asked to use each of the three optional handgels for one week at a time (with a wash out period in between weeks). After completion of testing the third hand gel the women were then asked to report on which formulation they preferred and the one which most women chose was used in the main pilot study.
The RCOG Congress is one of the most prestigious conference for professionals engaged in both maternal health clinical work and research. This study is using a new technology which attempts to address the issue of neo-natal sepsis. Presenting information about this study at this conference will reach a large audience of fellow maternal health researchers enabling strategic dissemination about this study.
Year(s) Of Engagement Activity 2016
 
Description Royal College of Obstetricians and Gynaecologists (RCOG) - Annual Conference(June 2016) - Birmingham, UK - Poster Presentation - Babygel study "Preventing neonatal sepsis in rural Uganda: a cross-over study comparing The tolerance and acceptability of 3 alcohol-based hand rub formulations" 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact EP6.048 (Conference e-poster booklet reference)
Study title: A pilot cluster randomised trial of alcohol-based hand rub to prevent community neonatal sepsis in rural Uganda Preventing neonatal sepsis in rural Uganda:
Poster title: A cross-over study comparing The tolerance and acceptability of 3 alcohol-based hand rub formulations
Ditai, J(1),(2); Abeso, J(3); Mudoola, M(1); Faragher, B(4) Adengo, M (1); Richards, JD(4); Carrol, E (5); Olupot-Olupot P (3); Storr, J (6); Gladstone, M(2); Medina-Lara, A(7)
(1) Sanyu Africa Research Insitute, Mbale, Uganda;
(2) Sanyu Research Unit, University of Liverpool, Liverpool, UK;
(3) Mbale Regional Referral Hospital, Mbale, Uganda;
(4) Liverpool School of Tropical Medicine, Liverpool, UK;
(5) Institute of Infection and Global Health, University of Liverpool, Liverpool, UK;
(6) WHO, Geneva, Switzerland;
(7) University of Exeter, Exeter, UK
Introduction
Neonatal sepsis is a global problem causing 0.5 million deaths annually, most of which are in low-resource settings. Babies born in African rural homes without running
water or toilet facilities are especially vulnerable. Alcohol-based hand rub (ABHR) is widely used to prevent infection. However, it is not known whether supplying it for regular perinatal use can prevent newborn deaths in settings with limited access to running water.
Methods A cluster trial was piloted in 10 villages in Mbale district, Eastern Uganda. Five villages were selected as intervention clusters and five as controls. Pregnant women of over 34 weeks of gestation were recruited over a 3-month period and followed-up for 3 months postnatally. Data were collected electronically on mobile phones using Open Data Kit (ODK). Women in intervention villages received a clean birthing kit (Maama Kit) along with a supply of ABHR whilst those in the control villages received the Maama kit only. Those with the ABHR were asked to use it at birth, as a single whole-body neonatal wash, on the cord stump and for 3 months postnatal hand hygiene.
Women with concerns about their babies took them to either local health centres or Mbale Regional Referral Hospital. Upon arrival, the infants were screened for sepsis using the WHO/Young Infant Clinical Signs Study Group criteria; a positive response was the study's primary outcome. Secondary outcomes were quantitative and qualitative, and included infant sepsis (physiciandefined and microbiological), infant mortality, quality of life (WHOQOL-BREF), and acceptability of study and intervention. Recruitment rates and inter-cluster coefficient were also assessed.
Results
175 pregnant women screened in the 10 villages from October to December 2015, 103 women were over 34 weeks and all agreed to participate. One woman in the intervention arm later withdrew her consent.
93 of these have already given birth and of these, 37 infants have completed follow-up. Five infants died (14%) and 15 others self-referred with suspected infection (41%).
Follow up of all participants will be finished by April 2016 and full results will be presented at the conference.
Conclusion The trial processes for the cluster randomised trial of community distribution of ABHR to prevent infant sepsis worked efficiently and recruitment rates were excellent. The ODK online data collection functioned well and there was no loss to followup.
Final analysis of follow-up data is awaited to fully assess feasibility
Year(s) Of Engagement Activity 2016
 
Description Women in Trouble conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact I gave a 30 minute lecture on 'Health care for women in time of war: a personal story'. Feedback was that it was the highlight of the conference for many attendees.
Year(s) Of Engagement Activity 2018
 
Description Women's Voices in African Low Income Settings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was a working group set up to take forward the concept of PPI (Patient and public involvement) in research in low income settings. Interested parties came from Leicester, London, Liverpool and Uganda to develop a funding application.
Year(s) Of Engagement Activity 2018