Globalisation is the increasing interdependence and interconnectedness of the markets, economies, societies and cultures of the world’s countries, and is causing profound changes in the global health landscape in way which are not yet fully understood. Many factors, such as increasing migration, urbanisation, climate change and world-wide instability, call for an interdisciplinary approach to research and a need to develop international partnerships to tackle global human (and animal) health issues, from climate change to antibiotic resistance.
In 2024, with support from the Quality-Related (QR) Research England International Science Partnerships Fund (ISPF) award to the University of Bristol, the Elizabeth Blackwell Institute launched the International Research Partnership Awards. The scheme gave University of Bristol researchers access to short term funding to enable collaborative work with countries on the Development Assistance Committee (DAC) list for international partnerships that focused on research activities, policy issues or capacity strengthening.
Here, we give an overview of the four projects funded as part of this scheme to share their findings:
Using Nanopore Sequencing for Rapid Antimicrobial Resistance Profiling of Non-typhoidal Salmonella in South Africa
Dr Sion Bayliss, Lecturer in Endemic, Enzootic and Emerging Infectious Diseases at the Bristol Veterinary School, partnered with Dr Ruan Marais from the Division of Medical Microbiology at the University of Cape Town on a project aimed at strengthening local diagnostic capabilities, improving disease management and antimicrobial stewardship, and promoting economic development and welfare in South Africa by addressing the growing public threat of antimicrobial-resistant non-typhoidal Salmonella.
Non-typhoidal Salmonella species are bacteria often associated with contaminated foodstuffs which cause a range of symptoms from gastroenteritis to more clinically serious infections such as bacteraemia — bloodstream infections. These infections are far more prevalent in patients with HIV, malnutrition, or sickle cell disease. Antimicrobial resistance (AMR), the ability of bacteria to evolve immunity to treatments, complicates disease management and is becoming increasingly prevalent in South African Salmonella cases.
In Bristol, Dr Bayliss’s team developed and optimised a method for concurrently identifying both the species and the AMR profile of different Salmonella species found in bloodstream infections directly from clinical samples. Researchers from South Africa then applied this technique to local cases, with ongoing work to sequence a full range of isolates over the coming months.
It is hoped that the project, alongside follow-on initiatives expanding the scope of the work, will improve mortality and morbidity rates, particularly among high-risk groups with HIV, malnutrition, or sickle cell disease. Consequently, there should be knock-on effects on societal healthcare costs, such as fewer workdays lost to sickness. The provision and training in sequencing technologies also enhance genomic research capability, research knowledge, and technology availability in South Africa.
“We anticipate benefits in clinical diagnostics and stewardship within a few years,” said Dr Bayliss. “Slightly longer term, the strengthened local capacity will enhance outbreak preparedness, surveillance, and health resilience — providing long-term economic and societal returns. These outcomes create a clear pathway to improved public health infrastructure and sustainable development, and are compatible with other ongoing projects and planned research activities to provide other synergistic benefits.”
Kenyan Community One Health Guidelines for Antimicrobial Prescribing
Dr Judy Betteridge is Senior Research Associate at the Bristol Veterinary School. Her project partners with the Cambodian National Institute of Public Health for a project investigating the how new guidelines might help in the fight against antimicrobial resistance.
Antimicrobial resistance is an increasing threat to human health; many countries are taking action to reduce antimicrobial usage in both humans and animals. In Kenya, guidelines – which can help prescribing practices – are typically only available in paediatric hospital wards. The project applies existing intervention design frameworks to determine how to develop widespread guidelines for both humans and animal health practitioners in Kenyan communities.
Canvassing stakeholders
Dr Betteridge and her team canvassed a variety of stakeholders for opinions on how to implement and support guidelines for use in community settings by human and animal health practitioners.
The team identified a wide range of issues regarding the prescribing environment, communication and information sharing and economic pressures. They compared human and animal health approaches that helped to identify good practices, and champions who could provide useful lessons for implementing guidelines across sectors in the future.
National action plan
Kenya has adopted a National Action Plan to formulate and implement AMR policy, but there are still many hurdles to overcome, particularly at the community level, including a gap between the theoretical knowledge of AMR and its application in practice.
“Our project findings have identified areas which could be strengthened,” said Dr Betteridge. “Several of these relate to the social and legislative environments that prescribers are working within: elitism and limited legislation in the veterinary sector; a lack of information-sharing between public and private healthcare sectors, and lack of feedback from government surveillance to healthcare and veterinary professionals on the ground. These elements would need to be strengthened before effective universal prescribing guidelines could be implemented.”
Differing needs
The work will continue, increasingly identifying the differing needs of medical and veterinary settings, as Dr Betteridge explains:
“For the veterinary sector, a key foundational element would be to establish trusted relationships between the regulatory bodies and groups of veterinarians and paraprofessionals that enable a system where legitimate prescribing practices can be followed. We are putting together a funding proposal to look at the political economy of antimicrobials in the Kenyan veterinary sector, to establish relationships between regulatory bodies and practitioners to facilitate prescribing practices.”
“For the human health sector,” Dr Betteridge continued, “one avenue is in the field of outbreak investigation and control, and how laboratory and genomic information can be better used in a hospital setting. Communication and information sharing needs be coordinated between the Ministry of Health, and public and private healthcare sectors.”
One Health Approaches to understand Climate Impacts on Water Related Disease in South Africa and Ethiopia
Dr Josephine Walker is Senior Lecturer in Health Economic Modelling. Her project aimed to strengthen an international multi-disciplinary collaboration focused on one health approaches for water related disease, and to collect pilot data to identify the most impactful direction for future research.
A cross-disciplinary team of researchers from the University of Bristol, Haramaya University in Ethiopia and the University of Cape Town, South Africa, developed plans for focus groups discussions in Cape Town and Dire Dawa, Ethiopia. Preliminary analysis of these discussions enabled the researchers to identify areas in which people perceive there to be a disease risk, as well as areas the researchers expect a risk to be perceived that the communities did not consider as critical.
Interdisciplinary and international
“Our international core research team included researchers in engineering, environmental and public health, anthropology, and infectious disease modelling”, said Dr Walker. “We worked together to implement qualitative research which will inform future work linking disease modelling and health policy.”
The team is currently finalising the focus group discussion analysis and will build on the areas identified as a priority to develop plans for a research project which can reduce disease risks for communities in areas which they find to be important, as well as to raise awareness of risk and mitigation approaches which the communities may not already be considering.
Building the Foundation for Hepatitis Modelling in Cambodia
Dr Aaron Lim of the Bristol Medical School and Dr Juliette Unwin of the School of Mathematics partnered with the Cambodian National Institute of Public Health for this project, which established a new international and cross-sectoral collaboration between the Cambodia National Institute of Public Health (NIPH) and the University of Bristol to spearhead key priority areas identified by NIPH.
The project identified and worked on two major priority areas identified by NIPH and emphasised by the NIPH Deputy Director: (i) Understanding Hepatitis B virus in Cambodia and its context in the wider Southeast Asia region, and (ii) developing in-house capacity in infectious disease modelling at NIPH.
Systematic review
Firstly, the team recruited a Cambodian Research Assistant at NIPH to investigate viral hepatitis infection prevalence in Cambodia and the wider Southeast Asian region. This led to a comprehensive systematic review, currently underway, to explore this topic in more detail – the team has identified 224 papers to extract data from.
Secondly, the team delivered a 5-day bespoke workshop at NIPH to 23 participants, including invited officials, team leaders, and researchers, to build capacity in infectious disease modelling.
Lastly, Dr Lim and Dr Unwin hosted a researcher from NIPH at the University of Bristol for two weeks to build connections with team members who have expertise in virology, epidemiology, programming, modelling, and health economics.
Addressing knowledge gaps
“Understanding HBV will help NIPH identify gaps in their current knowledge of their HBV burden,” said Dr Lim, “which will inform how they can develop ways to reduce the burden of the disease. The project also provided the necessary in-house skills to undertake advanced technical skills in mathematical modelling. Building in-country capacity in mathematical modelling skills will also enable Cambodia to develop better and more relevant models tailored to the Cambodian context. NIPH have already started using it to develop a Cambodian measles model.”
From climate change to antibiotic resistance, the health challenges facing the human race, intertwined with that of the animal and plant world and the effect on our food chains, are complex and interconnected. Elizabeth Blackwell Institute Director, Pat Kehoe, explains the importance of establishing international research partnerships:
“Complex problems sometimes require complex solutions. But innovative and equitable partnerships that facilitate meaningful engagement with people and communities with relevant lived experiences, as well as relevant public agencies and other partners in a position to bring about change, is really the only way to be able to truly get to grips researching the problems to hopefully help create solutions that have impact.
“A lot of this fuels our interest to support research related to Climate Change and Health that we are doing in partnership with Cabot Institute for the Environment, and where we are working to grow a new cohort of interdisciplinary trained PhD students.”
Find out more about our Climate Change and Health Research