I am a paediatric and public heath doctor by background and have worked in global health for over 20 years. My focus areas include:
- severe malnutrition (with a particular focus on infants);
- long-term outcomes/non-communicable disease post malnutrition;
- disability;
- commercial determinants of health;
- clinical trials and translation of research into policy.
- teaching, supporting and mentoring the 'next generation' of global health practitioners and policy-makers.
I have been at LSHTM since September 2014. Early experiences before that included:
- Undergraduate projects in Yugoslavia and Guyana, including a Raleigh International Expedition in South America;
- A year out of medical school in India: in and around Delhi leading projects on urban slum health and hospital waste; doing my first RCT in a Calcutta street clinic;
- Post-qualification work in Serbia, Bosnia and in the UK.
I initially trained in paediatrics in Plymouth and London. After gaining MRCPCH in 2001 I left the NHS in 2003 to volunteer for a year as a paediatric registrar/honorary clinical lecturer at the College of Medicine, Malawi. Most of that life-changing year I spent on “MOYO” ward of Queen's Hospital, Blantyre, one of Africa’s biggest and busiest nutritional rehabilitation units. Following a 2004-5 LSHTM MSc (PHDC) I returned to Malawi from 2005-8, again combining clinical work, teaching and this time my PhD research into "Improving the Treatment of Severe Acute Malnutrition in Childhood"
From 2009-2014 I was a specialty registrar in public health in London, gaining my MFPH (Member of the Faculty of Public Health) qualification in 2011 and becoming a Fellow of the Faculty of Public Health (FFPH) in 2014 upon completing CCT (Certificate of Completion of Specialty Training). During training, I also held academic posts which allowed me to maintain and develop international work alongside UK practice:
- NIHR Academic Clinical Fellow at the UCL Institute for Global Health
- NIHR Academic Clinical Lecturer at the UCL International Disability Reserach Centre
With my current focus on global health I no longer practice in the UK but remain on the GMC register (registered but without licence to practice)
Affiliations
Centres
Teaching
I love teaching. Working with, learning from and helping nurture our talented and motivated MSc and PhD students - the next generation of global health leaders - is a big highlight of my role at LSHTM.
MSc & RELATED TEACHING
- From 2014-2022 I was MSc Programme Director for Nutrition for Global Health.
- I lead the ‘Nutrition in Emergencies’ module in term 2 (#2451, slot D1)
- I teach on a number of other LSHTM modules and courses including the: Diploma in Tropical Medicine (DTM&H); Diploma in Tropical Nursing (DTN); Adolescent Health in LMIC short course.
I regularly do guest lectures at other universities and do short courses/talks to other organizations (e.g. to MoH / UNICEF / NGO staff)
MSc SUMMER PROJECTS
Since I started this in 2011, I have supervised/co-supervised over 70 MSc projects: this is a really enjoyable part of my teaching role.
I especially like to work on policy/practice-relevant projects which give students good experience of 'hot topics' in nutrition/malnutrition/child health. Such projects often result in conference presentations, peer review papers and other outputs which add valuable and much-needed new evidence to our field of work.
Some examples of past summer projects I supervised are HERE: https://www.ennonline.net/mami/evidence (along with the publications that arose)
Other past projects can be found on the LSHTM library page: https://www.lshtm.ac.uk/research/library-archive-open-research-services… (see the "Nutrition for Global Health" page)
PhD supervision
PhDs are a great way to start filling some of the many evidence gaps in global health. Plus are a gateway to MANY future careers - not just in academia! (see: https://www.vitae.ac.uk/researchers-professional-development/about-the-…)
I am open to supervise PhDs on any of my core research topics and am always happy to discuss plans with prospective students.
To date, I have supervised 4 PhDs to completion as first supervisor:
1) Long-term effects of severe acute malnutrition on growth, body composition, and function; a prospective cohort study in Malawi (2016)
https://discovery.ucl.ac.uk/id/eprint/1498712/
2) Middle-upper arm circumference for nutritional surveillance in crisis-affected populations: Development of a method (2017)
https://doi.org/10.17037/PUBS.03482690
3) Simplified, combined protocol for acute malnutrition in children 6-59 months : the ComPAS randomized controlled trial (2021)
https://doi.org/10.17037/PUBS.04661808
4) The Nutritional and Feeding Status of Children Living within Institution-based Care and an Evaluation of Process of the Child Nutrition Program (2022)
Current PhDs in-progress include:
- Sex Differences in Risk and Outcomes from Severe Malnutrition: Implications For Management (first supervisor)
- DrPH (second supervisor)
- Two MAMI-related PhDs (as second supervisor)
- Long-term post-malnutrition outcomes (as second supervisor)
PhD VIVAS
As of summer 2023, I have examined:
- 15 PhDs (8 in UK; 7 overseas)
- 5 LSHTM upgrading exams
Research
My main research focus is on severe malnutrition.
I am driven by the notion that global health research should be about real-world impact and should aim to tackle the many urgent priorities of our age. Hence, I’m interested in:
- Asking relevant, high-priority research questions
- Co-developing research with individuals and communities who will ultimately use the outputs (e.g. patients, families, national and international policymakers)
- Pursing what’s realistic as well as idealistic (too hard a push for ‘the best’ can become be the enemy of 'the good’)
- High quality science, providing as strong evidence as possible
- ‘GRIPPS’ (Getting Research into Policy & Practice, at Scale)
I am a member of the WHO Guideline Development Group on Child Wasting and contributed to:
2013 WHO Guidelines on Severe Acute Malnutrition in Infants and Children
2023 WHO Guidelines on Infant and Child Wasting (in-progress)
Recent and current research subthemes are:
1. MAMI: Management of small/nutritionally At-risk Infants aged <6months & their mothers
(https://www.ennonline.net/ourwork/research/mami)
MAMI’s vision is that "Every Small & Nutritionally At-risk Infant aged <6m and their mother/carer is supported to survive and thrive".
MAMI began in 2008 when I was lead researcher on a ENN (Emergency Nutrition Network) project exploring MAMI in humanitarian crises. Collaboration with ENN continues to this day and expands day-by-day. We now know that MAMI is not only an issue for resource-poor countries but is relevant to all countries worldwide. Notable outputs include:
- a paper documenting global 'burden of disease' of MAMI;
- a CHNRI research prioritization exercise highlighting evidence gaps (and consequent opportunities!);
- numerous other projects including in Malawi and Bangladesh
- developing a multi-disciplinary MAMI integrated care pathway
- formation of the MAMI Global Network, which I co-chair;
- MAMI being flagged as a priority area by the 'No Wasted Lives' coalition;
- contributing to a WHO "Nutrition and Growth Advisory Group" consultation that led to infants <6m, for the first time, being included in WHO Guidelines .
- An RCT of the MAMI care pathway in Ethiopia in collaboration with Jimma University and GOAL Ethiopia
2. Life-course and long-term effects of child (mal)nutrition
( https://datacompass.lshtm.ac.uk/id/eprint/2655/ )
Treatments for child malnutrition should not only help children survive the high short-term risk of death, but should help them thrive both short and long term. Our work has showed adverse long term outcomes of early-life malnutrition.
I am Chief Investigator on the MRC/GCRF funded CHANGE project (CHild malnutrition & Adult NCD: Generating Evidence on mechanistic links to inform future policy/practice).
Through this partnership with colleagues in Ethiopia, Malawi, Jamaica and Cambridge/Southampton UK we ultimately hope to refine future treatments for child malnutrition.
3. Disability and Nutrition
I recently supervised an excellent PhD focusing on this topic and have done a number of other studies on this theme
4. Commercial Determinants of Health
My main focus on this is how it impacts infant feeding (e.g. Advertising of Human Milk Substitutes in United Kingdom Healthcare Professional Publications)
Selected Publications
