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2021-22 Reckitt-LSHTM PhD studentships on Hygiene & Health in Sub-Saharan Africa

The London School of Hygiene & Tropical Medicine (LSHTM) invites applications from candidates from Sub-Saharan Africa for fully-funded 4-year PhD studentships to start a research degree programme on 3 January 2022. There are three studentships available.

Funding

These studentships have been made possible through the generosity of Reckitt, through an unrestricted donation to LSHTM.

Each PhD studentship will comprise:

  • Tuition fees at the LSHTM overseas fee rate for the duration of the research project (up to 4 years)
  • An annual tax-free stipend equal to the UKRI stipend level (inclusive of London weighting)
  • Up to GBP20,000 for research costs, travel and/or training

Projects

LSHTM has pre-identified eight research projects that address the links between hygiene and health in Sub-Saharan Africa in one or more of the following areas:

  • The role of hygiene in the prevention and transmission of infectious diseases and their consequences
  • Hygiene behaviours and hygiene behaviour change
  • The intersection of hygiene and broader social and economic impacts

Candidates applying for a PhD studentship under this scheme should choose one of the eight projects listed below that matches their interests, skills and experience and then develop the project further in their application.

Projects to choose from are as follows:

Exploring how a social business model can promote good menstrual health and improve the lives of women socially and economically

Project title

Exploring how a social business model can promote good menstrual health and improve the lives of women socially and economically

Supervisory team

  • Dr Jenny Renju, Assistant Professor, Faculty of Epidemiology & Population Health, LSHTM
  • Dr Elialilia Okello, Senior Research Scientist, Mwanza Intervention Trials Unit, Tanzania
  • Dr Jim Todd, Professor of Statistics, Faculty of Epidemiology & Population Health, LSHTM

Project description

Few studies have explored the experiences of menstruation among adult women in LMICs [1]. Interventions are needed to improve knowledge, social support, and the physical and economic environment to improve menstruation experiences and quality of life. Large surveys have reported that access to the provisions to manage menstruation are inadequate and that debilitating pain during menstruation is a common, affecting 45-95% of menstruating women [2] and impacts on quality of life [3] and cultural, educational, social and economic activities.

This project builds on the PASS Project, an in-school menstrual, sexual and reproductive health (MSRH) intervention. Programmatic evidence from Femme International (the implementing NGO on the PASS project) suggests that the implementation of in-school activities generates a demand for education and services in the communities surrounding the school. In response to this demand, “Twende” (Let’s Go in Swahili) was developed. Twende is a community-based social business model that capitalises on local structures in Tanzania, to select and train sales agents, who then work in their own communities to engage with key government, religious, and community stakeholders, run MSRH workshops, and sell reusable menstrual products with payment plans that promote sustainability and maximise accessibility.

However, rigorous evidence as to the effectiveness of this social business model in addressing the social and economic barriers that prevent women from managing their menstruation which subsequently impacts on their quality of life is limited.  In this project we are proposing to conduct implementation research to assess the effectiveness of the Twende model. We are proposing a general theme of inquiry to explore the broader social and economic impacts of this community based social business model. The process could include the refinement of the Twende theory of change and identification, adaption, adoption and application of a relevant framework of indicators to assess effectiveness.

The candidate could explore the economic impacts for the sales agents and women in the community by quantitatively and qualitatively capturing any changes in money and/or time spent on menstruation post uptake of reusable products. Social impacts may explore changes to participation in life events and self-efficacy after improved menstruation management. Factors that facilitate or inhibit the effective implementation[4], with a focus on the intersection between menstrual hygiene and broader social and economic impacts will be explored. Design: mixed-methods before and after study design using both secondary and primary data from a sample of communities in which Twende (and PASS) are implemented.

Key references

  1. Hennegan J, Shannon AK, Rubli J, et al. Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLOS Med 2019;16:e1002803.https://doi.org/10.1371/journal.pmed.1002803
  2. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: A critical review. Hum Reprod Update Published Online First: 2015. doi:10.1093/humupd/dmv039
  3. Iacovides S, Avidon I, Bentley A, et al. Reduced quality of life when experiencing menstrual pain in women with primary dysmenorrhea. Acta Obstet Gynecol Scand Published Online First: 2014. doi:10.1111/aogs.12287
  4. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci Published Online First: 2009. doi:10.1186/1748-5908-4-50

Project-specific requirements

The successful candidate would be required to have experience of conducting mixed methods research in Sub-Saharan Africa and a good understanding of the influence of gender and social norms in behaviours. A background in social sciences is essential and knowledge of health economics would be an asset. Fluency in English is required for this role and knowledge of Swahili would be an asset.

Links to existing research and/or funding

This project has been designed to complement the PASS project, which is an MRC-funded grant (a partnership between MITU, LSHTM and Femme International) funded from Nov 2021 until Oct 2023. Following the extensive formative phase (April-Dec 2021) the PASS project will be implemented in four secondary schools in two districts of Mwanza region (from Jan 2022 until Jan 2023). This project would take place in the same communities and therefore provide support for travel and community and school introductions and engagement. The PASS project will generate significant process evaluation data which will also provide context for this PhD. In addition, training opportunities would exist for both quantitative and qualitative research methods (through the NIMR/MITU annual Research methods training course) and within the PASS project, during the training sessions run by the project Health Economist, Dr Giulia Greco (LSHTM). A capacity strengthening aim of the PASS project was to build health economist research capacity within MITU Mwanza. A series of training sessions and mentoring opportunities would therefore be available.

Femme International will implement the Twende project in these purposively selected communities.  Implementation will start after baseline data has been collected. This PhD would therefore benefit from the funds that have already been allocated by Femme International to implement this intervention.

Skills a student is anticipated to develop while pursuing this project

Throughout the project, we expect the student to develop various technical competencies that will develop them on a trajectory to menstrual health research leadership. This includes the ability to:

  • Apply theoretical and practical knowledge of menstrual health and hygiene, public health, gender influences, economic and social theories to explore the effectiveness and impact of a social business model
  • Manage all aspects of the PhD data collection, management, analysis and interpretation to ensure lessons are learnt to inform the future implementation of this social business model to effect social and economic change in rural East African communities
  • Ability to present scientific findings with confidence and in various formats to different audiences
  • Solve complex issues with minimum guidance and supervision, and to adapt the research and interpretations to be applicable to the realities of the local context
  • Supervise and mentor junior scientists

Further information

For any queries regarding this project, please contact LSHTM supervisor Professor Jenny Renju (jenny.renju@lshtm.ac.uk).

Hygiene Interventions in Kampala’s Informal Settlements: global health imaginaries and local health realities

Project title

Hygiene Interventions in Kampala’s Informal Settlements: global health imaginaries and local health realities

Supervisory team

  • Dr Clare Chandler, Professor of Medical Anthropology, Faculty of Public Health & Policy, LSHTM
  • Dr Alex Mold, Associate Professor of History, Faculty of Public Health & Policy, LSHTM
  • Dr David Musoke, Lecturer, Department of Disease Control and Environmental Health, Makerere University School of Public Health, Uganda

Project description

Over one billion people around the world now live in informal settlements. Often characterised by what they lack – including basic infrastructure for water and sanitation – inhabitants have been the target of numerous interventions to reduce the health risks inherent in their environments. Hygiene interventions to reduce transmission of infectious diseases have attempted through various means to encourage, persuade and motivate people to reduce their exposure to pathogens. Nonetheless, infectious diseases remain an acute problem which stands to worsen with the reduction in effectiveness of antimicrobial treatments due to rising resistance. Measures to reduce pathogen transmission – especially in settings identified as hotspots of contagion – have become a focus for international concern [1, 2].

Hygiene interventions have a long history in public health, and for the past decades have been coupled with water and sanitation projects under the rubric of WaSH (water, sanitation and hygiene). In global health, hygiene interventions have become a subject of analysis for randomised controlled trials, with attempts to establish the key ingredients for successful and sustainable interventions. However, this evidence base shows mixed results of existing interventions [3] and there is growing recognition that the models that frame hygiene interventions may need reorientation.

In Uganda, Kampala’s informal settlements have been subject to programmes to study and improve WaSH for decades. Our research through the Antimicrobials In Society programme demonstrates that huge problems remain, with palpable hygiene challenges and health impacts including frequent diarrhoea, and a majority of residents consuming antibiotics monthly and many on a weekly basis. Here, we have characterised antibiotics as performing a ‘quick fix’ for hygiene [4]. Further research is required, however, to understand the lack of impact of the many previous attempts at hygiene interventions in these communities. Anthropological approaches are apposite to elucidate and situate the logics and framings of hygiene interventions to date, to study and contextualise hygiene locally, and to compare the constructions of each.

This project will explore the global health imaginaries and local health realities of hygiene interventions in Kampala’s informal settlements. Starting in Namuwongo, where our research has continued over the past several years, the ethnographic element will comprise interviews, oral histories, archival analyses and participant observation over an extended period of up to 12 months. The PhD student will embed themselves in local debates and contestations around issues relating to health and hygiene and will trace outwards the histories and political-economic dimensions of different initiatives and agendas that have shaped the interpretation, uptake and sustainability of hygiene interventions. The PhD student will also engage in a wider global health analysis of the construction of hygiene interventions as a policy object, identifying the parameters that have shaped the ways these interventions have come into being on the global stage. The analysis will take its lead from anthropological and science and technologies studies scholarship and will aim to inform future production of interventions to address pathogen transmission in urban informal settlements.

Key references

  1. Collignon, P. and J. J. Beggs (2019). "Socioeconomic Enablers for Contagion: Factors Impelling the Antimicrobial Resistance Epidemic." Antibiotics 8(3): 86.
  2. Nadimpalli, M. L., et al. (2020). "Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission." Nature Microbiology 5(6): 787-795.
  3. Cumming, O., et al. (2019). "The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement." BMC Medicine 17(1): 173.
  4. Nabirye, C et al (forthcoming) and Denyer Willis, L. and C. Chandler (2019). "Quick fix for care, productivity, hygiene and inequality: reframing the entrenched problem of antibiotic overuse." BMJ Global Health 4(4): e001590.

Project-specific requirements

  • Candidates are required to have a Masters’ degree in social sciences
  • Candidates must speak Luganda as well as English
  • Experience carrying out ethnographic fieldwork is essential
  • Experience conducting archival analyses and working in infectious diseases is desirable

Links to existing research and/or funding

This research extends from two existing research projects, the Antimicrobials In Society (AMIS) programme which includes research in Uganda through the Infectious Diseases Research Collaboration (IDRC), and the Drivers of Resistance in Uganda and Malawi(DRUM) programme which includes research in Uganda through Makerere University’s School of Public Health.

Skills a student is anticipated to develop while pursuing this project

The successful student will acquire skills in anthropological and historiographical scholarship, in bacteriology as required to understand pathogen transmission, and in global health policy analysis.

Further information

For any queries regarding this project, please contact LSHTM supervisor Professor Clare Chandler (clare.chandler@lshtm.ac.uk).

Understanding the sustainability of Menstrual Health and Hygiene interventions in schools in Uganda

Project title

Understanding the sustainability of Menstrual Health and Hygiene interventions in schools in Uganda

Supervisory team

  • Dr Belen Torondel, Associate Professor in Environmental Health (Disease Control Department), LSHTM
  • Dr Clare Tanton, Assistant Professor in Epidemiology, Faculty of Public Health & Policy, LSHTM
  • Dr Fred Matovu, Senior Lecturer, School of Economics, Makerere University and Director, Policy Analysis & Development Research Inst (PADRI), Uganda
  • Dr Chris Bonell, Professor of Public Health Sociology, Faculty of Public Health & Policy, LSTHM

Project description

The sustainability of school-based health interventions has been relatively unexplored in comparison to healthcare, and it has been even less explored in the case of menstrual health and hygiene (MHH) school interventions [1, 2]. A recent systematic review restricted to high-income countries [3] found that key facilitators of sustainable school-based interventions were, firstly, a committed principal and administration that could authorise continuation, allocate resources, integrate the intervention into school policies and enrol new staff into a community of practice; and secondly the importance of supporting staff who are confident in delivering health promotion and believe in its value. We are not aware of a similar review in low-income settings.

The proposed PhD project will be nested under MENISCUS project and will focus on exploring the different factors that can influence sustainability of a MHH school-based intervention in Uganda (“MENISCUS”), and to pilot adaptions of the intervention as needed to improve the sustainability. The intervention includes components to improve the social and physical school environment for menstrual health and hygiene, including provision of an MH kit, a drama skit to reduce stigma, pain management and basic WASH improvements [4, 5].

Objectives are to:

  1. Conduct an exploratory review of factors affecting sustainability of school-based hygiene interventions in low- and middle-income countries.
  2. Conduct a qualitative case study of the MENISCUS MHM intervention in Ugandan schools with a focus on understanding factors (at institutional level and individual level) that can act as facilitators or barriers for sustainability of a school based MHH intervention.
  3. Based on these findings, adapt the intervention as needed at the end of the trial, to implement in the control schools who request it.
  4. Conduct a process evaluation of the sustained intervention in the intervention schools (up to 2 years of intervention) and the adapted intervention in control schools (up to 1 year of intervention).
  5. Use the findings to provide policy guidance at National level (The Government Menstrual Health policy for Schools in Uganda) to guide schools on how to sustain an MHM intervention and use findings of this study to inform other global level policies.

Key references

  1. Sumpter, Colin, and Belen Torondel. "A systematic review of the health and social effects of menstrual hygiene management." PloS one 8.4 (2013): e62004.
  2. Hennegan, J., & Montgomery, P. (2016). Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low- and middle-income countries? A systematic review. PloS one11(2), e0146985.
  3. Herlitz, L., MacIntyre, H., Osborn, T., & Bonell, C. (2020). The sustainability of public health interventions in schools: a systematic review. Implementation Science15(1), 1-28.
  4. Kansiime C … and Weiss HA, 2020. Menstrual health intervention and school attendance in Uganda (MENISCUS-2): a pilot intervention study. BMJ open10(2).
  5. Nalugya R … and Weiss, HA. 2020.  Assessing the effectiveness of a comprehensive menstrual health intervention program in Ugandan schools (MENISCUS): process evaluation of a pilot intervention study. Pilot and feasibility studies, 6(1).

Project-specific requirements

  • Postgraduate degree: Master’s degree in Social Science, Disease Control, Epidemiology or closely-related discipline
  • Research experience: At least one years’ experience in one of the following in a low-income setting: Intervention design and evaluation; Qualitative methods; Process Evaluation; Behaviour change.
  • Excellent spoken, reading & written English (essential);
  • Basic quantitative analysis skills (descriptive analysis; logistic regression; linear regression)
  • Good spoken Luganda (desirable)

Links to existing research and/or funding

The proposed research will be nested within the ongoing MENISCUS trial, which is a JGHT-funded trial led by LSHTM and the MRC Uganda & LSHTM Research Unit (PI: Professor Helen Weiss).  The trial is funded to October 2023, including delivery of the intervention to 60 secondary schools in Uganda – 30 will be randomised to receive the intervention from January 2022, and the control arm schools will be offered the intervention after the primary evaluation in March 2023. The timeline for the PhD therefore allows the student to evaluate the delivery of the intervention in 5 selected “case studies” from the initial 30 schools, and modify it as suggested by the findings to be introduced in the subsequent 30 schools.  Fieldwork costs for this are included in the existing research. The funds of £20,000 will be used to cover travel for the student, and additional costs of qualitative interviews in 2024 to assess factors influencing sustainability of the intervention in the 5 case studies from the intervention schools, and a further 5 case study schools from the control arm.

Skills a student is anticipated to develop while pursuing this project

  • Design of qualitative research tools
  • Analysis of qualitative data
  • Process evaluation analysis
  • Behaviour change design approaches
  • Managing all aspects of the PhD data collection, management, analysis and interpretation to ensure lessons are learnt to inform the future implementation of this intervention in different settings
  • Communication and dissemination skills, including with government and non-governmental stakeholders

Further information

For any queries regarding this project, please contact LSHTM supervisor Professor Belen Torondel (belen.torondel@lshtm.ac.uk).

Assessing educational outcomes in a school-based menstrual health and hygiene intervention trial in Uganda

Project title

Assessing educational outcomes in a school-based menstrual health and hygiene intervention trial in Uganda

Supervisory team

  • Dr Helen Weiss, Professor of Epidemiology, Faculty of Epidemiology & Population Health, LSHTM
  • Dr Viola Nilah Nyakato, Department of Human Development and Relational Sciences, Faculty of Interdisciplinary Studies, Mbarara University of Science & Technology, Uganda
  • Dr John Jerrim, Professor of Education and Social Statistics, Institute of Education, University College London

Project description

There is little research on the impact of menstrual health and hygiene interventions on social and economic impacts including educational outcomes [1]. The aim of the proposed PhD project is to address the evidence-gap of the impact of a menstrual health intervention on educational outcomes in an ongoing cluster-randomised trial among secondary school girls in Uganda.

The trial (MENISCUS) is evaluating the effectiveness of a multi-component menstrual health and hygiene intervention on health, wellbeing and educational outcomes. It is being conducted in 60 secondary schools in Uganda, among ~3500 girls, and builds on 4 years of formative and pilot work [2-4]. The intervention includes components to improve the social and physical school environment for menstrual health and hygiene, including provision of an MH kit, a drama skit to reduce stigma, pain management and basic WASH improvements. 

The PhD will focus on the impact of the intervention on the following educational outcomes:i) educational performance, assessed through a bespoke examination on biology, English and Maths set and assessed by the Uganda National Examinations Board at baseline and endline; ii) school and class attendance, assessed by self-completed diaries daily for 3 months at endline; iii) school dropout.

The objectives of the PhD are to:

  1. Conduct a systematic review to assess the evidence that school-based health and hygiene interventions have an impact on educational outcomes; 
  2. Assess the effectiveness of the MENISCUS intervention on school absenteeism and educational performance
  3. Assess the impact of the intervention on school dropout, by designing and conducting a study nested in the main trial
  4. Compare methods of assessing school attendance by designing and conducting a validation study

Objectives 3 and 4 are additional to the main trial plans, and the PhD project is important to enable us to fully understand the impact of the menstrual hygiene intervention on school dropout (and hence inform potential biases in the intervention effect at endline); and to address an evidence-gap on how best to assess school attendance (a challenging methodological area of research in many settings where school registers are not reliable).

Findings will be disseminated to educational and policy stakeholders at national, regional and international level.

Key references

  1. Hennegan J and Montgomery P. Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low- and Middle-Income Countries? A Systematic Review. PLoS One, 2016. 11(2): p. e0146985.
  2. Miiro G … and Weiss HA. Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study. BMC Womens Health. 2018 Jan 3;18(1):4.
  3. Kansiime C … and Weiss HA, 2020. Menstrual health intervention and school attendance in Uganda (MENISCUS-2): a pilot intervention study. BMJ open, 10(2).
  4. Nalugya R … and Weiss, HA. 2020.  Assessing the effectiveness of a comprehensive menstrual health intervention program in Ugandan schools (MENISCUS): process evaluation of a pilot intervention study. Pilot and feasibility studies, 6 (1).

Project-specific requirements

  • Postgraduate degree in Public Health or Epidemiology
  • Excellent spoken, reading & written English (essential);
  • Excellent communication skills
  • Basic quantitative analysis skills (descriptive analysis; logistic regression; linear regression)
  • Experience working in education (desirable)
  • Good spoken Luganda (desirable)
  • Training in systematic reviews (desirable)

Links to existing research and/or funding

The proposed research will be nested within the ongoing MENISCUS trial, which is a JGHT-funded trial led by LSHTM and the MRC Uganda & LSHTM Research Unit (PI: Professor Helen Weiss).  The trial is funded to October 2023, including delivery of the intervention to 60 secondary schools in Uganda – 30 in the intervention arm and 30 in the control arm.

The baseline survey for the trial will commence in October 2021, with the endline survey scheduled for February 2023.  The intervention will be delivered to the randomly-allocated intervention schools throughout 2022 by an independent NGO (WoMena Uganda). Control arm schools will be offered the intervention after the endline survey.

The timeline for the PhD (start date January 2022) is ideal to enable the student to be part of a Ugandan-based research team, and to design and implement the nested studies proposed (objectives 3 and 4), as well as to plan and conduct appropriate statistical analyses to evaluate the impact of the intervention on educational outcomes (objective 2).

Fieldwork costs for all elements of the trial are included in the JGHT funding, with the exception of the active follow-up of girls who have dropped out. The funds of £20,000 will be used to cover these costs.

Skills a student is anticipated to develop while pursuing this project

  • Understanding of ethical issues of conducting clinical trials
  • Design of research tools
  • Project management skills
  • Quantitative analysis of clustered data using Stata
  • Public engagement skills, especially with adolescents
  • Communication and dissemination skills, including with Government and non-Governmental stakeholders

Further information

For any queries regarding this project, please contact LSHTM supervisor Professor Helen Weiss (helen.weiss@lshtm.ac.uk).

Economic analysis of a school-based menstrual health and hygiene intervention in Uganda

Project title

Economic analysis of a school-based menstrual health and hygiene intervention in Uganda

Supervisory team

  • Dr Giulia Greco, Assistant Professor in Health Economics, Faculty of Public Health & Policy, LSHTM
  • Dr Fred Matovu, Senior Lecturer, School of Economics, Makerere University and Director, Policy Analysis & Development Research Inst (PADRI), Uganda
  • Dr Helen Weiss, Professor of Epidemiology, Faculty of Epidemiology & Population Health, LSHTM

Project description

One of the worries that girls face when attending school is to manage their menstruation safely. Poverty, inadequate infrastructure, and scarce knowledge are key drivers of poor menstrual hygiene management (MHM) [1]. There is evidence that poor MHM can be detrimental to girls’ self-esteem, physical and mental health, and educational attainment. However, there is no agreement on which outcome measures are more adequate and reliable to use in the evaluation of MHM programmes [2], as many of these have not been used in MHM or in a LMIC context [3, 4]. 

This PhD proposal is an economic analysis nested within the MENISCUS project - a school-based menstrual health and hygiene intervention being evaluated in a cluster-randomised trial in 60 schools in Uganda. The objectives are:

  1. To investigate how household socio-economic status and community characteristics can influence MHM.
  2. To assess the impact of the MENISCUS intervention on MHM by household socio-economic status and community characteristics.
  3. To conduct a review of economic and quality of life outcome measures for MHM
  4. To estimate country- and population-specific value sets for a preference-based outcome measure to be used in the economic evaluation of MENISCUS.

The main discipline focus of this PhD will be health economics, using a mixed-method approach. The student will be working in a multidisciplinary research team including social scientists, clinicians, epidemiologists, statisticians, education experts, and policy makers.

Key references

  1. Rossouw, Laura, and Hana Ross. "Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low-and Middle-Income Countries." International Journal of Environmental Research and Public Health 18, no. 5 (2021): 2571.
  2. Phillips-Howard Penelope, Bethany Caruso, Belen Torondel, Garazi Zulaika, Murat Sahin & Marni Sommer “Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities”, Global Health Action, 9:1, (2016)
  3. Rowen, Donna, Oliver Rivero-Arias, Nancy Devlin, and Julie Ratcliffe. "Review of valuation methods of preference-based measures of health for economic evaluation in child and adolescent populations: where are we now and where are we going?." Pharmacoeconomics 38, no. 4 (2020): 325-340.
  4. Rowen, D., Keetharuth, A. D., Poku, E., Wong, R., Pennington, B., & Wailoo, A. “A Review of the Psychometric Performance of Selected Child and Adolescent Preference-Based Measures Used to Produce Utilities for Child and Adolescent Health”. Value in Health. (2020)

Project-specific requirements

  • Postgraduate degree: Master’s degree in Health Economics, Development Economics, Quantitative Economics, Economic Policy and Planning, with a strong focus on health OR a first degree in economics with a Master’s degree in public health/health sciences.
  • Excellent computer skills in advanced Microsoft Excel especially in the use of pivot tables; STATA/R Statistic; and Microsoft Word

Links to existing research and/or funding

The proposed research will be nested within the ongoing MENISCUS trial, which is a JGHT-funded trial led by LSHTM and the MRC Uganda & LSHTM Research Unit (PI: Professor Helen Weiss). The trial is funded to October 2023, including delivery of the intervention to 60 secondary schools in Uganda – 30 in the intervention arm and 30 in the control arm.

The baseline survey for the trial will commence in October 2021, with the endline survey scheduled for February 2023. The intervention will be delivered to the randomly-allocated intervention schools throughout 2022 by an independent NGO (WoMena Uganda). Control arm schools will be offered the intervention after the endline survey.

Fieldwork costs for all elements of the trial are included in the JGHT funding with the exception of the household survey with 300 girls. The funds of £20,000 will be used to cover these costs.

Skills a student is anticipated to develop while pursuing this project

Advanced methods for cost-effectiveness analysis, qualitative research methods, equity analysis.

Further information 

For any queries regarding this project, please contact LSHTM supervisor Professor Giulia Greco (giulia.greco@lshtm.ac.uk).

Hygiene-related determinants of enteric infection in rural and urban settings of Mozambique

Project title

Hygiene-related determinants of enteric infection in rural and urban settings of Mozambique

Supervisory team

  • Dr Oliver Cumming, Assistant Professor and Director of the Environmental Health Group, Faculty of Infectious & Tropical Diseases, LSHTM
  • Dr Jackie Knee, Research Fellow, Faculty of Infectious & Tropical Diseases, LSHTM
  • Dr Edna Viegas, Scientific Director, Polana Caniço Health Research and Training Center, National Institute of Health, Mozambique
  • Dr Chris Drakeley, Professor of Infection and Immunity, Faculty of Infectious & Tropical Diseases, LSHTM
  • The advisory committee will include the principal investigator of Countrywide Mortality Surveillance for Action project at the Mozambican National Institute of Health (INS) or another INS research team member.

Project description

In 2016, there were an estimated 165,000 diarrhoeal disease deaths attributed to inadequate hygiene [1]. This project will focus on understanding the relationships between household hygiene practices, infrastructure access, and enteric infection. The results will describe important hygiene-related transmission pathways and identify effective personal or domestic hygiene interventions to address these. The student will design and use survey and observational tools to collect data related to hand and personal hygiene, food hygiene, and domestic hygiene. Those data will be matched to dried blood spots, which can be used to measure pathogen-specific immune response to enteric infection (and other non-enteric infections) [2]; and/or stool samples which can be used to detect genetic material of enteric pathogens [3]. Both sample types can be analysed using multiplex methods to detect a suite of enteric pathogen targets for the leading global causes of diarrhea [3]. These results will allow the student to evaluate the association between specific hygiene practices and the transmission of different pathogens.

The student will use these data to explore the hygiene-related determinants of enteric infection in different settings and populations in Mozambique as part of two ongoing studies conducted in collaboration with the Mozambican National Institute of Health. The first study follows a longitudinal birth cohort of 200 children from birth through two years of age, with data and samples collected at 6-monthly intervals. That study, located in low-income neighbourhoods of urban Maputo, will allow the student to understand the impact that hygiene practices and infrastructure have on the rate of acquisition of 
enteric infections during the critical first two years of life. The second is a cross-sectional study evaluating the impact of food hygiene practices on enteric infection and growth among 500 children aged 6-36 months living in similar low-income neighbourhoods of Maputo. That study would allow the student to answer questions related to food hygiene but also personal and domestic hygiene among a larger paediatric study population in Maputo.

Key references

  1. Prüss-Ustün A, Wolf J, Bartram J, et al. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. Int J Hyg Environ Health 2019; 222: 765–77.
  2. Arnold BF, Martin DL, Juma J, et al. Enteropathogen antibody dynamics and force of infection among children in low-resource settings. Elife 2019; 8. DOI:10.7554/elife.45594.
  3. Liu J, Kabir F, Manneh J, et al. Development and assessment of molecular diagnostic tests for 15 enteropathogens causing childhood diarrhoea: a multicentre study. Lancet Infect Dis 2014; 14: 716–24.
  4. Liu J, Platts-Mills JA, Juma J, et al. Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: a reanalysis of the GEMS case-control study. Lancet 2016; 388: 1291–301.

Project-specific requirements

The student should have an undergraduate (Bachelors level) or graduate (Masters level) education in any of the following disciplines: public health, biology (inclusive of micro- and molecular), immunology, environmental science, or engineering. Applicants should have a professional working proficiency in English and Portuguese. Prior experience or training in a laboratory setting is expected and experience with molecular assays or immunoassays is preferred.

Links to existing research and/or funding

This project will complement three ongoing studies co-designed and led by LSHTM and INS by expanding the depth and range of specific hygiene-related questions answered. It will also further strengthen collaborative ties between LSHTM and INS through shared supervision of the student. This project will leverage samples and data collected as part of these ongoing studies, limiting the need for additional funds to support data collection and sample analysis activities. These studies include budgets to support travel to and from field sites, as well as to leading academic conferences (e.g. UNC Water & Health, ASTMH) where the student would be expected to present study results. Additionally, the supervisory team will support the student in identifying and applying for travel grants and other opportunities targeted at early career researchers.

Skills a student is anticipated to develop while pursuing this project

  • Specific laboratory skills, including experience with serology and molecular biology (e.g. PCR) techniques.
  • Statistical analysis using Stata (or other appropriate software like R).
  • Study coordination/management
  • Oral and written communication (manuscripts, verbal conference presentations, etc).

Further information

For any queries regarding this project, please contact LSHTM supervisor Professor Oliver Cumming (oliver.cumming@lshtm.ac.uk)

Economic evaluation of adding hand hygiene and point-of-use chlorination interventions to existing treatment for severe acute malnutrition in Senegal

Project title

Economic evaluation of adding hand hygiene and point-of-use chlorination interventions to existing treatment for severe acute malnutrition in Senegal

Supervisory team

  • Dr Ian Ross, Research Fellow in Health Economics, Faculty of Infectious & Tropical Diseases, LSHTM
  • Dr Oliver Cumming, Assistant Professor in Environmental Health Epidemiology and Director of the Environmental Health Group, Faculty of Infectious & Tropical Diseases, LSHTM
  • Dr Moustapha Seye, Professor, Département des Sciences Humaines, Université Cheikh Anta Diop De Dakar, Senegal
  • Dr Josephine Borghi, Professor in Health Economics, Faculty of Public Health & Policy, LSHTM
  • The advisory committee will include Dr Dieynaba N’Diaye, Action Contre le Faim.

Project description

The aim of this PhD project is to develop and apply methods for economic evaluation of hygiene interventions. It will take place alongside the ongoing TISA randomised trial in Senegal (clinicaltrials.gov: NCT04667767). TISA evaluates the effectiveness of adding hand hygiene and point-of-use (POU) chlorination interventions to existing outpatient treatment for severe acute malnutrition (SAM).

The rise of community-based management of SAM has shifted treatment to the household setting. This reduces treatment costs for the health system and individuals, but places the recovery of vulnerable children in a setting where the risk of infection due to contaminated water and poor hygiene may be higher. The TISA intervention is novel in dealing with both these risks simultaneously. Previous economic studies evaluated the incremental cost-effectiveness of POU water treatment options only (Rogers et al., 2019), considered part of hygiene as broadly understood (Boot & Cairncross, 1993). Existing ‘cost of illness’ (COI) estimates for SAM in Senegal and West Africa more broadly are insufficient, and do not incorporate the COI of the entire episode (including transfer between in-/outpatient facilities, community costs etc.). This precludes assessment of the full economic burden of the disease for financial planning and economic evaluation. More broadly, economic evaluations of hand hygiene interventions are limited in number and quality (Hutton & Chase, 2016). Cost-benefit and cost-effectiveness studies have typically modelled hypothetical interventions, with only one peer-reviewed study of an implemented hand hygiene intervention (Borghi et al., 2002). Benefits of hand hygiene beyond health have never been measured or valued in cost-benefit studies.

The objectives of the PhD project are:

  1. Costing – To estimate the economic cost, from a disaggregated societal perspective, of: (i) COI of a SAM episode; (ii) the TISA hand hygiene component; (iii) the TISA POU chlorination component.
  2. Cost-effectiveness – To estimate the incremental cost-effectiveness of the hand hygiene and POU chlorination interventions, based on “cost per additional SAM case recovered” as used in existing SAM economic evaluations
  3. Cost-benefit – To undertake a cost-benefit analysis of the TISA interventions and identify options for methodological advances that would be necessary to measure and value benefits it was not possible to include
  4. Broader benefits – To undertake a qualitative study of the broader benefits of the interventions to patients and families, to inform future efforts towards their measurement and valuation in cost-benefit analysis.

Key references

  1. Boot, M.T., Cairncross, S., 1993. Actions speak. The study of hygiene behaviour in water and sanitation projects. IRC, The Hague, The Netherlands.
  2. Borghi, J., Guinness, L., Ouedraogo, J., Curtis, V., 2002. Is hygiene promotion cost-effective? A case study in Burkina Faso. Trop. Med. Int. Heal. 7, 960–969. https://doi.org/10.1046/j.1365-3156.2002.00954.x
  3. Hutton, G., Chase, C., 2016. The knowledge base for achieving the sustainable development goal targets on water supply, sanitation and hygiene. Int. J. Environ. Res. Public Health 13. https://doi.org/10.3390/ijerph13060536
  4. Rogers, E., Tappis, H., Doocy, S., Martinez, K., Villeminot, N., Suk, A., Kumar, D., Pietzsch, S., Puett, C., 2019. Costs and cost-effectiveness of three point-of-use water treatment technologies added to community-based treatment of severe acute malnutrition in Sindh Province, Pakistan. Glob. Health Action 12, 1568827. https://doi.org/10.1080/16549716.2019.1568827

Project-specific requirements

It is essential to have:

  • a postgraduate degree in health economics, development economics, or another economics discipline, OR an undergraduate degree in economics with a postgraduate degree in public health or similar
  • Full professional proficiency in French

It is desirable to have:

  • Experience working in undernutrition
  • Experience working in francophone West Africa

Links to existing research and/or funding

This PhD project will take place alongside the ongoing TISA randomised trial in Senegal (clinicaltrials.gov: NCT04667767), which is funded by the US Office of Foreign Disaster Assistance (OFDA) and Action Contre le Faim (ACF). The consortium responsible for TISA’s implementation includes LSHTM, ACF and the LARTES lab at Université Cheikh Anta Diop de Dakar, Senegal. Ethical approval has already been received in the UK and Senegal.

Data collection for the purpose of cost-effectiveness analysis is already budgeted for as part of the trial, which only recently began recruiting participants. Therefore, the funding is available for the student’s primary quantitative data collection in support of objectives 1-3. It is anticipated that the student would undertake stakeholder interviews themselves to inform key variables and assumptions in objectives 1-3.

For Objective 4, it is assumed that the student will undertake qualitative interviews themselves. Collaborating on this with a junior colleague from LARTES in Dr Seye’s team could be achieved for under £10,000 in research costs, leaving sufficient funds for travel and training.

Skills a student is anticipated to develop while pursuing this project

We expect the student to develop skills in:

  • Advanced cost-effectiveness analysis
  • Cost-benefit analysis
  • Qualitative research
  • Study management
  • Written and oral communication (manuscripts and conference presentations)

Further information

For any queries regarding this project, please contact LSHTM supervisor Dr Ian Ross (ian.ross@lshtm.ac.uk).

Complementary food hygiene, childhood diarrhoea, and antibiotic use: exploratory research in peri-urban Zambia

Project title

Complementary food hygiene, childhood diarrhoea, and antibiotic use: exploratory research in peri-urban Zambia

Supervisory team

  • Dr Robert Dreibelbis, Associate Professor, Department of Disease Control, Faculty of Infectious & Tropical Diseases, LSHTM
  • Dr Roma Chilengi, Professor of Vaccinology/Chief Scientific Officer, Centre for Infectious Disease Research, Zambia (CIDRZ)
  • Dr Jayne Webster, Professor of International Health and Evaluation, Department of Disease Control, Faculty of Infectious & Tropical Diseases, LSHTM
  • Advisory Committee: The PhD will be supported by an advisory committee, including Dr Vanessa Hasris (Assistant Professor, Amsterdam Institute for Global Health and Development, University of Amsterdam) and Dr Anjali Sharma, Senior Researcher, CIDRZ

Project description

Diarrhoeal disease is one of the leading causes of appropriate and inappropriate antibiotic consumption among children [1]. Complementary food is a major cause of childhood diarrhoea [2]. Recent food hygiene behaviour change interventions in low-resource settings have demonstrated significant reductions in childhood diarrhoea [3]. By preventing disease, complementary food hygiene interventions, along with childhood vaccines and environmental health interventions have the potential to reduce antibiotic consumption and as a result, the emergence and spread of antimicrobial resistance [4]. Improved food hygiene may also reduce the transfer of antibiotic resistant genes between pathogens.

However, there is limited research on the factors that influence complementary food hygiene within peri-urban, low-resource contexts in Sub-Saharan Africa; research has largely focused on rural households. Studies have largely focused on the links between childhood diarrhoea or enteric infections and the broader links with antibiotic consumption remain under-investigated.

This proposed mixed-methods study will explore complementary food hygiene and its links with illness and antibiotic (mis)use within the context of multiple community-based studies in peri-urban Zambia. Scope and nature of the final study will be developed in collaboration with the skills and interests of the applicants.

The proposed study will be completed in two phases. Phase 1 will include mixed-methods investigation of complementary food hygiene practices, infant diarrhoea, and antibiotic use among child caregivers using structured observations, interviews, in-depth interviews, and basic microbiological assessment of complementary food hygiene.  Applicants will build on Phase 1 of the study by proposing research in one of two potential study tracks:

  • Behavioural track: The student will conduct further formative research to develop a complementary food hygiene and/or antibiotic (mis)use behavioural intervention targeting caregivers of young children and test this intervention in a small-scale efficacy trial. Formative research methods and the proposed intervention should be informed by existing behaviour change theories and approaches to the design and evaluation of behavioural interventions.
  • Clinical epidemiology track: The proposed research will further explore the links between food hygiene, illness, and child antibiotic use in a phase III vaccine efficacy cohort. A nested cohort study will provide additional data on the impact of vaccination on prescription and non-prescription antibiotic use, gut microbiome and resistome composition. The epidemiological investigation could explore causal pathway links between food behaviours, gut microbiome, biomarkers of enteric dysfunction and clinical outcomes in children such as diarrhoeal incidence, growth faltering including height for age, weight for age and other appropriate indicators.

Key references

  1. Rogawski ET, et al. Use of antibiotics in children younger than two years in eight countries: a prospective cohort study. B World Health Organ 2016; 95:49–61.
  2. Kirk et al. Diarrhoeal disease in children due to contaminated food. B World Health Organ 2017; 95(3):1–16.
  3. Manaseki-Holland et al. Effects on childhood infections of promoting safe and hygienic complementary-food handling practices through a community-based programme: A cluster randomised controlled trial in a rural area of The Gambia. PLoS Med 18(1): e1003260.
  4. Holmes et al., Understanding the mechanisms and drivers of AMR. Lancet 2016; 387:176–187.

Project-specific requirements

Skills are commensurate with the nature and scope of the proposed research. For applicants who wish to focus on behaviours and behavioural intervention, prior experience with social and behavioural research is requires. For applicants pursuing laboratory / microbiome research, appropriate training in biological sciences is required. All applicants should possess a Master’s degree or equivalent.

Links to existing research and/or funding

CIDRZ and LSHTM have a long history of collaboration on research projects related to water, sanitation, and hygiene (WASH), child health, and behaviour change interventions.

The proposed research will be one activity within a new formal, partnership between researchers at LSHTM and CIDRZ to conduct field research exploring the links between hygiene and health. As such, additional research funds may be available to support field research costs and capacity development activities.

Additional support for field data collection, including laboratory analysis, is available through currently ongoing studies at CIDRZ:

  • PATH – CVIA 061. A Phase 3 double-blind, randomized, active comparator-controlled, group-sequential, multinational trial to assess the safety, immunogenicity and efficacy of a trivalent P2-VP8 subunit rotavirus vaccine in prevention of severe rotavirus gastroenteritis in healthy infants: PI Chilengi
  • Wellcome Trust- 219775/Z/19/Z. ROTA -biotic: measuring the impact of rotavirus vaccines on paediatric antibiotic usage in Zambia: PI Harris

Skills a student is anticipated to develop while pursuing this project

Students are expected to develop skills in appropriate methods for data collection and analysis, including:

  • Direct observation
  • Survey methods
  • Key informant interviews
  • Environmental / microbiological assessment
  • +/- clinical evaluation of children

Students will also gain skills in mixed-methods research protocol development, research project management, and research project supervision.

Further information

For any queries regarding this project, please contact LSHTM supervisor Professor Robert Dreibelbis (Robert.Dreibelbis@lshtm.ac.uk).

Eligibility requirements

Applicants must be nationals of a country in Sub-Saharan Africa and meet the minimum LSHTM entry requirements. Additional skills and educational requirements are specified for each project. Please see the specific project information for further details.

How to apply

Information about the PhD programme structure at LSHTM, as well as application guidance and a link to the portal, can be found on the School’s Research Degrees and Doctoral College pages.

To apply for this studentship, applicants should submit an application for research degree study via the LSHTM application portal. Applications not submitted through this portal will not be considered.

In their applications, applicants should develop a research proposal based on one of the eight projects listed above. Applications not based on any of the eight projects will not be considered. The research proposal should be uploaded as a supporting document in section 8 of the online application form.

Applicants should also include a personal statement in section 6 of the online form in which they describe their long-term career goals and their vision for contributing to research into hygiene and health in Sub-Saharan Africa.

Applicants should apply via the LSHTM Faculty (ITD, EPH or PHP) of the primary supervisor listed for their chosen project. They should also enter ‘Reckitt-LSHTM Hygiene & Health PhD Studentship’ under ‘LSHTM Scholarship name’ in the ‘Funding Details’ section of the online application form.

Incomplete applications will not be considered for this studentship. To be considered complete an application must show all mandatory documents have been uploaded, and the application submitted, by the scholarship deadline. Applicants should note that referees will be contacted only once an application has been submitted. They must complete the online form. A letter in lieu of this will not be sufficient. Applicants should contact their referees in advance to make them aware of the request and the scholarship deadline.

Applications under this scheme will only be reviewed and processed after the deadline. All applications submitted before the deadline will be considered equally, regardless of their submission date. By submitting an application for this funding, applicants agree to its terms and conditions.

Application deadline

The deadline for applications is 23:59 (BST) on Sunday, 11 July 2021.