Epidemiological and statistical research on health problems of developing countries: MRC Tropical Epidemiology Group

The past decade has seen significant progress in health in developing countries as well as setbacks and new challenges. Gains in health in many low-income countries have been reversed due to the global epidemic of HIV/AIDS and steep increases in tuberculosis (TB). Malaria remains a major killer of children in Africa despite declines in some countries. There is an urgent need to find effective means of controlling these major diseases. The main aim of the MRC Tropical Epidemiology Group, based at the London School of Hygiene & Tropical Medicine, is to conduct research on interventions against diseases of major public health importance in Africa and other parts of the developing world. We collaborate with scientific groups overseas, including MRC Units in The Gambia and Uganda, assisting with the planning and analysis of research studies. These studies are designed to improve our understanding of risk factors for these diseases, and to evaluate the impact of different control measures. During the next five years, our main focus will continue to be on HIV, TB and malaria, and we will expand our work on non-communicable diseases, which are rapidly increasing in importance in developing countries. There have been major advances in HIV prevention in recent years, especially around the potential for antiretroviral drugs to be used to prevent HIV transmission. We will work on further studies to evaluate methods of preventing and treating HIV infection, and to scale up interventions, such as voluntary medical male circumcision, that are known to reduce the risk of HIV infection. We will also expand work on integration of care for HIV-patients with treatment of other chronic diseases such as heart disease and diabetes. Research on human papillomavirus (HPV), which can cause cervical cancer, will include studies of how best to deliver HPV vaccination to girls and young women in sub-Saharan Africa. Our TB research will focus on large-scale trials to assess how best to treat patients co-infected with both TB and HIV, and to improve the ways in which care for TB and HIV are integrated. A new diagnostic test for TB which has the potential to revolutionize TB diagnosis has recently been developed (Xpert MTB/RIF). We will also evaluate the impact and cost-effectiveness of this test for routine TB diagnosis in South Africa. Substantial reductions in malaria have been reported recently, but much of this progress has been in countries with low levels of malaria, and malaria rates remain unacceptably high in many African countries. In the Sahel region, most of the malaria mortality and morbidity occurs during the short rainy season. We have been closely involved in research showing that giving effective malaria chemoprevention during this period prevents illness and death from malaria in children. We will continue our research in this area, including assessing the impact of this treatment strategy on malaria cases and deaths when delivered through routine health services. We will also continue research on promising malaria vaccines, and to evaluate new methods to control the mosquitoes that transmit malaria. While the major infectious diseases continue to play a major role, especially in sub-Saharan Africa, there is increasing recognition of the impact of non-communicable diseases. The prevalence of conditions such as cardiovascular disease, diabetes and mental illness is increasing, especially in growing urban centres in developing countries, and will require innovative approaches to prevention and control. There are few experienced medical statisticians in research institutions and universities in Africa, and an important aspect of our work is to support a fellowship scheme, which provides a two-year training programme for statisticians. In addition, we teach research methods at workshops at collaborating sites and provide informal mentoring and supervision to statisticians and epidemiologists we work with.