From Research to Reality: The real impact of stroke in India

“What advice would you give to a good friend about having a stroke?”
Answer – “Don’t have one”.

This was part of a discussion I recently had with a stroke patient at the All India Institute for Medical Sciences (AIIMS) in New Delhi. AIIMS is one of the three dedicated pioneering hospitals that have specialist stroke teams and units that we are working with for NIHR Global Health Research Group. The focus of the partnership, which includes colleagues in India, UK and Australia is to improve stroke care in India.

Fore me, this was a humbling and inspiring visit. I was part of the bid writing team for the appreciation and led on collating the facts and figures about the incidence, impact and stroke care provision within India formed part of the application. I knew that fort instance, stroke occurs at a much younger age in India than in the UK and Australia, occurring around the age of 50 rather than 70. However, the reality of this was brought home at our discussion event where around 50 patients and carers attended. Most stroke patients were in their 30’s. Having run similar events in the UK, the average age of attendees would have been much older. And the impact of stroke is varied and huge. Listening to people’s stories, I was struck by the differences in the pathways to accessing care. Most people who had a stroke did not attend the hospital initially, but had been seen days, weeks or months later for specialist input. Few had been brought to hospital immediately after their stroke. All described  the profound changes to their lives and their worries for what the future held.

Visiting the ward areas and stroke unit, much was very familiar to me as a nurse, including the key messages about control of infection and current campaigns to raise awareness of new policies within the hospital. However, again the stroke patients being cared for, mostly by their families, were very young. We know the rates of younger people in the UK having strokes are rising.

Whilst I knew the statistics about stroke, the visit has brought home the reality of both the similarities and stark differences. Our current collaboration is aiming to improve stroke care in India by agreeing priorities and developing interventions appropriate to low resources environments that could be widely implemented in a variety of healthcare settings to ensure the maximum benefit for patients in achieved. We are a long way from being able to prevent stroke occurring, but perhaps what we achieve will reduce the impact of stroke and improve the lives of those affected by stroke in the near future. To find out more about our project visit uclanglobalhealth.co.uk and follow us on Twitter @UCLanGlobalHeal.

Funding statement: This research was commissioned by the National Institute of Health Research using Official Development Assistance (ODA) funding.
Disclaimer. The views expressed in this publication are those of author(s) and not necessarily those of the NHS, National Institute of Health Research or the Department of Health.STROKE CARE

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BiZiFED Mid-Project meeting in Pakistan

Last week was very exciting for the BiZiFED team, as we all came together for the first time since our launch meeting in June 2017. We chose the mountain resort of Murree as our venue, 30km from Islamabad. Murree was developed as a hill station (and sanatorium) for British troops in 1850, and is now a popular tourist destination. It provided a lush setting for our meeting, and we managed to find time to get outside and enjoy the surroundings.

Since our randomised controlled trial of bio-fortified zinc flour was completed in February 2018, the UK team was eager to hear from the field team about how it went. We were honoured to be joined by two community members who participated in the trial. This was a special opportunity because we were unable to visit the community in Peshawar due to security risks. We were pleased to hear that they had enjoyed the flour provided during the trial, and wanted to purchase more. They did not know which was the biofortified zinc flour and which was the control flour, but they reported that some participants had noticed health improvements during the trial.

The next priorities are sample processing and data analysis. We have collected hundreds of samples, which will be sent to different laboratories around the world, so we spent some time finalising our data management and quality assurance protocols. We hope to have preliminary results to share at the Agriculture, Nutrition & Health Academy in Ghana.

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BiZiFED team in Murree

Another important objective of the BiZiFED project is to explore stakeholder awareness and acceptance of biofortified zinc flour and zinc fertilisers in Pakistan. We spent a whole day engaged in group activities to develop our stakeholder mapping and research methods. For example, we divided into two teams and role played a village meeting to explore community perspectives on biofortified zinc flour. This helped us to understand some of the cultural issues that might arise when a traditional, rural community is encouraged to adopt a new type of flour. Great fun and extremely informative!

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Role play activity

After a productive few days in Murree, we travelled back to Islamabad for our final day. We hosted a research symposium at the National Agricultural Research Centre (NARC) with over 40 delegates including academics, crop specialists, NGOs and journalists. We presented information about the BiZiFED project, which generated a lot of interest. Guest speakers from the UK Department for International Development (DFID), Nutrition International, HarvestPlus and Khyber Medical University presented their work on nutrition interventions and nutrition research in Pakistan. The slides and videos from this event will be available to view on our project website soon.

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BiZiFED symposium at NARC
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Professor Nicola Lowe presenting BiZiFED

We also had a guided tour of the wheat plots located at NARC. A previous blog introduced our BiZiFED cost-effectiveness study, which involves growing biofortified zinc wheat (and other varieties) at three different sites, using different zinc fertiliser concentrations. It was nice to see the wheat growing and find out more about the crop breeding process and other innovations in biofortification.

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Guided tour of wheat plots

BiZiFED trial of biofortified zinc flour completed in Pakistan

Our randomised crossover trial of biofortified zinc flour (details in an earlier blog) was successfully completed in February. The field team achieved an impressive 90% retention rate (45/50 households) in the brick kiln communities across Peshawar.

Some of the families ran out of flour during the last week of the trial. As a result of this, the final sampling had to be done a few days ahead of schedule. The families reported feeling healthier during the trial (which they attributed to the new flour) and because of this, they had consumed more flour than expected!

Research Assistant, Babar Shahzad explained some of the some of the challenges of conducting research in this poor and marginalised population.

“In the beginning we had some difficulties with recruitment and we had to develop trust in the community. When the people consumed the flour and they felt good (although they did not know which flour they were consuming) they began to trust our project. During the whole trial, the families were very satisfied from the flour quality. During the last sampling they requested more flour but we had reached the end of the trial.”

The next steps are laboratory analysis, data entry and statistical analysis. We are very excited about seeing the results and we hope they will show improved zinc status associated with consuming bio-fortified zinc flour.

We are also planning the next phase of our study to assess stakeholder awareness and acceptance of bio-fortified zinc wheat and flour. This will be important in terms of long-term sustainability and scaling up across Pakistan. We will continue to work closely with our partners at Abaseen Foundation and Fauji Fertilizer Company to engage with relevant stakeholders including farmers and community members.

In March, we will travel to Pakistan for our mid-project meeting. We will spend three days together in Murree and, for some of us, this will be the first face-to-face meeting after months of working together. Skype, WhatsApp and good old email made this possible!

Then we will travel to Islamabad for a research symposium with invited delegates from the Department for International Development (DFID), the British Council, HarvestPlus, Nutrition International, Scaling Up Nutrition (SUN), the National Agriculture Research Centre and Khyber Medical University. This will be an opportunity to share preliminary findings from our study and develop relationships with potential collaborators.

 

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Data Collection: Blood Sampling
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Data Collection: 24-Hour Recalls (Dietary Assessment)

BiZiFED Innovating with Zinc for Healthier Diets in Pakistan

Our randomised crossover trial of biofortified zinc flour in Peshawar (details in previous blog) is now well underway and our colleagues are busy with successive phases of flour distribution, data collection and lab work to process and store the biological samples.

Meanwhile, our partners at Fauji Fertilizer Company have just finished coordinating the sowing of a wheat crop at three experimental sites across Pakistan. The aim of this part of the BiZiFED project is to determine the value of adding zinc fertilizers to wheat production in Pakistan, both in terms of yield and the potential health benefits from increasing the zinc concentration in the grain of the wheat used to make roti or chapatti.

This component of our work is extremely important because the plant-available zinc concentration of most soils in Pakistan is very low compared to other parts of the world. This limits the zinc wheat crop, both in terms of yield and zinc concentration.

At each of the three experimental sites, replicated plots have been sown of the high-zinc wheat variety released by HarvestPlus (Zincol-2016) and a local references variety of wheat.

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Wheat trial layout at one of the field sites, NARC, Islamabad (Munir Zia, FFC, Pictured).

Research funded by the HarvestZinc Fertilizer Project and led by Professor Ismail Cakmak from Sabanci University in Turkey found that addition of zinc fertilizers to soil and foliage, known as agronomic biofortification, can increase yield and enhance zinc concentration in the edible part of the wheat grain. Foliar application of fertilizers late in the growing season has been shown to be the most consistent and effective strategy in many countries. Zinc concentration of wheat grain can be doubled compared to no fertilizer using this technique, especially when the crop receives adequate nitrogen.

While these field trials have shown huge promise, it is also important to demonstrate the cost-effectiveness of genetic (breeding) and agronomic (fertilizer) biofortification. This information will be essential to demonstrate to farmers the value in investing in new seeds and zinc fertilizers, and to persuade governments (in Pakistan and elsewhere) to invest in scaling-up biofortified zinc wheat and supporting the development of new fertilizer markets (e.g. quality control systems).

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Blending zinc fertilizer with basal fertilizers in the field in Punjab (photo Munir Zia)

A recent study co-authored by several members of the BiZiFED team estimated the value of zinc fertilizer use on crop yield and dietary zinc intake in Pakistan. Our findings, based on farmer surveys but with several uncertainties in terms of future scenarios, indicated that application of zinc fertilizers to local wheat varieties could reduce the prevalence of zinc deficiency by 50% assuming no other changes to food consumption. The monetary value of increased yield was estimated at over US $800 million per year. The potential for combining new high-zinc varieties of wheat alongside zinc fertilizers were not considered in this study, however, we anticipate that the benefits of genetic and agronomic biofortification are likely to be additive, and maybe even synergistic.

Thanks to our expertise, spanning academic and private-sector partners, our BiZiFED project will generate new science-based evidence in a ‘real-world’ context, so that the cost-effectiveness of zinc fertilizers applied to the biofortified zinc wheat can be determined. We will calculate the health economic impact of new varieties and zinc fertilizer-use in terms of reductions in Disability Adjusted Life Years (DALYs). A DALY is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.

Ultimately, this study will show how many years of healthy life could be saved if the population was to fully adopt biofortified zinc wheat and zinc fertilizers.

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Zincol wheat demonstration plot in Faisalabad, Pakistan (photo FFC Agri. Services).

BiZiFED trial of biofortified wheat has begun in Pakistan

In a previous blog in March 2017, we announced that Professor Nicola Lowe had received a £300,000 grant from the Biotechnology and Biological Sciences Research Council (BBSRC) to investigate whether a newly developed strain of biofortified wheat could increase dietary zinc intake in Pakistan. The project is to be known as BiZiFED – biofortified zinc flour to eliminate deficiency. We plan to publish regular blogs so that you can share our excitement about this project, which has the potential to improve the lives of women and children in one of the world’s poorest countries.

The project was officially launched at a meeting in Islamabad in June 2017 with our partners from the University of Nottingham, the Abaseen Foundation, Khyber Medical University and Fauji Fertilizer Company.

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The new zinc-rich wheat was developed by HarvestPlus using traditional plant breeding techniques known as biofortification. Since it was approved for use in Pakistan, our colleagues have grown the wheat crop, harvested the grain and milled the flour. The zinc content of the crop was further enhanced using zinc-rich fertiliser and tests have confirmed it has double the zinc content of standard varieties. The next job is to test how well the zinc is absorbed and the impact on zinc status in the body.

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A double-blind randomised crossover trial has just begun and will continue until February 2018. Fifty households have been recruited from the brick kiln communities around Peshawar in North West Pakistan. These are among the poorest communities, with very high levels of zinc deficiency and stunting. Each household will receive a free supply of flour for the duration of the trial. They typically use flour to make chapattis every day. In the first 8-week period, 25 households will receive zinc-rich flour and 25 households will receive ‘control’ flour with standard zinc content. In the second 8-week period, they will swap and receive the other flour. This design will enable repeated measures of zinc status, with each household serving as its own control.

An important aspect of this research is developing techniques and biomarkers for measuring zinc status in the human body. Women and will provide blood, stool, nail and hair samples at each data collection time point, well as completing 24-hour dietary assessments. A continuous process of community engagement will ensure that everyone is aware of why these samples are being taken.

We will update you when the trial is complete. The next stage will be qualitative research to explore what farmers and families think about the new zinc-rich wheat.

 

 

 

 

Lancashire Science Festival 2017

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Last month UCLan hosted its sixth annual Lancashire Science Festival, which came back bigger and better this year, with a huge variety of shows, exhibitions and workshops to inspire young people about the real life applications of science.

Our School is largely involved with the festival where our staff and students coordinate the #SkillZone and run a variety of workshops and drop in sessions such as ‘Operation!’, ‘Outbreak’, ‘be a Paramedic’, ‘Children’s nursing’, ‘Become a mummy’ and ‘Mental health and well being’. We worked alongside local Ambulance, Fire and Police services who set up a crash scene in Harrington car park.

In the Sports Hall in STFSC we hosted a dress up station where hundreds of people had their photos taken as healthcare professionals, whilst the Stroke team, Lancashire Care NHS Trust and Comensus all had their own stalls throughout the 3 days.

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There was approximately 10,000 people that attended over the 3 days and the Festival as a whole has won the Heist award for best community engagement project. We have received fantastic feedback from people who attended which was all down to the staff and students that were involved, going above and beyond to make the #SkillZone, workshops and sessions such a success.

We are always looking for people to help out with the Science festival, email ejones14@uclan.ac.uk if you are interested, want any information or have any ideas for the festival for next year! The Science Festival can really showcase what we do as a school and also as Healthcare professionals to children who may want to go into the profession and is always a lot of fun!staff

 

Open day events in June

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Come and attend the UCLan open days which are being held on Friday 23rd June and Saturday 24th June. The events are open between 9am-3pm.

The main registration for the June Open Days will take place in the Atrium, with “Talk to a Tutor” stands in Venue 53.

On the day you will be able to talk to the tutors about the subjects you are interested in, you will be able to see the clincial skills labs & breakout rooms.

Main Talks are in Harrington Lecture Theatre

You can attend these talks between:-

09:45 – 10:30

11:00 – 11:45

13:00 – 13:45

 

Skills Labs & Break Out Rooms

Drop in sessions are avaialable throughout the day, come and speak to the Lecturers about the specific field of nursing you are interested in and see our amazing facilities.

Child field

Adult field

Mental Health field

 

There will be a number of fun activities taking place and a variety of food stalls, plus live music.

 

Book here to attend the Open Days at UCLan

UCLan Midwifery #Challenge10 Zumbathon

On Sunday 30th April UCLan Midwifery held the second event of #Challenge10 to raise money for SANDS (stillbirth and neonatal death charity).

Student midwife Sabrina Rojas organised and planned this event, which included glow sticks, cake stalls, face paint and a sports massage stall! The zumbathon was a huge success, with the exact total raised still to be confirmed, although it is thought that over £900 was raised.  SANDS provides bereavement support to families affected by stillbirth and neonatal death in addition to essential research in an attempt to reduce the number of babies who die.

A huge thank you to everyone who attended this fantastic event and to those who contributed to the day, we are very grateful!

Please join us for the remaining #Challenge10 events:

10th June – #Yorkshire3Peaks

1st July – Manchester Colour Run

12th August – Swimathon (Salford Quays)

9th September – Born Survivor!

31st October – Bikeathon

18th November – Charity Ball

18th December – Cake bake sale

If you would like to sponsor us or would like further information, please contact:     LKirk-Batty@uclan.ac.uk (midwifery lecturer)

 

Service User and Care Congress Day

On March 29th 2017, Comensus, UCLan’s service user and carer group held its bi-annual Congress day. The theme, challenging prejudices, has been one that characterised Congress Days for over 10 years; the type of community groups that delivered workshops this year reflected this. Comensus worked in partnership with local community groups and had members talk from their own personal experience in seminars covering topics such as HIV, young people’s suicide, head injuries, sexual abuse, laryngectomy, addiction to substances, transgender issues and life as an ex-offender. In addition, Comensus facilitated three group visits to the Traveller site adjacent to the UCLan’s main campus.

The ethos for the day was about challenging prejudice by students working with groups and hearing their stories, each group spoke on the issues they face in an honest and clear way. One student commented on the Laryngectomy workshop saying;

“‘K’s’ presentation was highly educational on so many levels. It was very informative – factual and personal. Having the chance to hear directly from ‘K’, who spoke so honestly and with such clarity and humour, watching the screen presentation gave me some insight into aspects of living with laryngectomy and how this can affect both the person and their loved ones.”

The student who attended this workshop told Comensus they would contact the trainers of the First Air course from their organisation to include a clear message to check whether the person in need of First Aid breathes via nose or neck and how to provide emergency treatment accordingly.

Another really important impact!

Another student gave feedback saying;

“Thank you for yesterday and my place at the Congress event, with Comensus. What a worthwhile day.”

We hope everyone who attended the Congress will continue to challenge prejudice.

If you want to leave any feedback comment below

 

Professor Nicola Lowe gains research funding into BiZiFED biofortified zinc flour to eliminate deficiency

 

dr_nicola_loweUCLan Nutritional Science Professor Nicola Lowe has been granted £30,000 from the Biotechnology and Biological Sciences Research Council (BBSRC) to investigate whether a newly developed strain of bio fortified wheat could increase dietary zinc intake in Pakistan. According to the World Health Organisation, dietary zinc deficiency is a global problem affecting 17% of the world’s population, with the greatest burden in developing countries. The most recent national survey in Pakistan indicates that over 40% of women are zinc deficient, compared with less than 15% in Europe and North America. The consequences of zinc deficiency are profound and far reaching, ranging from stunted growth and development in children, increased susceptibility to infections in children and adults and complications during pregnancy and childbirth.  This has a negative economic impact on the family, the community and the region.

The study is a collaboration with plant physiologist, Professor Martin Broadley at Nottingham University, as well as research partners in Pakistan including the Abaseen Foundation and Khyber Medical University and Fauji Fertilizer Company. The research will focus on families in a North West Pakistan rural community who will spend eight weeks eating the new strain of wheat grain growth in zinc rich fertilizer compared to standard grain to assess whether it increases zinc content in the body. The team will monitor the participants by testing hair samples and blood plasma as well as exploring new techniques to evaluate zinc levels. They will also look at hoe culturally acceptable bio fortification is within rural communities and key stakeholders including farmers.