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 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.

 

BiZiFED 2
Data Collection: Blood Sampling
BiZiFED 3
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.

Bizifeed Pic 1
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).

Bizifeed Pic 2
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.

Bizifeed Pic 3
Zincol wheat demonstration plot in Faisalabad, Pakistan (photo FFC Agri. Services).

Make the most of your library resources…

Calling all College of Health and Wellbeing students!

Did you know that the library team has tailor-made e-resources for your subject, at your fingertips?

Not only do you have access to all of our books, e-books, journals, and e-databases, you can also access our other, audio-visual, resources online for FREE. All you need is your UCLan login details.

Here are just a few of the less conventional learning tools you could use to help with your studies;

Acland’s Anatomy: ‘A Video Atlas of Human Anatomy’ with unique features including a three-dimensional look at anatomy; fresh human specimens in their natural colours; real movement; dissections and more.
This is great for students in nursing, physical and occupational therapy, kinesiology, and massage therapy. For students who don’t have access to dissection facilities, the Video Atlas provides an appreciation of the real human body and a direct understanding of the mechanics of body movement. Watch some sample videos here

Anatomy TV: Anatomy TV features 3D computer graphic models of human anatomy, dissection and radiology slides, animations and movie clips of biomechanics and surgical procedures. You can pinpoint exactly which area of the body you’re interested in, watch animations showing where the stresses of particular exercises take effect, and add or strip away layers to see every detail. Another bonus is that you can also take quizzes and do activities to test your knowledge (better than the standard eye-parching revision cram session, I’m sure you’ll agree!) Get Anatomy TV-literate here

BoB: BoB (Box of Broadcasts) National is a shared online off-air TV and radio recording service for UK higher and further education institutions. You can watch or listen to anything (yes, anything!) that has been on ‘terrestrial’ radio or TV in the past 10 years, and it doesn’t disappear after 28 days like some on-demand services. You can also create clips and playlists, which you can share.

Here are just a few examples of playlists which have been created for your subject;

Adult Nursing
Paediatrics
Midwifery
Mental Health
Nutrition
Sport and Exercise

Lynda.com: Lynda.com provides over 5000 bite-sized video tutorials covering the latest software, creative, and business skills. Taught by accomplished teachers and recognised industry experts, Lynda.com is a high-quality resource for students, faculty, and staff looking to develop skills in Microsoft Office, Adobe Creative Suite, project management, social media, and a wide range of other topics. Any course you complete can be added to your LinkedIn profile and is one more thing to add to your CV when you’ve graduated. Here‘s a good all-rounder playlist to get you started.

For a look at ALL the resources you have access to go and check out our A-Z page.

You can also book a one-to-one or group appointment with a librarian who can help you with all aspects of researching for your subject here.

For any more information on the ways we can help you contact your college librarians Mike Hargreaves (mhargreaves@uclan.ac.uk) or Megan Benson (mbenson4@uclan.ac.uk)