Defining outcomes and opportunities for reproductive health and pregnancy among adolescents in post-conflict Northern Uganda

 


The current generation of adolescents 10-24 years old is the largest in human history. Adolescence is a crucial time in terms of health, education and skills which will determine social and economic development over the life course. While focused global action on maternal and child health based on the Millennium Development Goals has resulted in impressive reduction in child mortality, the same cannot be said for adolescent well-being. Sexual, reproductive and maternal health issues remain a leading cause of death in adolescent girls, especially in low income countries. Adolescent pregnancies are associated with exceptionally poor outcomes for both the adolescent mother and child.

Adolescents often lack the awareness, choice and access to health services which contribute to poor sexual health and maternal outcomes. Contraception, family planning, human papillomavirus (HPV) vaccination and screening for sexually transmitted infections (STI) including HIV, gonorrhea, and Chlamydia are feasible, effective prevention tools that, when offered with treatment and counseling can save countless deaths among young people. The way forward is integration of health services where prevention and early treatment packages are tailored to the needs of adolescents.

The civil war in Northern Uganda, which lasted over two decades, displaced over 90% of the region into internally displaced people camps. The majority of this population (70%) was under 25 years old. During the war thousands of children were abducted to become soldiers, forced labourers, and sex slaves. Building on previous research, a team led by Dr. Patricia Spittal launched the Cango Lyec Project in 2011. This cohort consists of a random sample of participants aged 13-59 years in Northern Uganda residing in permanent settlement communities, transition camps, or internal displacement camps.

Through the BC Children’s Hospital Research Institute, Healthy Starts Catalyst program, a team of local researchers were funded to explore key factors related to adolescent health services in Northern Uganda, leveraging the Cango Lyec cohort. Dr Spittal has been leading projects in Northern Uganda since 1998, and is the Principal Investigator of the Cango Lyec Project. Dr Gina Ogilvie is a Canada Research Chair in global control of HPV related cancer & disease, and has been leading a women’s health initiative based in Uganda since 2007. Dr Ashley Roberts is a pediatric infectious diseases physician at BC Children’s Hospital with clinical and research experience in North America and abroad.

This study aims to understand existing access to reproductive and maternal health services for adolescents. Participants completed a survey on pregnancy intentions and outcomes during adolescence and access to sexual health services using community outreach workers who traveled to urban and rural villages in the region in early 2017. Results from the study are forthcoming, where the team will describe services available in this setting, and identify opportunities to improve adolescent maternal health. This data will be used to design future implementation trials and evaluations for adolescents in LMIC.

#MyRightToHealth

Girl wearing I Decide=#MyRightToHealth tshirtWorld AIDS Day 2017 is focusing on the theme “My health, my right” in support of universal right to health, which includes the prevention and treatment of ill health, ability to make health-related decisions, access to healthcare without discrimination or violence, and the right to education.  In the lead-up to World AIDS Day on December 1st, UNAIDS has been promoting the #MyRightToHealth World AIDS Day Campaign, which explores the challenges people around the world face in exercising their right to health.

These challenges are significant, but models of patient-centred care exist that can help women and children living with HIV realize their right to health.  BC Women’s Oak Tree Clinic practices this model of holistic interdisciplinary care focused on vulnerable women and children, and provides clinical care, research, teaching, and advocacy.  Oak Tree Clinic has been practicing “treatment as prevention” for twenty years, during which no HIV infected infants have been born to pregnant women engaged in care at the clinic.

On November 30th Oak Tree Clinic will be leading Grand Rounds in the form of rapid fire presentations.  Topics will include: Global and National statistics; a recently published paper entitled “Women living with HIV envision women centred HIV care”; challenges related to feeding infants born to women living with HIV; neurodevelopmental outcomes of HIV-exposed uninfected children; and a presentation on the results of the national study “Predictors of suboptimal antenatal treatment of pregnant women living with HIV in Canada, to prevent vertical transmission”.

The 2016 World AIDS Day “Portraits against Stigma Project” will also be on display at the event.

For more information on the rounds, click here.

To learn how to support the #MyRightToHealth campaign, click here.

Gender Equity in CIHR Research Funding: Implications for Women’s Health Research

By Liisa Galea, Ph.D.


On August 15, 2017, CIHR released a report outlining gender differences in the amount of approved CIHR funding and in March, 2017 on gender inequities in success rates with Project, Open Operating and Foundation grants1. Overall, within-sex success rates across all CIHR grant programs did not show a strong bias, with women showing overall higher within-sex success rates from 2007 to 2016 than men, with the exception of 2014-15. Perhaps more concerning is that overall success rates have dropped from a high of 40% to less than 25% over those same years. However the story starts to change when examining the data by particular granting opportunities within CIHR.

 All CIHR grant competitions between 2000/01 to 2015/16 A graph displaying the within-sex success rate of all cihr grant competitions between 2000/2001 to 2015/2016

The greatest diversity in terms of within-sex success rates favouring higher rates in men was in the Foundation Grant completions with 12-14% within-sex success rates for men but 8-10% in women over the 2014 to 2015 competition. Curiously, the within-sex success rates differed by career stage, with much higher within-sex success rates for men in the mid/senior career researchers compared to women but this same disparity was not seen in the early career researchers.

Foundation 2015/16 Competition

This finding seems to parallel the findings that fewer women awarded CRC and CERCs2 that the Canadian government is working to address3.  CIHR is making concerted efforts to correct these biases and we applaud them for paying attention to this matter. They have new CIHR Gender Equity Framework4.

However, equally concerning is that women, depending on career stage and funding competition, are not only less successful in their grant success but are receiving less money per grant, with the average disparity at $72,833.47 per year.  The largest disparities in funding amounts between men and women researchers were seen in Clinical Research and Social, Cultural, Environmental and Population Health Research with an average of over $82 000 or $142,000, respectively, per year in 2015/16.

All CIHR grant competitions between 2000/01 to 2015/16

average grant funds

It’s worth understanding that unlike NIH and other granting agencies CIHR budget allocations are based on what the researcher has asked and budgeted for thus it is more than likely that women are asking for less money to fund their grants than men. We urge researchers to budget for and ask for the appropriate amount of money to fund their research. Researchers should also be aware that typically CIHR has been using across the board cuts of 25-30% to budgets.

It is important to applaud CIHR and their work to be more transparent in funding decisions and metrics.  It matters as diverse researchers will examine different topics as so eloquently written about recently by Allison Sekuler5.  Thus, it has been suggested that women’s health is more likely to be researched by women4 and these results from CIHR and NIH6 suggest that the field is underfunded.

We applaud the Canadian government, CIHR and the Honourable Kristy Duncan for highlighting and drawing attention to Equity, Diversity, and Inclusion Action Plan3.  This can only help women’s health.

 

References Continue reading “Gender Equity in CIHR Research Funding: Implications for Women’s Health Research”

Kangaroo Mother Care at BC Women’s Hospital NICU

Attendees at the KMC event at BC Children's Hospital Teck Acute CentreOn November 15th BC Women’s Hospital, along with Perinatal Services BC, announced that their innovative Kangaroo Mother Care (KMC) program will receive financial support from the Ministry of Children and Family Development to help implement KMC in neonatal intensive care units (NICUs) across the province.

Mother practicing KMC with her baby using a wrap provided by the hospital.KMC is a skin-to-skin attachment program, wherein the mother (or partner) holds their baby against their bare chest for as many hours a day as possible. In Columbia, where KMC was developed in the late 1970s, babies would be propped in a wrap, skin to skin against their mother, for 24 hours per day.  The practice promotes a stronger bond between parent and baby, and in the case of premature infants, can help to shorten the length of time spent in the hospital.

Other benefits include reducing instances of postpartum depression, stabilizing the baby’s temperature, encouraging breastfeeding, boosting social and emotional development, and stress reduction.  Teaching mothers and partners how to practice KMC in-hospital will also provide them with the necessary skills to continue at home after their baby has been discharged.

Funding for the project was made possible through the partnership of BC Women’s, BC Women’s Hospital + Health Centre Foundation, Perinatal Services BC, and Women’s Health Research Institute.

The WHRI will be a collaborator on the project from initial inception through to all phases of implementation, and will collaborate on gathering and reporting implementation metrics.

To read the news release from the government of British Columbia, click here.

Women’s Health Research Symposium

On October 25 2017, the Women’s Health Research Institute, together with the Vice President Research Office at Simon Fraser University, hosted a half-day women’s health research symposium at the beautiful SFU Diamond Alumni Centre. The event was entitled, “Examining diversity across disciplines, decades, and distances”.

Associate Professor in the SFU Faculty of Health Sciences, Dr. Angela Kaida, and her very capable team of students organized and led the event, which was attended by 120 SFU faculty and students, members from the SFU Board of Governors, the Deputy Chief Medical Health Officer for First Nations Health Authority, and members of the WHRI community. Dr. Joy Johnson, SFU’s Vice President of Research, gave an inspiring and practical talk to trainees for launching a successful research career, and included sage advice to trainees, such as “Be generous with others”.

Dr. Johnson also delivered a keynote address on the “History and Future of Gender, Sex, & Health Research in Canada” and provided a fascinating account of the history of the Institute of Gender and Health at CIHR, noting that the women’s health movement was instrumental in the development of the sex and gender discourse. She also emphasized the need for researchers to consider both sex and gender in their grant applications and in their work: “Every cell is sexed; every person is gendered”.

There were three panels providing a wide range of topics in women’s health, and the conversations provided both breadth and depth in topics related to equity and diversity, science and technology, and policy and law as they pertain to women’s health. The conversations were rich and the insights were deep. Most importantly, the symposium provided a valuable networking opportunity for the WHRI and our SFU colleagues.

We look forward to building on the foundation of this successful symposium for the future!

Exciting Job Opportunity: Director of Surveillance at Perinatal Services BC

Perinatal Services BC (PSBC) is hiring!

This is a very exciting opportunity to do surveillance and quality improvement work to improve maternal and newborn health. BC’s Perinatal Data Registry collects information across the continuum of care (antenatal, intrapartum, postpartum) on every mother-baby pair and captures all births that take place in BC. The role includes directing surveillance activities, and leading and collaborating on knowledge generation, translation and quality improvement to advance perinatal health in British Columbia as well as contributing to national surveillance and implementation science.

Check out the position here.

WHRI’s 11th Anniversary Address

Happy 11th anniversary to the Women’s Health Research Institute! Having recently passed my first year mark as the institute’s Executive Director, it is an excellent opportunity to review our achievements over the past year. The Mission of the WHRI, “Creating new knowledge and evidence-based solutions that inform and transform the health and health care of women and their families” is woven into the fabric of what we do, from the front line research staff, students, and volunteers, to the nearly 200 members that belong to the WHRI family, to the WHRI’s executive team. Never before have I felt as proud to belong to a community of individuals sharing the same vision of better health for women, and living up to that vision through the work that they do.  Our 5-year Strategic Plan is organized around three primary goals, and those goals have guided several advancements and new initiatives over the past year.

Here is a brief summary of some of the highlights:

Goal #1: Enhanced Collaboration: To support an environment that promotes success for women’s health research in BC.

Over the past year, we have engaged with researchers across all health authorities and grew our network of women’s health research members by 23%. Other evidence of collaboration stems from holding a very successful 2nd annual WHRI Symposium in April, and now planning to bring mini symposia to SFU, University of Victoria/Island Health Authority, and UBC-O. We have implemented patient registries in now four programs at BC Women’s Hospital, and are working with the BC Children’s Research Institute to implement a campus-wide “permission to contact” effort. We have developed a multi-disciplinary and cross-pillar Scientific Advisory Board which guided the revision of our themes to four. We have also grown our Executive Team by bringing neuroscientist, Dr.Liisa Galea on site at the WHRI for one day per week.

Goal #2: To increase capacity for women’s health research in BC.

Our members have told us that grant support is a significant need. To respond, we have collaborated with the BC Children’s Hospital Research Institute to hire a part-time Research Development Facilitator (Amber Hui). We have also strengthened our partnership with the BC Women’s Hospital Foundation, and are grateful for their support in funding three new Catalyst Grants that were awarded recently. Karen Gelb, a contractor to the WHRI, has carried out several dozen interviews in an effort towards developing a provincial women’s health research agenda, which we plan to unveil at the 3rd annual Symposium on May 9, 2018 (mark your calendars!). We have expanded capacity by bringing on an SFU Communications Co-Op student, and a UBC Statistics Co-Op student, both contributing their energy and creativity throughout the WHRI.

Goal #3: To translate results from women’s health research into improvements in women’s health care.

We have held two Knowledge Translation workshops over the past year: a Scientist Knowledge Translation Training Workshop” and an “Implementation Science Workshop” in partnership with the Michael Smith Foundation for Health Research. We have held two extremely successful public events designed to disseminate evidence based women’s health information to the public, and we have developed a comprehensive Communications plan to ensure our members receive the information they need in an effective and timely manner.

I feel privileged to work with a team of exceptionally competent, devoted, bright, and creative staff at the WHRI, and I am proud of the research lead by our members which helps women prevent disease, manage and treat maladies, and live healthier, more fulfilling and rewarding lives.

-Lori  A. Brotto, PhD, R Psych, Executive Director

#SupportTheReport

Budget 2018 is just around the corner.

Will there be any new money dedicated to fundamental research?

Why and how you can make a difference?


By Liisa Galea, WHRI Scientist

The Canada Budget 2018 is just around the corner. Why should scientists and researchers care? Because the Fundamental Science Review commissioned by the Honourable Kristy Duncan was released in April 2017 and includes a “big” ask for $1.3 billion over 4 years to return tri-council funding to the levels in 2007. As most of us researchers know, success rates at tri-councils have declined, and average amounts of grant funding have not risen to keep abreast of the rising costs for research in Canada. Canada’s world rankings for GERD (Gross domestic Expenditures on Research and Development) intensity has fallen from 7th to more than 30th over the last 15 years, which is why the major recommendation of the Fundamental Science Review was to restore funding levels in tri-council (CIHR, NSERC, SSHRC) and CFI particularly for investigator-driven, and not priority-driven, research.

The Liberal government has been making a number of major science and innovation announcements since taking office, and lay people could be forgiven for thinking that scientists and researchers are flush with cash. However, as those of us in the trenches know, this is not at all the case. It is important – and in fact necessary – to have priority-driven research in Canada. Canada and other countries need to react to crises that affect Canadians adversely such as unexpected outbreaks in new viruses (SARS, EBOLA, Zika); to offset and reverse climate change damage; and even to battle “fake news.” But it is equally important to balance funding initiatives so that we do not put – as they say – all of our eggs in one basket.

As Dr. Tara Moriarity, so eloquently reports in her letter to Justin Trudeau, she is one of only two laboratories in Canada studying Lyme Disease – and her lack of funding jeopardizes knowledge in etiology/treatment of a disease that afflicts Canadians – not to mention an important investment in training our next generation of Lyme Disease scientists. As one respondent in my survey in 2016 noted:

“…An unfunded period brings an absolute end to continuity. Every lab has unique procedures, research topics and necessary background knowledge that are not immediately acquired by new lab members simply by showing up in the lab on their first day of work. Losing funding for six months doesn’t mean simply a six-month break in research; it can take many years to restore group expertise and knowledge to a lab. I am worried that the current funding situation is going to create this situation en masse for researchers all across Canada. Even a short interruption can set research back by many years.”

-Respondent 28

So, back to what we can do to #SupportTheReport. We need to contact our MPs, write, call and urge our friends and neighbours to do so as well. We need to ensure those around us that support for fundamental science is necessary for the healthy future of Canadian Science and the next generation of researchers. Remind MPs that we create jobs, knowledge and support staff, and students alike with our research, not to mention industry that obtains revenue from research itself.

Let’s face it: we do not know where our next big discovery will come from. Indeed, it was the curiosity-driven science that lead Thomas Brock and Hudson Freeze to study microbes in Yellowstone National Park which led to the discovery of Taq polymerase, a critical ingredient used in PCR needed for genetic testing. Unfortunately, many causal observers miss the critical difference between the funding of Canada150 chairs, Superclusters, and CFERF chairs compared to funding levels for tri-council, and it is important that we make MPs and the public aware of the importance of fundamental research.

We often hear that funds are not unlimited, and that governments need to make hard choices in what to fund that is most important and critical for our communities to be healthy. However, in many ways this is a false dichotomy. Fundamental Research can help Canadians and Canadian society in untold numerous ways – building better roads, safer cars, better schools, providing clean water, preserving Indigenous cultures, spanning the second valley of death, and finding the best ways to implement new policies and procedures to improve climate, and/or health care. Research matters and it important for the Canadian government to invest in the future of research and discovery broadly and diversely to maximize investment and discovery.

The Budget 2018 approaches, and if we want more money for fundamental science, the window is closing to influence those around us in government that make decisions to allocate funding for initiatives all across Canada.

I’ve personally met with Hon. Kristy Duncan, Jonathan Wilkson, Pamela Goldsmith-Jones, Dan Ruimy, Randeep Sarai, Simon Kennedy, Justin To, Kate Young, and Hon. Jody Wilson-Raybould. Most of these individuals we met as part of a trip I took to Ottawa with UBC President Santa Ono, Phil Hieter and Adriaan de Jager to show our support for the fundamental science review.

I am grateful I was included in that group, but we all have to do our part. The time is now.

#SupportTheReport for a better future.


To can find all the MPs who have been visited already you can visit this site, but don’t be shy if your MP has been visited already. It’s important for us to drive the message home.

For tools to approach and speak to your MPs see http://www.acechr.ca/summerofsciencecan.html, or drop me an email: liisa.galea@ubc.ca.

#CANADAvsHPV: HPV in HIV Study

This October 1st to 7th marked Canada’s first HPV Prevention Week, an initiative led by the Federation of Medical Women of Canada (FMW).  The theme for this year was #CANADAvsHPV, with the intention for Canadian health officials and government to help prevent the spread of HPV through education.

In honour of HPV Prevention Week, the Women’s Health Research Institute is pleased to provide an update on the “HPV in HIV Study”.


Canada is home to one of the first major studies globally to look at the human papillomavirus (HPV) vaccine in girls and women living with HIV.   Women with HIV are more vulnerable to HPV, experiencing significantly higher rates of HPV infection and progression from HPV infection to cervical cancer, compared to women without HIV.  Despite this, very little research has looked at the HPV vaccine specifically in persons with HIV.   In 2008, the “HPV in HIV research team”, led by Dr Deborah Money, of the University of British Columbia and Women’s Health Research Institute, set out to learn more about the efficacy and safety of the HPV vaccine in girls and women living with HIV.  The team’s aim was to learn how to best protect these women from HPV-related diseases including cervical cancer and genital warts. The national and international health implications of this project are significant; with upwards of 17 million women living with HIV, and many residing in resource constrained settings where cervical cancer screening is limited and invasive cancer rates are high, appropriate HPV vaccination can be lifesaving on a large scale.  Understanding the HPV vaccine in persons with HIV is a critical step towards global eradication of cervical cancer and realizing greater health equity for women and persons affected by HIV.

The HPV in HIV study includes 14 HIV care centres across Canada.  415 girls and women above age 9 were recruited and 353 received at least one of three planned doses of HPV vaccine.  To date, over 2,947 study visits are complete.  This speaks to an incredible team of dedicated participants, staff, investigators, and community partners.  The study is funded by the Canadian Institutes of Health Research, with support from the Canadian HIV Trials Network.  Vaccine (Gardasil™) and serology analyses were provided in-kind by Merck.

Our data so far have shown that the HPV vaccine is safe to use in women living with HIV.  Study participants mounted immune responses to the vaccine that were not inferior to those of women without HIV and effective use of antiretroviral therapy to control HIV resulted in the best immune responses.  Despite observing these high immune responses, our women have experienced more HPV breakthrough infection and disease (i.e. infection that should have been prevented by the vaccine) than vaccinated women without HIV.  Therefore, although the vaccine is likely providing some protection against HPV, the protection may not be complete and cervical screening will remain important for HPV-vaccinated women living with HIV.  Further follow-up will provide more information on the level of protection that women living with HIV can obtain through vaccination.

The Canadian Institutes of Health Research and the Canadian HIV Trials Network (CTN 236) have provided further funding to continue the study as a Long Term Follow-Up Study; data collection is ongoing with the first participants reaching 9 years of follow up in 2018.


A scientific report on safety and immune response in participants above age 15 is now available online here.

Metro Vancouver Study finds an association between South Asian Ethnicity and Risk of Vitamin B12 Deficiency during Pregnancy

Vitamin B12 (B12) sufficiency during pregnancy is essential for optimal maternal health and fetal and infant growth and development. Maternal B12 deficiency has been associated with poor pregnancy outcomes, such as preterm birth, low birth weight, intra-uterine growth restriction and neural tube defects, as well as poor cardiometabolic health and impaired cognitive development in the infant. Suboptimal B12 status has previously been reported in pregnant Canadian women. A secondary analysis study conducted by the research team of Dr Yvonne Lamers, Canada Research Chair in Human Nutrition and Vitamin Metabolism, aimed to determine B12 status and the prevalence of B12 deficiency in pregnant women in Metro Vancouver, using the more sensitive, combined measurement of a direct (plasma total B12) and functional (methylmalonic acid (MMA)) B12 indicator. The sample of the original cross-sectional study included 320 women with singleton pregnancies between their 20th and 35th weeks of gestation, with data collection between February 2009 and February 2010.

The prevalence of plasma total B12 concentration below 148pmol/L (reflecting B12 deficiency) and of concentrations between 148-220pmol/L (reflecting suboptimal B12 status) were 18% and 33%, respectively, in these 320 pregnant women of European, Chinese Asian, South Asian or other ethnicities. South Asian ethnicity was the strongest predictor of having plasma total B12 concentration reflecting B12 deficiency, with South Asian pregnant women having a 10x greater risk of B12 deficiency compared to European pregnant women. The odds of having elevated MMA concentrations (>220pmol/L) was 5x higher in South Asian compared to European pregnant women. Conversely, B12 supplement use decreased the risk of B12 deficiency by 69% in all pregnant women. A higher prevalence of B12 deficiency in South Asian pregnant women may be due to lower intake of animal source foods, the natural sources of dietary B12. Future research is underway to investigate the predictors of low B12 status in South Asian pregnant women. Overall, the study highlights the importance of determining B12 status early in pregnancy to allow for early intervention to prevent adverse maternal and fetal health outcomes.

Read the full study here.