Consuming alcohol ('drinking') causes cancers and other NCDs globally and more than 3 million people died due to harmful use of alcohol in 2016 (1 in 20 deaths). It has impacts on economic productivity and can lead to addiction, violent behaviours, injuries, and road-traffic collisions. It also impacts on health systems, particularly in low and middle income countries (LMIC) where those system already face significant challenges. Drinkers in Africa consume 21% more alcohol per day than the global average. Small disposable plastic sachets which contain alcohol or spirits have led to significant alcohol abuse amongst the most vulnerable and poorest communities in Malawi and Uganda, particularly the young. As a result Malawi and Uganda placed national bans on sachets of alcohol in Malawi (2016) and Uganda (2019), but those may not have had the impact anticipated. In March 2019, we organised a workshop with researchers from 6 LMICs including Malawi and Uganda to discuss issues around alcohol consumption and what research could be done to supports effective policies to control the supply of alcohol. The issue of the alcohol sachets and the policies to ban them was raised by Malawi and Uganda colleagues, who felt it was needed to study the implementation of the bans, to compare both countries and to see what lessons could be learnt. Our aims with this study are to understand why the bans were adopted and how they were presented, what mechanisms for implementation were proposed and put in place, how the bans were enforced in practice, and what unintended consequences may have occurred. We will do this through interviews with policy makers and major stakeholders, and also, through interviews with district and local stakeholders in enforcement and trade. We will also conduct focus group discussions with men and women, health staff from local health centres and with traditional/ church leaders and school headteachers, to explore the perceived impact of the ban on harmful forms of alcohol consumption and any unintended consequences of the bans (e.g. increased consumption of home brews). We will also examine perceptions of changes in harmful drinking within the community and amongst young people; and whether local health facility staff have seen changes in terms of addiction and harm at facility level because of the bans. We will share our results with stakeholders at special events in Malawi and Uganda. To achieve our aims we have assembled a team of seven highly experienced researchers from different disciplines (social science, epidemiology, psychology, population, and public health). Four of them are based in Uganda and Malawi where they will lead the research and two in South Africa. We will recruit full-time researchers in Uganda and Malawi to carry out the work and will train them to have the confidence to carry out alcohol research which can influence policy and help reduce alcohol-related harms. We have also assembled an international advisory group with 2 experts from high income countries and 7 from African low and middle income countries networks on alcohol We will work closely with stakeholders in each country and other African and global networks from start to finish, to give them an opportunity to understand our findings in their context, so they can use those findings in policy development, for advocacy, and to support further research.

Context of the research Each year over 30 million pregnancies occur in malaria endemic areas of sub-Saharan Africa. Malaria in pregnancy (MiP) has devastating consequences for the mother and unborn child. The control of malaria in pregnancy in parts of East and southern Africa is under threat. Pregnant women are often infected with malaria without showing any outward signs or symptoms which, if left undetected and untreated, can cause anaemia and interfere with the development of the foetus leading to loss of the pregnancy, or premature birth and low birth weight, which in turn increases the risk of early infant death. The World Health Organisation (WHO) therefore recommends a preventive strategy called 'intermittent preventive treatment in pregnancy' (IPTp) in which mothers receive a single dose of 3 tablets of medication called sulphadoxine-pyrimethamine (SP) at each scheduled antenatal visit starting in the 2nd and 3rd trimester. However, the effectiveness of this strategy is being compromised due to high levels of resistance to SP in the malaria parasite population. The recent search for safe, effective and well-tolerated alternatives drugs has proven elusive because most of the new candidates tested were not tolerated well enough to be used for preventive purposes. Other trials evaluating test and treat strategies have also proven disappointing. All hopes are now pinned on an antimalarial called dihydroartemisinin-piperaquine (DP), which is known to be safe in the 2nd and 3rd trimester of pregnancy and highly effective for treatment of clinical malaria. The high profile journals Lancet and the New England Journal of Medicine recently published the results of two exploratory trials, completed in 2015 (including one by this research team in Kenya). These showed that DP, when taken as IPT by pregnant women, was well tolerated and much more effective than SP in preventing malaria. However these two trials were not big enough to be able to evaluate the impact on the pregnancy outcome and the health of the newborn. WHO reviewed the evidence in July 2015 and concluded that DP is indeed a promising alternative to SP and recommended that a larger, confirmatory, trial is needed, before it can consider whether to recommend this drug as an alternative to SP in areas of high resistance. Study aims and objectives This multi-centre trial will enrol about 3,000 pregnant women in six hospitals in Kenya and Malawi and compare the safety, tolerance and beneficial effects of IPTp with DP to the current strategy with sulphadoxine-pyrimethamine in reducing pregnancy loss, low birthweight, preterm birth and small-for-gestational-age babies, and early infant deaths. The trial will include sub-studies on health economics to determine the cost of the strategy in relation to its benefits, the acceptability of the intervention among pregnant women and health providers, paying particular attention to adherence to the 3-day regimen, and the operational feasibility of implementing the intervention in the routine health system. Potential applications and benefits After a decade of intensive multi-centre trials to find new prevention strategies for malaria in pregnancy, DP has been shortlisted as the only potential alternative to SP for IPTp, but evidence of its benefits on infant outcomes is needed. As an experienced network, specialised in malaria prevention trials in pregnancy, we are in a unique position to address these gaps in an expedited manner. The findings of this new trial will provide the definitive evidence for whether or not this drug should be recommended to replace SP in areas with high levels of resistance by the parasite to SP. A positive result may lead to a direct policy change by the WHO in countries experiencing these levels of parasite resistance, including most countries in East and southern Africa, benefiting women at risk of malaria in these regions resulting in healthier pregnancies and healthier newborns.

Globally, more than a quarter of children under the age of five years are stunted (undernourished). Stunted children experience lifelong problems with their health and are more likely to die early. The time at which an infant transitions from receiving only breastmilk to needing additional foods (complementary feeding) has been shown to be associated with increasing problems with stunting. Currently only 22% of Kenyan and 8% of Malawian children aged 6-23 months receive the minimum acceptable diet, down from 39% (Kenya) and 19% (Malawi) between 2008 and 2014. It is estimated that interventions which promote optimal infant and young child feeding (IYCF) practices could prevent 20% of deaths in under-fives in countries with high levels of child deaths. Approximately one-third of urban residents in low and middle income countries live in slums, with an additional 100,000 moving in daily. Children living in slums are more likely to suffer from under-nutrition than other urban children. Nevertheless the literature tells us that there is a lack of evidence regarding nutrition interventions in slum environments, and almost no evidence regarding the potential for 'nutrition-sensitive' interventions that target the drivers of poor nutrition such as poverty, cultural and social practices, and poor physical environments. Successful design of these types of intervention requires a well-integrated interdisciplinary approach. In addition to nutrition expertise, contributions from other disciplines are needed to understand the cultural, social, physical and economic environments that influence IYCF practices. We therefore propose an interdisciplinary network with the aim to produce evidence to drive future research and inform policies to improve the nutritional status of IYC living in poverty in sub-Saharan African countries (SSA) experiencing rapid urbanisation. The network is led by Loughborough University with Kenyan partners at the African Population and Health Research Centre and Malawian partners at the University of Malawi and The Lilongwe University of Agriculture and Natural Resources as well as UK partners at The Universities of Sheffield and Southampton. The specific network objectives will be to: 1) Prepare a rapid review of evidence documenting interventions for the urban poor to improve the nutrition of IYC in SSA; 2) Convene the first network workshop (to include stakeholders) to firstly guide analysis of existing data sources on this topic, to secondly consider the current evidence base and policies identified in the rapid review and finally to ask key stakeholders to identify highest-ranking evidence/research gaps for improving IYC feeding programmes and policies; 3) Undertake analyses of existing data from demographic and health surveys in sub-Saharan Africa and pre-existing data from slums in Nairobi to explore how the various drivers of IYCF practices are influenced by urbanisation and to consider whether those drivers vary for the urban poor compared to other urban populations; and finally 4) Facilitate end-of-project workshops to develop research proposals informed by evidence from the first three objectives and to present findings of the secondary analysis and discuss these with stakeholders (including Ministries of Health, NGOs, communities) and policy-makers. The network will also foster the development of skills in data analysis and evidence synthesis in early career researchers in the UK, Malawi and Kenya, thus helping to ensure a sustainable group with potential for evolving future leadership. In the longer term we will develop a UK-Africa interdisciplinary network with expertise to support interventions to promote optimal IYCF practices in rapidly urbanising environments. It is envisaged that such interventions will improve the human capital of developing countries by reducing under nutrition, thus promoting optimal cognitive and physical development, and thereby increasing prospects for economic prosperity.

OVERCOME consortium include world-leading organisations to develop state-of-the-art research plan that integrates digital innovations in natural hazard and risk predictions in order to develop intervention strategies for strengthening the resilience of vulnerable communities against climate hazards and health impacts. The partners from the UK, Ghana, Malawi, Mozambique, and Zimbabwe will contribute knowledge and skills in climate and meteorology, hydrology and water resources, flood forecasting, droughts, water quality, epidemiology and public health, smart technologies, data science, environmental science, Water, Sanitation and Hygiene (WASH), risk communication, disaster management, social and policy sciences, and socio-economics. The collaboration will combine multidisciplinary knowledge to develop a novel holistic framework to forecast the impact of floods/droughts and associated disease outbreaks. OVERCOME also has strong support from global experts and local major stakeholders. The external partners will steer research direction throughout the project, contribute their complementary knowledge, and engage the team with additional partners through their strong international networking. OVERCOME will organise a kick-off meeting in one African partner's country to (1) brief our research ideas to the key stakeholders in African countries; (2) allow for all parties involved to learn from each other the capacity that each institution can contribute to the OVERCOME consortium; (3) understand the expectations that the stakeholders have on the project; (4) identify the knowledge gaps in research and the extra expertise required within the consortium. Following the kick-off meeting, the lead partners in Ghana, Malawi, Mozambique and Zimbabwe will further reach out to additional partners in their countries to complement the skills within the consortium. Networking and Capacity Building Workshops (NCBWs) will be organised to incorporate local stakeholders for co-designing research methodology and outcomes to ensure that the project outputs will be adopted by stakeholders for real-world practices to deliver long-term impact to communities. Local Stakeholder Engagement Workshops will be held for local stakeholders to review and feedback on the final second stage proposal. The participants will evaluate the objectives and planned tasks from WGs for shaping research topics to benefit most stakeholders and vulnerable communities. The engagement can also examine and guarantee the feasibility of proposed solutions. We will also synergise with other consortia, projects, and professional groups to further strengthen the consortium, enhance the research vision, collect data for the full research, and widen the impact from the project.

The discovery and development of antibiotics is one of the great scientific achievements of the 20th Century, however it rapidly became clear that bacteria quickly become resistant to these lifesaving agents, and the spread of antibiotic-resistant bacteria is now a problem of global concern. The poorest nations on Earth frequently have the greatest burden of severe and life threatening infections, and these nations are likely to suffer most from the spread of untreatable bacteria. There is much that is unknown about how antibiotic resistance spreads globally and this is particularly true of sub-Saharan Africa, where diagnostic laboratories are not commonly available. The "Drivers of Resistance in Uganda and Malawi" or DRUM Consortium will address how human behaviour and antibacterial usage in the home, around animals and in the wider environment in urban and rural areas of Uganda and Malawi contributes to the spread of antibiotic resistance in bacteria. The consortium is especially interested in the common bacteria E. coli and K. pneumoniae. E. coli is an example of a bacteria that often causes infections in the community, but may also spread around hospitals, whereas K. pneumoniae is a key cause of hospital acquired infections, particularly amongst vulnerable groups such as premature babies. We have chosen to study these bacteria together as they are from the same family and are able to share traits that make them resistant to antibiotics. The DRUM consortium plans to investigate which aspects of behaviour are most important in spreading antibiotic resistance by surveying human behaviour in relation to antibiotics, water, sanitation and hygiene and by investigating bacterial behaviour in response to these stimuli. We plan to use cutting edge mathematical techniques to "model" which behaviours are most important and then use this information to work with policy experts in Uganda and Malawi to design potential interventions to prevent them from spreading further.