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"Clinical and public health research to improve maternal, newborn health and to control sexually transmitted infections"

Final Report Summary - MNSIRSES (Clinical and public health research to improve maternal, newborn health and to control sexually transmitted infections)

The overall aim of MNSIRSES has been to establish a long-lasting collaboration between Moroccan, South African and European research teams involved in clinical, epidemiological and public health research. The project, structured in seven work packages (the first and the seventh are crosscutting), had the following specific objectives:
1. To train young researchers in state-of-the-art field research, laboratory techniques, data collection and data analysis as well as understanding different cultural contexts and research conditions
2. To build a network of 'the next generation' young researchers interested in epidemiological and public health research
3. To formulate new collaborative research projects by intensifying research partnerships and networking activities
4. To strengthen the position of each partner in the field of epidemiological and public health research, including research programmes management.
5. To evaluate interventions to improve mothers' and child health
6. To evaluate interventions to improve the control of STIs
7. To evaluate interventions aimed at improving health of the poorest, including access to and utilization of health care services

This project has brought partners together from Europe, Morocco and South Africa that have common research interests but that work in very different settings. Several partners have already been collaborating with each other but mainly on an ad hoc basis and not as a network.
The 4-year exchange programme has consisted of visits of young researchers (PhD candidates, postdocs) and senior researchers from EU partner countries to Morocco and South Africa and vice versa. Exchanges also include management staff.

MNSIRSES has set-up a management structure suited to the size of the project and the partnership (8 partners). This was based on the experience of the partners in previous large collaborative projects and lessons learnt. Several tools have been created to ensure the monitoring and the coordination of the project and between partners.
The MNSIRSES project has provided opportunities to strengthen partnerships between the European and non-European institutions involved, to know more about other organization systems and to find new opportunities for collaboration.
The particular format of this project with exchanges funded but not research itself has proved more challenging than expected, especially for issues that need laboratory work and training. The response, investing structural resources to support this project from a translational perspective, has opened exciting opportunities of collaboration between institutions with ambitious objectives, high likely impact in Moroccan health system, and long-lasting partnerships.

The work about maternal and newborn health research, and the most important (number of secondments and of deliverables), has permitted to afford the issue in a collaborative manner, including physicians, technicians, researchers and civil servants, to reinforce the knowledge, bring tools and recommendations for practitioners and for decision makers. Maternal death surveillance system, maternal morbidity, gestational diabetes, vertical transmission of infections and antibiotic resistance, perinatal network on a university hospital, are some of the subjects treated.

In South Africa, the MNSIRSES grant was able to support success in securing separate funding to test that acceptability and feasibility of adding tests for sexually transmitted infection to a demographic surveillance platform. As part of this process we were able to organise several small training sessions to build laboratory capacity in KZN/SA to conduct Nugent scoring for bacterial vaginosis, syphilis diagnostics. We also secured funding through the Bill and Melinda Gates Foundation to validate the use of HSV2 serology in dry blood spots collected during the demographic surveillance. Significantly the MNSIRSES funded secondments allowed us to build capacity around adolescent sexual health, STI research, and public health research methods including setting up clinical cohorts, conducting population based clinical research and conducting ethnographic research. This has resulted in success in securing grants from a range of funders, including the US National Institute of Health, the Bill and Melinda Gates Foundation; ViiV healthcare; the UK Medical Research Council; and the UK Engineering and Physical Sciences Research Council. The findings have been extensively disseminated nationally and internationally.

Concerning the HPV infection, cervical cancer and breast cancer, in the context of the application of the prevention and control national programme in Morocco, and even with the strategic changes concerning HPV vaccination during this period, the collaboration has permitted to know more about the performance and efficiency of the programme, to contribute to the capacity building concerning cost-effectiveness methodologies and to share other experiences about HPV vaccination introduction.

Antibiotic resistance is an important global public health challenge. It is a complex problem on where coordinated efforts on research located in different geographical areas is clearly needed. Between Morocco and Spain, the interest of collaboration and share of knowledge is evident. Additionally, the joint work on this issue has permitted the training on laboratory techniques and the capacity building of the research laboratory of the CHUIS, which creation was a collaborative project with ISGlobal. The initiative to create a Moroccan antibiotic resistance surveillance network, including a Spanish partner, still requires a long path of intensive networking, searching funds and bringing in key stakeholders, but the first steps are very encouraging.

The objective of the WP6 was to build up knowledge and skills of researchers and policy makers in evaluation of Social Health Protection schemes and on health financing analysis with a special attention to equity concerns, using the RAMED (i.e. the Moroccan medical assistance scheme targeting the poorest and vulnerable groups) as a case study and with reproductive health as "tracer" condition. The intention was to develop collaborative research projects with Moroccan research institutions and the Moroccan administration aiming at improving inclusiveness of the RAMED programme. After a preliminary work on "Informal employment and access to social health protection" (as part of a multi-case study research is sponsored by the Rockefeller Foundation), a first protocol was finalized by ITM and ENSP. This research was abandoned after the departure of the main ITM researcher. In parallel, the second PhD candidate of WP6 started to work on learning organizations and finalized his protocol on the analysis of the change process in the framework of RAMED experience in Morocco and with regard to its potential role in the development of learning health organizations.

The WP7, as WP1, has involved all the partners. The training activities have permitted, particularly to young researchers, to have experiences abroad and to know different cultural contexts and different training and research conditions. With the idea of learning-by-doing, the research activities have resulted of the training ones.

We can underline the publication of more than ten articles and the dissemination of work in international events like the Congress on Tropical Medicine and International Health, 16-20 October 2017, Antwerp (Belgium), the AIDS Impact Conference held in Cape Town (SA), 12th of November - 15th of November 2017) and with the organization of an international Colloquium in Rabat (Morocco), on 24-27 November 2015, leaded by ITM and ENSP.