[Project]

Measles is a highly contagious disease and causes a substantial health burden in children. Undernutrition has a profound effect on child growth and immune system development and thus may change measles susceptibility and treatment outcomes. As a socioeconomic indicator, undernutrition was also associated with access to immunisation services. Nevertheless, the role of undernutrition in measles transmission and vaccination has yet to be thoroughly investigated and addressed in modelling research.

This PhD project aims to understand the interplay between measles and undernutrition and assess the potential interventions in at least one setting facing the dual health burden (e.g. Ethiopia), with three proposed objectives:

Objective 1: A literature review will be conducted on (1a) the epidemiological and socioeconomic association between undernutrition and measles, with possible consideration of climate- and/or conflict-related effects, and (1b) current applications of modelling to study the interplay of nutrition and vaccine-preventable diseases. The review will also help identify the relevant data sources and methods to inform the burden estimation and control measures for measles and undernutrition in the selected setting.
Objective 2: The student will then use the findings from the literature review to develop a mechanistic model of measles transmission dynamics and vaccination and incorporate the risk structure of undernutrition into the model. The geographical scope of the model can be regional, national, or subnational, depending on the research questions and data availability. Characterisation of the model will account for multiple types and sources of data, such as demographics, measles serological surveys and surveillance data, and programmatic data on vaccination and nutrition (e.g. coverage in the target populations).
Objective 3: Historically, measles immunisation and vitamin A were provided together to children through mass campaigns, demonstrating the feasibility of integrated programmes. Following stakeholder engagement with both immunisation and nutrition teams in the selected setting, the student will identify potential intervention strategies for measles vaccination and nutrition supplements. The impacts of the nominated strategies on the measles and nutritional outcomes will be assessed using the model developed in objective (2).

The project can be extended to evaluate the cost-effectiveness of potential strategies based on the policy interest and feasibility of collecting cost data. The student will also have an opportunity to engage with the OptiMAx project, which trials the provision of nutrition supplements as an incentive to increase vaccine coverage.

[Particular prior educational requirements for a student undertaking this project]

Essential: Proven experience and training in quantitative methods for health research (e.g. infectious disease modelling).
Essential: Demonstrable proficiency in a programming language (e.g. R).
Desired: Analytical experience in vaccine epidemiology, nutrition and economic evaluation.

[Skills we expect a student to develop/acquire whilst pursuing this project]

Understand the epidemiology of measles and undernutrition.
Develop literature review skills and potentially field experience in data collection.
Appraise and analyse multiple types of data, including serological surveys, disease surveillance, vaccination and nutrition programmes.
Construct a mathematical model for measles transmission and vaccination with the incorporation of the risk structure of undernutrition.
Engage with stakeholders and policy makers on immunisation and nutrition in the local study context.