Gender & health Group: previous projects

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Tuberculosis and Equity

TB REACH 2010-13:

Innovative community-based approaches for enhanced tuberculosis case finding and treatment outcome in Southern Ethiopia


Funded by the WHO’s Stop TB Partnership, the objective of the TB REACH programme is to promote early and increased case detection of tuberculosis (TB) cases and ensure their timely treatment, while maintaining high cure rates within the national TB programmes. TB REACH focuses on using ground-breaking approaches and activities in reaching people who are poor, vulnerable or have limited access to TB services. This collaborative implementation project was conceived by Dr. Mohammed Yassin (Global Fund to Fight AIDS, Tuberculosis and Malaria and honorary research fellow at LSTM) who designed it with Dr. Daniel Datiko (TB REACH project, Ethiopia/LSTM), Prof Luis Cuevas (LSTM) and Dr. Sally Theobald (LSTM). The project is managed in Ethiopia by Field Director Dr. Daniel Datiko and team.The initial grant of US$689,163 was awarded in 2010-11, and additional funds of US$ 654,722 and US$ 999,000 were secured to refine activities and explore potential for scale up in 2012 and 2013.

Ethiopia has the 7th highest TB burden in the world. Geographical and socio-economic and cultural barriers restrict access to TB diagnosis and treatment and mean TB notification rates in Ethiopia remain low despite decentralization of the DOTS programme. The project is based in Sidama Zone in the Southern Nations, Nationalities and Peoples Region in collaboration with the TB control programme. The aim is to improve TB case-detection and treatment outcomes in vulnerable groups, particularly women, children, the elderly and disabled. This is a community-based approach that has engaged locally deployed female Health Extension Workers (HEWs). The HEWs are employees of the Ministry of Health, live in the villages where they work, and are thus part of and accepted by the community and familiar with the local culture. 

In year 1 HEWs working in 524 villages and over 300 staff from health facilities were trained. Individuals with symptoms of TB are identified by HEWs through house-to-house visits and outreach activities, they collect sputum, prepare smears and liaise with supervisors using mobile phones. . One supervisor with a motorbike is deployed in each of the districts to collect and submit slides to laboratories and feedback results, initiate treatment for smear-positive cases in their residence and screen contacts. In year 2 the diagnostic process is being strengthened by introducing LED Fluorescent microscopes and the automated nucleic acid test (Xpert® MTB/RIF) for smear-negative patients with a high risk of having active TB (such as HIV co-infected individuals and children). In year 3 the intervention is being scaled up to cover a much larger population of 7 million. The innovative community-based approach is supported by key stakeholders in the region; it brings services closer to communities and in year 1 smear-positive case notification almost doubled. 

For further information please contact: 
Dr. Mohammed Yassin 
Dr. Sally Theobald 

TB REACH 2010-11:

Increased detection of children, women and elderly individuals with smear-positive TB in Yemen

Funded by the WHO’s Stop TB Partnership, the objective of the TB REACH programme is to promote early and increased case detection of tuberculosis (TB) cases and ensure their timely treatment, while maintaining high cure rates within the national TB programmes. TB REACH focuses on using ground-breaking approaches and activities in reaching people who are poor, vulnerable or have limited access to TB services. This collaborative project is led by Najla Al-Sonbuli (Sana’a University, Yemen) and Sally Theobald (LSTM) with Nasher Al-Aghbari (Sana’a University, Yemen) and Luis Cuevas (LSTM). A grant of US$ 287,621 was awarded to fund activities from 2011-12.

The aim of this project is to facilitate access to TB diagnostic services and increase TB case detection rate among vulnerable groups (women, children and the elderly). Service providers report a higher proportion of males than females attending diagnostic services and programme experience shows that Yemeni women face many gender-specific barriers to TB diagnosis and care. In Yemen very few children are diagnosed as having TB and the vast majority of these are not confirmed by laboratory tests and those who are diagnosed have a much lower treatment completion rate. Local customs require women to ask permission from their husbands to seek medical care and to visit these services in the company of a male or elderly person, therefore women and children may have more opportunity to be diagnosed if the diagnosis were made at home. 

This project has attempted to access vulnerable groups by conducting home visits and increase the acceptability of the service by accelerating the diagnosis of TB by collecting at least two sputum samples from women and elderly household members at a single visit. This will facilitate early and swift diagnosis. In addition TB case detection rates of children may be improved by optimization of the collection of samples for smear microscopy by collecting multiple specimens from different anatomical sites in a single day. Paediatric adherence is encouraged by prompting parents/guardians to offer medication to their children via mobile phone. Political crisis in Yemen for much of 2011 have necessitated a responsive approach to daily challenges, for example, when home visits cannot be made, household contacts of TB patients are offered subsidized transport to attend the hospital for diagnosis.

For further information please contact: 

Dr. Najla Al-Sonboli 
Dr. Sally Theobald 

ESRC DFID 2008-12: 

Identifying barriers to TB diagnosis and treatment under a new rapid diagnostic scheme

Award dates: May 2008 – November 2011, with no cost extension to October 2012.

Summary of research project:

The purpose of this study is to identify barriers to Tuberculosis (TB) treatment uptake and strengthen the evidence that accelerated diagnostic schemes lead to increased access to treatment in high incidence countries. The study is taking place in Ethiopia, Yemen and Nigeria. In these contexts, TB has a high incidence and many patients abandon the diagnostic process and fail to initiate treatment.

The Special Programme for Research in Tropical Diseases of the World Health Organisation (TDR-WHO) has sponsored several studies in these settings aiming to optimise smear microscopy. These and other studies have led to the endorsement by WHO in 2011 of a revised smear microscopy scheme in high TB burden settings.

The current study was designed to be embedded within the TDR-WHO-sponsored studies and aims to describe the interplay of non-clinical barriers preventing patients from completing the diagnostic process and taking up treatment once the new diagnostic schemes become operational. The specific aims are to:

  1. Identify barriers preventing adults from completing the diagnostic process for TB when examined through the new accelerated schemes.
  2.  Establish whether these accelerated schemes result in an increased uptake of TB treatment.
  3.  Identify changes required by health services to address these barriers.

For further information please contact:

Sally Theobald
Luis Cuevas


Gender equity, sexual reproductive health and rights

EU 5P7 2011-14:

Maternal health in India: Evaluating demand side financing to improve delivery care access (MATIND),

MATIND is an impact evaluation of two large-scale state programmes focused on reducing maternal mortality in India. Funded under the EC FP7 programme, it will run from 2011 – 2014. The purpose of both these state run programmes, operating in two large Indian provinces, is to reduce maternal deaths, by promoting institutional delivery, and by reducing access barriers to maternal healthcare for poor women. Each programme operates through the use of different innovative demand-side financing mechanisms, which are specifically aimed at improving access for vulnerable groups. While both programmes are based on similar concepts - i.e. financial incentives for the provision and utilisation of care and the participation of the private sector – there are major differences in the socioeconomic contexts in which each programme operates, including financing mechanisms, provider payment models and incentives, amounts of financial assistance, and levels of private sector involvement, all of which will have a bearing on desired maternal health outcomes. The project aims to conduct a comparative analysis of these programmes, taking these differences into account, and also to indirectly compare them with programmes to improve financial access to institutional delivery care in China. The project is led by the Karolinska Institute, Sweden in partnership with: LSTM; the Indian Institute of Public Health in Ahmedabad, India and RD Gardi Medical College in Ujjain, India. 

For further information please contact:

Rachel Tolhurst
Helen Smith
Joanna Raven
Kate Jehan

UNICEF, 2011:

Literature review on gender and child survival

The UNICEF-commissioned report “Gender influences on child survival, health and nutrition: a narrative review” and the accompanying “Guidance on methodologies for researching gender influences on child survival, health and nutrition“ focus on a range of questions exploring how gender influences household dynamics in relation to aspects of young child health and nutrition. These documents were commissioned following the publication of UNICEF’s operational guidance on gender analysis and programming on the Focus Area of Young Child Survival and Development (published in 2011). The development of the operational guidance drew attention to the limited availability of data on the impact of gender on child survival outcomes and highlighted a need for more tools to conduct quality gender analyses. Thus, the literature review provides a systematic overview of the available research on gender influences on child survival, health and nutrition, while the accompanying Guidance identifies and explains the relevant methodologies and tools for undertaking such research.

For further information please contact:

Esther Richards
Rachel Tolhurst

UNAIDS, 2011-12:

Exploring the role of structural drivers of HIV on women and men over 50 in Uganda: A gender analysis 


The UNAIDS-funded research project “Exploring the role of structural drivers of HIV on women and men aged 50 and over in Uganda: A gender analysis” is a small, exploratory study with the aim of generating evidence on aspects of older people’s experiences of HIV in Uganda. There has been very limited work on understanding the role of structural drivers in shaping both vulnerabilities of the over 50s to HIV and its impact on the lives, wellbeing and livelihoods of older people. Through in-depth interviews and focus group discussions the study will explore structural drivers mediating older women and men’s individual risk of HIV and their access to and experiences of HIV services. The study will involve key stakeholders at each stage of the research process and will produce a number of outputs to appropriately maximise the dissemination of the findings. The study is undertaken in collaboration between MRC Uganda (Janet Seeley and Flavia Zalwango) and LSTM (Sally Theobald and Esther Richards).

For further information from LSTM please contact

Esther Richards
Sally Theobald

DFID 2009-11:

Strengthening the research to policy and practice interface: Exploring strategies used by research organisations working on Sexual and Reproductive Health and HIV and AIDS,

The mechanisms for getting research into policy and practice are receiving and increasing attention from health researchers and donors. A meeting to exchange learning adn communication research findings for policy and practice took place at LSTM in May 2009, this culminated in the publication of a supllement on Health Research Policy and Systems Journal in 2011. The supplement draws on the work of the Sexual Health HIV Evidence into Practice (SHHEP) initiative Funded by DFID. SHHEP is a collaboration across four DFID Research Programme Consortia (RPC) that undertake research and action on HIV and Sexual and Reproductive Health in resource poor contexts. The group has formulated a range of targeted mechanisms to communicate health research to different audiences and were finalists for the British Medical Journal 2010 Getting Research into Practice prize. The supplement was funded by DFID with additional financial contributions from Boehringer Ingelheim GmBH, and Merck Sharp & Dohme Corp (total £19,260) 

The supplement’s papers fit in to four themes (1) The theory and practice of research engagement (two global papers); (2) Applying policy analysis to explore the role of research evidence in sexual and reproductive health (SRH and HIV/AIDS policy (two papers with examples from Ghana, Malawi, Uganda and Zambia); (3) Strategies and methodologies for engagement (five papers on Kenya, South Africa, Ghana, Tanzania and Swaziland respectively); (4) Advocacy and engagement to influence attitudes on controversial elements of sexual health (two papers, Bangladesh and global); and (5) Institutional approaches to inter-sectoral engagement for action and strengthening research communications (two papers, Ghana and global). The supplement is open access and all 15 papers are available from

For further information contact:

Sally Theobald 
Olivia Tulloch


UNICEF, Malawi, 2011-12:

'Assessment of the Capacity of the Health Sector to respond to Violence Against Women and Children in Malawi’


UNICEF has commissioned an “Assessment of the capacity of the health sector to respond to violence against women and children in Malawi” to learn more about the health sector’s capacity to respond to the serious nature of violence towards women and children in Malawi. A comprehensive review of the policy and legislative environment in Malawi as well as available literature is combined with primary research data from health facilities, NGOs and government offices. The mixed methods study maps services and organizations working in Malawi on violence against women and children; interviews service providers and key stakeholders from the health and other sectors and includes a case study of one referral hospital to understand the type of violence that reaches hospitals. Outputs will include a final report and a workshop to be held in Malawi and which will bring together key stakeholders working in the area of violence in order to improve mutual learning and action on the health sector’s response to this important issue.


For further information contact:

Miriam Taegtmeyer
Esther Richards