Pacific partnerships lead to healthier lives

Long-term partnerships can generate great benefits for communities.

For almost two decades, Murdoch Children's Research Institute (MCRI) researchers have worked closely with the Fiji Ministry of Health and Medical Services to address significant health issues including rheumatic heart disease, scabies, vaccine-preventable diseases and maternal, newborn, child and adolescent health.

In 2019, the close relationship led to a significant breakthrough when MCRI was named one of five winners globally to share in the $50 million Macquarie 50th Anniversary Award. It means an opportunity to drive back scabies for the whole population of Fiji and the Solomon Islands through mass administration of the drug ivermectin.

MCRI's Professor Andrew Steer says that "our research has found that ivermectin is a highly effective community-based treatment. It has been used to treat over 1 billion people for other parasitic infections and is known to be very safe."

"This award recognised the global significance of the partnership's scabies research," says Hon. Dr Ifereimi Waqainabete, the Fijian Minister for Health and Medical Services. "Health research is a key tool to deliver change that positively impacts the lives and health outcomes of our people."

Professor Kim Mulholland of MCRI outlines a long partnership in Fiji, which began with strong leadership from the Fiji Ministry of Health and Medical Services and from clinicians including Dr Lisi Tikoduadua, who recognised the importance of local research to inform health policy and programs.

"20 years of work has made major contributions to the health of Fijians" says Kim.

"Fijian-led health research is critical to overcoming local health challenges," says Andrew.

"The Ministry of Health and Medical Services plays a leading role in defining what the important health issues are for children and adolescents in communities, and how we respond."

The Hon. Dr Ifereimi Waqainabete believes research can "identify the priorities, provide supporting evidence, assist in strengthening health systems, and ensure that we are using our resources in a cost-effective and efficient manner".

Our collaboration has given the Fijian Government confidence to invest in vaccines for diseases such as rotavirus diarrhoea and bacterial pneumonia, which every year are responsible for the deaths of almost half a million children under five.

Our work together has also underpinned Fiji's decision to introduce the HPV vaccine for cervical cancer, which is the country's leading cause of cancer-related deaths.

Global health at MCRI

The need for increasing antimicrobial stewardship

Antimicrobial resistance has been identified by the World Health Organization as one of the top ten threats to global health.

Antimicrobial stewardship – ensuring these vital drugs are used appropriately – is essential to ensure the usefulness of antibiotics into the future. Our partnerships with researchers in low and middle-income countries have revealed this is a growing issue in both Indonesia and Vietnam.

MCRI and University of Melbourne Professor Julie Bines worked with Dr Jarir At Thobari from Universitas Gadjah Mada, Yogyakarta, to evaluate antimicrobial use in infants in Indonesia. They found that, despite the overall low community consumption rate, antibiotic overuse for certain infections offered a major opportunity to develop stewardship programs.

Overuse of antibiotics runs the risk of leading to diseases that evolve resistance to the available antibiotics, making them effectively untreatable.

MCRI's Professor Steve Graham is working closely with Dr Hoang Tran and Dr Phuong Nguyen, senior paediatricians at Da Nang Hospital for Women and Children, to evaluate and address inappropriate antibiotic use in newborns and children in Vietnam.

Phuong's PhD research highlights excessive antibiotic use and unnecessarily high costs of care for children admitted with pneumonia, the most common cause of paediatric hospital admission in Vietnam. She has shown that most paediatricians in Vietnam believe that improved antibiotic stewardship is needed and that over-thecounter antibiotics should be restricted.

What we've learned from medical educators in Laos

Consultant paediatrician and medical educator with the University of Melbourne, MCRI Associate Professor Amy Gray, has sustained a 10-year partnership with the University of Health Sciences (UHS) in Vientiane, Lao PDR, to educate future doctors.

Amy says much has been learned about overcoming the challenges of medical education in resource-limited settings.

"UHS have recognised the need to 'leapfrog' current medical education models and instead adopt a forwardthinking approach to aim for what medical education could look like in Australian institutions five years from now," says Amy.

"For example, potential exists in team-based learning as an educational method, which is feasible in Laos with current staff-to-student ratios.

"With a growing number of medical students seeking online resources, targeted development of multimedia resources and other information-sharing tools such as blogs, offer potential to make content available in a timely way that can be adapted over time."

The Murdoch Children's Research Institute is a signatory to the Australian Council for International Development (ACFID) Code of Conduct. As a signatory, our work is conducted with transparency, accountability and integrity in line with the guidelines and principles of the ACFID Code of Conduct. Further information on the code is available on the ACFID website.