International Child Health
We address the major treatable and preventable diseases that affect populations in the Asia-Pacific with a focus on equity and the health professionals and systems which deliver care.
Each year, over five million children die from preventable causes in the world, and most of these deaths occur in poor countries and vulnerable populations in the Asia-Pacific and African region.
Our group is working to increase recognition of and improve care for treatable and preventable diseases in newborns, children, and adolescents. To achieve this, we engage with global, regional and national partners across the spectrum, from advocacy and policy development to improved practice and evidence generation.
We support health care providers and researchers in low and middle-income countries, particularly in the Asia-Pacific region, in capacity building through research collaboration and technical assistance.
Our group includes global leaders in the prevention and management of pneumonia, invasive bacterial disease, tuberculosis and newborn care, as well as national leaders in providing immigrant and refugee health care.
Our focus
A major focus is the improvement of standards in facility and community-based care for the management and prevention of common diseases in newborns, children, and adolescents.
Our major impact
- Improving clinical care and outcomes for newborns, infants and children in resource-limited settings through health systems strengthening, education and implementation research.
- Child pneumonia management and oxygen systems strengthening.
- Improving detection, treatment and prevention of tuberculosis.
- Strengthening services for immigrant and refugee health in Australia.
More information
Our projects
Oxygen access and improved oxygen systems
Oxygen therapy is a life-saving therapy that is used for millions of patients every day–from newborns to adults with respiratory distress and pneumonia, for emergency care, perinatal care or anaesthesia. However, many patients in low- and middle-income countries do not receive oxygen when they need it. The COVID pandemic has starkly highlighted the deficiencies and the need. Clinicians and researchers on the Melbourne Children’s campus have been working with partners to address oxygen access for over a decade - in PNG, Laos, and Nigeria - developing and testing strategies to improve oxygen systems and access.
Caring for newborns and babies born too soon
In the Western Pacific, nine in every 1,000 newborns die in their first month of life, and almost two million are born too early. Improving care during birth and after a baby is born can be life-saving. We are implementing Early Essential Newborn Care interventions in countries in the region, such as in the Solomon Islands.
Quality health care and education in Laos
Implementation of evidence-based, quality health care for sick children can significantly improve outcomes and build capacity among health workers in resource-limited settings. Medical education and evaluation of implementation are critical steps in improving quality of care. Since 2015, we have collaborated with paediatricians, WHO, Save the Children, and the Ministry of Health in Laos to improve the quality of care for children. Interventions have focused on district hospitals including: implementation of clinical guidelines; affordable oxygen systems; improved essential newborn care; and development of training and evaluation tools and methods to monitor and report hospital data.
Refugee child health and advocacy
Australia settles 13,750 refugee arrivals each year; more than half are children or young people, with new arrivals from Afghanistan in 2021. There are also many people in Australia seeking asylum, and Australian immigration policy has substantial effects on the health of this group. Our team works across clinical care, education, policy and research in refugee health. Our clinician-researchers are involved in developing guidelines and contributing to policy at the local, state and federal level. Areas of work include immunisation, national refugee health screening guidelines, asylum seeker health, vitamin D deficiency and addressing learning problems in refugee children.
Pneumonia updates
In 2021, led a series of systematic and scoping reviews for WHO that have informed updates for epidemiology and case management as well as identify research needs for pneumonia in children, both young children (<5 years) and school-aged children. Major contribution to update of the Global Action Plan for Pneumonia and Diarrhea.
Child and adolescent tuberculosis
Tuberculosis (TB) is a major infectious disease globally, particularly common in poor and marginalised populations, with most cases occurring in the Asia-Pacific region. TB in children and adolescents is common but neglected. Multi-drug resistant TB is increasingly common. We collaborate with WHO Global TB Program, and research institutions and TB programmes in Asia-Pacific and Africa. Our projects improve the detection, treatment and prevention of TB in children and adolescents, in PNG, Vietnam, Indonesia, Uganda, Mongolia and Laos. We play a leading role in advocacy and translation to address the wide policy-practice gap and develop child-friendly treatments. Co-chaired update of WHO guidelines in 2021.
Community-based detect-treat-prevent tuberculosis elimination strategy
Leading projects that implement, strengthen and evaluate impact of decentralised and community-based activities for the detection and treatment of TB and MDR TB in communities, and preventive treatment strategies that protect at-risk individuals from disease and have potential to reduce ongoing community transmission. Projects in Mongolia funded by John Burge Trust, Uganda in collaboration with The Union and CDC, PNG and Indonesia with funding and collaborations from NHMRC, Indo-Pacific Centre for Health Security and MRFF, Burnet Institute, Kirby Institute and with TB Centre of Research Excellence at the University of Sydney and Centenary Institute.
Strengthening TB services for children and adolescents in Victoria
Leading projects that have introduced new strategies to strengthen and evaluate the impact of health services in Victoria for the detection and treatment of TB in children and adolescents.
Child health in PNG and Solomon Islands
Multiple projects building capacity in research, public health, clinical care, and leadership in PNG - through grants and technical support to enable fellows to research priority areas of child health, take part in continuing professional development and develop health policy. The program has supported in PNG: training of over 50 paediatricians, the PNG National Child and Adolescent Health Plan (2021-2030), a national surveillance system for paediatric illnesses, publication of annual reports of Child Morbidity and Mortality, training of 300 nurses and other health care workers in hospital care for children; plus support to a newly established child health nursing course in Solomon Islands.
Global childhood cancer systems
As child mortality from infections and newborn conditions fall, countries face the challenge of rising morbidity and mortality from childhood cancer. Diagnosing and treating cancer is often viewed as expensive. Yet cost-effective approaches to building child cancer services exist. Our project explores current strategies for childhood cancer workforce development and potential future solutions to this growing need.
Funding
- National Health and Medical Research Council (NHMRC)
- Medical Research Future Fund (MRFF)
- John Burge Trust
- Save the Children
- Unicef
- European & Developing Countries Clinical Trials Partnership (EDCTP)
- Grand Challenges Canada
- Indo-Pacific Centre for Health Security
- Department of Health, Victoria
Collaborations
UN agencies
- WHO Geneva
- WHO SEARO
- WHO WPRO
- UNICEF
- Unitaid
Academic
- University of Sydney
- Menzies School of Health Research
- University of PNG
- Universitas Gadjah Mada
- University of Health Sciences Lao PDR
- University of Ibadan / University College Hospital Ibadan
- University College London
- Johns Hopkins University
- University of Munich
- University of Bordeaux
- University of Stellenbosch
- Karolinska Institute
- Makarere University
- University of Tasmania
National Institutions
- NCDC Mongolia
- Woolcock Institute Viet Nam
- NTLP Uganda
- Burnet Institute
- Kirby Institute
- icddr’b Bangladesh
- NTP PNG
- IMR PNG
NGOs
- Save the Children UK/Nigeria/Australia
- Clinton Health Access Initiative (CHAI)
- International Union Against TB and Lung Disease (The Union)
- EGPAF
- Mongolian Coalition Against Tuberculosis
Government
- Department of Health, Victoria
- DFAT
Other
- Asian Development Bank
Featured publications
- Impact of systematic tuberculosis detection on mortality in young children with severe pneumonia in high tuberculosis incidence countries – a stepped wedge cluster randomized trial. Marcy O, et al, for the TB-Speed Pneumonia study group. Lancet Infect Dis 2023; 38: 341-351
- Quality of inpatient paediatric and newborn care in district hospitals: WHO indicators, measurement, and improvement. English M, Aluvaala J, Maina M, Duke T, Irimu G. Lancet Glob Health 2023; 11: e1114-e1119
- Health of children who experienced Australian immigration detention. Tosif S, Graham H, Kiang K, Laemmle-Ruff I, Heenan R, Smith A, Volkman T, Connell T, Paxton G. PLoS One 2023; 18: e0282798
- Shorter treatment for non-severe tuberculosis in African and Indian children. Turkova A, et al, and the SHINE Trial Team. N Engl J Med 2022; 386: 911-922
- Cost-effectiveness and sustainability of improved hospital oxygen systems in Nigeria. Graham HR, Bakare AA, Ayede AI, Eleyinmi J, Olatunde O, Bakare OR, Edunwale B, Neal EFG, Qazi S, McPake B, Peel D, Gray AZ, Duke T, Falade AG. BMJ Glob Health 2022; 7: e009278
- Implementation of an effective decentralized program for detection, treatment and prevention of tuberculosis in children. Dongo JP, Graham SM, et al. Trop Med Infect Dis 2021; 6:131
- Implementation lessons from a multifaceted national newborn program in Solomon Islands: a mixed-methods study. Tosif S, Jatobatu A, Maepioh A, Gray A, Gilbert K, Hodgson J, Duke T. Am J Trop Med Hyg 2020; 102: 667-75
- Oxygen systems to improve clinical care and outcomes for children and neonates: A stepped-wedge cluster-randomised trial in Nigeria. Graham HR, Bakare AA, Ayede AI, Gray AZ, McPake B, Peel D, Olatinwo O, Oyewole OB, Neal EFG, Nguyen CD, Qazi SA, Izadnegahdar R, Carlin JB, Falade AG, Duke T. PLoS Med 2019; 16: e1002951
- Improved oxygen systems in district hospitals in Lao PDR: a prospective field trial of the impact on outcomes for childhood pneumonia and equipment sustainability. Gray AZ, Morpeth M, Duke T, Peel D, Winter C, Satvady M, Sisouk K, Prasithideth B, Detleuxay K. BMJ Paediatr Open 2017; 1: e000083
- A qualitative study of provider perceptions of influences on uptake of pediatric hospital guidelines in Lao PDR. Gray AZ, Soukaloun D, Soumphonphakdy B. Am J Trop Med Hyg 2017; 97: 602-610