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- Institute for Global Health
- Faculty of Pop Health Sciences
As a medical officer in a remote rural district of Nepal, leading a public health programme for mothers and children in a population of 300,000, I addressed the problems of mothers and children in the developing world. In 1989 a research fellowship allowed me to study diagnostics for childhood tuberculosis with Professor Graham Rook and Professor John Stanford at UCL.
From 1990, as a senior lecturer in international child health at ICH, my collaboration in Nepal with Professor Dharma Manandhar began. We founded MIRA (Mother and Infant Research Activities), which is now the largest health research organisation in the country, employing, at one time, up to 800 field staff. Our first studies were hospital-based, focusing on the epidemiology of common and preventable newborn problems, such as the epidemiology of birth asphyxia and the effects of low birth weight.
In 1995 our randomised controlled trial of conventional health education aimed at postnatal mothers demonstrated surprisingly little impact on behavioural and health outcomes. So we tested a peer education approach using women’s groups, through another trial in remote mountainous populations. Larger than expected benefits of this intervention on both neonatal and maternal mortality raised many questions about international policy for maternal and child health. Published in the Lancet in 2004, the paper emphasised the importance of community participation in the amplification of behavioural change in poor populations.
Since 2002, supported by DFID and a Wellcome Trust Strategic Award, we have established six new trials of women’s groups and other low cost interventions in southern Nepal, Bangladesh, and east India where tribal populations are predominant, in urban slums in Mumbai, and in central Malawi. Our trial in a tribal population of 230,000 in east India, published in the Lancet in 2010, showed a 45% reduction in newborn mortality and a 57% reduction in maternal depression. We have also conducted multiple micronutrient trials in pregnancy in southern Nepal showing effects on birth weight, blood pressure and childhood nutrition. A meta-analysis of the 7 trials published in the Lancet in May 2013 showed that maternal mortality was halved and newborn mortality cut by one third in populations where >30% of pregnant women joined the women's group programme.
This portfolio of trials has established surveillance systems for maternal and newborn mortality covering a combined population of more than 2 million worldwide. The studies have enabled us to examine prospective maternal and infant mortality rates, risk factors and social determinants of ill health and death.
Quality of care is a new priority. In the Lancet we reported modelling of the impact of new strategies to deliver life-saving drugs to women in Africa, with a new strategy recommendation about how to reduce deaths from sepsis and haemorrhage. Several other trials of community interventions are ongoing which focus on survival and nutrition. We are exploring new approaches to integrated development which look at health, nutrition and environmental outcomes such as ecosystems and agricultural yields.
Anthony Costello is Professor of International Child Health and Director of the UCL Institute for Global Health. He trained as a paediatrician and has expertise in maternal and child health epidemiology and programmes in developing countries. He contributes papers on paediatrics, maternal health, health economics, health systems, child development, nutrition and infectious disease.
His areas of scientific expertise include the evaluation of community interventions on maternal and newborn mortality, community mobilisation through women's groups, the cost-effectiveness of interventions, community and social life saving treatments for maternal and newborn mortality in the poorest populations, and links between sustainable livelihoods and nutrition. He is currently exploring the health effects of climate change in south Asia and Africa.
Board member, Global Partnership for Maternal, Newborn and Child Heath
Mentor, Academy of Medical Sciences
International Advisory Board, The Lancet
Chair, UCL Lancet commission on managing the health effects of climate change.
Board member, Wellcome Bloomsbury Centre for Tropical Medicine
Founder and former Executive Director, Women and Children First
Founder and co-ordinator of partnerships with universities and institutes in Nepal, India, Bangladesh, and Malawi providing surveillance in populations covering up to 3 million.
Director, Towards 4plus5 consortium for achieving the Millennium Development Goals for mothers and children. Investigator on the Evidence for Action programme to reduce maternal and newborn mortality in six African countries.
Director, Wellcome Trust Strategic Award for Population Science in India, Bangladesh, Nepal and Malawi
Director (1995-2010) of three UK Department for Inetrnational Development Research Programme Consortia covering Nepal, India, Pakistan, Bangladesh, Malawi, Burkina Faso, Ghana and Tanzania
Vice President, Royal Society of Tropical Medicine and Hygiene (2009)
Board, Bill and Melinda Gates Foundation Saving Newborn Lives (up to 2006)
Consultant or facilitator to the World Bank, UNDP, UNFPA, USAID, DFID, WHO, Unicef, Medical Research Council, Save the children, UBS Foundation, the Big Lottery, the Health Foundation.
Board chair of Masters programmes in child health and global health and development, ICH and UCL
With my superb team of colleagues, led by our education director, Mike Rowson, based at the Institute of Child Health, we have developed a new and highly successful Masters programme in Global Health and Development which provides a truly multi-faculty curriculum, and attracts 80 or more students per year. For twenty years I have been a major contributor to the Masters in international child health, initially as course director.
In 2006 we took over the highly successful BSc in international health for medical students, which had been pioneered by Professor John Yudkin. The course has remained popular and been replicated by five other UK universities.
I have made contributions to undergraduate and postgraduate courses at the universities of Oxford and Cambridge and ten other British universities or medical schools, Trinity CollegeDublin, Johns Hopkins University, Swiss Tropical Medicine Institute, University of Lund (Sweden), Kathmandu Medical College (Nepal), Dhaka Medical College(India), and Ibrahim Medical College (Bangladesh).
Guest plenary lectures or keynote talks for numerous Government departments, international charities, academic and medical conferences throughout the world, including in Bangladesh, Germany, India, Malawi, Nepal, Netherlands, Nigeria, Pakistan, Saudi Arabia, Tanzania, USA, Yemen.
|1980||MRCP||Member of the Royal College of Physicians – Clinical Medicine||Royal College of Physicians|
|1978||MB.ChB||Bachelor of Medicine, Bachelor of Surgery – Clinical Medicine||To be updated|
|1975||BA||Bachelor of Arts||To be updated|