Parasitic and parachute research in global health

We read the Editorial1The Lancet Global HealthClosing the door on parachutes and parasites.Lancet Glob Health. 2018; 6: e593Summary Full Text Full Text PDF PubMed Scopus (36) Google Scholar about parasitic research in The Lancet Global Health with great interest. As a group of malnutrition researchers based in and outside Malawi, we would like to share our journey towards establishing a sustainable programme that builds on local talent and the model we have developed to prevent parasitic research. A long-standing history of malnutrition research at the College of Medicine (CoM), Blantyre, University of Malawi dates back to the 1990s. Research capacity has steadily grown through excellent local leadership from past and present heads of the Department of Paediatrics and Child Health at the CoM and the Department of Paediatrics at the Queen Elizabeth Central Hospital (QECH). This led to an opportunity to further develop a research programme focusing on children admitted to hospital with malnutrition in the past years. Our malnutrition research group now contains stakeholders from the CoM, QECH, and external partners including scientists from the Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, ON, Canada, and from the Global Child Health Group, Emma Children's Hospital/AMC, University of Amsterdam, Amsterdam, Netherlands. These stakeholders meet frequently, with an aim to develop a long-term vision to stimulate and foster nutrition-focused research for children in care at the QECH. These discussions have led to a leadership structure that is formed by established external scientists and talented local scientists, with oversight from leadership at the CoM and QECH. This leadership aims to further develop local talent in bioinformatics, project management, and nutrition. Grant funding is, in part, used to support these talented staff to take specific courses and visit other institutions to develop additional expertise. Malawian students are offered opportunities to participate in research projects, sometimes together with students from external institutions. Overall, participation in our research group has enabled local capacity building of senior team members and sustainable growth of more junior team members. We do not subdivide research projects, and they are often spun into primary and secondary data analysis. All team members should benefit and grow from and within these projects, and local participation is assessed at all levels of each project. This includes planning and writing research proposals and tools, actual data collection, analyses, and, finally, writing manuscripts. Secondary data analysis projects have taken more time to develop because they often use advanced analytical and statistical approaches requiring specialised input. However, where initially local staff played a more supportive role, they are now moving towards taking more leading roles, which has been reflected in authorship positions. Additionally, the overhead of the research funding is deliberately spent at CoM to contribute to local Malawian capacity building. We are now participating in the Childhood Acute Illness and Nutrition Network (CHAIN) and investigating the relation between acute illness over a range of undernutrition. At the onset of CHAIN, we agreed that senior researchers at the Malawi site would take junior researchers under their wings and help them grow through the opportunities of this international research collaboration, with the ultimate goal of developing junior members into independent researchers who are competitive for international grants. Malawian team members are able to visit other sites within the CHAIN network and learn from the knowledge and experience there. They can also complete a Master's or PhD while working within the group. The researchers based outside Malawi are honorary lecturers at the CoM and spend substantial amounts of time doing research and bedside teaching and giving lectures at both the undergraduate and postgraduate level in the department. This means that all those participating in the research have a good and clear understanding of the clinical situation and challenges on the ground. This has not been an easy journey, and continuous commitment and proper communication of all team members is crucial. Challenges include the limited clinical staff in relation to the clinical needs at QECH, thus reducing their capacity to take leading roles in research projects. Talented local researchers are recognised quickly and then pulled in different directions (eg, being asked to serve on committees) and thereby reducing their time to develop research expertise. We have a memorandum of understanding between all group members. On a yearly basis we meet to discuss how the entire research balance has been in the past year and assess any need for adjustment. Through open communication about expectations and deliverables, a focus on local and sustainable capacity building, and a memorandum of understanding, we try to make sure that everyone benefits from being involved in our research group. We hope this will continue for many more years. We declare no competing interests. Closing the door on parachutes and parasitesNo one likes a parachute researcher: the one who drops into a country, makes use of the local infrastructure, personnel, and patients, and then goes home and writes an academic paper for a prestigious journal. At The Lancet Global Health, we look extremely unfavourably on papers submitted by authors who have done primary research in another country (particularly a low-income or middle-income country) but not included any author from that nation. For research involving patient recruitment, treatment in existing facilities, and follow-up, the notion that no locally based individuals made a “substantial contribution” (per authorship criteria) to the acquisition of data is pure fiction. Full-Text PDF Open Access

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