Karin's dissertation made the WHO change its recommendation

Child deaths from malaria, pneumonia and diarrhoea have dropped by ten per cent in Uganda over the past 15 years, a trend that most likely owes a great deal to the research collaboration between Karolinska Institutet and Makerere University.

When Karin Källander travelled to the Ugandan capital of Kampala in 2002 as an early doctoral student in the newly initiated Karolinska Institutet–Makerere University collaboration, she had no idea she would eventually spend eleven years in the country, seven of them full time. Nor did she know that she would get to know 65 villages, or that her thesis would make the World Health Organization (WHO) change its recommendation for how locally trained healthcare providers examine and treat feverish children.

She was equally unaware that her closest student colleague, Jesca Nsungwa-Sabiiti, would rise to become a senior official for child health in the country’s health ministry. After her PhD, Karin Källander was made principal investigator at a populationbased research station in eastern Uganda that centred on the study of health and demography. “All the studies we have done at the Iganga research station are based on how we can improve healthcare given the resources available and the general situation there,” she says. “There is not always access to roads and ambulances, so we’ve been working a lot with village health teams to help them learn to diagnose communicable diseases in children and treat them with effective drugs.” 

When Dr Källander arrived in Uganda, the policy was to treat all feverish children with malaria pills. The problem was that pneumonia and diarrhoea, which show the same symptoms as malaria, claim many children’s lives if not treated properly. This is something she wanted to investigate. Child deaths from malaria, pneumonia and diarrhoea have dropped by ten per cent in Uganda over the past 15 years, a trend that most likely owes a great deal to the research collaboration between Karolinska Institutet and Makerere University.

This project, which is financed by SIDA, is one of Karolinska Institutet’s largest international partnerships. Karin Källander, her field assistant Merton Murombe and village health worker Lina Alberto, who has been trained to treat feverish children through one of Karolinska Institutet’s international research projects. “My thesis gave Uganda the evidence it needed to revise its programme for treating childhood fever,” she says. “They now also look for symptoms of pneumonia and diarrhoea every time a child comes down with a fever.” 

To do this, the health workers use a manual that guides them step by step on how to examine the symptoms of each disease. One step involves counting the breaths the children take in one minute. If the number exceeds a certain threshold,  the child, who otherwise would not have been treated for pneumonia, is given the treatment he or she needs – in a timely manner. “It’s been proven that children are getting the right treatment much earlier than before, and that’s fantastic,” she says. 

“For many children, it could mean the difference between life and death.” The WHO has also changed its recommendation on this count, and now over 40 countries in the world are advised to look for symptoms of all three diseases.

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