Landmark meningitis studies at MLW defined the high burden and high case fatality rate of cryptococcal and pneumococcal meningitis and the important contribution of group B strepto-coccus to neonatal disease. Subsequent high impact clinical intervention trials have tested adjunctive therapies in bacterial and cryptococcal meningitis and emphasised the impact of early health seeking behaviour, nursing care and appropriate antibiotics – but outcomes remain poor [89]. A trivalent glycoconjugate Group B streptococcal vaccine was evaluated in an early phase study in HIV-infected women confirming immunogenicity. Initial studies of health seek-ing behaviour in meningitis led to subsequent MRF funded work on improving the response to severe illness in children in primary health care systems through use of an Emergency Triage As-sessment and Treatment (ETAT) package using digital health technology. This successful approach is now being rolled out nationally and is included in the new Malawi Essential Health Package.
(PIs: Desmond, Heyderman, Lalloo)