Bio

Bio Dr Jacquie Oliwa

I am a paediatrician, clinical epidemiologist/research fellow and a lecturer in the Department of Paediatrics and Child Health. I am currently involved in health systems research. I have a keen interest around child lung health, infectious diseases and quality of health care. I was co-investigator in a randomised control trial on treatment of severe pneumonia in children and an observational study on optimising diagnosis of tuberculosis in children.

Publications


2016

  2016.  Better Outcomes through Learning, Data, Engagement, and Research (BOLDER) – a system for improving evidence and clinical practice in low and middle income countries. AbstractWebsite

Despite the many thousands of research studies published every year,
evidence for making clinical decisions is often lacking. The main problem is that
the evidence available is generated in conditions very different from those that
prevail in routine clinical practice and with patients who are different. This is
particularly a problem for low and middle income countries as most evidence is
generated in high income countries.
A group of clinicians, researchers, and policy makers met at Bellagio in Italy to
consider how more relevant evidence might be generated. One answer is to
conduct more pragmatic trials—those undertaken in routine clinical practice.
The group thought that this might best be achieved by developing “learning
health systems” in low and middle income countries.
Learning health systems develop in communities that include clinicians,
patients, researchers, improvement specialists, information technology
specialists, managers, and policy makers and have a governance system that
gives a voice to all those in the community. The systems focus on improving
outcomes for patients, use a common dataset, and promote quality
improvement and pragmatic research. Plans have been developed to create at
least two learning systems in Africa.

English, M, Grace Irimu, R W Nduati, Agweyu A, Gathara D, Oliwa J, Ayieko P, Were F, Paton C, Tunis S, Forrest CB.  2016.  Building Learning Health Systems to Accelerate Research and Improve Outcomes of Clinical Care in Low- and Middle-Income Countries., 2016 Apr. PLoS medicine. 13(4):e1001991. AbstractWebsite

Mike English and colleagues argue that as efforts are made towards achieving universal health coverage it is also important to build capacity to develop regionally relevant evidence to improve healthcare.

2015

Agweyu, A, Gathara D, Oliwa J, Muinga N, Edwards T, Allen E, Maleche-Obimbo E, English M.  2015.  Oral amoxicillin versus benzyl penicillin for severe pneumonia among kenyan children: a pragmatic randomized controlled noninferiority trial., 2015 Apr 15. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 60(8):1216-24. Abstract

There are concerns that the evidence from studies showing noninferiority of oral amoxicillin to benzyl penicillin for severe pneumonia may not be generalizable to high-mortality settings.

Oliwa, JN, Karumbi JM, Marais BJ, Madhi SA, Graham SM.  2015.  Tuberculosis as a cause or comorbidity of childhood pneumonia in tuberculosis-endemic areas: a systematic review., 2015 Mar. The Lancet. Respiratory medicine. 3(3):235-43. Abstract

Pneumonia is a major cause of morbidity and mortality in infants and children worldwide, with most cases occurring in tuberculosis-endemic settings. Studies have emphasised the potential importance of Mycobacterium tuberculosis in acute severe pneumonia in children as a primary cause or underlying comorbidity, further emphasised by the changing aetiological range with rollout of bacterial conjugate vaccines in high mortality settings. We systematically reviewed clinical and autopsy studies done in tuberculosis-endemic settings that enrolled at least 100 children aged younger than 5 years with severe pneumonia, and that prospectively included a diagnostic approach to tuberculosis in all study participants. We noted substantial heterogeneity between studies in terms of study population and diagnostic methods. Of the 3644 patients who had culture of respiratory specimens for M tuberculosis undertaken, 275 (7·5%) were culture positive, and an acute presentation was common. Inpatient case-fatality rate for pneumonia associated with tuberculosis ranged from 4% to 21% in the four clinical studies that reported pathogen-related outcomes. Prospective studies are needed in high tuberculosis-burden settings to address whether tuberculosis is a cause or comorbidity of childhood acute severe pneumonia.

Oliwa, JN, Marais BJ.  2015.  Vaccines to prevent pneumonia in children–a developing country perspective. AbstractWebsite

Pneumonia accounted for 15% of the 6.3 million deaths among children younger than five years in 2013, a total of approximately 935,000 deaths worldwide. Routine vaccination against common childhood illnesses has been identified as one of the most cost-effective strategies to prevent death from pneumonia.

Vaccine-preventable or potentially preventable diseases commonly linked with respiratory tract infections include Streptococcus pneumoniae, Haemophilus influenza type-b (Hib), pertussis, influenza, measles, and tuberculosis. Although here have been great strides in the development and administration of effective vaccines, the countries that carry the largest disease burdens still struggle to vaccinate their children and newer conjugated vaccines remain out of reach for many.
The Global Vaccine Action Plan (GVAP) has identified priority areas for innovation in research in all aspects of immunization development and delivery to ensure equitable access to vaccines for all.

2013

  2013.  Module 4: Management of common conditions that may lead to altered consciousness in children. Emergency Triage Assessment and Treatment - Plus (ETAT+) Modules For Participants. , Nairobi: Kenya Paediatrics Associationetat_module_for_distance_learners.pdf

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