̽��ֱ�� of Cambridge - Department for International Development (DFID)

Antiretroviral therapy fails to treat one-third of HIV patients in Malawi hospital

Anonymous — Thu, 03 Sep 2020 11:37:55 +0000

̽��ֱ��observational study involving more than 1,300 people was led by the London School of Hygiene & Tropical Medicine (LSHTM), ̽��ֱ�� of Malawi College of Medicine and ̽��ֱ�� of Cambridge.

It found most patients admitted to hospital knew their HIV status, and that 90% were taking antiretroviral therapy. However, approximately one-third of patients established on HIV treatment had significant levels of HIV in their blood, and more than 80% of these patients had resistance to two or more of their HIV antiretroviral drugs.

Patients with multidrug resistant HIV were 70% more likely to die within two months of being admitted to hospital than those without drug resistance.

This is the first study reporting such data in hospitalised patients, as access to HIV drug resistance testing is not widely available in high-HIV-burden African settings.

Dr Ankur Gupta-Wright from LSHTM and project lead said: “There has been an unprecedented scale-up of antiretroviral therapy in high-HIV prevalence settings in sub-Saharan Africa. However, HIV remains a common cause of admission to hospital, with a high risk of death. Our results show drug resistance is an important cause.”

Distinguishing HIV drug resistance from alternative explanations for progressive illness whilst taking antiretroviral (HIV) treatment, such as patients not sticking to required dosage or stopping treatment altogether, is not usually possible. Patients who develop advanced HIV while established on ART often go undetected.

Most available data on HIV drug resistance come from outpatient clinics, where failing HIV treatment is much less common. However, hospitalised patients represent a key target group for intensified interventions, given their relatively high risks of treatment failure, advanced immunosuppression, and high short-term mortality.

This study was based on patients living with HIV who were admitted to hospital in Zomba, southern Malawi. Samples were collected at the time of hospital admission to test for the amount of HIV virus in the blood, to see if patients were responding to their HIV antiretroviral medication.

By sequencing the virus and looking for mutations, patients with high levels of HIV in their blood were tested for resistance to HIV drugs. After two months, the team compared whether patients failing ART and/or with HIV drug resistance were more likely to die.

Of 237 patients with HIV drug resistance results available, 195 (82%) had resistance to lamivudine, 128 (54%) to tenofovir, and 219 (92%) to efavirenz (all first-line drugs used to treat HIV at the time of the study).

Dr Gupta-Wright said: “These are worrying results. ART changes and saves lives, but drug resistance is threatening this progress. Timely diagnosis and management of ART failure and drug resistance in this patient population could improve individual patient outcomes and contribute to the UNAIDS 95-95-95 targets set for 2030. Rapid HIV-1 viral load tests for hospital inpatients need to be implemented, so results are available quickly and patients can be switched to alterative antiretroviral therapy.

“This could potentially save the lives of many patients living with HIV on treatment who are admitted to hospital.”

Professor Ravi Gupta, from Cambridge ̽��ֱ�� and senior author on the study said: ‘’These important findings highlight the threat posed by drug resistant HIV and call for rapid tests for drug resistant virus that could aid in determining treatments and interventions for patients in hospital.’’

̽��ֱ��authors acknowledge limitations of this study including the introduction of a new antiretroviral drug in Malawi last year called Dolutegravir, which may overcome some of the resistance found in this study.

̽��ֱ��study was funded by the Joint Global Health Trials Scheme of the Medical Research Council, UK Department for International Development, and Wellcome.

Reference
Gupta-Wright, A, et al. Virological failure, HIV-1 drug resistance, and early mortality in adults admitted to hospital in Malawi: an observational cohort study. Lancet HIV; 1 Sept 2020; DOI: 10.1016/S2352-3018(20)30172-7

Adapted from a press release from the London School of Hygiene & Tropical Medicine

Antiretroviral therapy (ART) failure and drug resistance are extremely common in patients living with HIV who are admitted to hospital in Malawi, according to new research published in Lancet HIV.

These important findings highlight the threat posed by drug resistant HIV and call for rapid tests for drug resistant virus that could aid in determining treatments and interventions for patients in hospital

Ravi Gupta

Andrew Moore

Get Grades Not AIDs

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How could multilingualism benefit India’s poorest schoolchildren?

sjr81 — Tue, 20 Nov 2018 09:00:13 +0000

̽��ֱ��crowded and bustling streets of Delhi teem with life. Stop to listen and, above the din of rickshaws, taxis and buses, you’ll hear a multitude of languages, as more than 20 million men, women and children go about their daily lives.

Many were born and raised there, and many millions more have made India’s capital their home, having moved from surrounding neighbourhoods, cities and states or across the country, often in search of a better job, a better home and a better life.

Some arrive speaking fluent Hindi, the dominant language in Delhi (and the official language of government), but many arrive speaking any number of India’s 22 officially recognised languages, let alone the hundreds of regional and tribal languages in a country of more than 1.3 billion people.

Around 950 miles south of Delhi lies Hyderabad, where more than 70% of its seven million people speak Telugu. Meanwhile, in Bihar, in the northeast of India, Urdu has replaced Hindi as the dominant language across this poor and populous state of more than 100 million people.

What links Delhi, Hyderabad and Bihar is a four-year project, Multilingualism and multiliteracy: raising learning outcomes in challenging contexts in primary schools across India, funded by the Economic and Social Research Council and the Department for International Development. Led by Professor Ianthi Tsimpli, from the Department of Theoretical and Applied Linguistics, the project involves Dr Dénes Szucs from the Department of Psychology, plus researchers from the ̽��ֱ�� of Reading and project partners in Karnataka, Hyderabad and New Delhi.

̽��ֱ��overriding aim of the project is to find out why in a country where multilingualism is so common (more than 255 million people in India speak at least two languages, and nearly 90 million speak three or more languages), the benefits and advantages of speaking more than one language, observed in Europe for instance, do not apply to many of India’s schoolchildren.

For Tsimpli, the answers to this conundrum may lie within the dataset she and her colleagues are compiling with the help of more than 1,000 primary-age schoolchildren across Delhi, Hyderabad and Bihar.

“Each year across India, 600,000 children are tested, and year after year more than half of children in Standard 5 [ten-year-olds] cannot read a Standard 2 [seven-year-olds] task fluently, and nearly half of them could not solve a Standard 2 subtraction task,” says Tsimpli, who co-leads Cambridge Language Sciences, the ̽��ֱ��’s Interdisciplinary Research Centre that brings together researchers from different fields to tackle ‘grand challenges’ where language is a factor.

“Low literacy and numeracy limit other important capabilities, including critical thinking and problem solving. Low educational achievement can lead to many dropping out of school – a problem disproportionately affecting female students. And the gap between state schools and private schools increases every year.”

She and colleagues are looking at whether these low learning outcomes could be a by-product of an Indian school system whereby the language that children are taught in often differs from the language used at home.

“We are looking at eight to 11-year-old schoolchildren in rural and urban areas,” she explains. “Within those urban areas we make the distinction between boys and girls living in slum and non-slum areas.

“Many children are internal migrants who move from remote, rural areas to urban areas. They are so poor they have to live in slums and, as a result of migration, these children may speak languages that are different to the regional language.

“By looking at the mismatch between home and school languages, and by using tests and other socio-economic and educational variables, we try to find out whether these children are advantaged or disadvantaged in literacy, numeracy, mathematical reasoning, problem solving and cognitive skills.”

Two years into the four-year project, the team has discovered considerable variation in the provision of education across government schools in the three areas, with different teaching practices and standards.

Having tested all 1,000 children, they will now embark on retesting them, looking not only at test results, but also allowing for other variables such as the standard of schooling, the environment and the teaching practices themselves. It’s possible that one of the causes of low performance is the lack of pupil-centred teaching methods; instead, the teacher dominates and there is little room for independent learning.

Although the findings are at a preliminary stage, Tsimpli and her team have found that the medium of instruction used in schools, especially English, may hold back those children who have little familiarity with, or exposure to,the language before starting school and outside of school life.

“Most of the evidence from this and other projects shows that English instruction in very disadvantaged areas might not be the best way to start, at least in the first three years [Standards 1 to 3] of primary,” says Tsimpli.

“What we would recommend for everyone, not just low socio-economic status children, would be to start learning in the language they feel comfortable learning in. ̽��ֱ��medium of instruction should reflect the strengths of the child. When it does, that child will learn better. English can still be used, but perhaps not as the medium of instruction in primary schools. It could, for example, be one of the subjects that are being taught alongside other subjects, starting perhaps from the third year of primary school.

“We are not suggesting that English be withdrawn – that ship has sailed – but we perhaps have to think more about learner needs. There is perhaps too much uniformity in teaching and less tailoring to the children’s language abilities and needs.”

While the preliminary results show that there is no difference in general intelligence among boys and girls from slum versus urban poor backgrounds, a surprising finding has been that children from slum backgrounds in Delhi do not seem to lag behind other children from other urban poor backgrounds – and in some cases perform better (e.g. in numeracy and literacy tasks).

This unexpected finding may be down to the life experiences of children growing up in slums, where they are likely to mature faster and come into closer contact with the numeracy skills essential for day-to-day survival.

Tsimpli adds that, despite the project only being at its midpoint, it has already caught the attention of government ministers, including Delhi’s Minister for Education, who is keen to use their findings to inform and adjust school policy in India’s capital city and the wider state.

“Delhi may be keen to adopt root-and-branch reform if our findings support it,” explains Tsimpli. “They are as keen as us to understand how the challenging context of deprivation can be attenuated when focusing on the languages children learn and use while at school.

“Our findings don’t mean that you’re doomed if you’re poor. It may be that these low learning outcomes are because of the way education is provided in India, with a huge focus on Hindi and English as the mediums of instruction, to the potential detriment of children unfamiliar with those languages.

“Language is central to the way knowledge is transferred – so the medium of instruction is obviously hugely influential. We hope to be able to show that problem solving, numeracy and literacy can and do improve in children who are educated in a language of instruction that they know. ̽��ֱ��trick may be to bridge school skills with life skills and make use of the richness of a child’s life experience to help them learn in the most effective ways possible.”

Inset image: credit Ianthi Tsimpli.

Read more about our research on the topic of children in the ̽��ֱ��'s research magazine; download a pdf; view on Issuu.

Multilingualism is the norm in India. But rather than enjoying the cognitive and learning advantages seen in multilingual children in the Global North, Indian children show low levels of learning basic school skills. Professor Ianthi Tsimpli is trying to disentangle the causes of this paradox.

̽��ֱ��trick may be to bridge school skills with life skills and make use of the richness of a child’s life experience to help them learn in the most effective ways possible

Ianthi Tsimpli

One of the partner schools

Research partnership

Co-Investigators (India)
National Institute of Mental Health and Neuro Sciences, Karnataka (Prof. Suvarna Alladi); ̽��ֱ��English & Foreign Languages ̽��ֱ��, Hyderabad (Dr Lina Mukhopadhyay); Jawaharlal Nehru ̽��ֱ��, New Delhi (Prof. Minati Panda)

Co-Investigators (UK)
̽��ֱ�� of Cambridge (Dr Dénes Szucs); ̽��ֱ�� of Reading (Prof. Theodore Marinis and Prof. Jeanine Treffers-Daller)

Project partners
British Council, India
Language and Learning Foundation (India)
Bilingualism Matters (UK)
Quest for Learning (UK)
̽��ֱ��Communication Trust (UK)

Funding
ESRC Research Grant Number: ES/N010345/1

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UK should invest in global education to improve lives, says report citing Cambridge research

ag236 — Tue, 21 Nov 2017 15:40:21 +0000

̽��ֱ��House of Commons’ International Development Committee (IDC) has published the results of its inquiry into the Department for International Development (DFID)’s work on global education.

̽��ֱ��report, published today, examines DFID’s efforts to ensure the UK is making a significant contribution towards meeting the fourth Sustainable Development Goal agreed by the UN in 2015 –to “ensure inclusive and quality education for all and promote lifelong learning”.

While recognising that DFID is a world leader in promoting education in international development settings, the report calls for increased spending on global education to ensure no child is left behind.

It cites evidence provided by the Faculty of Education’s Research for Equitable Access and Learning (REAL) Centre on the importance of investing in early childhood education and the early years of primary school for benefits in later life.

Drawing on research by the REAL Centre, the IDC’s report states that global spending on pre-primary education is low –DFID’s expenditure on pre-primary education accounts for under 0.6% of its bilateral education budget. Based on the evidence, the report recommends that DFID increases its spending on pre-primary education.

Responding to the evidence, the Minister of State for International Development, the Rt Hon Alistair Burt MP told the inquiry: “It [early childhood education] has not been funded well enough in the past. It has been an area that has been neglected. It does bring the highest returns in the future, and the returns are greatest for the most marginalised children.”

It is widely recognised that getting into school is not enough to ensure children are learning. In many poor countries, children are often spending up to four years in school without being able to read or do basic mathematics.

Drawing further on the REAL Centre’s evidence, the report argues that “it is vital that teachers are equipped with skills to teach in diverse classrooms” to ensure marginalised children –such as children with disabilities—are not excluded from the education process.

̽��ֱ��report has tackled the controversial issue of the role of private schooling, a growing phenomenon in low and lower middle income countries. Research by the REAL Centre shows that “low-fee private schools” are not accessible to the poorest families, leading the IDC report to recommend that DFID should continue to prioritise its spending towards government schools.

DFID is currently updating its education priorities through a “policy refresh”. It is hoped that the messages from the IDC report will help to focus resources on the most marginalised –including the poorest girls, and children with disabilities— and on early years of education, which is most likely to benefit children.

Read the full report here.

Evidence provided by the Research for Equitable Access and Learning (REAL) Centre informs the findings of a cross-party report calling for “significant spending” on early-years education

Early childhood education has not been funded well enough in the past. It has been neglected. It brings the highest returns in the future, and the returns are greatest for the most marginalised children.

Rt Hon Alistair Burt MP, Minister of State for International Development

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Opinion: How the UK and India can lead the development of ecologically smart cities

Anonymous — Tue, 08 Nov 2016 15:23:56 +0000

British Prime Minister Theresa May is visiting India on her first significant overseas visit outside the EU – and there is real interest in how it could be a harbinger of Britain’s post-Brexit future. Analysts are cautious about any major breakthroughs or significant trade deals, especially given strained relations between the UK and India over issues of immigration, which affect students and professionals in particular.

But part of the UK’s agenda is to work bilaterally with India on a number of areas of mutual interest at the UK-India Tech Summit. Discussions will include the technological possibilities for “smart cities”, an area that has been identified by the UK delegation as a major focus for the event. This also resonates with Indian Prime Minister Narendra Modi’s high profile smart cities initiative, launched last year.

Plans focus on making these urban settlements technologically-enabled, to ensure connectivity and communication using the latest information technologies. But what is missing is a sense of how cities may also be “ecologically smart” by securing the essential needs of their inhabitants – particularly clean air, especially important in smog-hit Delhi, and drinking water. It is also important to recognise that “ecological smartness” must include an understanding of the interests, aspirations and current circumstances of the different groups that live in these places.

Bidur town in Nepal, facing pressures after the 2015 earthquake reduced water flows

Water wisdom

Over the past three years, a project jointly funded by the UK Department for International Development, the Natural Environment Research Council and the Economic and Social Research Council, has investigated the ways in which people living in and around six small towns in the Western Himalaya access water through a diversity of sources. These range from springs to piped supply, and the project also examined the sustainability challenges faced by these sources.

Through these multiple and far-ranging case studies in Himachal Pradesh, Uttarakhand and Nepal, the team highlighted important lessons relevant to understanding water supply and how it is used and sourced in the urbanising hills. It has also outlined the policy options for securing water supplies for the needs of these hill residents.

Nainital, a tourist town in Uttarakhand, which faces severe water shortage during the summer tourist season

There are a number of key lessons that emerge from this project, which provide helpful guidance on how to make all cities ecologically, as well as technologically, “smart”. These are:

̽��ֱ��importance of critical water zones. ̽��ֱ��long-term sustainability of water sources is essential for the maintenance and growth of urban settlements. Urban planning and development occurs within city boundaries – but we must also proactively identify, manage and protect the critical water zones – the areas that are essential for the maintenance and regeneration of water flows across all landscapes, and which are often under threat due to rapid urban expansion, encroachment, changes in land use and deforestation.

Inequality and the politics of water distribution. Within towns, cities and surrounding rural settlements, water is highly unequally distributed. Access is determined by a range of historical and socio-economic factors – and negotiations and conflicts around water access, distribution and quality between up- and downstream settlements characterise life in the hills. ̽��ֱ��diversion and appropriation of water to urban areas could create new conflicts – and we need to understand them.

Local preferences and diverse water strategies. Households in the hills depend on multiple water sources, complementary to piped water connections. This is to do with cultural preferences – such as a belief that spring water in the mountains is sweeter – and risk management, due to the unreliability of municipal supplies. This continued preference for traditional sources alongside technological innovations should inform interventions to improve water availability, especially in small towns.

Rajgarh in Himachal Pradesh, a rapidly growing small town which transports water through a 18km pipeline across mountainous terrain

Large infrastructure decisions and management choices. States and donors are increasingly developing top-down, large-investment infrastructure projects to supply water in mountain areas. These so-called “solutions” don’t always consider the full range of possible options – especially those that are more local, small-scale and relevant to those they serve.

Multiple overlapping institutions for water supply. Water supply systems to address the needs of small towns are adopting new and varied governance structures. Donor and state-led systems should engage with local people and institutions both up and downstream, to ensure that development is useful to the communities it affects.

Decision-making and research in the hills often takes place with little access to data, as most of the areas do not have long term monitoring and records. In such contexts, different forms of knowledge are required – these include local wisdom, experience over generations, expert opinion, as well as more innovative approaches to address data gaps (such as modelling). As India and the UK look to each other for areas of mutual dialogue, a focus on ecological smartness might provide a unique opportunity for harnessing the considerable wealth of research on these issues in both countries, as well as responding to the challenges that both India and the UK face as they become increasingly urbanised.

̽��ֱ��dialogue around technology involving Britain and India must expand to include the importance of finding ways for living well and sustainably in the rapidly urbanising 21st century.

Bhaskar Vira, Reader in Political Economy at the Department of Geography and Fellow of Fitzwilliam College; Director, ̽��ֱ�� of Cambridge Conservation Research Institute, ̽��ֱ�� of Cambridge and Eszter Kovacs, Postdoctoral Researcher in Conservation, Agriculture and Water Management Policy and Practice, ̽��ֱ�� of Cambridge

This article was originally published on ̽��ֱ��Conversation. Read the original article.

Bhaskar Vira and Eszter Kovacs (Department of Geography and ̽��ֱ�� of Cambridge Conservation Research Institute) discuss how lessons learned about water management in Nepal and India can guide how cities can be made "ecologically smart".

Bhaskar Vira

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Not a drop to drink

sc604 — Mon, 19 Oct 2015 13:00:21 +0000

Nainital is picture perfect: lying in a lush green valley in India’s ‘Lake District’, the town sits on a crescent-shaped lake, surrounded by the snow-capped peaks of the Himalayas. Its picturesque location makes it a hugely popular destination for domestic and foreign visitors: each year, Nainital’s population increases fivefold due to the influx of tourists, placing huge strains on the town’s resources, including the water supply.

It’s not just tourists that are contributing to the strain, however. For years, Nainital has been plagued by illegal construction, which has been affecting its ability to supply water. ̽��ֱ��main lake in Nainital is connected to a smaller lake via an underground channel, and together they supply most of the town’s water. ̽��ֱ��smaller lake remains dry for just over half the year, but when it fills again during the monsoon, it becomes an important reserve reservoir for the main lake.

But despite a ruling from the Indian government banning development in the dry lake bed and the surrounding area, illegal construction has been relentless, to the point where the smaller lake can no longer store enough water to supply the main lake, and water levels in Nainital are under severe pressure.

“Not being able to supply water is a major liability for any government or local authority,” says Dr Bhaskar Vira of Cambridge’s Department of Geography. “What we’ve been doing is looking at the underpinning science, seeing what the political and social issues might be, and then working with the relevant people who can intervene and make a difference.”

Vira is leading a major research project that is examining the ways in which small towns in hill and mountain regions of South Asia depend on springs, streams and rivers for their supply of water. Vira and his colleagues from the Southasia Institute of Advanced Studies in Nepal and the Centre for Ecology Development and Research (CEDAR) in India are looking at six towns – four in India (including Nainital) and two in Nepal – to understand how they are coping with the ever-increasing demand for water. ̽��ֱ��project is part of the Ecosystem Services for Poverty Alleviation programme, which is funded by the Natural Environment Research Council, the Economic and Social Research Council and the UK’s Department for International Development.

India is a wet country, but almost all of the rain falls in about two and a half months during the annual monsoon. ̽��ֱ��problem in India is how to safely store and transport water so that it’s available 12 months a year, and distributed evenly throughout the country.

Small towns – those with populations below 100,000 – in the hill regions of India and Nepal have grown rapidly, with very little planning for infrastructure needs, more generally, and water supply, in particular. Across the region, almost half of the urban population in the Indian states of Himachal Pradesh and Uttarakhand, and in the hill regions of Nepal, live in small towns.

“Many of these towns are looking at what you’d call nature-based solutions – they don’t have the budget to pump water in from 200 miles away,” says Vira, who is working with Dr Eszter Kovacs on the project. “So they’re much more dependent on the water that’s available in their immediate vicinity, and they’re looking at ways they can harness the resources they do have.”

One of the approaches that the researchers are taking is to identify and protect what they call ‘critical water zones’ – places where the springs that ultimately supply many of these towns are recharged. For example, one of the towns (Rajgarh, in Himachal Pradesh) which the researchers are studying has its water source in the Churdhar Wildlife Sanctuary, which not only protects the wildlife, but also protects the water supply, as the trees absorb the water so it doesn’t run off. ̽��ֱ��ultimate benefit is a dual one, since the landscape is protected, but so is the water supply for the town.

“Water is a precious resource, and it’s very rare to find a water source in India that has no other existing users,” says Vira. “So there are always going to be trade-offs; there are always going to be winners and losers when it comes to water in India.” In Rajgarh, water that is being piped from 14 km away to the town is bypassing villages along the way, raising concerns about the water needs of the surrounding rural communities.

In Mussoorie, another popular Uttarakhand tourist town, the team is looking at the dhobi (washing) community, which for about 100 years has washed all of the laundry generated by the local hotels, schools and passing tourists by hand in the local stream. Today, the work of the dhobi is supplemented by washing machines and driers, but much of the washing is still done in the stream, and many people still rely on it for their livelihoods.

About 15 years ago, town authorities needed to increase their water capacity and approached the dhobi community to ‘share’ their water with the town, through the laying of new pipes and construction of a pumping station. Unsurprisingly, they were resistant to the idea. “Eventually, a compromise was reached so that some of the water was left behind for the dhobi to continue washing, but is it working? Was it a fair trade-off, for the town or the dhobi? These are the kinds of issues we’re looking at,” says Vira, who is Director of the ̽��ֱ�� of Cambridge Conservation Research Institute.

Back in Nainital, the researchers supported local activists who brought a case to the Uttarakhand high court to remove the illegal buildings. ̽��ֱ��Cambridge–CEDAR team also convened expert geologists and hydrologists who made recommendations about how the lake’s water-storing capacity could be restored, which in turn supported the legal case.

“Additionally, through our awareness campaign, we were able to galvanise the local population so they could see the risk that this illegal construction is posing to the community,” says Dr Vishal Singh from CEDAR, one of Vira’s collaborators, who recently spent two months in Cambridge on a Commonwealth Professional Fellowship. “This lake is so important for the region’s sustainability and, for years, construction was allowed to continue despite the fact that it was illegal.”

In mid-July, the high court ordered the formation of two committees: one to mark and demolish the illegal constructions, and another to determine which officials were liable for allowing the construction to happen in the first place.

Singh, who grew up in Nainital, says he’d like to see the dry lake bed returned to what it was when he was a child. “It should be cleaned up and preserved so children can play there in the dry season,” he says. “This lake is so important to Nainital’s identity – let’s preserve it.”

Inset image: Nainital, northern India, faces an ever-increasing demand for water (Ross Huggett).

A major research collaboration is looking at how small towns in the hills of India and Nepal are coping with increasing demand for water: who wins and who loses when resources get scarce?

There are always going to be winners and losers when it comes to water in India

Bhaskar Vira

Carsten Tolkmit

Lonely tap

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Education that adds up

lw355 — Fri, 16 Oct 2015 08:17:10 +0000

It’s a numbers game. Three million households, seven million children, 30,000 volunteers, and a decade of assessing the basic reading and maths abilities of 3–16-year olds across India.

This is the size of the largest non-governmental survey of the state of Indian education ever conducted, and it’s a key source of information for communities and policymakers on children’s learning outcomes available in India today. ̽��ֱ��Annual Status of Education Report (ASER) is all the more impressive given the deceptive simplicity and fundamental importance of the question it seeks to answer: how many children are learning the basics in mathematics and reading?

But the numbers have to be huge given what’s at stake. ̽��ֱ��education system in India is in crisis; in rural areas, fewer than one in five poor children of around 11 years of age have even the most basic of literacy and numeracy skills, although most have been in school for five years. And it’s a pattern echoed worldwide in what UNESCO has declared “a global learning crisis” – even after going to school, 250 million children globally cannot read, write or count.

“What’s the point in an education if children emerge after years in school without the skills they need?” says Professor Pauline Rose from Cambridge’s Faculty of Education, whose team collaborates with the organisation in India responsible for ASER. “ ̽��ֱ��rhetoric about education used to be about giving children access to school but now it must also be about making sure they learn what they need to learn once they are there.”

Rose was previously Director of UNESCO’s Education for All Global Monitoring Report. In 2014, the Report assembled the first evidence on the scale of the education crisis. “There was already a debate rumbling. It was becoming clear that increasing the number of children enrolling in school was not enough. But the report brought the evidence into one place. That number of 250 million children without basic skills slaps you in the face – you can’t ignore it. It’s also an entry point to understanding why we have got to this situation and what we can do about it.”

Rose leads Cambridge’s Research for Equitable Access and Learning (REAL) Centre, which has highlighted some of the factors that limit children’s learning in India and Pakistan. Among them are an over-ambitious curriculum that leaves children behind and a lack of training and support for teachers, who may themselves be the product of a poor education.

Now the Centre has been awarded funding by the Department for International Development (DFID) and the Economic and Social Research Council (ESRC) to look at ways to improve the effectiveness of teaching quality in India and Pakistan.

“Education increases opportunities in life, it can pull people out of poverty, with better jobs and higher wages; for girls, education often results in delaying marriage and having fewer children, who as a result are healthier,” she explains. “Nationally, a young, educated workforce can transform the wealth of a country.”

India has made a significant investment in schooling over the past decade, achieving near universal enrolment in primary education. According to government figures, around 195 million children are currently in primary school. However, the question of how effective is the teaching within the classroom has largely been overlooked.

Over the past few months, Rose and Dr Ben Alcott have been using the ASER datasets, covering all of rural India, to identify the extent to which children are learning and who in particular is being left behind.

“Among the most disadvantaged girls, fewer than 10% are learning by the time they should have had five years in school,” says Rose. “Some aren’t learning because they’ve dropped out of school, others because of the poor quality of education. Governments, schools and teachers have tended to focus on the more advantaged, able children. But to close educational inequalities, they must focus on the disadvantaged, whether it’s by poverty, gender, caste or disability.”

Rose and Alcott suggest five key steps: encourage children to start school as young as possible; set the curriculum at the right pace for the majority of learners, not the minority of able learners; train teachers to teach the most disadvantaged learners; provide schools with appropriate textbooks in the right language; and hold schools and policy makers accountable for improving learning outcomes for those who would otherwise be left behind.

Of course, improving the quality of education requires a better understanding of what is actually going on in the classroom. In the newly funded ESRC–DFID programme, Rose, Professor Anna Vignoles and Dr Nidhi Singal are working with an independent education research group in India – Collaborative Research and Dissemination (CORD) – to create a new dataset that will follow children through their learning experience, from home to school.

Singal’s focus is on children with disabilities: “In many cases, children with disabilities are given access to mainstream school just for ‘socialisation purposes' – there’s an assumption that they are not there to learn.

“My reason for researching what happens to children with disabilities in school is not only to do with issues around social justice and human rights, but also because problems will be magnified for the most marginalised of the marginalised – if teaching can be more effective for this group then it can respond to the needs of all disadvantaged children.”

̽��ֱ��research will assess children both in the household and in schools, testing their basic skills on a yearly basis. ̽��ֱ��aim is to identify what makes a difference to learning, and to understand the problems teachers face and the support they need.

“There’s a big debate on how the global Sustainable Development Goal of all children learning by 2030 can be achieved,” adds Rose. “This project will help understand what we need to do to make sure we are not failing children who are coming from some of the most disadvantaged of backgrounds.”

Will governments take notice? “I don’t think we as researchers can always go knocking on doors and say look at our evidence. But I do think that, through the networks that CORD and ASER have, this research can have an influence. These partnerships are really central to what we do: it’s no good us sitting here doing all this wonderful research if it’s not actually changing anything for children’s experiences on the ground.”

As part of the Festival of Ideas and WOW Cambridge, Pauline Rose is participating in a panel discussion on this topic with Philippa Lei from the Malala Fund on October 27. Visit http://www.equality.admin.cam.ac.uk/events/school for more information.

We are in the midst of a “global learning crisis” according to UNESCO, with too many children worldwide learning little or nothing at school. A new research programme focusing on India and Pakistan aims to understand what needs to be done to ensure that education adds up.

That number of 250 million children without basic skills slaps you in the face – you can’t ignore it.

Pauline Rose

Global Partnership for Education

India: Teaching Girls

Let Them Learn

Professor Pauline Rose will take part in discussion hosted by the ̽��ֱ�� of Cambridge and Georgetown ̽��ֱ�� in Washington DC on 30 November 2015 to follow up on Michelle Obama’s announcement of a UK-US initiative as part of the Let Girls Learn campaign.

̽��ֱ��event will bring together key stakeholders to identify the biggest challenges to girls’ education in conflict settings, with the aim of developing a research agenda that will provide policymakers with evidence-based policy recommendations.

Specifically, during the First Lady’s visit to the UK in June 2015, the USA and UK committed to building an evidence-base around increasing access to education and enhancing learning for girls in conflict and crisis situations, including in refugee and internally displaced person settings. ̽��ֱ��event will be hosted by the ̽��ֱ�� of Cambridge’s Vice Chancellor Professor Sir Leszek Borysiewicz and Ambassador Melanne Verveer.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Out of poverty

bjb42 — Mon, 01 Nov 2010 14:04:57 +0000

Bangladesh is a country beset by seasonal cycles of poverty and hunger. Almost 20 million people in the country are extremely poor and are vulnerable to natural disasters such as flooding. ̽��ֱ��UK Department for International Development (DFID) has invested a combined £120 million in two projects aimed at overcoming the poverty cycle by providing people who have almost no assets with the resources to build and secure a sustainable livelihood.

Professor Nick Mascie-Taylor and Dr Rie Goto, together with other members of the Human Epidemiology, Nutrition, Growth and Ecology (HENGE) group in the Department of Biological Anthropology, are supporting the projects by conducting in-depth nutritional and health surveys, as well as looking for ways of improving the nutritional status of the very poor.

Small steps to stability

Under the £65 million DFID-funded ‘shiree’/ Economic Empowerment of the Poorest programme, which runs until 2015, a consortium of NGOs is helping 750,000 of the poorest individuals across Bangladesh to generate assets and improve their income. ̽��ֱ��idea is that, by stimulating economic improvements, individuals can take iterative steps (shiree is the Bengali word for steps) out of poverty.

̽��ֱ��HENGE team will be carrying out annual surveys throughout the project, providing a measure of how nutrition and health changes as a result of the development programmes. ̽��ֱ��baseline assessment survey has just been completed and the results provide a stark illustration of why the intervention is needed: as many as 80% of individuals are undernourished, compared with 40% across the Bangladesh population. For children, this rises to 85%, and one in seven children is stunted, wasted and underweight.

Cash-for-work

̽��ֱ��DFID-funded Chars Livelihoods Programme is focused on an area in north-western Bangladesh where people living on large flat islands (chars) in river channels live with the frequent risk of losing their homes and crops to flooding. ̽��ֱ��project is providing 55,000 of the poorest households with a raised earthen plinth to lift their homes above the flood plain, plus income-generating assets – livestock or a vegetable garden – to help them not slip back into poverty.

A cash-for-work plinth building programme during the Monga (hungry) season gave local people approximately 2.6 million person-days of paid work. Although cash-for-work schemes are a familiar feature of development programmes, no research has looked at their impact on nutritional status. A concern levelled at such schemes has been that the increased physical work might cause weight loss. Results of the first such investigation have just been published by the HENGE team. Working with chars dwellers engaged in cash-for-work during a particularly severe Monga, they found no evidence to back up the concerns. By contrast, the scheme led to greater food expenditure and consumption, and a significant increase in the nutritional status of families.

Health package

̽��ֱ��team is also investigating how they can translate their research into tangible health benefits. They have been looking at the perennial problem among the extreme poor of gut parasites like hookworm (picked up through the soles of bare feet), which damages the lining of the gut, contributing to nutrient loss and anaemia.

Professor Mascie-Taylor has trialled a combination of deworming and dietary supplementation with vitamins, supplied in powdered form so that they can be sprinkled onto food. In only three months, the results were dramatic; the children, in particular, showed a 54% reduction in wasting.

With innovation funding from the shiree project, work has already begun on putting together a combined health package comprising regular deworming, micronutrients in sachets and flip-flops to prevent hookworm infection. ‘Our aim,’ he explains, ‘is to provide a cost-effective means of helping people back to the health needed to sustain graduation out of poverty.’

For more information, please contact Professor Nick Mascie-Taylor (nmt1@cam.ac.uk) at the Department of Biological Anthropology or visit http://henge.bioanth.cam.ac.uk/

Cambridge researchers are contributing to projects in Bangladesh that aim to lift 1 million people out of poverty by 2015.

Our aim is to provide a cost-effective means of helping people back to the health needed to sustain graduation out of poverty.

Professor Nick Mascie-Taylor

Nick Mascie-Taylor

Chars dwellers building plinths as part of the cash-for-work scheme

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