Charles Opondo

• PhD MSc BPharm
• Associate Professor at London School of Hygiene and Tropical Medicine

Background Bullying, aggression, and violence among children and young people are some of the most consequential public mental health problems. We tested the Learning Together intervention, which involved students in efforts to modify their school environment using restorative practice and by developing social and emotional skills. Methods We did...

Background Globally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs). Methods For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, t...

Objectives This study aimed to describe the variation in risks of adverse birth outcomes across ethnic groups and socioeconomic circumstances, and to explore the evidence of mediation by socioeconomic circumstances of the effect of ethnicity on birth outcomes. Setting England and Wales. Participants The data came from the 4.6 million singleton li...

Background Malnutrition underlies 3 million child deaths worldwide. Current treatments differentiate severe acute malnutrition (SAM) from moderate acute malnutrition (MAM) with different products and programs. This differentiation is complex and costly. The Combined Protocol for Acute Malnutrition Study (ComPAS) assessed the effectiveness of a simp...

Background The burden of malaria infection in sub-Saharan Africa among school-aged children aged 5–15 years is underappreciated and represents an important source of human-to-mosquito transmission of Plasmodium falciparum. Additional interventions are needed to control and eliminate malaria. We aimed to assess whether preventive treatment of malari...

Background Studies evaluating the impact of kangaroo mother care (KMC) on neonatal mortality and morbidity often rely on healthcare worker records or caregiver reports to measure intervention duration. However, the accuracy of these methods remains uncertain. We examined the validity of different methods of KMC duration measurement amongst neonates...

Background The traditional use of sealed envelopes for randomisation is susceptible to manipulation and the risk of damage to envelopes during shipping and storage. Additionally, the filling and sealing of envelopes are tedious, time-consuming, and error-prone. Other randomisation alternatives such as web-based methods are preferred. However, they...

Background: Foodborne diseases are an important cause of morbidity and mortality globally. Most diarrhoeal diseases can be caused by foodborne enteric infections, especially in children. The aim of this review is to synthesise the evidence for the effectiveness of domestic food hygiene interventions on the microbiological quality of child food and...

Background Globally, some 45 million children under five years of age are wasted (low weight-for-height). Although 2023 World Health Organisation guidelines on their care did not aim to identify optimal weight gain, they did mention 5–10 g/kg/day as a target, which is a change from prior guidelines that recommended 10–15 g/kg/day, when inpatient-on...

Introduction This programme effectiveness study responds to the need for evidence of the effect on birth weight of switching from iron-folic acid supplementation to multiple micronutrient supplementation as part of routine antenatal care in Ethiopia. A 2019 meta-analysis reported a mean increase of 35 g in birth weight among newborns of women who t...

In low and middle‐income countries, addressing maternal and child nutrition needs is crucial. Prenatal multiple micronutrient supplementation (MMS) holds promise in reducing low birthweight and preterm births. Ethiopia is considering a transition from the provision of iron‐folate supplementation to the provision of MMS in antenatal care, guided by...

Background: Pregnancy within a year of childbirth has negative impacts on women and their children’s health. We developed a digital health intervention (DHI) to empower women in contraceptive choices postpartum. Our pilot randomised controlled trial (RCT) aimed to establish the feasibility of a main RCT of the effects of the DHI compared with stand...

Introduction Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmaceutical company sales representatives to evaluate p...

Annually, 30 million children are affected by newborn conditions, most in low-income countries, with long-term implications for survivors. We aimed to evaluate neonatal intracranial pathologies identifiable on cranial ultrasound (CUS) in sub-Saharan Africa (SSA). This systematic review and meta-analysis explored the spectrum of neonatal intracrania...

Background: Considering the well-established link between experiencing violence in childhood and poor mental health, it is important to understand the role of contextual factors in which young people live, learn, work, and play. Evidence has highlighted the importance of work as a contextual factor in the lives of young people, but it is unclear w...

Objective To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy. Methods In a prospective cohort study of 9420 pregnant women from 13 hospitals across Indi...

Despite Nigeria’s stillbirth rate reducing from 28.6 to 22.5 per 1,000 births from 2000–2021, progress trails comparable indicators and regional variations persist. We assessed stillbirth incidences and associated risk factors in 20 secondary hospitals in Imo state, to generate essential local evidence to inform policymaking to reduce mortality. Th...

Background Studies evaluating the impact of kangaroo mother care (KMC) on neonatal mortality and morbidity often rely on healthcare worker records or caregiver reports to measure intervention duration. However, the accuracy of these methods remains uncertain. We examined the validity of different methods of KMC duration measurement amongst neonates...

Introduction This programme effectiveness study responds to the need for evidence of the effect on birth weight of switching from iron-folic acid supplementation to multiple micronutrient supplementation as part of routine antenatal care in Ethiopia. A 2019 meta-analysis reported a mean increase of 35 grammes in birth weight amongst newborns of wom...

Background School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance. Methods The WISE cluster-randomised trial, conducted...

Mortality from human immunodeficiency virus (HIV)–associated tuberculosis (TB) is high, particularly among hospitalized patients. In 433 people with HIV hospitalized with symptoms of TB, we investigated plasma matrix metalloproteinases (MMP) and matrix-derived biomarkers in relation to TB diagnosis, mortality, and Mycobacterium tuberculosis (Mtb) b...

IMPORTANCE Supplementing potassium in an effort to maintain high-normal serum concentrations is a widespread strategy used to prevent atrial fibrillation after cardiac surgery (AFACS), but is not evidence-based, carries risks, and is costly. OBJECTIVE To determine whether a lower serum potassium concentration trigger for supplementation is noninfe...

Objective To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease. Design Population‐based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare data sets. Setting Grampian region, Scotland. Population A cohort of 70 904 w...

Objective To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease. Design Population-based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare datasets Setting Grampian region, Scotland Population or Sample 70,904 women who...

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Background Posttraumatic stress (PTS) and anxiety are common mental health problems among parents of babies admitted to a neonatal unit (NNU). This review aimed to identify sociodemographic, pregnancy and birth, and psychological factors associated with PTS and anxiety in this population. Method Studies published up to December 2022 were retrieved...

A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal c...

Objectives To systematically synthesise the evidence on prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries (LMICs). Design Systematic review and meta-analysis. Data sources MEDLINE, Embase, PsycINFO, Scopus, Web of Science, Global Health, Global Index Medicus and the grey literature were search...

Background Water, sanitation and hygiene (WASH) interventions in schools may improve the health and school attendance of schoolchildren, particularly among post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban WASH in schools programme (Project WISE) on child health and attendance. Methods The WISE cluster-random...

Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these facto...

To address high rates of malnutrition among children from vulnerable households in Rwanda, the government initiated a national food supplementation programme. A before and after evaluation, using repeat cross‐sectional surveys in randomly selected villages was conducted; aimed at assessing the effectiveness of providing fortified blended food (FBF)...

Background Atrial Fibrillation After Cardiac Surgery (AFACS) occurs in about one in three patients following Coronary Artery Bypass Grafting (CABG). It is associated with increased short- and long-term morbidity, mortality and costs. To reduce AFACS incidence, efforts are often made to maintain serum potassium in the high-normal range (≥ 4.5mEq/L)....

Background: Although 45 million children under five are wasted, the optimal rate of weight gain during treatment for severe malnutrition is unknown. Historically, inpatient treatment programmes focused on rapid weight gain (WG), with the rationale that this would optimise outcomes. However, recent evidence suggests that too rapid WG might be associ...

OBJECTIVE To investigate clinical and non-clinical factors influencing labour induction and augmentation in pregnant women in India. DESIGN Prospective cohort study of 9305 pregnant women. SETTING 13 tertiary and community hospitals in six states across India. PARTICIPANTS Women ≥18 years of age and planning a vaginal birth in the study hospital we...

Background Sub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine t...

Nutritional rehabilitation during severe acute malnutrition (SAM) aims to quickly restore body size and minimize poor short-term outcomes. We hypothesized that faster weight gain during treatment is associated with greater cardiometabolic risk in adult life. Anthropometry, body composition (DEXA), blood pressure, blood glucose, insulin and lipids w...

Background MRC The Gambia and MRC Uganda joined London School of Hygiene and Tropical Medicine (LSHTM) in 2018 to form a family of institutions committed to high quality research. Each institution supports Clinical Trials through a formally-constituted Clinical Trials Unit (CTU) or equivalent resources, where the function is to provide end-to-end s...

Mortality from HIV-associated tuberculosis (HIV-TB) is high, particularly among hospitalised patients. In 433 people living with HIV admitted to hospital with symptoms of TB, we investigated plasma matrix metalloproteinases (MMP) and matrix-derived biomarkers in relation to TB diagnosis, mortality and Mycobacterium tuberculosis (Mtb) blood stream i...

The traditional use of sealed envelopes for randomisation is susceptible to manipulation and the risk of damage to envelopes during shipping and at storage. Additionally, the filling and sealing envelopes is, tedious, time-consuming, and error prone. Other randomisation alternatives such as web-based methods are preferred. However, they are expensi...

Age and sex influence the risk of childhood wasting. We aimed to determine if wasting treatment outcomes differ by age and sex in children under 5 years, enroled in therapeutic and supplementary feeding programmes. Utilising data from stage 1 of the ComPAS trial, we used logistic regression to assess the association between age, sex and wasting tre...

Background: Perineal trauma, involving either naturally occurring tears or episiotomy, is common during childbirth but little is known about its psychological impact. This study aimed to determine the associations between childbirth related perineal trauma and psychological outcomes reported by women three months after giving birth and to explore...

Low hemoglobin is widely used as an indicator of iron deficiency anemia in India and other low‐and‐middle income counties, but anemia need not accurately reflect iron deficiency. We examined the relationship between hemoglobin and biomarkers of iron status in antenatal and postnatal period. Secondary analysis of uncomplicated singleton pregnancies...

Introduction Improving maternal health and survival remains a public health priority for Sudan. Significant investments were made to expand access to maternal health services, such as through the training and deployment of providers with varying skills and competencies to work across the country. This study investigates trends in the coverage of di...

Background: Community-based interventions are increasingly being implemented in Sub-Saharan Africa (SSA) for stillbirth prevention, but the nature of these interventions, their reporting and acceptability are poorly assessed. In addition to understanding their effectiveness, complete reporting of the methods, results and intervention acceptability...

Introduction Malaria infection and curable sexually transmitted infections and reproductive tract infections (STIs/RTIs) adversely impact pregnancy outcomes. In sub-Saharan Africa, the prevalence of malaria and curable STIs/RTIs is high and, where coinfection is common, combination interventions may be needed to improve pregnancy outcomes. The aim...

There is limited evidence of health interventions impact on cognitive function and educational outcomes. We build on two prior systematic reviews to conduct a meta-analysis, exploring the effects of one of the most consequential health interventions, malaria chemoprevention, on education outcomes. We pool data from nine study treatment groups (N=4,...

Objective: Explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition, and describe associations with survival and non-communicable disease (NCD) risk seven years post-treatment. Design: Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score (WAZ) and heigh...

Background : Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and...

This article presents an application of the causal inference approach to mediation analysis using the example of a complex intervention that aimed to improve the quality of care at health centres in Uganda. Mediation analysis is a statistical method that aims to isolate the causal mechanisms that make an intervention work in a given context. We com...

Background About 45.1% of all induced abortions are unsafe and 97% of these occur in low- and middle-income countries (LMICs). Women's abortion decisions may be complex and are influenced by various factors. We aimed to delineate women's abortion decision-making trajectories and their determinants in LMICs. Methods We searched Medline, EMBASE, Psy...

Background : Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and...

Objectives Toilet users often report valuing outcomes such as privacy and safety more highly than reduced disease, but effects of urban sanitation interventions on such outcomes have never been assessed quantitatively. In this study, we evaluate the impact of a shared sanitation intervention on quality of life (QoL) and mental well-being. Design W...

Intermittent preventive treatment of malaria among schoolchildren (IPTsc) reduces clinical malaria, asymptomatic parasitemia, and anemia. The effects of IPTsc by gender have not been studied longitudinally. We investigated overall IPTsc efficacy and conducted a secondary analysis to explore gender-specific differences. We enrolled schoolchildren ag...

Background Cardiac complications are a leading cause of maternal death. Cardiac imaging with echocardiography is important for prompt diagnosis, but it is not available in many low-resource settings. The aim of our study was to determine whether focused cardiac ultrasound performed by trained obstetricians and interpreted remotely by experts can id...

Background: This prospective cohort study compared primary-school-aged outcomes between children with Hirschsprung disease (HD) following Soave, Duhamel or Swenson procedures. Methods: Children with histologically proven HD were identified in British/Irish paediatric surgical centres (01/10/2010-30/09/2012). Parent/clinician outcomes were collected...

Background WHO guidelines recommend dolutegravir plus two nucleoside reverse transcriptase inhibitors (NRTIs) for second-line HIV therapy, with NRTI switching from first-line tenofovir to zidovudine. We aimed to examine whether dolutegravir is non-inferior to darunavir, the best-in-class protease inhibitor drug, and whether maintaining tenofovir in...

Background Nutritional rehabilitation during severe malnutrition (SM) aims to rapidly restore body size and minimize poor short-term outcomes. We hypothesized that too rapid weight gain during and after treatment might however predispose to cardiometabolic risk in adult life. Methods Weight and height during hospitalization and one year post-hospi...

Background Perinatal anxiety is associated with adverse outcomes for women and their infants. Women in low- and middle-income countries (LMIC) may be at higher risk of perinatal anxiety. We aimed to systematically review and synthesise the evidence on prevalence of perinatal anxiety in LMIC. Method We searched MEDLINE, Embase, PscyhINFO, Global He...

Objectives Toilet users often report valuing privacy and safety more highly than reduced disease, but effects of urban sanitation interventions on such outcomes have never been assessed quantitatively. In this study, we evaluate the impact of a shared sanitation intervention on quality of life (QoL) and mental wellbeing. Design We interviewed indi...

Background Rapid catch-up growth after prenatal undernutrition is associated with increased risk of non-communicable diseases (NCDs) in high-income countries. Severe malnutrition treatment programmes in low- and middle-income countries promote rapid post-malnutrition growth (PMGr) as desirable. Our aim was to explore patterns of PMGr during and in...

Complementing a recent systematic review and meta-analysis which showed that boys are more likely to be wasted, stunted, and underweight than girls, we conducted a narrative review to explore which early life mechanisms might underlie these sex differences. We addressed different themes, including maternal and newborn characteristics, immunology an...

Background There is increasing global focus on malnutrition in infants aged under 6 months (u6m) but evidence on how best to identify and manage at-risk individuals is sparse. Our objectives were to: explore data quality of commonly used anthropometric indicators; describe prevalence and disease burden of infant u6m malnutrition; compare wasting an...

Two billion people globally lack access to a basic toilet. While improving sanitation reduces infectious disease, toilet users often identify privacy, safety and dignity as more important. However, these outcomes have not been incorporated in sanitation‐related economic evaluations. This illustrates the general challenge of outcome measurement and...

Objective To examine trends and variations of caesarean section by economic status and type of healthcare facility in Arab countries in the Middle East and North Africa (MENA). Methods Secondary data analysis of nationally representative household surveys conducted between 2008–2020 across nine Arab countries in the MENA region. The study populati...

Background Uncertainty remains regarding the validity of screening tools to detect common mental disorders (CMDs) during perinatal periods. This umbrella review aims to provide an up-to-date summary of psychometric properties of tools for the identification of perinatal CMDs. Methods Reviews were identified via Ovid MEDLINE, PsychINFO, EMBASE, Glo...

Objectives To investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7–9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth. Design A prospective cohort study of pregnant women recruited in the third trimester and fol...

Background Malnutrition is a leading cause of morbidity and mortality in children aged <5 y, especially in low- and middle-income countries (LMICs). Unlike severe acute malnutrition, moderate acute malnutrition (MAM) affects greater numbers globally, and guidelines lack a robust evidence base. This systematic review and meta-analysis assessed the e...

Background Common mental disorders (CMD) in the perinatal period are associated with significant adverse outcomes for women and their families. Prevalence of perinatal CMD is significant in low- and middle-income countries such as India, where women living in socio-economic deprivation, those experiencing intimate partner violence and those with lo...

Background Perinatal anxiety is associated with adverse outcomes for women and their infants. Women in low- and middle-income countries (LMIC) may be at higher risk of perinatal anxiety disorders. Aims We aim to systematically review the evidence on prevalence of perinatal anxiety and calculate pooled prevalence estimates of antenatal and postnata...

Background: The SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt. Methods: Hospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India cove...

Objectives Exposure to tobacco products during pregnancy presents a potential harm to both mother and baby. This study sought to estimate the prevalence of vaping during pregnancy and to explore the factors and outcomes associated with vaping in pregnancy. Setting England. Participants Women who gave birth between 15th and 28th October 2017. Met...

Background Perinatal common mental disorders are associated with significant adverse outcomes for women and their families, particularly in low- and middle-income settings. Early detection through screening with locally-validated tools can improve outcomes. Methods We searched MEDLINE, Embase, PsycINFO, Global Health, Cochrane Library, Web of Scie...

Objective: To examine trends and variations of caesarean section by economic status and type of healthcare facility in Arab countries in Middle East and North Africa (MENA). Methods: Secondary data analysis of nationally representative household surveys across nine Arab countries in MENA. The study population was women aged 15-49 years with a live...

Weight-for-age z-score (WAZ) is not currently an admission criterion to therapeutic feeding programs, and children with low WAZ at high risk of mortality may not be admitted. We conducted a secondary analysis of RCT data to assess response to treatment according to WAZ and mid-upper arm circumference (MUAC) and type of feeding protocol given: a sim...

Introduction Severe and moderate acute malnutrition (SAM and MAM) affect more than 50 million children worldwide yet 80% of these children do not access care. The Combined Protocol for Acute Malnutrition Study (ComPAS) trial assessed the effectiveness of a simplified, combined SAM/MAM protocol for children aged 6–59 months and found non-inferior re...

Background: Malnutrition is a leading cause of morbidity and mortality in children aged under five years, especially in low and middle income countries. Although severe acute malnutrition (SAM) is considered the most serious form of malnutrition, moderate acute malnutrition (MAM) affects greater numbers globally and, unlike SAM, guidelines lack a r...

Background The UK still has the highest rate of teenage births in western Europe. Teenagers are also the age group most likely to experience unplanned pregnancy, with around half of conceptions in those aged < 18 years ending in abortion. After controlling for prior disadvantage, teenage parenthood is associated with adverse medical and social outc...

Background: The SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt. Methods: Hospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India cov...