Up to 1 in every 3 adolescent girls will experience a mental health condition during the pregnancy and the year after birth (known as the perinatal period). While the majority of adolescent pregnancies occur in sub-Saharan Africa, there is limited evidence as to what interventions can improve mental health outcomes in this setting. The Innovative approaches for adolescent periantal wellbeing (INSPIRE) project sought to address this gap in knowledge and care by developing solutions to improve adolescent perinatal mental health outcomes in rural and peri-urban settings in Kenya and Mozambique. Through this project the Thriving Mamas programme was developed. The programme is an enhanced antenatal course designed to provide adolescents with skills and knowledge related to pregnancy and child birth, caregiving, life skills, and family planning. During the course of the INSPIRE project, our engagment with key stakeholders highlighted the difficulties policymakers, health planners, and service providers had in integrating new interventions into existing services. Existing implementation guidelines and frameworks lack utility for those without practical integration experience. The current project (Scaling-up co-designed adolescent mental health interventions) focuses on this challenge. It aims to develop an effective and useable tookit to guide stakeholders through the process of adaptation and integration of adolescent mental health interventions. A draft operational toolkit for adaptation and delivery will be developed through a series of workshops with policymakers, techinical experts, service providers, and young people. The agreed toolkit will then be tested through the adaptation of the Thriving Mamas programme for delivery in Mombasa (Kenya) and Maputo (Mozambique). Throughout these processes, qualitative and quantitative data will be collected to better understand participants' experiences of engaging in co-design activities, the utility and comprehensiveness of the operational toolkit, and the percieved feasibility, acceptability, and appropriateness of the Thriving Mamas programme in a new, urban setting.

In adolescence, health-related behaviours are adopted that will have substantial positive or negative impacts on the individual's short- and long-term health, educational attainment, and employment prospects. However, in most low-income countries few adolescents have any contact with health services, especially for health promotion and disease prevention, and services are not always appropriate for their needs. Due to resource constraints there is often limited capacity to provide high-quality youth-friendly health services. Technological advances provide opportunities to deliver services and information away from traditional clinical settings, hence reducing barriers such as cost or confidentiality. Adolescents may be particularly receptive to digital platforms that allow them to self-manage their health and well-being. What is Y-Check? The programme screens and treats/refers adolescents for common conditions through health check-ups in younger (10-14y) and older (15-19y) adolescents. Adolescents are only screened for conditions with an accurate and acceptable test and a locally accessible effective intervention e.g. mental health, HIV, vision and hearing, anaemia. What exactly has been done so far? We developed, pilot-tested, implemented and evaluated the innovative Y-Check programme and an accompanying digital platform in Zimbabwe. Check-up visits took place at schools for younger and older adolescents, and in the community for older adolescents. The youth-friendly digital platform reduced the workload of staff by allowing adolescents to self-screen using questionnaires (e.g. mental health, risk behaviours) and pre-existing apps (to test hearing, eyesight). What were the main outcomes? Answers to the following questions - Do adolescents attend the screening and referral appointments? What impact do visits have on their health and education? How much does it cost for an adolescent to be screened and to obtain the recommended care for a condition? Is this a good value for money? What is innovative about this study? The approach is innovative and novel, because, few LMICs currently provide check-up visits for adolescents and in countries where they are provided, the visits don't always meet the needs of adolescents e.g. don't include mental health screening. This proposal takes the innovative and bold step of moving from condition-specific health programming towards an adolescent-centered approach focusing on what matters most to adolescents. This is the first empirical study to have investigated the effectiveness and cost-effectiveness of multi-component adolescent health check-ups. Specific innovations: - Youth Researchers participated in a human-centered design approach to intervention development - Digital platform on which adolescents completed some of the health screening activities, saving consultation time and improving the quality and efficiency of data collection - Novel adolescent engagement activities including crowdsourcing contests Why Zimbabwe? Zimbabwe is an ideal location for Y-Check with great potential for scale-up given the close collaboration between the Biomedical Research and Training Institute and the Ministries of Health and Education, the emphasis on prevention within the 2018 School Health Policy, and the absence of other good ways to screen and refer adolescents. In other African settings, there is considerable interest in adolescent check-ups and the model has recently been adapted and implemented in Tanzania and Ghana. In this next phase, we propose to conduct additional data analysis and mathematical modelling to decide on the best content and format for a Phase 2 Y-Check intervention, to design a rigorous evaluation study to determine the Phase 2 interventions' effectiveness, and to estimate the potential longer-term impact of prevention interventions in adolescence.

Gaining too much weight without getting taller damages different organs and functions of human body and causes many diseases. This means that people with obesity tend to have multiple diseases at the same time. This is called multimorbidity and has negative impacts on a person's overall health and wellbeing. Obesity has gone up for years in most countries, but how much it has increased differs between different regions of the world. In some parts of the world, obesity exists side by side with being undernourished. It is also believed that some people are more likely to gain weight in the form of fat that deposits in the abdomen compared to other parts of the body. Also, by how much those affected by obesity also experience other harmful social and lifestyle factors, like smoking, is different across the world. For these reasons, we expect that multimorbidity in people with obesity is a complex phenomenon that is different in different regions of the world. But there is very limited information on multimorbidity in people affected by obesity in terms of what combination of diseases they have and how common each combination is. This is especially the case in lower income countries. This research study will use a large collection of data that have measured weight and height in tens of millions of people from different countries. The same data also have information about different diseases that people have or have had in the past, behaviours like smoking and alcohol use, and measures like blood pressure and cholesterol. The data do not have any information that can identify individual persons but can tell us what is happening in whole countries. The data have been brought together by hundreds of researchers, doctors and public health experts from around the world. Our research team will use advanced methods to identify people who have similar set of diseases and measure how common each group (or cluster) of people is. For example, some people with obesity may have a combination of diabetes and kidney disease, and have had a stroke in the past. Another group may have liver disease, diabetes and back pain, and so on. We will also study how much differences in multimorbidity in people who have similar weight for their height is due factors like their smoking, alcohol use, blood pressure or cholesterol. Through this information, we can better use our budgets for providing optimal health care that will benefit people in each country, and to understand how obesity affects multiple diseases so that we can improve disease prevention. This work involves collaboration between researchers in the UK and in other regions of the world so that by the time it is completed, we will each be able to do studies like this in our own region and compare results to learn about the best ways to prevent and treat disease, and improve people's health.

This work will deliver a review of cost estimates for the regional / global (supranational) activities needed to improve health security preparedness and protect the world from health emergencies like epidemics and pandemics. Working in collaboration with the World Health Organization (WHO) and academic partners at Duke University, this project will deliver evidence to inform new WHO guidance and policy recommendations, Government of Twenty (G20) negotiations, and related policy negotiations prior to the 75th World Health Assembly and beyond. The COVID-19 pandemic has highlighted the need for such work, with experiences over the past two years showing the importance of health security preparedness across country, regional and supranational levels. This work will complement ongoing WHO efforts to detail cost estimates for country-level resource needs for such preparedness activities. In doing so, this research will address five key issues related to determining cost estimates for pandemic preparedness and response reform: 1) Locating current and future budget / costing requirements at supranational and regional levels; 2) Detailing 'supranational' from 'regional' and 'national' activities; 3) Address the key knowledge gap around efficiency and effectiveness at the interface between national, regional and supranational levels; 4) Locate activities contributing to 'global common goods for health', and; 5) model subsystem investment prioritization strategies that can best realize these common goods for health in pandemic preparedness and response.

Between 2010 and 2050, the number of people aged 60 and over is expected to increase by one and a quarter billion, reaching 22 per cent of the world's population. Of these, 81 per cent will be living in low and middle income countries (LMICs). There is an urgent need to identify policies that are effective in promoting the health, economic security and quality of life of older people in these countries. We should not assume that policies working reasonably well in high income countries will suit the circumstances of poorer ones. To date, research on older people in LMICs has been limited by a lack of reliable data. The World Health Organisation has sought to fill this gap by conducting a set of large surveys of older people's health and wellbeing in six LMICs: China, Ghana, India, Mexico, the Russian Federation and South Africa. Together, these countries already account for 36% of the world's 60+ population. This is an unprecedented data source, which promises to generate highly significant insights for policy-makers and researchers. The research team have conducted preliminary analysis of the data and this study would enable them to extend their work. We propose to focus our analysis on three key themes. (i) What effect does receiving a pension benefit have on older people's health and wellbeing? Policy for older people in LMICs is heavily focussed on providing pensions. It is assumed that, as well as ensuring their economic security, this will help them pay for health services and consequently improve their health. Yet the evidence for this is not always clear. For example, South Africa has a generous pension scheme but poor health outcomes for older people. We will conduct a systematic analysis of pensions, health and wellbeing, assessing the extent to which they are linked in the different SAGE countries. This will inform policy-makers about the relative importance of pensions and other policies, such as the upgrading of basic health services. (ii) Hypertension is a major cause of serious illness, including stroke, heart disease and dementia. Preliminary analysis of the new WHO data base has revealed large variations in the prevalence of hypertension across LMICs. There are also large variations in the extent that people are aware of these conditions and are receiving effective treatment for them. Our study will explore the reasons for these national variations in awareness and treatment, as well as for variations within countries. This will be done by more detailed analysis of the WHO data, combined with additional information obtained from documentary sources and interviews key informants in the SAGE countries. We will pay particular attention to the policy implications of these variations. (iii) How people experience later life is strongly influenced by previous life effects, but our precise knowledge of these effects is limited. WHO SAGE includes large amounts of information about older people's past lives, including their parents' education and occupational status. We will use this data to analyse life course effects and compare them across the SAGE countries. This will improve knowledge about how earlier life interventions may enhance wellbeing in old age. The research project will include a large element of dissemination and engagement with policy-makers, including meetings in each of the study countries.