Benedict Warner
I am a Respiratory Medicine specialty registrar, with an interest in global and public health, including tuberculosis and health service delivery, particularly in low- and middle-income countries. My project for the Fellowship will be on ‘Multimorbidity, physical activity and sleep in rural and urban populations in Malawi’. Through the University of Glasgow, and the Malawi Epidemiology and Intervention Research Unit, I will be undertaking my project in two locations in Malawi: the capital, Lilongwe, and a rural district in the North of the country, Karonga. I will be supervised by Professor Mia Crampin, director of MEIRU; Prof Stuart Gray of the University of Glasgow; Dr Alison Price of the LSHTM; and Dr Owen Nkoka of the University of Glasgow.
I studied medicine at the University of Dundee, and intercalated with a BSc in International Health from the University of Leeds, where I completed a qualitative research project into community health worker-delivered family planning interventions in Bangladesh through an internship the Bangladeshi NGO, BRAC. After the Foundation Programme, I completed the East African Diploma in Tropical Medicine & Hygiene through the London School of Hygiene and Tropical Medicine in Tanzania and Uganda, and then worked for 16 months in South Africa’s Eastern Cape as a community service medical officer in a rural hospital, encountering first-hand the ‘quadruple burden of disease’ – maternal and neonatal, infectious, non-communicable, and trauma – that the country faced. I became interested in delivering integrated care to complex, multimorbid patients, and completed a literature review on the role of community health workers in achieving universal health coverage, which I presented at the South African Rural Health Conference.
Since commencing higher specialty training in Respiratory Medicine, I have been undertaking a distance-learning MSc in Public Health, to develop further my understanding of the wider determinants of health and disease. I am now taking time out of my clinical training in order to pursue the Multimorbidity PhD Programme for Health Professionals fellowship and devote my full attention to developing academic research skills and examining the root causes of multimorbidity that I have encountered throughout my clinical career.
My project will look at the relationship between physical activity, sleep, and multimorbidity. It will contribute to MEIRU’s larger ‘Healthy Lives Malawi’ Long Term Condition survey, which is collecting cross-sectional and longitudinal data on around 50,000 adults in across two settings (urban and rural) in Malawi. While the wider survey asks participants about their long term conditions and many determinants of health, including levels of physical activity and sleep patterns, my project will objectively measure these factors in around 4000 participants through the use of accelerometers worn for 7-day periods, with sampling occurring over a 2 year period to ensure every aspect of the farming seasonal cycle. While similar studies have been undertaken in high-income settings, such as the UK Biobank study, this will give an opportunity to validate the use of such devices in a large scale study in a low-income setting, where patterns of physical activity may be very different. The purpose of the study is to investigate the possible relationships between multimorbidity, physical activity, and sleep patterns, to lead to future work designing interventions.
In the future, I hope to build on the experience and findings of this project, to further examine the contributing factors to multimorbidity and to shape public health and health systems policies and services to both address and accommodate multimorbidity, in the UK and globally. I plan to combine my clinical and academic careers, to draw on the rich insights gained from daily interaction with patients to inform the design and implementation of policy-changing research which is relevant to patients and the public.
Project: Multimorbidity, physical activity and sleep in rural and urban populations in Malawi
Primary Supervisor: Prof Mia Crampin (University of Glasgow)
Secondary Supervisors: Prof Stuart Gray (University of Glasgow), Assistant Prof Alison Price (London School of Hygiene and Tropical Medicine) and Dr Owen Nkoka (University of Glasgow)
