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Thank you very much. Thanks a lot for that rose. OK. So I'm going to launch straight straight into it because I have just um 15 minutes to talk. Um I came all the way from Lagos, Nigeria yesterday. So excuse my um creakiness. Um So we're talking today uh and I on successful partnerships in global National health and this is my beautiful University of Lagos from one particular perspective. And um I'm going to speak in the context of starting with my background, talking about how research funding is low in my environment and the poor health indices generally speak about the collaborations. Um A few projects that we're carrying out at the moment and then some brief results from one of our um recently concluded clinical trials and then hand over to my colleague here who is going to tell you some more on the implementation science aspect. So this um a piece of my background, this is this, I mean, this picture doesn't do justice to this beautiful university that I trained in in Nigeria. It's called the universities in if OK. Also went there in incidentally, we didn't know that before we started working together Um, and from there, after training in medicine and getting schooled into how, you know, we are the ones that can sort Nigerians problems out. I went over to the UK briefly to get my, um, specialization in obstetrics and gynecology did that in 4.5 years and came straight back because I wanted to do it quickly and come and sort out Nigerians health problems. Um, and then came into the College of Medicine um where I rose to the ranks over the last 25 years to become a professor. Now, the College of Medicine is also on the same side as the Lagos University Teaching Hospital. And um between those two institutions, we get to work together on a lot of um maternal health um projects. Now the background for Nigeria, the problem is that we actually have the highest number of women in total according to the 2020 who indices dying of maternal health. As of 2020 82,000 women died of maternal mortality or had maternal mortality, preventable deaths in Nigeria. And that was about a third of the total 247,000. We have a population of greater than 200 million. And one of the problems that we have is that we don't have enough doctors, talk less of maternal health doctors. So we have about 55,000 doctors currently registered yet in the past 13 years, we've had over 36,000 doctors migrate to the UK and more than 41,000 nurses UK, maybe about 60% of them. And then there are other countries they listed that they also go to. Now in research money, we have very little research funding as well. We have less than 15 million for all disciplines dollars, you know, in Nigeria available. In fact, I'm being quite generous when I say that, but that's just because I'm factoring um some other universities that I don't know what their research uh matters are. So, in that context, what is our approach to high quality research? How do we try to make this work with my experience? What we tried to do? First of all is look for a mentor who is doing some work that you feel is interesting. And that was what happened to me when I first got into the college about 25 years ago. Um one of my mentors was working in sickle cell pregnancy. And I really was fascinated by that because that Nigeria has the highest number of people living with sickle cell in the world. And I started working in that area, went on to apply for a P HDA doctorate in medicine in in Nottingham because he had worked with somebody there and applied for what was a huge grant at the time, a University of Lagos Central Grant which was about $10,000 equivalent to do all that to do the, you know, doctorate to do the work, the research work looking at plasma volumes and their determinants in sickle cell pregnancy and managed to, you know, create um produce some research in that way, high, relatively high quality research. Some of my colleagues also did that but a lot of, a lot of it was also self funded. Another thing is the mentored research. We have these resident doctors that we supervise for their dissertations as consultants and we um supervise them. They come up with, we come up with the ideas, they tend to, you know, do a lot of the work. We make sure that they do the work properly, they self fund. We also, you know, contribute a bit of money to it if necessary. And together we manage to get some good research going. That's how we started off generally. Then as time went on after going through several applications for external grants not getting them, we applied to T Fund Nigeria, which is an educational trust fund where that is where they give up to $5 million in total in each year to many, many disciplines. And they give about 50 out. And we were able to secure this grant for one of our sickle cell pregnancy projects where we are looking at low dose aspirin. We've almost completed the trial now and we should be getting results next year. And so II put all this here because this is, this is the thought of um uh research funding we have available um in Nigeria. And because of that, we have to look outwards and um I'm going to talk about briefly the pathway to the partnerships and collaborations we've had thus far. I've already mentioned that I went to the University and Royal College now in the College of Medicine itself, which is in the same campus as the Lagos University Teaching Hospital. We have many different disciplines as you would in general um colleges in that way. So we have um the Obstetricians, we have the public health physicians. One of them is in the audience right now. Doctor Balog, who we started working together. We have sociologists in the university. We have pharmacists, we have so many different disciplines and we start working together now within the country as well in um ba ba University and in LA and all other universities. We also collaborate. Well, then how do we actually get the global, full, global um collaborations? I put the Gates Foundation there because it was from one of the big grants that we are now able to build capacity and trying to get phd students also on board. So we had this unique collab um situation where because we know we have a brain drain, a huge brain drain. We decided to try and get the benefit of having phd students in some of these institutions I've mentioned here, the London School, the Liverpool School, the Institute of Tropical Medicine in Belgium. The Karolinska Institute through people that we had met during some of our previous um mentees um work and the Gates Foundation funds the trials that we're doing. So we're doing the work in, in house. They are registered at these institutions to do their P hds. And it's a win win situation where they get their P hds there or they do the work in Nigeria. We collaborate with the researchers in the different universities. They work with us. Some of them are Nigerians. Aurra is here. Aura is one of the people that has done a lot of work with us as well and it helps us get, you know, this um the knowledge, the capacity to build more people doing phds and hopefully bringing the research in and getting some more research funding. Um Other successful partnerships is not just the UK. So we've partnered with, we have some D 43 grants with um um Harvard and Northwestern. And recently we had um a collaboration with the Mayo Clinic in Florida where we actually published this paper recently because Nigeria has the highest number of women with cardiomyopathy in the world as well. And in particular, we were able to prove that an A I guided screening tool for ecgs in cardiomyopathies predicted more um cardiomyopathies than uh the routine um point of care. And we just published it in Nature Medicine and we're quite proud of that particular um publication. We are going on to Emory Universities at the moment to try and um plan another day three. So how, what did all these, you know, bring about it? Brought about um us developing a center called the Center for Clinical Trials Research and Implementation Science in the University of Lagos. And when I say center, I make it seem as if we have this grand building. No, we just have some poky little offices in different places, but we have 25 members of staff which are, you know, employed with these grants. I know that that's standard in a lot of countries in the UK and in the global north. But in the context where we are, it's not some that is routine at all because remember that, like I said, uh regular research funding is less than $15 million per annum in the whole country to all the different disciplines. So for us to be able to have this, you know, in one particular area is really huge and we've been able to do that with some of the grants that we managed to pull in. We have several projects ongoing and it's one of them that I'm going to talk about. Now. We just published the I trial which is about intravenous iron versus oral iron for iron deficiency anemia in Nigeria. We're also, it was an R parallel and, but we are also working on one called Azithromycin versus usual care and that one is in 60 sites all in Nigeria, we have about a recruiting of over 5000 women for that particular trial. And we've just, we are going to, we are just training for it. We are going to start working on it um very soon now, talking about the IVO trial. Um basically, we know about anemia in pregnancy. We know that it's commonly caused by iron deficiency. Um in Nigeria, between 25 and 46% of women will have um iron deficiency as a cause. We know here in the global notes that intravenous iron is, you know, where rapid, rapidly correct anemia in pregnancy, particularly iron deficiency anemia and is well tolerated. In particular ferric carboxy maltose, you only require one dose, which is 11 of the reasons why it's so unique and interesting to us because um a lot of women don't come back for these contacts. They don't come for antenatal care. They don't actually um come back to have the iron refilled. So if you can give them one dose of iron to reduce the anemia, you could solve a lot of problems for oral iron. A lot of them, you know, don't take it well, they have to have repeated visits. They generally have to, they have side effects and some of them don't even absorb it well. So for that reason, we went on to do this open label superiority. 1 to 1 prior design, randomized controlled trial. We recruited 1056 women in two Nigerian states, one in the northern region of Nigeria and one in the southern region. And both of them have differences in terms of poverty level, illiteracy differences. Lagos is a bit more economically buoyant. Kano is not and there is more, the level of poverty is a bit higher in Kano. So we recruited women between the ages of 2032 weeks, gestation aged less than 10. And we it was both an effectiveness and an implementation trial is going to tell us about some of the implementation work we did on this. So just um looking at the outcomes where um maternal anemia of hb less than 11 was our primary outcome at 36 weeks, gestation and preterm birth um are less than 37 weeks. We also looked at secondary outcomes including maternal depression and some um o other um infants and maternal outcomes. Like I said, we did the implementation side and we are also working on the cost effectiveness. Um on this. These are results. Um we didn't find any differences in our primary outcomes that is anemia itself and preterm birth. But for iron deficiency, we had about a an um 73% reduction in iron deficiency as well as um 78% reduction in iron deficiency anemia. And even in the subgroup analysis of women who actually had iron deficiency anemia, there was a reduction in anemia as um not surprising. We also found a sig significant increase in HB concentration um with IV iron compared to oral ion at four weeks, post enrollment and it was safe. Um, there were no severe adverse events or hypersensitivity reactions. In fact, uh, most serious adverse events were found with intravenous iron that was drug related because, um, women who had, um, um, oral iron had diarrhea and one of them, one or two of them ended up in hospital because of that. Um We had a transient hypotension um during administration with IV because we were doing it for, you know, to uh 15 to 20 minutes, but it was not symptomatic at all. Hypophosphatemia is a known um complication of um ferric carboxymaltose, but it was only just at the four week event. And after that, we, um there was no difference. In fact, we did a cold blood analysis and there was no difference in hypophosphatemia between those who had um intravenous or oral iron. We just published, like I said, just five days ago, we were published in the Lancet Global Health and we are quite, you know, pleased about this. And um in conclusion, uh we found it to be more effective than oral to prevent iron deficiency and iron deficiency anemia. And we decided that um iron ion should be prioritized in iron deficiency anemia in pregnancy and considered in moderate anemia because of the context we are in these are women who do not attend antenatal care. And we know it is safe and um uh and ferritin tests are expensive to conduct. So um this is us is here, this is us in Kano, this is us um in um uh one of our implementation science works and also visiting a CMD for some of these advocacy visits that you do. This is us launching our center and also doing some other very interesting um work. Uh Ami is a consultant obstetrician and gynecologist has previously introduced. She's an adjunct lecturer at at at the college. She's a phd student at the Karolinska Institute in Sweden. She's a member of the center and she's my teacher when it comes to all things implementation science. Um Thank you very much for listening to me. She's going to speak to that now. Um Thank you for for introduction. Good afternoon everyone. Um So I'm going to be given um reports of some implementation research we've conducted so far and the the key findings um some focusing on in pregnancy as pro said, this is a condition of public health significance with high prevalence globally. It is a lot of mobilities for the mother and the baby as well. And also um a lot of maternal deaths in Nigeria and the commonest cause of this is iron deficiency. And we normally what we use to treat this condition is we use high dose of her therapy to treat this condition. Unfortunately, this with a lot of um gastrointestinal adverse events that cause it caused a lot of um a poor adherence, poor compliance to this intervention and hence anemia continues to grow. Equivalence continues to rise in Nigeria. So um an alternative to this is the use of I therapy, which has been shown to be safe and effective. But we need to know that, you know, establishing the effectiveness of an intervention does not really guarantee it up inter practice, we need to do a lot more to be able to make sure that the scale up of this intervention. So for example, in Nigeria, we we know we know that it's highly effective. We do not know if it's going to be accepted in our setting. We have no understanding of the on the delivery in Nigeria. Also, we do not know if the guidelines that we have to be able to help our health care facility and providers to give this according to the protocol. Also, we know that yes, we know that is going to be on the high side cost wise, but compared to the or the, but we have no evidence if it is going to be cost effective when we compare that to the standard form of treatment. And that was what um made us to realize that no, we can't just go ahead and do effectiveness to establish the effectiveness of high behind therapy. We need to do a lot more and to be able to do this, we decided that we need to move away from the traditional research pipeline which take a long time for finders to pay inter service. So we decided to go through the service um throughout of implementation science, which is an act of integrating evidence based finding practice and to be able to, you know, shorten this gap, we decided to conduct a research um with hybrid design to be able to shorten the crap what we know works and what we do routinely and then that was what we got. The haven't tried, spoke about the other time and this trial use of effectiveness, implementation design, it has to the effectiveness and then the implementation which are the for of focus at home this afternoon. Um So um for the implementation ham, so we, like she said, we conducted ha on trial which is to compare or oral therapy, which is standard form of treating in pregnancy to high therapy. And this was a study that was conducted amongst um 1056 pregnant women between 20 within the age of 2032 weeks. And it was conducted in 11 healthcare facilities in Nigeria in two most populated state that is a legal state or in state. So for us to be able to understand what we are doing, we need to find out the context to which this intervention is going to be established or investigated. So we use a determinant framework that we call a this is consolidated framework of implementation research. It has five domains and nine constructs. And we used to be able to understand the outcomes of interest that is related to high as an intervention for the purpose of this presentation. Focusing on three outcomes here, acceptability, visibility and fidelity. So we started as a um a study on of high behind therapy. This was a qualitative study that we conducted before the trial started and it was done amongst stakeholders and came here is to understand the factors that would impede or enable the acceptability of High Behind Therapy. We conducted focus group discussions and 2019 interviews among more assistant stakeholders. And then we added five factors from these different groups. For example, for the pregnant women and the family decision makers, we had, we had a lot of concern came up about the high cost of therapy when compared to the oral. And then we have challenges, its own awareness, events and misconstruction for the healthcare workers. Um lack of confidence to give this intervention heavy workload, fear of adverse events came up and infrastructure wise, we have um challenges with inadequate space to give inadequate human resources and a regular supply of iron. So we transcribed our findings and we used theoretical framework of analysis to analyze our findings. And we realized what we need to put in place to ensure that this IV is accepted in our environment. So what we did like, let's let's look at this visual, for example, we can add a pregnancy men, we need to be able to, you know, synthetise awareness, we're able to let them know what IV is all about. So what we think we need to do is integrate IV ion into health. So this will stimulate the confidence to receive this intervention and it's to receive, give them the knowledge about how intervention works and to reduce complication of anemia. At the, at the end of the day, for the healthcare workers, we need to train them. This will increase the confidence to, to give this intervention and then we need to work on the cost of II if it subsidize this will make this to be accessible to all women who actually needs this intervention more for infrastructural challenges. We need that you know, like said uh health care work are mi every day. There is brain doing in the country. What do we need to do? We need to make sure there's a human resource and this will this will reduce the cost of time that they perceived to give this intervention by the health care workers or the cost of time that the pregnant women will perceive to receive this intervention. This is the opportunity cost. All this if we do for them is to increase the positive affective attitude of this intervention and to increase the acceptability of high behind therapy. So we went ahead to conduct a study, the quantitative study to um to um to assess the feasibility of utilizing within the context of Nigeria system. And we use the of intervention measures to do this. And this is a graphical representation showing the percentage of health health care workers who agreed or completely agreed that is visible, you know, its integration is visible in our environment. And as you can see here, the rate is high and we attribute this rates actually to the strategies that we put in place. Now, following the acceptability study, all those factors made us to put a lot of strategies in place because it is the clinical trial. And for example, we train the health care workers for them to welcome the fear of adverse events that may, that they feel may occur from high behind therapy that stimulates their interests and their confidence to give this intervention. We also employed research workers who work hand in hand with the facility, health care workers and this helps them to see and realize that this is actually visible in our environment. So of course, in the clinical setting. So it's within the context of that clinical setting. So we buffered for a lot of things to make sure that at least let's see if this thing will be in our environment. But in real world setting, we realize that it is very important for us to make sure it is adequate human resources. And this may be a challenge. Yes, what we could look and look at policy on task shifting where um lower ca are trained to be able to give this intervention in our environment. So we went on to conduct a study on fidelity, which is the degree to which an intervention is given according to protocol. And there was a mixed up study. So the we check to the level of adherence to protocol um in all the facilities involved. And as you can see here, you know, the facilities, we have moderate score which is 66% and the lowest score was at the primary healthcare facility. So we went ahead to check, ok, what are the factors that influence this level of adherence in our environment? So we selected and 40 healthcare workers in nine healthcare facilities, those with high fidelity level, those with low fidelity level and realized that team walk um protocols um charts enabled high level of higher in this um some facilities with high, high level and a to put all and then contextual factors like low inadequate human resources more in the primary healthcare facilities. And then this contributed a high workload for these healthcare workers, prolonged patients waiting in order to be able to meet up the expedited the administration of high therapy such that some steps were missed and that was what contributed to the low fidelity in the study. So we look to have a patient, do they, are they satisfied with treatment options that they received during the trial? Uh We looked at pregnancy men who had pregnancy men who had oral therapy as well. And as I can see here, 80% of pregnancy men were satisfied with the therapy was 62% were satisfied with oral therapy. And these were really significant. Now, all this looks so juicy, it looks so good, you know, so good to behold. But we need to realize that it is within the context of a clinical trial even though Pragmatic. And so we realized that yes, let's take a step further and conduct a research, real implementation research in real world setting where we, you know, for anything and see if I can be utilized seamlessly in the environment. So we went ahead to conduct what we call hi, this is an acronym for implementation research for intravenous use in Nigeria. Um So it was, it was, it was conducted in close out of six facilities including 1 to 2 private facilities and one primary healthcare facility. So the design was of participatory action and research um with an implementation management frame. What do I mean by that? We have a management team comprising of so many people, the health care workers. So pregnant women, postpartum women, their family members, the community leaders, the policymakers and the academic researchers. All these people come together to talk about how high can be implemented in our environment. And one of the aim is to identify and improve implementation bottlenecks regarding IB therapy. So we conducted quarterly bottleneck analysis using diva as a tool. Di is an acronym for diagnosing what the problem is intervening. You know, by looking at the solutions to a problem, verify if we actually working on those solutions and see if we can adjust and we define some strategies and improve more on that. So we believe that and we use model which has five determinants of health care system evaluation. And we have just two, well, not just 25 of them have issues, but we have two that we have major challenges regarding high therapy. And as you can see, accessibility is one of them. Um So the I MT members are there in each facility, but we have a lot of non I MT members and they are not aware of this um intervention. So women who see them do not have access to this intervention. When I MT members are not on duty, it is difficult for pregnancy, mental assess it as well. So what do they do? They brainstorm on what to do. So they increase awareness among all the healthcare workers in each facility, they involve whole health care workers and then the schedule more to when I MT members on ground acceptability has to do with problems with research in our environment when it comes to consent. And you know, people tend to feel there's a catch to an intervention where you're asking them to consent. So we have challenges with this. So they work more by strengthening their communications, by um increasing our awareness on the two different means, videos leaflets. And at the end of the day, we were able to absorb such stories from all the things we've been able to don to do in real was set. For example, there's increase in patient engagement and empowerment, you know, because it increased the patients awareness of this intervention. The readily agree now consent and to participate to receive the intervention, it increased it enhanced patient outcomes because the hemoglobin level got um corrected over time, it reduced hospital admissions. And um according to one of the IMC members, there's reduced rate of blood transfusion in the facility, meaning that the intervention itself is ineffective and what carrying everybody along. And also this health care provider, capacity building, it's enhanced their competence give this intervention because they've been trained to do this reaction, the fear of events associated with is no longer there. So we're more enthusiastic to be involved in this um intervention. So in conclusion, effective collaboration has helped us to be able to go beyond establishing effectiveness of an intervention. But instead to translate our findings into practical applications, it has given us the opportunity to conduct implementation research, to understand the barriers, to find solutions to barriers and to improve equitable asset to those who need this intervention more. It has enabled us to narrow the gap, which is what you know what and what we actually practice every day and it has helped us to link evidence to practice so that the new findings that is not delayed in any way but sustainable uh in our environment. I want to say a big thank you to everyone for listening. Thank you. OK. Thank you so much for two incredible talks and a really impressive demonstration of how your vision. Professor Ela over 20 years ago has led to the set up of this center and the delivery of some really impactful high quality. And I'm sure that is an aspiration that a lot of the early career researchers both with us here in the room and online would really like to emulate. We do have a lot of questions. So I will start with some relating directly to the iron work. So from Professor Critchley, who also I know has a lifelong interest in this area. Thank you very much for this important work that you're doing. Are you going to be able to follow up on the newborn and childhood outcomes for the babies that were born out of the research study that you were doing? And also have you thought about or is there other plans to look at this kind of intervention and particularly high risk groups like women with heavy menstrual bleeding, maybe even pre or periconception to optimize their outcomes in that phase? Thank you. Thank you for that question. So, um regarding the initial trials, we didn't have the plans follow up babies, but we do have um, another one ongoing now in postpartum women that we are giving the intravenous iron to postpartum women within six and 48 hours after delivery. And we are following up the themselves and their babies up to about six months. Um, and we're also um planning uh an implementation um project where we're going to just since we know it's effective and since we know it's safe, we're going to just treat women with um the intravenous iron and then follow them up and their babies for, you know, some time just over three years, actually looking at different um population um indices this time around. So yes, thank you for the, regarding the G ones, the heavy menstrual bleeding and so on. That's going to be a different one altogether that I will probably think about. Thank you. Um We are really getting a lot of questions. So this is very inspiring research. Um I will go back to asking a more general question um because I think it's something that we all want to think about. You, professor have decades of experience building collaborations and you've leveraged those extremely successfully to build capacity. And I think highlighting your strategic vision in developing phd researches is a really important part of that. But what would you say in your view has been the main essential ingredient in the successful collaborations that you've built and a lesson that we can all take as we're trying to build these partnerships to address these big challenges. Um Money is coming from the global South. I think that one of the things that one can do is to look for people from your environment that are, you know, in different institutions. It helps because the trust is there a lot of the um uh partnerships I made outside the country, apart from the ones I had already had from the UK were from former students through former students or Nigerians that are in some institutions where I could now, you know, we could meet up and they could introduce me to some of their own um workers. So that's one way of um one of the things that I've learned and also, of course, the obvious one of paying forward, you know, generally when you're mentoring people, you're not necessarily doing it with, you know, you're going to get something in, but something always comes back. If you mentor fully and open openly, you will definitely get the rewards back in being able to get um networks and partners. I'm not a very um you know, network person but somehow or the other. It's, it's coming into place because of the people that have mentored in the past. I think we've got a question here from Alice B MRE which relates to the sort of research funding landscape in Nigeria we're quite interested in obviously in the UK. We're familiar with applying to the MRC NHR in the US, they've got NH and that funding stream, that reliable funding stream is so important for developing sustainable programs of work. Is there an equivalent government research funder in Nigeria? If there isn't, what kind of measures are there or strategies for developing that in the future? Thank you. So, the TE fund that I mentioned, um the funds for TED Fund come from the tax something I think it may be petrol. There's something they tax that we get the funds for TED Fund from and they, they keep it for university funding. And um about um $5 million equivalent, like I said, comes annually, apart from TED Fund, there are different universities that have their own central research fund, but it's usually quite small, like I mentioned for the UNI one. Um I think it's just the continuous advocacy. So some of this research that we're doing generally, we, we also apart from doing the research, we're also, we also have advocacy arms. We, we engage with policymakers, we have meetings where the Federal Ministry of Health people, you know, are um involved. The current Minister for Health too is very big on this type of thing. So when we let them know a lot of the work we're doing, I think from with that, that's the main strategy I can see and ensuring that we disseminate deliberately and intentionally the work that we're doing to the um policymakers that are important, the stakeholders that are important, including those that work in the government. Unfortunately, under normal circumstances, we shouldn't have to do these things ourselves. But because of the context we have, we, we, we, we incorporate that into a lot of the work we're doing. We do have a lot of questions, but I'm selfishly gonna ask my own before anyone answers, which is, you've established a really successful research center and a model for developing capacity and with a lot of collaborations. What do you think the role is of South to South research collaborations as you're now a leader, a research leader yourself? Yes, that's something that I've been particular about to and interested in. So there's the AC which is a African Population Health research Center that we're collaborating with quite a bit there in Kenya. And then there's some Ghanaians that we've been collating with in terms of the sickle cell research. So we're working in that as well because it is important to, to try and do South South and not just South North. It helps us pull each other up together. OK. That's wonderful to hear. I'm gonna ask a question specifically to um because you're our implementation research expert and there's a lot of interest in the room about that and recognition that it's a really under recognized and important part of research particularly as you say, to underpin sustainable translation rapidly into clinical practice. What do you think that we can do more to enable this across Africa, across all settings because I think I would say I find this even in high income settings if we don't think enough about the implementation. And so what do you think we should be doing as researchers to enable this more in our settings? Ok. Um Thank you for that question. I think, I think we need to start from the grassroots. Um We need to involve the medical student or nothing students starting from the grassroots, letting them know that yes, the importance of clinical trials of clinical trial is very there. It's important, but we need to take a step for that. For example, this in next has been shown to be effective as well. How many women are using it? They have it, they give them to take home, most of them do use it. So we, we need to let them know that acting on this. Find this intentionally goes a long way and then we need to treat them. We need to include that in the curriculum in the universities as well for people to be aware about this um that research field and this will enlighten people and this will at the end of the day for people to wanting to conduct this kind of research on evidence based findings and increase the uptake of that intervention. I've got a question from Alex Ridout, which is one that I found myself as well as redesigning implementation research that there's maybe less consensus about exactly the best way to analyze and present the data to make it most effective. And what's your experience in that and what have you found to be useful? I'm still a student. My supervisor is here and in every day there are challenges. Yes. Um you know, challenges in designing that research and having a and knowledge gaps, you know, having the skills of how to analyze quantitative qualitative conducting research without being biased, all those things you need. And that is a life long training and which I'm still learning every day. Um Well, just feel that we need to go through that process. It's not hard, it's not difficult, it just wants to be intentional and to focus and with time you will on the scale that's really helpful. Thank you. We do have one or two more detailed questions about your implementation findings. One from Sarah comments, wondering why do you think the doctors felt that the IV I was less implementable at the end of the survey, end of the study survey rather than the baseline? What are your thoughts on that? Ok. Well, for example, in a my healthcare facilities, yes, like I said, we have strategies in place but the strategies didn't work more in some clinic, you know, some facilities, for example, in primary health care facilities where we have no health care workers. So even though we tried to provide the strategies and put things in place, they were still able not, they were not able to welcome the challenges, which is the contextual one. So they feel it has more to their workload. So to them, it's not that visible compared to what they felt initially. Um So all these challenges contributed to their response rate at the at the headline of the trial reality bites doesn't, but that is implementation research. That's, that's what we're there to find out is how to fix that. And we've got our colleague as well. No, is asking if we can have any sneak peeks on the cost effectiveness analysis will come up that now. Yes. So this is why we are conducting starting from next month, first week in October, we could start analyzing the data that we have. Hopefully before the end of the year, next year, we should be able to get our find out to people one last question to wrap up the session before we move into lunch. Can I ask you both? How do you navigate balancing the interests of the funders who often have quite specific wishes or areas with what you see as the need for important research on the ground? That's a very good question. The beauty of it is that I am actually very interested in anemia in pregnancy, you know, so it was just, in fact, it was the the funders reached out to me because of some work I had done um in Iron Def in pregnancy. Um Now on the other hand, having done all this work and moving forward and doing several other things, there is also some more work I still want to do in sickle cell pregnancy. And um that's not their own um area, but they do tend to be sufficiently flexible to um allow when it comes to anything to do with nutrition and maternal health um to support and they find ways of um creating new grants for other things from which one can use some of the funds. They, they're quite flexible funders, which is a good thing, but they are not the only funders and it's important to get other funders. And that's part of why we are not just, you know, sitting on their funding, we're looking um outside of them and, you know, getting a lot of other ones working on a lot of other ones. Well, um thank you very much to both of you. I'm sure everyone will join me in a big round of applause. Mhm. Um It's too far to walk in my heels. Um So we have arrived at lunch time. Thank you all for your attention this morning. Our next sessions will be workshops, so we won't all be back here. So we've got three workshops this afternoon at two, the workshop that is up here is going to be the dragon's den of dangerous research ideas and will be the one that is shared with our online audience and we're looking forward to four presentations from early career researchers outlining their ideas and looking for feedback from our expert panel of dragons who will be Professor Critchley, Professor Shannon and Samantha Palmer from the MRC. We also have two other excellent workshops that will be happening downstairs and those are just for you people in the room. We've got Professor Weeks and Joe Weeks will be leading a session on publication fraud and we've got a team from Oxford will be leading an excellent workshop on a practical guide to developing A I tools for women's health. So please can you make sure that you're at your sessions promptly for two o'clock so that we can start and that we can hopefully finish our afternoon sessions on time as well. In the meantime, please enjoy your lunch.