Dear Colleagues

I hope that you are well and keeping safe in these unprecedented times. COVID-19 has had a major impact across the world, affecting all of us, but particularly those of us who care for the children of vulnerable populations. There are positive aspects to come out of the pandemic, with increased collaboration and care for our communities, opportunity to reflect on our practices. For ICNA, the most profound consequences of the COVID-19 pandemic will be the impact on the biannual conferences which is the major source of income for ICNA, but also improved telecommunications which has accentuated reaching out to many more people, particularly those that could not travel to meetings.

If I am elected as President, besides the aims set out in the attached statement, I will endeavour to mitigate the economic impact of COVID-19 by raising funds from sources not usually accessed by ICNA and improving telecommunications of ICNA activities. I have a track record of raising funds (over 65 million dollars over the last 30 years for research and charity) and will concentrate my efforts to raise funds for ICNA activities. Over the last few months, I have been involved in developing educational material for webinars, conducting symposiums and workshops over the internet as part of my university and for other organisations.

I have been an active member of ICNA since 1998 when I first presented at the International Child Association Congress in Slovenia. Since 2002 I have served Executive Board, sitting on following committees: Research (2002 – 2018); Technology (2002 – 2014); and Education (2002– 2006): Search Committee for Chief Editor of the Child Neurology Knowledge Environment (2003); Editor of the International Review of Child Neurology Series (2006 – 2014), Selection Committee for the Sheila Wallace Award: (2003 – present). In addition I am the founding editor of Journal of International Child Neurology Association, took over the chair of the Scientific Committee for the 15th International Congress of Child Neurology due to illness to the appointed chair. I am deeply honoured to have my contributions to Global Child Neurology recognised by ICNA with the Frank Ford Award (the most prestigious award by ICNA).

I have attached my vision for ICNA and a biographic chapter written for the Child Neurology: Its Origins, Founders, Growth and Evolution by colleagues.

It is important that the ICNA membership takes an active role in the development of the association and I urge you to vote in this election.

Take care wherever you are.

Charles Newton MBChB (UCT), MA (Oxford), FRCP (London), MD (UCT), FRCPCH
Cheryl and Reece Scott Professor of Psychiatry
University of Oxford, UK
Head of Neurosciences
Kenya Medical Research Institute-Wellcome Trust Collaborative Programme
Kilifi, Kenya

Charles Newton was born in Nakuru, in the Great Rift Valley in Kenya in 1958. In 1964 he relocated with his family to the United Kingdom and Ireland. When he was 15 years of age he travelled to South Africa to finish his schooling and to train in medicine at the University of Cape Town (UCT). At UCT Charles studied under the inspirational neurologist Frances Ames, who took on the South African medical establishment over its role in the death of Steve Biko, a black rights activist who died in detention in 1977. Ames was often described as private, discreet, but extremely determined; all qualities that are echoed in Charles Newton. After qualifying, Charles worked in the mid-1980s as a houseman at Guy’s Hospital in London, in the UK. Whilst there he worked under Brian Neville and Fenella Kirkham. They remained friends and collaborators for many years. With Neville’s recent passing (2017) Newton and Kirkham continue the work that the three of them had started decades ago.

With a career that has criss-crossed the globe, Newton has primarily shared his time between a number of African countries (particularly Kenya, to which he returned in 1989 to set up a research unit in a poor rural area) and the UK.

He also spent 2-years in the United States at Johns Hopkins in Baltimore where he studied mechanisms of brain damage in central nervous system (CNS) infections. He completed his training in pediatric neurology at Great Ormond Street Hospital. In 1998 he was awarded a Wellcome Trust Senior Clinical Fellowship at University College London, which enabled him to return to Kilifi, to study CNS infections in children in the African context. The Kenya Medical Research Institute-Wellcome Trust Research Program, in Kilifi on the Kenyan coast has remained one of the major bases for his research during his career and home for many years. In 2011,Newton took up the position of Cheryl and Reece Scott Professor of Psychiatry at the University of Oxford and since then has balanced his time between his commitments in Oxford and ongoing work and mentorship at the different African sites.

Charles has devoted much of his career to highlighting the health challenges and needs of children in the low and low-middle income countries (LMIC) of the world, especially Africa¹ His early career included seminal work on cerebral malaria, an area he continues to research, with solution driven targets being the priority.

The incidence of cerebral malaria cases has declined significantly in many parts of Africa, reflecting effective preventative and often low-cost interventions. Newton’s work in this area has been crucial in uncovering the impact of malaria on the brain, and particularly the role of intracranial hypertension and the various effects of malarial exposure on childhood neurodevelopment.^2-4 His research has confirmed a previously suspected association between childhood exposure to malaria and the subsequent development of epilepsy.² With some 228 million globally reported cases of malaria and 405,000 malaria related deaths in 2018, Charles has been a key contributor to the understanding that the disease is one of the most important preventable causes of epilepsy globally. He has subsequently proceeded to expand work in five African countries looking at the association between exposure to various parasites and neurodevelopmental disorders^{5, 6}.

His research has been key in addressing many previously unanswered questions, including helping to uncover the appreciation that the higher prevalence of childhood epilepsy in Africa, than in Asia, or Europe. Charles’s contributions to understanding the etiology, epidemiology and psychiatric co-morbidities of epilepsy, have played an important role in the drive to reducing stigma and narrowing the epilepsy treatment gap in Africa, where 50-90% of affected individuals have no access to treatment despite the global availability of inexpensive medicines.

His research has incrementally increased our understanding of the association between the epidemiology of various childhood infections and subsequent behavioral consequences, particularly because of the contributing increased risks associated with various environmental and social adversities in low-income countries.

Examples include the association of autism spectrum disorders and other developmental disorders with CNS infections such as malaria, HIV and bacterial meningitis. He also has played a critical role in exploring the relation between sickle cell disease and neurocognitive sequellae in many African countries.

Newton also has been involved with seminal work exploring the genetics of autism, epilepsy and psychosis in sub-Saharan Africa.

These interdisciplinary collaborations across Africa and beyond, involve some of the earliest research exploring the unique contributions of African genetics to neurodevelopmental disorders and has stimulated an interest in the mental health of children from immigrant populations in the United Kingdom and Europe.

Over the years, Newton has worked consistently to explore previously poorly understood non-communicable diseases which, in the LMIC setting, have fallen behind the research and attention given to communicable diseases, namely neurodevelopmental disorders and neurodisability. His close connection to Africa has given him a unique perspective on these important, often neglected focus areas.

His current projects include genetic characterization of NeuroDevelopmental disorders in African populations-Kenya (Neuro-Dev Kenya), Autism and Neuropsychiatric genetics of African Populations- Psychosis (NeuroGap-P) and epilepsy in sub-Saharan Africa. He also is conducting related studies of autism and epilepsy in other African countries and is working on the neurodevelopmental problems associated with sickle cell disease in Tanzania. These efforts represent strong collaborative and mentorship relationships across the continent including in Kenya, Tanzania, Uganda, South Africa, Malawi and Ghana.

Newton’s current affiliations are with the Kenya Medical Research Institute-Wellcome Trust Program, Kilifi, Kenya and Department of Psychiatry, University of Oxford, UK with an additional honorary professorship at his alma mater, the University of Cape Town, South Africa. He has published on a wide variety of subjects concerning sick children in tropical countries and covering all of the areas mentioned above. Charles has over 70 review articles, over 290 original research publications, and numerous book chapters. He frequently presents at international meetings but also supports global educational programs with a particular focus on those in resource limited settings. He serves or has served on the editorial boards of Developmental Medicine and Child Neurology, Epilepsy Research and Treatment, Lancet Neurology, Lancet Psychiatry, Autism research and is editor in Chief for the Journal of the International Child Neurology Association. He has recently been honoured with the Frank Ford award from the International Child Neurology Association for the 2020 International Child Neurology Congress (ICNC), reflecting the scope of his contribution to child neurology over his career, particularly in vulnerable populations in Africa and more broadly in the less resourced areas of the world.

Newton has been a leader in expanding the number of Kenyan scientists, especially psychologists, who are now able to confidently define the phenotype of conditions such as autism in a culturally specific way. His insight into local nuances has ensured that conditions are not misrepresented, for example, in parts of rural Kenya it is viewed as inappropriate for a child to look an adult directly in the eye. People with autism struggle with eye contact, so children in Kilifi score very highly on those parts of the autism questionnaire not because they have autism, but because of the way their culture conditions them to act. The increasing ability of young African researchers to “ask the right sorts of questions” is just one of the many immense changes that Charles Newton has seen take place.

Charles has mentored many clinicians as they developed their career paths, successfully supervising some 20 master degree students, and over 20 PhD students. He has been honored for his continued commitment to capacity building amongst clinicians, scientists and academics in settings spanning rural Kenya to Oxford University and this will remain an enduring legacy. He has served on multiple international boards from the International Child Neurology Association, to the African branch of the International Brain Research Organization, Advisory Committee for Malaria, Geneva, WHO Child Health Epidemiology Research Group (assessment of the Global Burden of Disease), International League Against Epilepsy and the WHO expert panel on mental health Gap Action Program (mhGAP). The scope and depth of these roles represent the global respect he is afforded for his scientific contributions and leadership across these initiatives.

Professor Newton is unique in having maintained throughout his career, a seamless balance of maintaining high level, engaged African research, in Africa, typically leading projects which involved and developed researchers from within Africa who have then gone on to lead research programs and academic institutes in their own right. He truly follows the ethos “lift as you rise”, identifying and mentoring future African leaders in the field of child neurology and development and supporting growth, always with his characteristic generosity and humble, unassuming manner.

REFERENCES

1. Berkley JA, Mwangi I, Ngetsa CJ, et al. Diagnosis of acute bacterial meningitis in children at a district hospital in sub-Saharan Africa. Lancet 2001; 357: 1753-1757. DOI: 10.1016/S0140-6736(00)04897-2.
2. Carter JA, Neville BG, White S, et al. Increased prevalence of epilepsy associated with severe falciparum malaria in children. Epilepsia 2004; 45: 978-981. DOI: 10.1111/j.0013-9580.2004.65103.x.
3. Newton CR, Kirkham FJ, Winstanley PA, et al. Intracranial pressure in African children with cerebral malaria. Lancet 1991; 337: 573-576. DOI: 10.1016/0140-6736(91)91638-b.
4. Carter JA, Ross AJ, Neville BG, et al. Developmental impairments following severe falciparum malaria in children. Trop Med Int Health 2005; 10: 3-10. DOI: 10.1111/j.1365-3156.2004.01345.x.
5. Ngugi AK, Bottomley C, Kleinschmidt I, et al. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. Lancet neurology 2013. DOI: 10.1016/S1474-4422(13)70003-6; 10.1016/S1474-4422(13)70003-6.
6. Mbuba CK, Ngugi AK, Fegan G, et al. Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study. Lancet neurology 2012; 11: 688-696. DOI: 10.1016/S1474-4422(12)70155-2; 10.1016/S1474-4422(12)70155-2.

Reproduced with permission from:
Ashwal, S. (2021 in Press) Child Neurology: Its Origins, Founders, Growth and Evolution, 2e, 9780128216354. New York: Elsevier

ICNA has undergone seismic changes in the last 10 years under inspirational leadership, with the abolishment of fees that has increased the membership from 240 in 2004 to over 3000 in 2020, promotion of young leaders, Global Burden of Disease Fellowships, collaboration with national and international organisations, biennial International Congresses that generate income for ICNA and the publication of position ICNA papers on topics that are important for paediatric neurologists. I think following this tremendous increase in activity and change in membership, ICNA should consolidate and reach out to the members to ask what else ICNA can do for them.

I propose to:

1. Survey ICNA members for their suggestions as to how the organisation can serve them;
2. Reach out to areas under-served by ICNA and the ancillary professions, and promote child neurology in international organisations;
3. Establish JICNA and ICNApedia as multi-lingual and technologically advanced platforms for the dissemination of scientific research and professional documents, that can be used for recognised Continuing Medical Education;
4. Establish a registry of international studies on childhood neurological disorders for trials of rare disorders to the impact of global conditions e.g. COVID-19;
5. Recognise founders and ardent supporters of ICNA such as Isabelle Rapin and Masaya Segawa through lectureships.
6. Increase the Webinars and online workshops for ICNA members.

I vouch to support and develop further the initiatives and activities that are the core of ICNA, to ensure that ICNA continues to grow into a vibrant, energic truly international organisation for the benefit of professions that care for children with neurological disorders; and the children and their families with these disorders.