Congratulations Bridget Wills, Professor of Tropical Medicine at our OUCRU unit in vietnam, awarded RSTMH Sir Rickard Christophers Medal. The Sir Rickard Christophers Medal is awarded triennially for work in tropical medicine and hygiene in its broadest sense and in particular for practical and field applications.
Posted 04/05/2021. This survey in Jakarta, Indonesia, led by Licia Limato & Raph Hamers, evaluated patterns and quality indicators of antibiotic prescribing in six public and private hospitals. The study reported a high rate of empirical use of broad-spectrum antibiotics, coupled with poor documentation and guideline adherence, suggesting important areas for antimicrobial stewardship interventions.
Posted 09/04/2021. Survivorship after an intensive care unit (ICU) stay is associated with long-term disability throughout the world. Nguyen Thi Kim Anh, Louise Thwaites and colleagues designed, implemented and evaluated the feasibility of a sustainable ICU rehabilitation programme in a resource-limited setting with the aim of improving the long-term outcome of critically ill patients.
Posted 23/03/2021. In tuberculous meningitis, raised intracranial pressure often results in irreversible neurological injury. In this study of 107 participants with tuberculous meningitis, Joseph Donovan and colleagues show how optic nerve sheath diameter ultrasound may provide a low-cost point-of-care option for the identification of individuals with raised intracranial pressure in tuberculous meningitis
Posted 12/03/2021. Henry Surendra, Raph Hamers and colleagues report a large retrospective study of patients hospitalised with COVID-19 in Jakarta, Indonesia. In-hospital mortality was lower than reported in high-income countries, likely explained by the younger population, fewer comorbidities and less severe disease. Nonetheless, this study affirmed the vulnerability of elderly and comorbid patients as well as children under 5 years in LMICs
Posted 02/02/2021. Indiscriminate antimicrobial use (AMU) in animal production is a driver of antimicrobial resistance globally. In this trial, Juan Carrique-Mas and colleague provided regular veterinary advice to chicken farmers in Vietnam aiming to reducing AMU. AMU was quantitatively reduced by 66% and flock mortality by 40%. This study demonstrates that reductions in AMU without compromising health and productivity can be achieved in LMICs.
Posted 22/01/2021. Raph Hamers and colleagues conducted a multi-country prospective study of Africans with HIV-1 on suppressive antiretroviral therapy. Plasma concentrations of sCD14 and CRP predicted subsequent poor CD4+ T-cell recovery, and CXCL10 and sCD163 predicted viral rebound. Further research is needed to increase our understanding of and to explore the potential for adjunctive therapeutic interventions targeting these pathways.
Posted 19/01/2021. Tan Le Van and colleagues show that metagenomics could detect enteroviruses (n=23), hepatitis B virus (3), HIV (2), molluscum contagiosum virus (1) and germycircularvirus (1) in 14.7% of 204 cerebrospinal fluid from Vietnamese patients presenting with central nervous system infections of unknown origin. It remains a challenge to identify a plausible cause in patients with brain infections.
Posted 12/01/2021. Azithromycin is effectively the last remaining oral antimicrobial to treat typhoid fever and is widely used for empirical therapy in South Asia. Although azithromycin resistance in Salmonella Typhi has rarely been reported, Abhilasha Karkey and colleagues show that an increasing reliance on this drug has led to the emergence of azithromycin resistant S. Typhi in the region.
Posted 20/11/2020. Providing compensation for participants in clinical research is well established but defining compensation in low-resource settings is challenging due to ethical concerns and the lack of appropriate frameworks. Evelyne Kestelyn and colleagues at OUCRU Vietnam developed a compensation and reimbursement framework, providing a consistent, fair and transparent decision-making process that will be implemented across all future clinical research.
Posted 17/11/20. Rogier van Doorn and colleagues show that antibiotics were prescribed to almost all 500 children with mild respiratory infection presenting to an outpatient clinic. They assessed prior antibiotic use by questionnaire and urine testing (HPLC), and reported overuse and overprescription of antibiotics when most respiratory infections are caused by viruses, and selection of resistant Enterobacteriaceae in gutflora with transmission potential.
Posted 20/10/2020. Buddha Basnyat and colleagues describe findings from NUFIT, the Nepal Undifferentiated Febrile Illness Trial, a randomized, double blind, placebo controlled trial. The trial revealed that 7 days of sulphamethoxazole-trimethoprim (Bactrim) is inferior to azithromycin in the treatment of undifferentiated febrile illness (fever without a focus) and enteric fever in Nepal and the wider region in South Asia.
Posted 11/09/2020. Nineteen different enterovirus serotypes were detected in 1196 Vietnamese children presenting with hand foot and mouth disease during 2015-2018. Le Van Tan and colleagues show that EV-A71 was the major cause, especially in those with severe disease, followed by CV-A6, CV-A10 and CV-A16. Multivalent vaccines are urgently needed to control hand foot and mouth disease.
Posted 19/06/2018. Many people with pre-existing heart problems (including heart attack, pacemaker implantation, arrhythmia), high blood pressure and even past history of a stroke seek advice regarding high altitude travel ( > 2500m) for recreation, meetings or pilgrimages. Dr Buddha Basnyat and colleagues succinctly try to address these conditions at altitude and make reasonable recommendations in the face of limited data.
Posted 17/12/2019. Typhoid fever is rampant in South Asia. This new typhoid vaccine (studied in Kathmandu, Nepal, by Buddha Basnyat and colleagues) appears to be very effective in the prevention of typhoid. Administration of the new vaccine, especially in children, will revolutionize the prevention of this disease. And, crucially, help fight typhoid treatment resistance, a burgeoning problem.
Posted 18/05/2020. The etiology of high altitude pulmonary edema (HAPE), a disease sometimes seen in sojourners to high altitude, is lack of adequate oxygen and not an inflammation provoked by an infectious agent like the novel coronavirus. Except for supplemental oxygen, Buddha Basnyat and colleagues strongly caution against managing COVID-19 lung injury with treatments that are used for HAPE.
Posted 02/04/2019: Underdiagnosed in South Asia, melioidosis is caused by a bacterium called Burkholderia pseudomallei which is often referred to as a remarkable imitator. Pulmonary involvement including infections mimicking tuberculosis is a common form of presentation. In this case report, Buddha Basnyat and colleagues show that if a South Asian patient does not respond to anti tuberculosis treatment, melioidosis should be considered.
Posted 02/10/2018. Rising prevalence of HIV drug resistance in low and middle-income countries poses a growing threat to the HIV response. To curb resistance, enhanced strategies are needed that improve quality of ART care and treatment. Raph Hamers reviews contemporary data and highlights the potential impact and resistance risks of novel ART strategies and knowledge gaps.
Posted 07/04/2017. Collaboration between photographer Pearl Gan and Professor Kevin Baird from our EOCRU unit in Jakarta, Indonesia, this photographic project aims to raise public awareness of malaria as a serious health problem for the region by telling the human story of Asia’s invisible malaria burden.
Posted 28/05/2019. Kevin Baird calls attention to the importance of local expertise in anopheline mosquito ecology as an essential weapon in striving to eliminate malaria. Slight but very specific modifications to environments that disfavour those mosquitoes achieved very significant gains before the advent of DDT insecticide and synthetic antimalarial commodities in the middle of the 20th century. Loss of those commodities, and a lack of alternative strategies, led to the great malaria resurgence of the latter 20th century.
Posted 06/08/2020. Cholesterol is required for efficient dengue virus (DENV) replication, however statin treatment did not show efficacy against dengue in clinical trials, and underscored the need for a more detailed understanding of the interaction between DENV and cellular cholesterol. In this paper, in collaboration with DUKE-NUS, Sophie Yacoub and colleagues demonstrate the pivotal role of PCSK9 in DENV infections.
Nepal is seeing a COVID surge that is proportionately similar to India. While we try to treat the sick by increasing hospital space and ensuring oxygen supply, we must also plan for an exit strategy. Over-preparation rather than under-preparedness needs to be our mantra, with widespread vaccination the key to get us out of this pandemic, by Professor Buddha Basnyat
World Immunization Week highlights the role vaccinations play in improving the health of communities. As the COVID pandemic continues to impact countries worldwide, governments are facing challenges related to coverage, equity and sustainability of routine immunisation alongside access and the particular maintenance requirements related to the SARS-CoV-2 vaccines. Communication with communities has been key to ensure continued engagement with the vaccine programs despite the challenges of current contexts.
Anuraj Shankar from our EOCRU unit in Jakarta, Indonesia, with Elizabeth Prado and Leila Larson describe a meta-analysis showing that responsive caregiving boosts infants’ brain development. Parenting group sessions and home visits improve cognitive, language, and motor skills. And nutrition-only programmes have much less effect than comprehensive interventions.
The Randomised Evaluation of COVID-19 Therapy (RECOVERY) Trial, the world’s largest clinical trial for COVID-19 treatments, has now expanded internationally with Indonesia and Nepal among the first countries to join. The first patients have been recruited to RECOVERY International.
The Indonesian government policy to exclude the elderly in the first phase of the COVID-19 vaccination program could hinder the vaccine’s impact in lowering mortality rates. COVID-19 mortality rates in Indonesia, the highest in Southeast Asia, are dominated by those in the 60 years and above age bracket. In this article published in The Conversation, Kartika Saraswati and fellow DPhil students elaborate how, by prioritising vaccination for elderly, Indonesia may optimally reduce the hospital burden and COVID-19 deaths amidst a limited vaccine supply during the first vaccination phase.
Congratulations to Pearl Gan, OUCRU Photographer in Residence, for her winning image selected for the Lancet Highlights 2020: Framing Health Stories. Despite the difficulties of this pandemic year, The Lancet received fascinating and varied entries for our Highlights 2020 photography competition. 15 striking photographs were selected. Each picture captures a unique moment, highlighting a health story.