Results of the Wellcome Trust funded trial of the experimental anti-Ebola drug TKM-130803 have been published today in PLOS Medicine. Using a novel approach designed to get rapid indications of a drug's effectiveness, the trial showed that at the dose given the drug did not improve survival compared to historic controls.
Posted 27/07/2021. This qualitative study by Mira Schneiders and colleagues discusses the important nutrition-related roles and responsibilities of grandparents caring for grandchildren in rural Cambodian ‘skip-generation’ households. Grandparents appear highly motivated to improve grandchildren’s health and nutrition, but lack necessary resources, leading to frequent moral dilemmas and ethical trade-offs. Interventions to improve child health and nutrition should be designed to be inclusive of older caregivers.
Posted 23/07/2021. Effective management and leadership are essential for everyday health system resilience, but health managers are often under-prepared and under-supported in these roles. Particular challenges have been observed in communication skills, emotional competence and supportive oversight. Jacinta Nzinga and colleagues share their learning from implementing a package of leadership development interventions in Kenya
Posted 20/07/2021. The ethical dilemmas faced by frontline staff conducting health research among ‘vulnerable’ populations are increasingly recognized. However, there is little documented on how staff might be supported in identifying and handling these dilemmas. Sassy Molyneux and colleagues share an approach and tools they developed in Kenya, centred on group reflections linked to a set of policy responses tailored to the context. They encourage further adaptation and evaluation of the approach
Posted 16/07/2021. Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. What prognostic factors are associated with severe metabolic acidosis and uraemia in African children with severe falciparum malaria? Secondary analysis of a randomized trial by Mavuto Mukaka and colleagues
Posted 13/07/2021. The overwhelming COVID-19 case numbers and deaths expected in African countries, as seen elsewhere following identification of the first COVID-19 cases, have not materialised. However, through serosurveillance of blood donors, Ifedayo Adetifa, Sophie Uyoga and colleagues demonstrate widespread SARS-CoV-2 infection in Kenya despite the lower COVID-19 cases and associated mortality.
Posted 09/07/2021. Dr Tan and his colleagues showed that only subgenogroup B1a of coxsackievirus A16, a common cause of the ongoing Hand Foot and Mouth Disease epidemic in Asia was circulating in southern Vietnam between 2011-2017. Active surveillance for viral circulation is critical to informing outbreak response and vaccine development.
Posted 07/07/2021. Frank Smithuis and colleagues conducted a large cluster randomized evaluation of mass drug administration (MDA) with dihydroartemisinin-piperaquine for malaria elimination in an area with high artemisinin resistant Plasmodium falciparum. MDA was a safe and effective tool to accelerate P. falciparum elimination, alongside routine community-based malaria control measures. It was well tolerated and well accepted. MDA did not select for drug resistant parasites.
Posted 06/07/2021. Surveillance of Antimicrobial resistance (AMR) is important in generating evidence to support efforts in controlling the infection. Cherry Lim and colleagues discuss the strengths, potential sources of bias, and challenges of routine microbiology data and different surveillance strategies and solutions used in low- and middle-income countries. Areas requiring support and improvement are highlighted.
Posted 02/07/2021. Chemoprophylaxis against emerging and pandemic infections offer potential for prevention. Lakshmi Manoharan and colleagues evaluated significant design features of COVID-19 chemoprophylaxis trial registrations. The findings illustrate that the majority of trials were underpowered to detect clinically meaningful protection at epidemiologically informed attack rates. Future trials should be large enough to generate strong evidence and allow structured entry and exit of candidate agents. International trial coordination mechanisms and collaboration is required.
Posted 30/06/202. In a cluster-randomised trial of mass microscopic diagnostic screening and treatment for malaria in eastern Indonesia, Kevin Baird and colleagues show that the intervention had no impact on the prevalence of carriage of gametocytes infectious to mosquitoes. The findings highlight the requirement for much greater sensitivity of diagnostics for this intervention to provide benefit to communities.
Posted 29/06/2021. Frank Smithuis and colleagues describe a cluster of 29 children with severe, painful bone deformities living in very remote Nagaland, northwest Myanmar. They had low 25-hydroxyvitamin D, elevated parathyroid hormone, and elevated alkaline phosphatase levels, consistent with nutritional rickets secondary to vitamin D deficiency, calcium deficiency, or a combination of both. After treatment with vitamin D3 and calcium carbonate, we saw significant improvement in symptoms, biochemistry, and radiography. This is the first report of nutritional rickets in Myanmar in over 120 years.
Posted 25/06/2021. In the ISARIC multicentre, cohort of 48 902 patients, admitted to UK hospital with COVID-19 during the first pandemic wave (6 Feb-8 June 2020), bacterial infections were uncommon. 85% of patients were prescribed antibiotics, with substantial regional variations highlighting that antimicrobial stewardship should be prioritised and integrated into Covid19 care pathways, by Louise Sigfrid and colleagues.
Posted 23/06/2021. In an RCT of three artemisinin-based combination therapies in pregnancy on the Thailand-Myanmar border where artemisinin resistance is widespread, only dihydroartemisinin-piperaquine provided satisfactory efficacy for P. falciparum, in this study by Makoto Saito & colleagues. Mefloquine-artesunate provided the longest recurrence-free period for P. vivax. Vivax recurrence was so common, chloroquine prophylaxis is warranted after malaria of any species.
Posted 22/06/2021. Diagnosis of bacterial meningitis in low- and middle-income countries is challenging due to limited laboratory capacity. Christina Obiero and colleagues conducted a revalidation study of previously identified signs of meningitis in children aged ≥60 days and found that KCH-2002 signs had lower sensitivity. Although bacterial meningitis is now uncommon following conjugate vaccination in Kenya, identifying cases is more difficult and support for basic cerebrospinal fluid analysis is crucial.
Posted 18/06/2021. Grace Irimu and colleagues show that newborns account for 46% of admissions and 66% of deaths among children 0-13years in Kenyan hospitals. Most deaths are caused by preventable and treatable causes. The authors call for need to prioritize newborn care for Kenya to achieve the SDGs target.
Posted 16/06/2021. The progress made in treatment of malaria is threatened by the emergence of resistance to current first line treatments artemisinin-based combination therapies (ACTs). There are currently no good alternatives for the treatment of uncomplicated malaria in the African setting in the event of resistance emerging to antimalarials that are in the ACTs. Mainga Hamaluba, Rob van der Pluijm and colleagues demonstrate that triple artemisinin combination therapies (TACTs) can potentially be used safely to prevent, delay or manage uncomplicated malaria in our setting.
Posted 15/06/2021. Plasmodium vivax caused an estimated 14 million malaria cases in 2017. By collating economic and epidemiological data, Angela Devine and colleagues estimated an economic cost of $359 million associated with these episodes. A scenario analysis explored how costs might change with global access to safe radical cure, estimating cost savings of $17-93 million.
Posted 11/06/2021. Burkholderia pseudomallei, a bacterium found in soil, can cause melioidosis, a potentially fatal disease. Melioidosis was first described in Myanmar but rarely reported over the past decades due to lack of awareness and limited diagnostic facilities. Frank Smithuis and colleagues report a widespread distribution of the organism in Myanmar soil. This should alert clinicians to consider melioidosis as a potential cause of sepsis, pneumonia or abscesses.
Posted 09/06/2021. Chris Paton and colleagues describe how predictive human-computer interaction (HCI) modelling could be used to improve the safety and usability of digital health systems. We reviewed the history of predictive modelling in HCI and describe how modelling could be integrated with the human-centred design techniques used when developing digital health interventions.
Posted 08/06/2021. Alice Kamau and colleagues show that passively collected routine health facility data does offer opportunities to detect malaria ‘hotstops’ down to the village level, at an affordable cost. It will be important, however, to refine the current surveillance tools such that they have the potential of collecting information at sufficiently precise scale.
The RECOVERY Trial has won the Project Management Institute’s Special Covid-19 UK Response Project Award. The award specifically recognised RECOVERY’s work to investigate whether the cheap steroid dexamethasone was an effective treatment for patients hospitalised with severe COVID-19.
COVID-19 has exposed our vulnerability to pandemic infections and shown what works, and what does not. It has tested the effectiveness of the Oxford-based global, open-source, collaborative approach set up 10 years ago to prevent illness and deaths from infectious disease outbreaks: ISARIC, the International Severe Acute Respiratory and Emerging Infection Consortium.
The RECOVERY trial has been jointly awarded Health Data Research UK’s 2021 Impact of the Year Award. This award is open to projects which had effectively used health data to improve people’s lives, including through clinical practice, policy, software, algorithms, or publications. The award was presented by James O’Shaughnessy at HDR UK’s online Annual Scientific Conference: Data Insights in a Pandemic.
Nguyen Lam Vuong, Sophie Yacoub & colleagues have identified a combination of biological markers in patients with dengue that could predict whether they go on to develop moderate to severe disease. Biomarkers are used to identify the state or risk of a disease in patients; these findings could aid the development of biomarker panels for clinical use and help improve triage and risk prediction in patients with dengue.
A new study led by the University of Oxford has found that previous infection, whether symptomatic or asymptomatic, does not necessarily protect you long-term from COVID-19, particularly against new Variants of Concern.
The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial has demonstrated that the investigational antibody combination developed by Regeneron reduces the risk of death when given to patients hospitalised with severe COVID-19 who have not mounted a natural antibody response of their own.