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\n \n \n \nPosted 18/05/2021. Rose McGready and colleagues show a strong association between P. falciparum infection and hypertension, in a large prospective cohort of women followed from the first trimester of pregnancy. Falciparum malaria which sequesters in the placenta most likely drives the development of chronic placental hypoxia, eventually progressing to clinical gestational hypertension or pre-eclampsia. This is important given hypertension is in the top 3 killers of pregnant women and that most pregnancy related hypertensive deaths occur in sub-Saharan Africa where malaria prevention strategies are not implemented until the beginning of second trimester or later.
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\n \n \n \nPosted 14/05/2021. Cryptococcal meningitis is a common serious HIV-associated infection, responsible for 15% of AIDS related deaths globally. Patients are usually treated as in-patients. Frank Smithuis and colleagues reviewed 76 patients treated with amphotericin and fluconazole as out-patients in primary care clinics in Yangon, Myanmar. One-year survival (86%) was higher than existing hospital-based treatment studies and 1029 hospitals days were saved.
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\n \n \n \nPosted 12/05/2021. Jacob Kazungu, Edwine Barasa and colleagues examined the level and inequality in health insurance coverage in 36 sub-Saharan African countries. They found that insurance coverage in sub-Saharan Africa is both low and pro-rich; only 8 of the 36 countries examined had a mean level of insurance coverage of above 10%.
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\n \n \n \nPosted 05/05/2021. On the Thailand-Myanmar border, 39% of migrant women and 47% of refugee women experience maternal depression. Gracia Fellmeth and colleagues show that among migrant women, higher levels of social support are associated with lower depression. The perinatal period offers a valuable opportunity to ask women about depression and support networks and offer help to those who need it.
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\n \n \n \nPosted 11/05/2021. Microbiology laboratory data management is complex and is a rate-limiting step for AMR surveillance in low- and middle-income countries. Paul Turner, Liz Ashley, and colleagues summarise the urgent IT infrastructure requirements needed to ensure that the substantial ongoing efforts to develop capacity for AMR surveillance in LMICs realise their full potential.
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\n \n \n \nPosted 07/05/2021. Multidrug-resistant tuberculosis (MDR-TB) remains a significant burden in the Southeast Asia region. Using mathematical modelling approach, Wirichada Pan-Ngum and colleagues assessed the population-level impacts of short-course MDR-TB treatment compared to the conventional therapy. Early initiation of treatment and good level of treatment eligibility are identified to be important determinants to the success of MDR-TB control programmes.
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\n \n \n \nPosted 30/04/2021. In many low- and middle-income countries febrile children are managed by health workers with limited training, in settings where referrals can confer substantial costs and risks. Spot Sepsis, a multi-centre study being implemented by MORU and MSF, aims to develop a practical prognostic tool to help community healthcare providers identify febrile children who may benefit from referral for facility-based medical care.
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\n \n \n \nPosted 16/04/2021. This systematic review by Arjun Chandna and colleagues identified clinical and laboratory prognostic factors, measured at the point of presentation, that can help identify children at risk of severe febrile illness. Most studies included only hospitalised children and further work is required to identify the best predictors to build data-driven triage tools for use by community healthcare providers.
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\n \n \n \nPosted 27/04/2021. The complete treatment of vivax malaria requires a radical cure with a course of 8-aminoquinolines. Bipin Adhikari and colleagues interviewed policymakers in Asia why the radical cure is currently so poorly implemented and what can be done to improve the uptake of the radical cure.
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\n \n \n \nPosted 23/04/2021. COVID-19 case management is one of the key interventions in country responses to the pandemic. Angela Kairu, Edwine Barasa and colleagues estimate the unit costs for COVID-19 case management in Kenya useful in informing policy decisions around resource allocation, planning and budgeting, and development of appropriate healthcare purchasing arrangements. The findings illustrate that COVID-19 case management costs are substantial, ranging between two and four times the average claims value reported by Kenya\u2019s public health insurer.
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\n \n \n \nPosted 21/04/2021. Tobias Brummaier and colleagues report a high burden of soil-transmitted helminth infections and an association with maternal anaemia in pregnant migrant and refugee women on the Thai-Myanmar border. Whether the protective effect of Ascaris lumbricoides infection against miscarriage observed in this retrospective dataset results from helminth immune modulation remains to be determined.
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\n \n \n \nPosted 20/04/2021. Artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated falciparum malaria, but the ACT drugs are starting to fail. Triple artemisinin-based combination therapy (TACT) is being studied to replace ACTs. In this paper, Phaik Yeong Cheah and colleagues discuss the most important ethical and practical considerations in the potential deployment of TACT.
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\n \n \n \nPosted 14/04/2021. Germana Bancone and Cindy Chu review the current knowledge about drug-induced haemolysis in G6PD deficiency, and discuss new clinical and laboratory approaches to understand haemolytic risk in G6PD variants. A more comprehensive genotypic and phenotypic characterization, together with haematologic responses upon exposure to different drugs, will help define a clinically useful classification of G6PD variants
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\n \n \n \nPosted 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.
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\n \n \n \nPosted 06/04/2021. Melioidosis is an under-recognised disease, and mortality remains unacceptably high. Treatment requires prolonged antibiotic therapy and adherence is challenging, particular in resource-constrained settings. Arjun Chandna and colleagues at Angkor Hospital for Children reviewed the treatment of 355 children with culture-confirmed melioidosis over a decade and found significant gains can be made over time.
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\n \n \n \nPosted 30/03/2021. Reactive case detection has played a role in the elimination of malaria in China. The approach has been adapted and is used in the Greater Mekong Subregion. Because it requires considerable man power but only few cases are detected the approach is controversial. Jacqueline Deen, Lorenz Von Seidlein and colleagues included 8 articles in a meta-analysis that found the percentage of positive malaria cases among potential contacts using microscopy or rapid diagnostic test was 0.56%.
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\n \n \n \nPosted 26/03/2021. Ketamine is an essential drug widely used in low-resource settings, but there was no data on its safety in lactating women until this report. In this study by Mary Ellen Gilder and SMRU colleagues, outcomes for breastfeeding infants whose mothers received ketamine are good, and not affected by ketamine dose. In contrast, high dose maternal intravenous diazepam may be harmful.
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\n \n \n \nPosted 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
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