On 4 June 2020, after a week of increasing scientific concern and scrutiny, first The Lancet, then the New England Journal of Medicine, retracted studies that were based on inaccessible data. The studies have been extremely damaging to chloroquine and hydroxychloroquine COVID-19 clinical trials around the globe. MORU researchers played a key role in bringing this scandal to light, whose consequences continue to play out.
Posted 12/06/2020. Safety of drugs is important, particularly during pregnancy. Makoto Saito and colleagues have pooled the data of 4503 women who had malaria in pregnancy and found that the currently used artemisinin-based combination therapies are equally safe for fetus. This study also highlights that risk of small-for-gestational-age (SGA) is high after malaria in pregnancy even treated with highly efficacious drugs, suggesting that prevention is important for reducing SGA in malaria endemic areas.
Posted 14/04/2020. Enormous emergency efforts are underway to find optimal medical products, to prevent, diagnose, and treat COVID-19, that 7.8 billion people will depend on. With dire disruption of pharmaceutical production and supply and increasing falsified and substandard products, we need strategic planning now to ensure global access to quality-assured medical products and monitoring of supply chains
Posted 17/03/2017. An investigation conducted by the international medical organisation Médecins Sans Frontières revealed that over a thousand people in a remote area of the Democratic Republic of Congo suffered toxic effects after ingesting fake diazepam pills. The research was published in The Lancet Global Health with contribution from Prof Paul Newton from IDDO and LOMWRU.
Posted 02/07/2019. Highly efficacious treatment can limit the cumulative deleterious impact of malaria during pregnancy on the mother and fetus. Correct assessment of treatment efficacy with an adequate length of follow up is required. Makoto Saito and colleagues at the Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border suggest that pregnant women need to be followed up longer than the currently recommended duration of follow-up to assess antimalarial drug efficacy.
Posted 01/09/2020. This paper provides an overview of FIEBRE’s activities. The study aims to identify infections that are treatable and/or preventable, to assess antimicrobial susceptibility of bacterial pathogens and to collect qualitative data on care-seeking and treatment behaviours. Paul Newton and colleagues detail clinical and laboratory assessments, data analysis plan, and outline the study’s strengths and limitations.
Posted 13/11/2020. Use of antimicrobials in animals and the environment has been established to contribute to the global antimicrobial resistance (AMR), and yet there have been inadequate collaborative efforts to tackle this problem. Sunil Pokharel, Bipin Adhikari and colleagues discuss how and why ‘One health’ approach is important to tackle antimicrobial resistance.
Posted 01/10/2019. In the light of the alarming global increase in diabetes, Kartika Saraswati and colleagues at the LOMWRU-IDDO Medicine Quality team found few investigations on the quality of antidiabetics and supplies for self-monitoring of blood glucose. However, poor quality medical products were identified on four continents. This important public health issue should thus be further investigated.
Posted 27/10/2020. Madeleine Clarkson, Paul Newton and colleagues reviewed when individual species of human pathogens were described in Laos, and estimated the in-country diversity and how many more pathogens there may be. Combining modelling with historical assessment improved understanding of the factors affecting pathogen description. During the last decade there has been a 33-fold increase in the description rate, coinciding with the strengthening of medical research in Laos.
Posted 09/02/2021. Wirichada Pan-ngum and colleagues address key knowledge gaps on human-animal-water-source interactions and leptospirosis in high-risk settings, Thailand. Water-source sharing networks and human–animal contact patterns are key information potentially involved in the epidemiology of leptospirosis. Occupations related to animals/environmental water and consuming water from more than two sources increased the risk exposure to leptospirosis.
Posted 05/01/2021. Diagnosing rickettsial infections is difficult in low-resource settings; this leads to delays in receiving appropriate treatment. Before this study the distribution of rickettsioses in Myanmar was not known. This report of a serosurvey by Philip Elders, Elizabeth Ashley and colleagues shows rickettsioses are widespread in Myanmar, with high scrub typhus prevalence in central and northern regions.
Posted 08/12/2020. “No bacterial culture, no drug-resistant infections.” Cherry Lim, Direk Limmathurotsakul and colleagues show that the impact of low blood culture utilization on the observed proportions and incidences of drug-resistant infections could be high. This is likely happening in most of LMICs. A set of recommendations are proposed.
Posted 18/12/2020. Lorenz Von Seidlein and colleagues observed that poorest people in rural Tanzania were the oldest people and especially old people without children. This observation came as a surprise because generation, the baby boomers has accumulated wealth throughout life and ended up wealthier by the time they reached retirement. There is a need to provide more financial and housing security for older people in rural Africa. Currently for many older people in rural Africa the only security are their children.
Posted 11/12/2020. COVID-19 has hit informal urban settlements particularly hard. The control and prevention of COVID-19 in slums starts with organizing community infrastructure, provision of basic needs and protection of people at highest risk. Slums are a source for persistent transmission. In view of the constant risk that slums present to the entire population decisive steps need to be taken to rehabilitate and improve informal settlements, Lorenz Von Seidlein and colleagues provide suggestions.
Posted 15/12/2020. A recent study co-led by Paul Turner and colleagues at COMRU identified extremely high prevalence of antimicrobial resistant (AMR) bacterial carriage in households from Siem Reap, Cambodia. Extended-spectrum beta-lactamase producing Escherichia coli were detected in stool samples from >90% of participants. The results highlight the challenges to AMR control in locations where antibiotic overuse is common.
Posted 04/12/2020. Paul Turner and COMRU researchers, working with Cambodia’s University of Health Sciences and Fondation Merieux, evaluated recently the potential of MALDI-TOF-based serotyping of Streptococcus pneumoniae for vaccine impact surveillance. Despite early promise, the team found that MALDI-TOF performed poorly and should not replace existing serotyping methodologies.
Posted 01/12/2020. This paper confirms that research is important to inform evidence-based medical care in LMICs settings. Napat Khirikoekkong, Phaik Yeong Cheah and colleagues found that migrants living along the Thai-Myanmar border, who were traditionally deemed vulnerable, exercise their agency and resourcefulness when navigating through their daily challenges, and participating in important health research
Posted 27/11/2020. The migrant-friendly residential TB program of SMRU on the Thailand-Myanmar border has achieved high treatment success rate. However, many TB patients admitted to the centers are in advanced stage of disease. Win Pa Pa Htun and colleagues show that early TB death (in the first month of treatment) is highest among pulmonary TB cases and in particular in HIV co-infected patients and in those with co-morbidity. Early detection and treatment for both TB and HIV are crucial for migrants, if the case fatality rate is to be reduced in this marginalized population.
Posted 24/11/2020. Malaria Screener is a smartphone application developed by the National Library of Medicine, in partnership with Richard Maude and colleagues at MORU Epidemiology, aiming to improve the availability of high quality malaria diagnosis. It is cheap, fast and easy-to-use with a standard smartphone and microscope and detects malaria parasites by machine learning.
Posted 10/11/20. Artemisinin-based combination therapies are not only effectively curing malaria, they also impact male malaria parasites in their capacity for onward transmission to the mosquito. Here, Andrea Ruecker and colleagues provide clear evidence that artemisinin resistant parasites overcome this sterilising effect to successfully infect mosquitoes under drug pressure, facilitating the spread of artemisinin resistance.
Posted 06/11/20. Victor Chaumeau and colleagues assessed the impact of outdoor residual spraying on the biting rate of malaria mosquitoes in four villages in Kayin state, Myanmar. They reported a 10-fold decrease in mosquito biting rate immediately after the intervention and concluded that outdoor residual spraying can be used to control malaria mosquitoes in this area.
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.
A study to explore the variations of how microscopy methods are reported in published malaria studies has recommended standardised procedures should be implemented for methodological consistency and comparability of clinical trial outcomes.
The first patients are being vaccinated as part of the UK’s rollout of the Oxford / AstraZeneca coronavirus vaccine, ChAdOx1 nCoV-19, at the Oxford University NHS Hospitals Trust. The Oxford AstraZeneca vaccinations will be delivered at a small number of hospitals for the first few days for surveillance purposes, as is standard practice, before the bulk of supplies are sent to hundreds of GP-led services later in the week.
Blog by Rima Shretta. Preliminary efficacy results from three vaccine candidates currently in Phase 3 trials have shown an efficacy of more than 90% against the development of symptomatic COVID-19. While these results are promising, all vaccines are in relatively early stages of testing. A comprehensive and transparent roadmap is urgently needed, to determine how limited doses of the first vaccines to be licensed will be distributed, together with which groups will initially be prioritized.
A new study quantifying the high risk of Plasmodium vivax parasitaemia after treatment of Plasmodium falciparum malaria aims to identify populations in which a policy of universal radical cure, combining artemisinin-based combination therapy with a hypnozoitocidal antimalarial drug, would be most beneficial.
Dr Clare Ling has been made an honorary Fellow of the Royal College of Pathologists (FRCPath). Currently running Shoklo Malaria Research Unit (SMRU) Microbiology department and supporting the unit’s molecular activities, Clare is a clinical scientist who has worked at SMRU on the Thai-Myanmar border since 2012.