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 13/04/2021. Self-regulated learning (SRL) remains unexplored for healthcare workers in low-income countries. Tim Tuti, Chris Paton and Niall Winters detail how SRL strategies impact on healthcare providers’ learning gains when using digital learning platforms. We apply Latent Profile Analysis (LPA) to questionnaire responses. We provide insights into the learner factors to consider when implementing technology-mediated learning.
Posted 15/04/2021. Philippe Guérin co-authored a letter published in The Lancet drawing attention of the risk of pooling data from uncomplicated illness and more severe ill hospitalised patients in the development of COVID-19 treatment guidelines. Although SARS-CoV-2 is one virus, the COVID-19 disease has a complex and evolving physiopathology pathway and requires different therapeutic approaches depending of the stage of the disease. In low-resource settings, the prevention of hospital admission is the therapeutic priority.
Posted 31/03/2021. Patient safety is a key goal of WHO but identifying harms and developing strategies to deliver safe care has been given little attention. Mike English and colleague describe a ‘portfolio’ approach to safety improvement in four broad categories: prioritising critical processes, improving the organisation of care, control of risks and enhancing responses to hazardous situations that we believe is relevant to low resource settings. We focus attention on the possible roles of practitioner groups and professional associations as key to advancing patient safety through collaboration and skill development in this field
Posted 22/02/2021. Paper continues to be an important medium for recording inpatient care in low‐ and middle‐income countries. Naomi Muinga and colleagues synthesise evidence on how paper‐based nursing records have been developed within inpatient settings to support documentation of nursing care, and that a human‐centred design approach might better meet users' needs
Posted 16/02/2021. Dexamethasone has been shown to reduce mortality in COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Rima Shretta and colleagues estimate that approximately 12,000 lives could be saved in the UK and 650,000 globally between July-December 2020. Dexamethasone is a cost-effective option with an incremental cost of GBP 940 per life-year gained.
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 02/01/2018. Technological potentials have raised high hopes on healthcare access in LMICs like India. However, five years of research by Dr Marco Haenssgen paint a less optimistic picture and show adverse consequences of mobile phone diffusion, which creates more competition and new divisions and leaves the poorest strata of population worse off than before.
Posted 20/03/2020. 199 patients received standard care, of which 99 received lopinavir-ritonavir for 14 days. Lopinavir-ritonavir didn’t induce significant clinical improvement, and mortality was similar in both groups. However, patients treated with lopinavir-ritonavir spent less time in hospital and in intensive care. The trial enrolled severely ill patients and was not big enough to detect modest benefits. Much larger studies are warranted to confirm or exclude if lopinavir-ritonavir treatment can help.
Posted 12/02/2021. The majority of digital health projects have failed to translate into scaled, routine services, leaving many health leaders cautious and uncertain of how to proceed. Chris Paton and colleagues identify factors that can influence successful and sustainable integration of digital health within local health systems in low resource settings.
Posted 20/02/2018. The malaria parasite is a major cause of illness and deaths throughout the tropics. To survive, the malaria parasite needs to be transmitted by mosquitos form person to person. In this paper Martin Rono and colleagues show at the cellular and molecular level how the parasite balances its investment between growing efficiently in humans and maximising the chances of being transmitted by mosquitos, depending on the local environment.
Posted 12/12/2017. Snakebite envenoming is a neglected tropical disease that kills 100,000 people and maims 400,000 every year. Impoverished populations living in the rural tropics are particularly vulnerable; snakebite envenoming perpetuates the cycle of poverty. Intravenous administration of antivenom is the only specific treatment to counteract envenoming. Confronting snakebite envenoming at a global level demands the implementation of an integrated intervention strategy involving local, national and international organisations.
Posted 05/12/2017. Zika virus RNA is frequently detected in the semen after Zika virus infection. To learn more about persistence of viruses in genital fluids, Dr Alex Salam and Professor Peter Horby searched PubMed and found evidence that 27 viruses can be found in human semen. This may have implications for the risk of sexual transmission, embryonic infection, congenital disease, miscarriage, and infection transmission models.
Posted 28/11/2017. Prabin Dahal reviewed the evolution of statistical methods used to understand and define antimalarial drug efficacy in uncomplicated P. falciparum malaria. The article gives a thorough insight into the historical practices and critically reviews the challenges and limitations associated with current approaches and offers alternative methodologies leading to improved study design and analysis.
Posted 13/10/2017. Professor Peter Horby outlines potential epidemics in Africa. It is difficult to predict when and where new epidemics might occur so we can be better prepared and have a proactive response. This modelling is based on information on each virus as well as governance, communication, infrastructure and health care provision. Some areas remain at high risk and would benefit from improved surveillance, diagnostic capabilities and better health systems and local policies.
Posted 04/10/2017. Melioidosis is a neglected tropical disease estimated to kill 89,000 people a year across tropical regions and a vaccine is urgently required. In this collaboration with Imperial College, Professor Susanna Dunachie report for the first time a link between people with the HLA-B*46 genotype and around a three-fold increased risk of death. Survival from melioidosis is correlated with immune responses to nine key proteins from the causative bacteria, Burkholderia pseudomallei. This gives the foundation for development of an effective vaccine.
Posted 13/09/2017. Amanda Rojek and Peter Horby published a review aimed at clinicians who may treat patients with Ebola Virus Disease. This review outlines advances in understanding the clinical presentation, outcomes and long term sequelae of the disease, and outlines the status of experimental vaccines and treatments.
Posted 22/08/2017. Selecting and trialling therapeutics for preventing congenital Zika disease is challenging. The target product should be low risk, acceptable to the mother, highly effective in preventing adverse fetal outcomes, and practical for widespread clinical use in resource-limited settings. Professor Peter Horby and fellow researchers discuss strategies for addressing these challenges in a recent paper.
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 03/11/2016. Six harmonised protocols to capture Zika-related data to help public health professionals, clinicians and clinical researchers to gain a better understanding of the disease has been published on the WHO website. A number of partners - under the leadership of Institut Pasteur and WHO, including ISARIC and CONSISE have contributed to the development of these protocols to address key public health concerns associated with the Zika virus outbreak. The Working Group on ZIKV Harmonized Research, which included Dr Gail Carson and Professor Peter Horby, published a commentary on the project in the Lancet Global Health yesterday.
Every year, over a million children fall ill with tuberculosis (TB) globally, and about a quarter die from this potentially preventable and curable disease. The main challenge remains the diagnosis of TB, especially in resource-constrained settings. We currently need to collect mucus from the lungs or liquid contents of the stomach, which must be collected in a hospital. Different ways to diagnosis TB in children are urgently needed, especially for those infected with HIV. An international collaboration is now conducting a large diagnostic study in Uganda to fill this gap. The study aims to detect TB bacteria in body fluids such as blood, urine, stool and saliva that are easier to collect.
The Medicine Quality Research Group has published a new Medical Product Quality Report focussing on increasing issues around substandard and falsified (SF) COVID-19 vaccines. With the implementation of the key innovations of COVID-19 vaccines, there have been growing numbers of reports of SF vaccines in the public domain. Given the vital role they will play in ending the pandemic and protecting the global population but severe issues with equitable access, SF vaccines are highly likely to be a growing problem.
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.