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 25/05/2021. Seeking treatment including antibiotics without prescription at drug shops is a common practice in Nepal which can contribute to rising antibiotic resistance. This may leave us without effective antibiotics for future infections. In this study, Bipin Adhikari and colleagues explore why people buy antibiotics over the counter in Nepal and implications for its control.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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
Posted 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.
Posted 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%.
Posted 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.
Posted 19/03/2021. Tobias Brummaier reports that collaborative research efforts with SMRU and SIDRA have demonstrated that vaginal microbial composition and local vaginal immune environment are associated with preterm birth in Asian women from a low-resource setting, possibly providing an avenue towards an early predictive tool for preterm birth
Posted 16/03/2021. Many women in Southeast Asia are smaller than their Western counterparts. How might this affect an otherwise healthy pregnancy? A recent study from the Thai-Myanmar border by Sue J Lee, Ahmar Hashmi and colleagues suggests that maternal height should be considered when providing advice regarding weight gain during pregnancy.
Posted 09/03/2021. X-linked glucose-6-phosphate dehydrogenase deficiency is the most common human enzymopathy. Ghulam Awab and colleagues analysed their clinical study and epidemiological data from Afghanistan gathered over the last decade and showed that the G6PD Mediterranean variant provided a marked gene dose proportional protection against P. vivax malaria.
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 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.
Oxford is world-famous for research excellence and home to some of the most talented people from across the globe. To showcase our global research, the University launched a Global Research Map, highlighting areas of research we are conducting overseas.
Oxford University’s enduring global reputation, cutting edge research and unique teaching environment have helped retain first place in the Times Higher Education World University Rankings for a fifth consecutive year. THE rankings use 13 separate performance indicators to cover universities’ core missions across teaching, research, knowledge transfer and international outlook. The award follows a year when the University of Oxford has been at the centre of international attention for its work on finding a vaccine for COVID-19 as well as taking a leading role in trialling therapeutic drugs and antibody testing.
The Conversation article, by Lakshmi Manoharan, Medical Epidemiologist. Widespread protests have broken out across the US in response to the killings of black Americans at the hands of police. Demonstrations have also erupted in the UK and other countries in solidarity with the Black Lives Matter movement and in protest at these countries’ own domestic cases of institutional racism. These protests are happening in the middle of a pandemic, which raises issues regarding the spread of the virus, and also highlights deep inequalities due to structural racism and its effects on people’s health. Although health authorities rightly discourage congregations of people, these protests may be the only way for the systemically disenfranchised to have their voices heard.
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.