Research Highlights

Accuracy of the direct agglutination test for diagnosis of visceral leishmaniasis: a systematic review and meta-analysis

Posted 01/12/2023. Parasitology is the gold standard for the diagnosis of visceral leishmaniasis (VL), however, other less invasive tests are available such as the direct agglutination test (DAT). As part of the series of systematic reviews and meta-analysis on diagnostic accuracy of diagnostics for FIEBRE infections, Tamalee Roberts and colleagues estimate the diagnostic sensitivity and specificity of DAT for the diagnosis of VL.

National prevalence and risk factors for tungiasis in Kenya

Posted 29/11/2023. Tungiasis is a highly neglected tropical skin disease for which the global disease burden is unknown. Lynne Elson and colleagues report here on the first ever national prevalence survey which found a 1.3% prevalence in Kenya with 40% of primary schools having at least one case and extreme heterogeneity in distribution.

The influence of internship training experience on Kenyan and Ugandan doctors’ career intentions and decisions: a qualitative study

Posted 28/11/23. Medical internship is a key period for doctors’ individual career planning and also a transition period for the broader labour market. Daniel Mbuthia and colleagues highlighted how experience during internship shaped medical doctors’ career intentions in Kenya and Uganda, and emphasized the importance of job availability and context in influencing doctors’ career choices.

Development and validation of a new measurement instrument to assess internship experience of medical doctors in low-income and middle-income countries

Posted 22/11/2023. Routine surveys are used to understand the training quality and experiences of junior doctors but there are lack of tools designed to evaluate the training experiences of interns in LMICs where working conditions and resource constraints are challenging. Yingxi Zhao and colleagues described their process developing and validating a “medical internship experience scale”.

A systematic review of neglected tropical diseases (NTDs) in Myanmar

Posted 21/11/2023. Neglected tropical diseases (NTDs) are a group of preventable and treatable diseases common in Myanmar, primarily affecting marginalized rural communities. Myo Swe and colleagues provide an overview of reported NTDs in Myanmar over 100 years, indicating gaps in knowledge about certain diseases to inform future research directions related to NTDs in Myanmar.

A Prognostic Model for Critically Ill Children in Locations With Emerging Critical Care Capacity

Posted 20/11/23. Tools to assess illness severity are often impractical in settings with emerging critical care capacity. A prognostic model developed by Arjun Chandna and colleagues proved effective for triaging critically ill children. The tool provides holistic assessment of critical illness by combining measures of organ dysfunction with important contextual determinants of outcome, such as healthcare accessibility and the nutritional status of a child.

Use of antimicrobials during the COVID-19 pandemic: A qualitative study among stakeholders in Nepal

Posted 17/11/2023. Early critical phase of the COVID-19 pandemic added tremendous pressure to find curative therapies. A lot of empirical treatments, including antimicrobials, were recommended. Drawing on interviews with patients, clinicians and drug dispensers, Bipin Adhikari and colleagues explore how and why antimicrobials may have been used for the management of COVID-19 in Nepal.

‘We were treated like we are nobody’: a mixed-methods study of medical doctors’ internship experiences in Kenya and Uganda

Posted 15/11/2023. Medical interns are an important workforce providing first-line healthcare services in hospitals. Yingxi Zhao and colleagues provided an overview of doctors’ internship experience in Kenya and Uganda, and highlighted challenges experienced by interns spanning from burnout, stress, challenging working environment, inadequate support and poor quality of supervision.

The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance

Posted 10/22/2023. Sean Cavany and colleagues publish a new perspective in Nature Communications that describes the possible mechanisms by which substandard and falsified antimicrobials could affect antimicrobial resistance and suggests ways to improve our understanding of this relationship. The article arose from the work of the FORESFA project, funded by a Wellcome Collaborative Award.

Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

Posted 07/11/2023. As COVID spread globally support for LMIC focused on skilled, technologically enabled ICU care. This ignored fundamental weaknesses in health systems and the need for basic, effective care to save lives in all clinical settings. Whole of system vigilance and response requires reorientation of priorities and effective change management, by Mike English.

A Clinically Oriented antimicrobial Resistance surveillance Network (ACORN): pilot implementation in three countries in Southeast Asia, 2019-2020

Posted 01/11/2023. ACORN (A Clinically Oriented Antimicrobial Resistance Surveillance network) is a WHO GLASS compatible case-based surveillance method for antimicrobial resistance that produces more meaningful and locally actionable data. Rogier van Doorn and colleagues publish the results of a pilot in three countries, showing proof of principle and valuable lessons to be learned going forward. More at: acornamr.net

Leadership in global health

Posted 24/10/2023. In the review of a book ‘Tore Godal and the evolution of global health by Conrad Keating’, Bipin Adhikari and Lorenz von Seidlein discuss Tore Godal’s contributions to Global Health projects while remaining in the background. There are lessons for those aspiring to influence Global Health.

Malaria vaccine coverage estimation using age-eligible populations and service user denominators in Kenya

Posted 10/10/2023. Angela Moturi and colleagues evaluate RTS,S/AS01 malaria vaccine coverage in Kenya's pilot phase, showing high EPI (Extended Programme for Immunisation) user coverage (78%) for dose 3, but lower community coverage (57%). The 4th dose at 24 months had low coverage (<39%). Universal coverage of 3 doses of malaria vaccine needs improving. 24-month dosing remains a challenge.

Vaccine mandates and public trust do not have to be antagonistic

Posted 29/10/2023. Historically, vaccine mandates and opposition to vaccines have co-existed, starting with smallpox vaccination mandates in the 1800s. During the COVID-19 pandemic, the benefits of vaccine mandates were weighed against potential damage to public trust. Bipin Adhikari and colleagues discuss whether and how vaccine mandates can co-exist with public trust.

Pharmacokinetics of single low dose primaquine in Ugandan and Congolese children with falciparum malaria

Posted 29/09/2023. This large study on the pharmacokinetics of single low dose primaquine in young Ugandan and Congolese children will help the MORU team develop an optimal dose for children with falciparum malaria to block malaria transmission and contribute to malaria elimination, especially of resistant falciparum parasites. By Bob Taylor

Improving neonatal health in rural Africa: how much do we know about neonatal jaundice?

Posted 26/09/2023. In this pilot study, Caterina Fanello and colleagues evaluated the prevalence of neonatal hyperbilirubinemia and related neonatal and maternal risk factors in a semi-rural area of the Democratic Republic of Congo. They also explored knowledge and practices of expectant mothers regarding this condition. Ways forward to improve diagnosis and treatment in these settings are discussed.

Expanding the role of village malaria workers in Cambodia: Implementation and evaluation of four health education packages

Posted 22/09/2023. The transformation of village malaria workers (VMWs) into community health workers with roles beyond malaria is a promising approach for sustaining health care provision in remote areas. Rupam Tripura and colleagues discuss on how training on health education could be optimized for VMWs.

Sharing results with participants (and community) in malaria related research: Perspectives and experience from researchers

Posted 08/09/2023. Sharing results with participants from research studies is largely underappreciated. Bipin Adhikari and colleagues explore the perception and practice of results-sharing in malaria related clinical trials among researchers. Although there was a consensus on the rationale of result sharing to participants, most researchers thought that disseminating results to policymakers and stakeholders for research translation was more important.

An artesunate pharmacometric model to explain therapeutic responses in falciparum malaria

Posted 06/09/2023. Sompob Saralamba and colleagues have proposed a new model explaining why increased dosing of antimalarial drug artemisinin doesn't speed up parasite clearance. It suggests that exposure to the drug makes some malaria parasites temporarily resistant, leading to either delayed death or reactivation. This could revolutionize treatment strategies for this deadly disease.

Point-of-care prognostication in moderate Covid-19: Analytical validation and prognostic accuracy of a soluble urokinase plasminogen activator receptor (suPAR) rapid test

Posted 05/09/2023. Arjun Chandna and colleagues show that a point-of-care test for the soluble urokinase plasminogen activator receptor (suPAR) has good prognostic accuracy to predict oxygen requirement in patients presenting with moderate Covid-19 and suggest that suPAR should be explored for risk stratification of other infectious diseases.

Longitudinal comparison of bacterial pathogen seropositivity among wet market vendors in the Lao People's Democratic Republic

Posted 31/08/2023. Vendors at wet markets in Laos may be exposed to different zoonotic pathogens depending on the types of food they sell. A one-year serological survey by Matthew Robinson and colleagues identified that individuals selling vegetables, domestic farmed meat, or wildlife meat, were potentially infected by important bacterial pathogens associated with both farmed animals and wildlife.

A rapid review of community engagement and informed consent processes for adaptive platform trials and alternative design trials for public health emergencies

Posted 30/08/2023. Alternative Design Trials (ADTs) and Adaptive Platform Trials (APTs) have enabled efficient large-scale testing of biomedical interventions during recent Public Health Emergencies (PHEs). Alun Davies and colleagues aimed to rapidly review evidence on engagement and informed consent for ADTs and APTs during PHE to consider what (if any) recommendations can inform practice.

Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study

Posted 30/08/2023. This study by Makoto Saito and colleagues analysing 213 severe malaria cases in pregnancy at SMRU, MORU and OUCRU showed vital organ dysfunction led to high maternal and fetal mortality. In contrast, severe anaemia or hyperparasitaemia alone did not. This marked difference may explain the variation of mortality reported in the literature. Early diagnosis and treatment of malaria and anaemia in antenatal care should be promoted.

Impact of the COVID-19 pandemic on tuberculosis control in Indonesia: a nationwide longitudinal analysis of programme data

Posted 29/08/2023. A large-scale study in Indonesia found devastating consequences on TB control during the COVID-19 pandemic, estimating declines of TB case notification by 26% and treatment coverage by 11%. Districts with high COVID-19 incidence and limited healthcare resources were most affected. Henry Surendra, Raph Hamers and colleagues emphasise the need for resilient health systems.

Quality of inpatient paediatric and newborn care in district hospitals: WHO indicators, measurement, and improvement

Posted 25/08/2023. Mike English and colleagues outline in their Lancet Global Health Viewpoint the challenges of measuring quality of care and the challenging pathways from measurement to actual improvement in health service delivery. They argue in particular that collecting data for measuring quality is too often the main focus with little attention is paid to the complex work required to actually change health care practices.

Not just surveys and indicators: narratives capture what really matters for health system strengthening

Posted 25/08/2023. Dorothy Oluoch, Lisa Hinton and colleagues in a new Viewpoint explore the rich potential for patient narratives to complement typical epidemiological and health service evidence on the status of health systems in low-income countries. They explain that we have much to learn about the improvements needed to systems and where to intervene from patients’ stories about their experiences of health care, and that doing this is key to developing person-centred care.

Examining the absorption of post-internship medical officers into the public sector at county-level in devolved Kenya: a qualitative case study

Posted 23/08/2023. Kenyan medical schools are now estimated to be training and graduating increasing numbers of doctors, however recent data suggested that only less than half of these trainees are being absorbed by the public sector. Yingxi Zhao and colleagues conducted a qualitative case study to understand how post-internship medical trainees are absorbed into the Kenyan public sector.

Medical device regulation and oversight in African countries: a scoping review of literature and development of a conceptual framework

Posted 22/08/2023. Medical devices are a fundamental component of health systems, but how are these governed to ensure benefits are achieved and harms are minimised? Naima Nasir and collesgues explore governance arrangements for medical devices in African countries and proposes a conceptual framework for the exploration of governance realities across the health system.

Drawing by village health volunteers, showing various modes of tranportation to a clinic

Fever and health-seeking behaviour among migrants living along the Thai-Myanmar border: a mixed-methods study

Posted 18/08/2023. Fever is a common reason to seek healthcare in Southeast Asia, and the decline of malaria has further complicated fever perceptions and actions taken. This mixed-methods study from 2019, on Thai-Myanmar border revealed diverse range of fever conceptions, symptoms and believed causes. Napat Khirikoekkong, Supa-at Asarath and colleagues mapped out context-specific healthcare seeking strategies and discussed its influencing key determinants.

Refugee camp on the Thailand-Myanmar border

Defining the role of host biomarkers in the diagnosis and prognosis of the severity of childhood pneumonia: a prospective cohort study

Posted 16/08/2023. Tools for safe community-based childhood pneumonia management are needed. Studies often do not include outpatients or consider whether laboratory tests add value to clinical assessment. Arjun Chandna and colleagues found that Angiopoietin-2 improved performance of a validated risk score (LqSOFA) to predict oxygen requirement amongst refugee children with pneumonia on the Thailand-Myanmar border.

Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya

Posted 26/07/2023. Critical illnesses cause several million deaths annually, many occurring in low-resource settings. Despite great efforts and investments, lower income countries faced constraints in upscaling critical care during the COVID-19 pandemic. Rosanna Mazhar, Jacquie Oliwa and colleagues explore how Kenya’s efforts to do so were operationalised, offering insights into some of the challenges faced.

The spatio-temporal distribution of acute encephalitis syndrome and its association with climate and landcover in Vietnam

Posted 05/07/2023. The aetiology of acute encephalitis syndrome (AES) varies greatly in Vietnam and is unknown in many cases. Hannah Brindle, Marc Choisy and colleagues used national surveillance data to analyse the spatio-temporal distribution of cases of AES from 1998 until 2016, which showed differences by region. The number of cases of AES was also positively associated other syndromes and pathogens, climate, landcover and the number of pigs suggesting that many cases may be due to vector-borne pathogens, particularly Japanese encephalitis virus.

Studying the health benefits of improved housing in rural Tanzania: challenges and progress

Posted 30/06/2023. Millions of affordable healthy homes are needed for the rapidly expanding population of sub-Saharan Africa. A pilot project in northern Tanzania demonstrates the potential of novel house designs to reduce infectious disease transmission in homes. Lorenz von Seidlein and colleagues describe the challenges experienced during the construction and initial evaluation of the novel homes.

COVID-19 and unintended steps towards further equity in global health research

Posted 21/06/2023. In this paper, Tamara Willows and colleagues share how COVID-19 helped reflect on our global health research practice during the POETIC study. We add to ongoing discussions about decolonisation of global health by sharing the steps we took to put into action our commitment to equity within global health.

Experiences, coping strategies and perspectives of people in Malaysia during the COVID-19 pandemic

Posted 20/06/2023. The SEBCOV study reveals captivating insights into the Malaysian experience during the COVID-19 pandemic. With a nationwide Movement Control Order and a race to administer vaccines, Malaysians faced unprecedented challenges. Phaik Kin Cheah, Phaik Yeong Cheah and colleagues highlight the coping strategies, economic impacts, lifestyle changes, and evolving perceptions of the COVID-19 vaccine.

The feasibility of novel point-of-care diagnostics for febrile illnesses at health centres in Southeast Asia: a mixed-methods study

Posted 16/06/2023. The decline of malaria in Southeast Asia means other causes of fever are increasingly relevant, but often undiagnosed. Deployment of novel point-of-care tests for acute febrile illnesses in primary care settings is feasible if tests are user-friendly, well-selected for local pathogens, accompanied by disease-specific education, and have simple management algorithms. By Thomas Peto and Bipin Adhikari

Global knowledge gaps on antimicrobial resistance in the human health sector: a scoping review

Posted 14/06/2023. This scoping review, led by Raph Hamers with WHO, aggregated knowledge gaps in antimicrobial resistance in bacteria, including TB, and fungi: 2340 knowledge gaps were consolidated into 177 thematic research questions across 14 AMR areas. The findings informed research priorities in the novel WHO AMR Global Research Agenda for human health.

Dengue in Myanmar: Spatiotemporal epidemiology, association with climate and short-term prediction

Posted 08/06/2023. Richard Maude and colleagues investigated dengue in Myanmar, focusing on its epidemiology, association with climate, and short-term prediction. Dengue was observed to be widespread across the country, with an increasing spatial reach. Incidence was influenced by climate factors, but varied across different regions. Utilizing time series analysis, researchers also forecasted dengue incidence one month ahead at subnational levels. The findings highlight the potential of spatiotemporal modelling to quantify risk factor associations and generate short-term predictions, assisting in intervention planning.

Pneumococcal colonisation and pneumonia severity in hospitalised Cambodian children following introduction of the 13-valent pneumococcal conjugate vaccine

Posted 26/05/2023. In a recent study from Angkor Hospital for Children, Paul Turner and colleagues recruited over 2,000 Cambodian children with clinical pneumonia in the first three years following pneumococcal conjugate vaccine (PCV13) introduction nationally. PCV13 vaccinated children were less likely to have severe presentations, i.e. x-ray confirmed or hypoxic pneumonia, compared to non-vaccinated children.

Culturally responsive research ethics: How the socio-ethical norms of Arr-nar/Kreng-jai inform research participation at the Thai-Myanmar border

Posted 23/05/2023. Napat Khirikoekkong, Supa-at Asarath, Phaik Yeong Cheah, and colleagues analyse how the socio-cultural norm of Arr-nar or Kreng-jai influences the research experiences of individuals taking part in research on the Thai-Myanmar border. Arr-nar (in Burmese/Karen) or Kreng-jai (in Thai) encompasses multiple meanings including consideration for others and graciousness.

Immunogenicity and safety of fractional doses of 17D-213 yellow fever vaccine in HIV-infected people in Kenya (YEFE): a randomised, double-blind, non-inferiority substudy of a phase 4 trial

Posted 10/05/2023. Although yellow fever vaccine provides a lifelong protection to most people, little research was done on HIV population. Josephine Bendera and colleagues evaluate the immunogenicity of fractional and standard doses of yellow fever vaccine on the HIV population. They demonstrate that fractional doses of vaccine are safe, effective and immunologically non inferior to standard doses in HIV-infected individuals.

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border

Posted 09/05/2023. Implementation of evidence-based newborn care interventions in low-resource settings works! Very and moderate preterm neonatal mortality reduced by 68% and 53% between 2008-2017 in refugees and migrants. Find out how Ahmar Hashmi, Verena Carrara, Rose McGready and SMRU colleagues achieved this.

Raising awareness of antimicrobial resistance: development of an ‘antibiotic footprint calculator’

Posted 02/05/2023. The ‘Antibiotic footprint’ concept supports a global reduction in antibiotic overuse. In this paper, Direk Limmathurotsakul and colleagues describe ‘antibiotic footprint calculator’, an open-access, web-based application that lets anyone calculate how different individual decisions can reduce or increase their own personal antibiotic footprint.

FLASH-TB: an Application of Next-Generation CRISPR to Detect Drug Resistant Tuberculosis from Direct Sputum

Posted 25/04/2023. Providing tuberculosis patients with optimal and timely treatment depends on rapid drug resistance diagnosis. Nguyen Thuy Thuong Thuong and colleagues applied a genome editing method and successfully detected drug resistance directly from sputum with 93.7% concordance to the standard phenotypic drug test, which potentially speeds up drug resistance diagnosis in tuberculosis and other infectious diseases.

Which trial do we need? A global, adaptive, platform trial to reduce death and disability from tuberculous meningitis

Posted 21/04/2023. Tuberculous meningitis kills around 25% of sufferers. New antimicrobial and adjunctive anti-inflammatory agents offer an unparalleled opportunity to reduce mortality. But small trials, testing single interventions, are unlikely to transform outcomes. Guy Thwaites and colleagues therefore propose a global platform trial in adults and children with tuberculous meningitis that will investigate multiple interventions at scale and at speed.

Examining the influence of health sector coordination on the efficiency of county health systems in Kenya

Posted 19/04/2023. Lizah Nyawira and colleagues examined how health sector coordination influences the efficiency of the Kenyan health system. The study found that duplication, fragmentation, and misalignment of functions compromised coordination. This compromised efficiency by increasing transaction costs, impairing the implementation of health programs with negative impacts on health system performance.

Spatiotemporal Evolution of SARS-CoV-2 Alpha and Delta Variants during Large Nationwide Outbreak of COVID-19, Vietnam, 2021

Posted 18/04/23. Dr Anh and colleagues investigated the evolution of SARS-CoV-2 in Vietnam, 2021. The Alpha and Delta variants were the responsible viruses. The Delta variant was confined to AY.57 lineage, likely via a single introduction, causing over 1.7 million infections and more than 32,000 deaths. Viral transmission was strongly affected by non-pharmaceutical interventions.

Investigating rapid diagnostic testing in Kenya’s health system, 2018–2020: validating non-reporting in routine data using a health facility service assessment survey

Posted 14/04/2023. Angela Moturi and colleagues investigate the accuracy of routine data in assessing rapid diagnostic test availability for enhancing healthcare accessibility in Kenya. They address concerns over non-reporting of data by triangulating information from routine systems and a health facility survey. Contrary to expectations, the study finds that non-reporting persists despite established capacity.

Distribution and origins of Mycobacterium tuberculosis L4 in Southeast Asia

Posted 12/04/2023. There are now 9 recognised lineages of Mycobacterium tuberculosis, with 1-4 being found most widely around the world. Lineage 4 is understood to have emerged in Europe and been introduced into Asia through trade and colonisation. Timothy Walker and colleagues have identified that relatively unique sub-lineages of lineage 4 have however been circulating between south-east Asian countries since being introduced, possibly with China serving as a conduit from Europe. This leads to the hypothesis that there may have been host population-specific evolution of lineage 4 in south-east Asia.

Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures

Posted 24/03/23. Lynne Elson of KEMRI-Wellcome Trust and colleagues used thermography to help define a new disease severity classification for tungiasis (sand flea disease). In the process they found when children spent many months at home during COVID-19 school closures, the prevalence and severity of tungiasis increased.

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Research Highlights