Research Highlights

Rebecca Inglis and co-workers, in front of a door to the ICU

Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Posted 17/07/2024. A large multidisciplinary team conducted qualitative research in five ICUs in Bangladesh and India. They found that less restrictive ICU visiting policies improved experiences for patients and families – and the family’s presence at the bedside could improve patient care. Supporting nurses to give routine updates promoted better communication with families. By Rebecca Inglis

A randomised trial of malaria vaccine R21/Matrix-M™ with and without antimalarial drugs in Thai adults

Posted 16/07/2024. Borimas Hanboonkunupakarn and coworkers from MORU and the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand have shown that the co administration of the malaria vaccine R21/matrix M combined with the antimalarials drugs DHA/piperaquine and the single low dose primaquine does not interfere with the immunogenicity of the vaccine or the concentrations of piperaquine.

Genetic diversity, determinants, and dissemination of Burkholderia pseudomallei lineages implicated in melioidosis in Northeast Thailand

Posted 15/07/2024. A recent study from northeast Thailand identified three major bacterial lineages responsible for melioidosis in the region. Each lineage carries unique gene sets that likely contribute to successful dissemination. These genes are expressed under environmental rather than infectious conditions, with one lineage showing overexpression under nutrient deprivation, highlighting environmental persistence is a prerequisite for infection. By Claire Chewapreecha

Embedding community and public voices in co-created solutions to mitigate antimicrobial resistance (AMR) in Thailand using the ‘Responsive Dialogues’ public engagement framework

Posted 11/17/2024. Tackling antimicrobial resistance requires collaboration between communities, stakeholders and researchers. In the ‘AMR Dialogues’ project, Tassawan Poomchaichote, Phaik Yeong Cheah and colleagues conducted a series of conversations, bringing together people from different backgrounds. This paper summarises issues identified across Thailand and highlights four locally actionable ‘building blocks’ of co-created solutions.

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

Posted 10/07/2024. Physician associate and nurse practitioner roles have been developed largely to meet changing healthcare demand and increasing workforce shortages. Yingxi Zhao and colleagues summarise the factors influencing their development and integration in hospital teams, advocating for organisation context-specific workforce solutions, long-term investment, substantial resources, and transparent processes to meet evolving healthcare challenges.

Estimated global and regional economic burden of genital herpes simplex virus infection among 15–49 year-olds in 2016

Poster 09/07/2024. Genital herpes infections and their related complications lead to billions of dollars in health care expenditures and productivity losses globally, say researchers who calculated the first-ever global estimates of the economic costs of these conditions. The study calls for greater investment in prevention of herpes transmission, including concerted efforts to develop effective vaccines against this common virus. By Puttarin Kulchaitanaroaj; MAEMOD, MORU.

Towards a machine-learning assisted non-invasive classification of dengue severity using wearable PPG data: a prospective clinical study

Posted 05/07/2024. Early warnings of clinical deterioration through continuous non-invasive monitoring could benefit clinical care in dengue-endemic settings. Taking the approach of using low-cost wearables, Chanh Ho Quang and colleagues successfully demonstrate the ability to classify dengue patients with different severity and disease state. The implementation of these models could improve patient outcomes and resource allocation

Obesity differs from diabetes mellitus in antibody and T-cell responses post-COVID-19 recovery

Posted 04/07/2024. Some known risk factors for severe COVID-19 outcomes disproportionately affect South Asian populations. In Bangladesh, Mohammad Ali and colleagues showed that overweight/obesity is linked to lower neutralising antibody levels and higher T-cell responses post-COVID-19 recovery, while type 2 diabetes does not alter antibody or T-cell responses. This research highlights the importance of targeted vaccination and treatment strategies.

Mitigating machine learning bias between high income and low–middle income countries for enhanced model fairness and generalizability

Posted 03/07/2024. Collaborative AI efforts between high-income countries (HICs) and low- to middle-income countries (LMICs) are essential for pooling resources and expertise. Jenny Yang, Louise Thwaites and colleagues show that AI approaches can lead to divergent outcomes across HIC and LMIC settings. Using COVID-19 screening data, we demonstrate that bias mitigation methods improve fairness and maintain diagnostic sensitivity.

Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate–pyronaridine to control malaria outbreaks in Cambodia

Posted 25/06/2024. The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, an effective response to malaria outbreaks becomes the vital strategy. Authors report a programmatic response to a 2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia. By Bipin Adhikari.

Bioequivalence of a new coated 15 mg primaquine formulation for malaria elimination

Posted 21/06/2024. A new study by Bob Taylor and colleagues confirms that a 15 mg generic primaquine tablet, made by IPCA in India, is bioequivalent to the reference Sanofi product. The dossier has been submitted to WHO for prequalification. Once prequalified, it will be used to help eliminate malaria.

A youth advisory group on health and health research in rural Cambodia

Posted 19/06/2024. Bipin Adhikari and colleagues reflect on how engagement with a youth advisory group on health and research engagement is carried out in a remote malaria endemic district of Cambodia. Authors discuss the processes, outputs and outcomes of youth group engagement including their relevance to broader goals of community engagement using a theory of change.

Rectal artesunate: lives not saved

Posted 03/06/2024. Childhood deaths from severe malaria can be prevented by giving rectal artesunate suppositories (RAS) but in January 2022, based on preliminary interpretation of a flawed observational study, WHO issued a moratorium on RAS. This has now been partially lifted, but use of RAS has markedly declined and thousands of malaria deaths have not been prevented. By Nick White.

Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life

Posted 31/05/2024. Tungiasis is a neglected tropical skin disease. Lynne Elson and colleagues aimed to determine its impact on school children in nine counties of Kenya. They found infected children experience considerable pain, itching, difficulty sleeping and feel ashamed, leading to lower school attendance, concentration and exam scores, than uninfected children.

Care seeking for childhood illnesses in rural Mtwara, south-east Tanzania: a mixed methods study

Posted 29/05/2024. In Africa, children < 5 years remain highly vulnerable to infectious diseases. Salum Mshamu and colleagues explored treatment seeking behaviour related to childhood illnesses in rural Mtwara, south-east Tanzania which was a part of community based novel housing intervention. How treatment seeking behaviour was influenced by institutional and community level factors are discussed in the article.

Gender and equity considerations in AMR research: a systematic scoping review

Posted 28/05/2024. Bhensri Naemiratch and colleagues report on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours.

Leprosy identified in Sumba Island, eastern Indonesia: elimination targets under threat

Posted 24/05/2024. Frontline healthcare workers detected 60 persons affected by leprosy in Sumba Island, Indonesia, through teledermatology, over a 3-year period. Marlous Grijsen and colleagues at the Sumba Foundation and Gadjah Mada University highlight the challenges of delivering leprosy care in remote areas, how these translate into population risks of ongoing transmission and disabilities, and how leprosy can re-emerge after reaching national elimination targets.

Nutritional supplementation in children with severe pneumonia in Uganda and Kenya (COAST-Nutrition): a phase 2 randomised controlled trial

Posted 21/05/2024. Severe pneumonia is a leading cause of illness and hospitalization in African children, resulting in poor outcomes. Kathryn Maitland and colleagues tested if adding ready-to-use therapeutic food to diets improves the recovery of children in Uganda and Kenya. The study found no significant benefits, suggesting future research should focus on high-risk, undernourished children.

New Tools and Nuanced Interventions to Accelerate Achievement of 2030 Roadmap for Neglected Tropical Diseases

Posted 15/05/2024. Collection of articles in the Clinical Infectious Disease Journal supplement. NTDs are a major cause of death, disability, and economic hardship, particularly in low- and middle-income countries. The research by Professor Déirdre Hollingsworth et al aims to better understand which interventions are needed to achieve the 2030 NTD targets, determine the best strategies for keeping NTDs under control after target achievement, and assess the costs associated with different options.

Decolonising global health: why the new Pandemic Agreement should have included the principle of subsidiarity

Posted 14/05/2024. The WHO Pandemic Agreement aims to promote a better global response to pandemics. Caesar Atuire and colleagues argue that not including the principle of subsidiarity as a pragmatic strategy was a missed opportunity to decolonise global health governance and promote global solidarity. Subsidiarity empowers local units to make decisions and address issues at their level, fostering collaboration, coordination, and cooperation. We discuss the elements of subsidiarity—agency and non-abandonment—and highlight the need to strike a balance between them.

Climate change, malaria and neglected tropical diseases: a scoping review

Posted 10/05/2024. The NTD Modelling Consortium contributed to the World Health Organization scoping review led by Petra Klepac et al. It highlights the urgent need for collaborative modelling and greater evidence to understand the effects of climate change impacts on neglected tropical diseases and malaria.

Accelerating Progress Towards the 2030 Neglected Tropical Diseases Targets: How Can Quantitative Modeling Support Programmatic Decisions?

Posted 08/05/2024. The NTD Modelling consortium and WHO hosted a stakeholder meeting to identify priority modelling questions that are relevant for decision-makers, especially those designing, implementing and evaluating national and subnational programs, to achieve the ambitious targets set out in the NTD 2021–2030 road map. Future modelling studies should continue to move towards models which support better programmatic action by incorporating local context. By Andreia Vasconcelos.

Comparison of lumefantrine, mefloquine, and piperaquine concentrations between capillary plasma and venous plasma samples in pregnant women with uncomplicated falciparum and vivax malaria

Posted 01/05/2024. Makoto Saito and SMRU colleagues compared capillary and venous plasma concentrations of mefloquine, lumefantrine, and piperaquine in pregnant women with malaria. While there was a strong correlation, direct interchangeability was limited. Predictability within a ±10% precision range varied by drug. Caution is needed when converting capillary samples at the individual level.

Group photo of a Momentum meeting, March 2024

Strategies for Deploying Pediatric Death Audit to Improve Quality of Care

Posted 26/04/2024. Pediatric death audits can be used to improve health care quality and outcomes for children. In this report, MOMENTUM Country and Global Leadership examined the use of death audits in Kenya, Nigeria, Sierra Leone, South Africa, and Zambia. These experiences suggested both challenges in the use of death audits for improving pediatric quality care as well as options to begin developing effective systems that incorporate audits, even in low-resource settings. Three HSC researchers are members of the Momentum team.

Cost-effectiveness analysis of a multiplex lateral flow rapid diagnostic test for acute non-malarial febrile illness in rural Cambodia and Bangladesh

Posted 09/04/2024. Using data collected in the SEACTN Rural Febrile Illness project, Christopher Chew and colleagues evaluate the cost-effectiveness of a putative multiplex rapid diagnostic test able to diagnose enteric fever and dengue, coupled with CRP measurement to guide antibiotic prescribing for respiratory tract infections, in rural Cambodian and Bangladeshi primary care settings.

Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

Posted 05/04/2024. There are complex ethical tensions and competing interests that surround interventions to mitigate antimicrobial resistance (AMR). In this paper, Phaik Yeong Cheah, Bipin Adhikari and colleagues have identified how these are especially reflected in low- and middle-income countries. They highlight that these ethical tensions need to be kept in mind when designing AMR policies.

Feasibility of wearable monitors to detect heart rate variability in children with hand, foot and mouth disease

Posted 26/03/2024. Dr Le Nguyen Thanh Nhan and colleagues at the Oxford University Clinical Research Unit showed that wearable devices could be used to monitor heart activity in children with hand foot and mouth disease. This monitoring method was feasible even in young children, and the heart activity measured was linked with the virus causing the disease.

Effectiveness of a multi-country implementation-focused network on quality of care: Delivery of interventions and processes for improved maternal, newborn and child health outcomes

Posted 12/03/2024. The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) works with healthcare professionals to improve quality of care at global, national and local levels. In this evaluation Mike English and colleagues explore QCN’s effectiveness in Bangladesh, Ethiopia, Malawi and Uganda and provide useful knowledge for future multi-country global health networks.

Vulnerability and agency in research participants’ daily lives and the research encounter: A qualitative case study of participants taking part in scrub typhus research in northern Thailand

Posted 12/03/2024. Phaik Yeong Cheah and colleagues conducted a qualitative study in northern Thailand among hilltribe ethnic minority groups to understand their challenges related to participating in research. These challenges included language barriers, travel difficulties, uncertain legal status and lack of access to healthcare. Researchers need to be aware of these to minimise the burdens of research participation.

Breaking the silence on first referral hospitals and universal health coverage

Posted 01/03/2024. First referral hospitals (FRHs) are neglected in the current discourse on universal health coverage (UHC) in low-income and middle-income countries. Mike English and colleagues propose a comprehensive approach that increases the focus on FRHs in the UHC discourse and shows that they are integral to enhancing primary health care (PHC) in low-income and middle-income countries.

First referral hospitals in low- and middle-income countries: the need for a renewed focus

Posted 28/02/2024. First referral hospitals (FRHs) fulfil important functions in health systems in low- and middle-income countries. Through three reviews Rosanna Mazhar and colleagues found confusion around the definition and function of FRHs and called for renewed interest and investment in FRHs from the global health academic and policy-making community.

Emerging Enterovirus A71 Subgenogroup B5 Causing Severe Hand, Foot, and Mouth Disease, Vietnam, 2023

Posted 14/02/2024. Le Van Tan and colleagues describe a 2023 outbreak of severe hand, foot, and mouth disease in Vietnam caused by an emerging lineage of enterovirus A71 subgenogroup B5. Affected children were significantly older than those reported during previous outbreaks. The virus should be closely monitored to assess its potential for global dispersal.

Characteristics and clinical outcomes of patients with pre-delta, delta and omicron SARS-CoV-2 infection in Indonesia (2020–2023): a multicentre prospective cohort study

Posted 26/01/2024. A recent prospective study among Indonesian patients hospitalised with COVID-19, from 2020 to 2023, demonstrated that, despite lower disease severity than delta, the omicron variant still caused substantial patient burdens. Older and unvaccinated individuals remained at higher risk of adverse outcomes, warranting optimised treatment and vaccine booster strategies for this setting. By Raph Hamers

Individualised, short-course antibiotic treatment versus usual long-course treatment for ventilator-associated pneumonia (REGARD-VAP): a multicentre, individually randomised, open-label, non-inferiority trial

Posted 26/01/2024. Ventilator-associated pneumonia is common amongst critically-ill patients. Mo Yin and colleagues investigated a personalized approach to shorten antibiotic duration, and found it as effective as a longer treatment in terms of death or pneumonia recurrence; it also reduced antibiotic side effects significantly. This study provides crucial evidence to guide antibiotic prescription to reduce resistance emergence.

Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs

Posted 19/01/2024. Newborn mortality rates post-hospital discharge in low-and-middle-income countries are a growing concern, with most deaths occurring within 30 days of discharge. Gulraj Grewal and colleagues highlight the interventions used to support care continuity post-discharge, assumptions underpinning these interventions, opportunities and challenges, and whether participatory methods were used in intervention development.

Early warning systems for malaria outbreaks in Thailand: an anomaly detection approach

Posted 16/01/2024. Oraya Srimokla, Sompob Saralamba and their team developed specialized anomaly detection algorithms and a dashboard to enhance Thailand's malaria surveillance and elimination efforts. This system improves outbreak prediction accuracy and integrates seamlessly with existing infrastructure, aiding in the effective monitoring and identification of potential malaria outbreaks at the provincial level.

Teledermatology to Improve Access to and Quality of Skin Care in Eastern Indonesia

Posted 12/01/2024. Our recent study in Sumba, a remote island in eastern Indonesia, shows that teledermatology improves access to skin care. Using limited resources, this is a great way to empower frontline healthcare workers, build local capacity and support remote and medically underserved communities across the globe. The project is in collaboration with Sumba Foundation, Gadjah Mada University and OUCRU-Indonesia. From Marlous Grijsen

Expanding the roles of community health workers to sustain programmes during malaria elimination: a meeting report on operational research in Southeast Asia

Posted 10/01/2024. As malaria progressively declines in Cambodia, there's a concern about the diminishing relevance of village malaria workers (VMWs). In August 2023, a meeting addressed the feasibility and policy implications of VMWs managing non-malarial fevers, part of the operational research in western Cambodia to ensure VMWs remain active until malaria elimination is achieved. From Bipin Adhikari.

Ethical and cultural implications for conducting verbal autopsies in South and Southeast Asia: a qualitative study

Posted 20/12/2023. The verbal autopsy method can be sensitive to the individuals interviewed, their families and communities. Prior to study implementation, Nan Shwe Nwe Htun, Tom Peto and SEACTN colleagues sought to explore local beliefs and practices about death to inform appropriate bioethical practices and found that verbal autopsy is acceptable across a wide range of cultural settings in Bangladesh, Myanmar, Thailand, Laos PDR, and Cambodia.

Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania

Posted 12/12/2023. Bipin Adhikari and colleagues compared community health worker programmes between Southeast Asia and Sub-Saharan Africa using a systematic review of the published literature. This was supplemented by discussions with key informants in Cambodia and mainland Tanzania to inform the existing malaria service delivery strategies in Tanzania.

Characterising support and care assistants in formal hospital settings: a scoping review

Posted 05/12/2023. The adoption of ‘Care Assistants’ in formal hospital settings as a HRH strategy is gaining more traction in the Global North than the Global South. Vincent Kagonya and colleagues highlight their effect on care as well as gaps in the labelling, role assignment, training, clinical governance, and regulation in the clinical environment.

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.

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Research Highlights