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  • How can interventions that target forest-goers be tailored to accelerate malaria elimination in the Greater Mekong Subregion?

    Posted 18/03/2019. Tailored interventions that specifically target at-risk populations, such as forest-goers, will be crucial for achieving malaria elimination in Southeast Asia. This review By Tom Peto and colleagues highlights the behaviours and attitudes of forest-goers towards malaria prevention and control interventions to identify what changes can be made to reduce the malaria incidence in this population.

  • Mortality after inpatient treatment for diarrhea in children

    Posted 15/03/2019. There is increasing recognition that children remain at increased risk of death following discharge from hospital in resource-poor settings. Alison Talbert and colleagues found that admission in children aged under 5 years with diarrhoea alone does not increase 12-month post-discharge mortality compared to admission with other conditions excluding severe pneumonia.

  • Collider bias and the apparent protective effect of G6PD deficiency on cerebral malaria

    Posted 12/03/2019. Large case-control studies have reported that glucose-6-phosphate dehydrogenase deficiency exists due to its opposing effects on falciparum malaria: protection against cerebral malaria but an increased propensity to develop severe malarial anaemia. A reanalysis of these claims by James Watson and colleagues shows they are likely explained by 'collider bias', as case definitions excluded patients with both anaemia and coma on presentation.

  • Sub national variation and inequalities in under-five mortality in Kenya since 1965

    Posted 08/03/2019. Peter Macharia and colleagues used all available census and survey data in Kenya to evaluate subnational changes in child mortality rates between 1965 and 2015. Although Kenya has made huge gains in reducing child mortality, with a 62% reduction, the success remains uneven with considerable disparity. The study also demonstrates suboptimal performance to meet global milestones in child survival. The results are key in tracking SDG 3.2

  • Optimal dosing of dihydroartemisinin-piperaquine for seasonal malaria chemoprevention in young children

    Posted 05/03/2019. Seasonal malaria is common in the Sahel, resulting in malaria-related morbidity and mortality, particularly in young children. Seasonal chemoprevention with the antimalarial drug dihydroartemisinin-piperaquine is effective and safe. However, results presented here by Palang Chotsiri and colleagues show that malaria incidence could be reduced substantially by using an increased and extended dosage in young children.

  • International biological reference preparations for epidemic infectious diseases

    Posted 01/03/2019. Peter Horby and colleagues highlight the essential importance of standardised biological reference materials (such as antibodies) for the development of new diagnostic tests, treatments and vaccines, yet their widespread absence for dangerous diseases such as viral haemorrhagic fevers. They suggest a framework for developing these materials that addresses practical as well as ethical and equity issues

  • Tafenoquine versus Primaquine to Prevent Relapse of Plasmodium vivax Malaria

    Posted 26/02/2019. In this multi-center randomized controlled trial, Cindy Chu and colleagues assess the safety of a single dose tafenoquine for Plasmodium vivax radical cure. With appropriate G6PD testing, the number of adverse events, frequency and severity of haemoglobin reduction are similar to primaquine. Anti-relapse efficacy of tafenoquine is similar to primaquine; 69.1% vs 73.2%, respectively.

  • Molecular characterization and mapping of G6PD mutations in the Greater Mekong Subregion

    Posted 19/02/2019. Germana Bancone and colleagues characterized glucose-6-phosphate dehydrogenase deficiency in over 10 thousand samples collected in 138 villages in Cambodia, Lao PDR, Myanmar, Thailand and Vietnam, showing a country-level prevalence in males ranging from 7.3% to 18.8%. Given this high prevalence, G6PD testing should be carried out in the Greater Mekong Subregion before P. vivax radical cure with 8-aminoquinolines.

  • A high risk of P. vivax after P. falciparum infection

    Posted 12/02/2019. In this study, Professor Ric Price, Rob Commons and colleagues show a high risk of vivax parasitaemia after treatment of falciparum malaria, particularly in areas with short relapse periodicity and after rapidly eliminated treatment. In co-endemic regions, universal radical cure for all patients with uncomplicated malaria has the potential to prevent recurrent parasitaemia, reduce ongoing transmission, and enhance malaria elimination efforts.

  • The Estimates of the Health and Economic Burden of Dengue in Vietnam

    Posted 08/02/2019. Dengue has been estimated to cause a substantial health and economic burden globally. However, the specific estimates from different studies vary significantly. This review by Dr Hugo Turner and colleagues provides an overview of the different dengue burden estimates, using Vietnam as a case study. Understanding the methodology behind these calculations is vital when interpreting economic evaluations of novel dengue interventions.

  • Association of mutations in P. falciparum Kelch13 gene with parasite clearance rates after artemisinin-based treatments

    Posted 05/02/2019. In this study, the WWARN K13 genotype-phenotype Study Group gathered 18 studies from Africa and Asia to explore the relationships between identified Kelch 13 mutant alleles and delayed parasite clearance. Results show one P. falciparum specific mutant and 20 pfk13 propeller region mutant alleles strongly associated with the slow clearance phenotype, including 15 mutations that have not been confirmed before. It was reassuring that no pfk13 alleles associated with slow parasite clearance were observed in the parasites from African studies gathered between 2000-2017.

  • Optimizing respiratory management in resource-limited settings

    Posted 01/02/2019. In many low- and middle-income countries, putting a critically ill patient on a ventilator is associated with a high risk of the patient dying or developing additional problems. In this paper, Rebecca Inglis and colleagues explore measures avert to the need for a ventilator. They also look at ways to improve the safety of ventilators in low-resource settings.

  • Clinical research networks and assessing pandemic severity

    Posted 29/01/2019. Gail Carson, Peter Horby, Laura Merson and colleagues promote the importance of developing clinical research networks in low-resource settings as a pillar to epidemic preparedness in a Letter to Lancet Global Health. The CTM&GH researchers are focused on developing capacity and partnerships across settings at highest risk of infectious disease outbreaks.

  • A novel Plasmodium falciparum merozoite protein microarray to facilitate malaria vaccine candidate prioritization

    Posted 22/01/2019. Scientists don’t know which of the malaria parasites’ ~6000 proteins make good vaccines. Conflicting results abound partly due to a lack of standardized tests. To make better vaccines, Professor Faith Osier and colleagues designed KILchip v1.0: a glass slide imprinted with 384 proteins using microarray technology. Coupled with human samples from the SMART Network, we used KILchip to generate data spanning close to 30 years in 3 months.

  • Effect of point-of-care C-reactive protein testing on antibiotic prescription in febrile patients attending primary care in Thailand and Myanmar

    Posted 15/01/2019. Dr Thomal Althaus and colleagues managed to reduce antibiotic prescription using the C-reactive protein (CRP) test among 2,410 children and adults presented with a fever in primary care centres in Thailand & Myanmar. The perspective of a rapid and affordable test for CRP, identifying febrile patients who really need an antibiotic, is now possible!

  • The double burden of diabetes and global infection in low and middle-income countries

    Posted 08/01/19. Four out of five people in the world with diabetes now live in low and middle income countries. Professor Susanna Dunachie and her Thai collaborator Parinya Chamnan describe how diabetes leads to increased risk and worse outcomes for global infections such as TB, melioidosis and dengue, alongside discussing potential mechanisms and interventions.

  • The Lancet Highlights 2018: health stories in focus

    Posted 21/12/18. A photo from Pearl Gan, Photographer In Residence for OUCRU, was selected for The Lancet Highlights 2018. The picture shows Senior Nurse Shikh Rema changing the dressing for Jabeda Begom, a 65-year-old woman with leprosy, at the Jalchatra Hospital in Bangladesh. Treatment of leprosy is a lengthy process, but thanks to dedicated staff, patients are given the care and attention they need.

  • National and sub-national variation in patterns of febrile case management in sub-Saharan Africa

    Posted 18/12/18. Various drivers of treatment-seeking behaviour contribute to disease outcomes. Victor Alegana and colleagues set out to quantify the probability of seeking treatment for fever in 29 sub-Saharan African countries. The probability of seeking-treatment for fever was less than 50% in half the countries. Findings provide insights into public sector utilization at national and subnational levels, and aim to improve planning, resource allocation and disease burden estimation.

  • Challenges arising when seeking broad consent for health research data sharing

    Posted 11/12/2018. Phaik Yeong Cheah and colleagues report a qualitative study on how best to seek broad consent to sharing individual level health research data beyond research collaborations. Their findings demonstrated that research participants prioritise information about the potential benefits and harms of data sharing. The researchers also found that explaining data sharing to research participants was challenging.

  • Complex interactions between malaria and malnutrition

    Posted 05/12/2018. A WWARN team recently completed a large systematic literature review to understand whether undernutrition places children at higher, lower, or no differential risk for getting malaria. We raise the concern whether an adapted antimalarial treatment strategy is needed in malnourished children. The results present the risks associated with chronic and severe acute malnutrition and the impact on sub-optimal drug exposure, poor patient outcomes and the potential contribution towards an increased risk of antimalarial drug resistance. Photo credit: Albert González Farran, UNAMID, 2013

  • Severe enterovirus A71 associated hand, foot and mouth disease, Vietnam 2018

    Posted 27/11/2018. Since January 2018 there has been a significant increase in hospital admissions due to hand, foot and mouth disease across Vietnam. In collaboration with Children’s Hospital 1 in Ho Chi Minh City, Dr Tan and colleagues set out to describe the etiology, clinical characteristics and demographics of the affected patients.

  • Antimalarial drugs for treating and preventing malaria in pregnant and lactating women

    Posted 20/11/18. Malaria in pregnancy affects both mothers and fetuses. Safe and efficacious antimalarials are needed for treating pregnant and breastfeeding mothers to protect them from devastating outcomes due to malaria. Dr Makoto Saito, Professor François Nosten and colleagues at the Shoklo Malaria Research Unit have reviewed and summarised the maternal and fetal safety of the currently available antimalarials in pregnancy and postpartum, spotlighting this neglected and vulnerable population.

  • The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs

    Posted 13/11/2018. Quinoline and related antimalarial drugs are vital tools in the fight against malaria. However, concerns about their possible effects on the heart rhythm may limit their use. Dr Ilsa Haeusler, Dr Xin Hui Chan, and colleagues found that these serious side effects are reassuringly rare in the treatment of malaria

  • Anaemia and malaria

    Posted 06/11/18, review by Professor Nick White. Malaria, a parasitic infection of red blood cells, is a leading cause of anaemia in the tropics. Where malaria transmission is intense patients, typically children, may die from severe anaemia. However when falciparum malaria causes other vital organs to fail, moderate anaemia appears to protect against death.

  • Transmission and age impact the risk of developing febrile malaria in children with asymptomatic parasitemia

    Posted 30/10/18. Isabella Ochola-Oyier and colleagues investigated what impact individuals who carry parasites and show no malaria symptoms (asymptomatics) has on developing clinical malaria. They identified age and transmission intensity as factors that increase the risk of clinical infection. Asymptomatic individuals irrespective of age were at increased risk of clinical malaria at low transmission.

  • Field detection devices for screening the quality of medicines

    Posted 23/10/18. A plethora of innovative portable devices to screen for poor quality medicines has become available. In a review of the scientific evidence regarding their performances, Dr Celine Caillet and colleagues show that there is a vitally important lack of independent evaluation of the majority of the 41 devices (most being spectrophotometers) found in our search, particularly in field settings. Intensive research is needed in order to inform national medicines regulatory authorities of the optimal choice of device to combat poor quality medicines.

  • Performance of different clinical trial designs to evaluate treatments during an epidemic

    Posted 16/10/18. Clinical research is a crucial component of outbreak response as it provides evidence to improve the prevention and treatment of diseases with epidemic potential. However, disease epidemics are unpredictable and often short-lived, and this adds many challenges to the conduct of clinical research. Professor Peter Horby and colleagues have evaluated some commonly used clinical trial designs in order to determine the optimal design for this context.

  • Valuing the unpaid contribution of community health volunteers to mass drug administration programs

    Posted 10/10/2018. Community volunteers are used to deliver a number of healthcare interventions. Although these volunteers are not paid, their time still has an economic value, known as an opportunity cost. Dr Hugo Turner and colleagues found that this economic value is significant for mass drug administration programs: for the African Programme for Onchocerciasis Control alone it would be valued at US$60-90 million.

  • HIV drug resistance in low-income and middle-income countries

    Posted 02/10/2018. Rising prevalence of HIV drug resistance in low and middle-income countries poses a growing threat to the HIV response. To curb resistance, enhanced strategies are needed that improve quality of ART care and treatment. Raph Hamers reviews contemporary data and highlights the potential impact and resistance risks of novel ART strategies and knowledge gaps.

  • New variant of drug-resistant Salmonella enterica associated with invasive disease in immunocompromised patients in Vietnam

    Posted 25/09/2018. Invasive non-typhoidal Salmonella disease is common in parts of Africa; there is an ill-defined burden in Asia. Stephen Baker and colleagues describe a new variant of Multi-Drug Resistant Salmonella associated with invasive disease in Vietnam. The identification of this organism highlights new ways zoonotic pathogens can exploit human niches to cause serious infections.

  • Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use

    Posted 18/09/2018. Let by Professor Yoel Lubell, researchers from MORU and IDDO estimated the economic costs of AMR associated with the consumption of a range of antibiotic classes in high and lower-middle income countries. These estimates are essential for economic evaluations of interventions that affect antibiotic consumption to reflect the full costs and benefits of their use.

  • Secondary analysis and participation of those at the data source

    Posted 12/09/2018. The Infectious Diseases Data Observatory (IDDO) has answered a call from the Editors at Lancet Global Health to inform future policy and expectations on authorship of publications based on secondary use of data. The IDDO position, based on the promotion of equity, effectiveness and sustainability in global health research, serves as an excellent example of the collaborative approach endemic to the Center for Tropical Medicine and Global Health.

  • Important antimalarial drug DHA-piperaquine safe to use

    Posted 04/09/2018. DHA-piperaquine is an important antimalarial recommended by the WHO for the treatment of malaria, and an ideal candidate for mass use in malaria elimination. In a large meta-analysis of ~200,000 subjects, Dr Xin Hui Chan and colleagues find the risk of sudden unexplained death after DHA-piperaquine is extremely low and not higher than baseline, confirming the drug’s safety for the treatment and prevention of malaria.

  • Variability in distribution and use of tuberculosis diagnostic tests in Kenya

    Posted 21/08/18. Globally, approximately 40-75% tuberculosis cases are missed, mostly due to under-reporting and under-diagnosis. Jacquie Oliwa and colleagues describe TB case notification rates, patterns of distribution and use of diagnostic tests as per Kenyan guidelines. There is an under-use of TB diagnostics tests, especially in children, which results in a notification rate eight times smaller than that of adults. New strategies are needed to increase the use of diagnostics, including innovations to improve access and overcome local barriers to the adoption of guidelines and technologies.

  • Addressing challenges faced by insecticide spraying for the control of dengue fever

    Posted 24/07/18. A study from Bangkok by Professor Wirichada Pan-Ngum and colleagues shows accessing households for proper spraying was a problem for control dengue outbreaks. In addition, inefficient communications among the sectors from hospital to district offices led to inaccurate or missing patient addresses for spraying. Involving community networks help to improve public engagement with and participation in the programmes.

  • Risk-based reboot for global lab biosafety

    Posted 17/07/2018. This paper by Professor Stuart Blacksell and colleagues describes the first update to the WHO Laboratory Biosafety Manual in 15 years. The need to update international lab biosafety guidance is part of a broader initiative to globalize biosafety, emphasizing principles and approaches that are accessible to countries spanning a broad range of financial, technical and regulatory resources.

  • The decline of malaria in Vietnam, 1991-2014

    Posted 10/07/2018. The decline of malaria in Vietnam can largely be attributed to the use of artemisinin-combination therapy (ACT) for case management. Recent analyses from Africa showed that insecticide-treated nets had the greatest effect on lowering malaria prevalence, suggesting that the success of interventions is region-specific. Malaria elimination efforts should focus on both vector control and increased access to ACT.

  • Comparison of the Cumulative Efficacy and Safety of Chloroquine, Artesunate, and Chloroquine-Primaquine in Plasmodium vivax Malaria

    Posted 03/07/2018. Chloroquine, the recommended treatment for vivax malaria, delays but does not prevent relapses. Primaquine is the only widely available drug that prevents relapses but it can induce haemolysis in patients with G6PD deficiency. Cindy Chu and colleagues showed that added to chloroquine, primaquine is very effective for relapse prevention, but should be used alongside quantitative G6PD testing.

  • Small children and pregnant women may be underdosed with widely used antimalarial drug

    Posted 27/06/2018. Current recommended treatment regimens for the most widely used medicine for uncomplicated Plasmodium falciparum malaria may be sub-optimal for small children and pregnant women according to a study led by Professor Joel Tarning.

  • Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions

    Posted 19/06/2018. Many people with pre-existing heart problems (including heart attack, pacemaker implantation, arrhythmia), high blood pressure and even past history of a stroke seek advice regarding high altitude travel ( > 2500m) for recreation, meetings or pilgrimages. Dr Buddha Basnyat and colleagues succinctly try to address these conditions at altitude and make reasonable recommendations in the face of limited data.

  • Effect of supplementary food on mortality in severely immunocompromised HIV-individuals initiating antiretroviral therapy

    Posted 12/06/2018. Among people with HIV infection who are starting antitretroviral treatment in Africa, both the amount of HIV virus in the body and the person's nutritional status are risk factors for dying. Professor Jay Berkley and colleagues found that giving a supplementary diet led to weight gain, but did not improve survival or illness. Malnutrition, rather than the severity of HIV, should guide the use of supplementary food.

  • Treatment for malaria and malnutrition could impair normal height growth

    Posted 05/06/2018. Children suffering from malaria and malnutrition might experience diminished height growth when treated for both conditions simultaneously. Philippe Guerin and colleagues found that children treated for both falciparum malaria and uncomplicated severe acute malnutrition in Niger experienced a reduction in height gains while increasing their weight at the same time.

  • Genomic insights into the emergence and spread of antimicrobial-resistant bacterial pathogens

    Posted 30/05/2018. Drug resistant bacterial infections are becoming a major problem. Genomics has become a fundamental tool for tracking bacteria and provides us with the data and knowledge to begin to initiate a response. Stephen Baker and colleagues discuss how resistant bacteria emerge and spread and outline some approaches and knowledge gaps that can help us tackle this global heath emergency.

  • Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities

    Posted 22/05/2018. A new Case Study by Naomi Muinga from the Global Health Informatics Group reports on the challenges faced implementing an Open Source Electronic Health Record system in Kenya and the strategies employed by the Ministry of Health and development teams for increasing user adoption as the system is scaled up.

  • Scrub typhus point-of-care testing

    Posted 15/05/2018. Kartika Karaswati, Stuart Blacksell and colleagues reviewed the diagnostic accuracy of the available scrub typhus point-of-care tests, feasible to be used in resource limited settings. Although the available evidence is varied in methodology and quality, POCTs appear to have low false positive rates, thus confidence in interpreting a positive result can be high.

  • The ethics of using placebo in randomised controlled trials

    Posted 08/05/2018. Is it ethical to withhold a recommended treatment from a patient in clinical trial? In this paper we evaluate whether exchanging placebo for an active drug is ethical. We use the example of a randomised control trial of primaquine to determine its anti-relapse efficacy against vivax malaria and conclude that in some cases a placebo arm is imperative.

  • Emerging coxsackievirus A6 causing hand, foot and mouth disease in Vietnam

    Posted 01/05/2018. Hand, foot and mouth disease is a major public-health issue in Asia. Herein, Dr Tan and colleagues at OUCRU report the first detection of emerging coxsackievirus A6 among hand, foot and mouth disease patients in Vietnam, and document how this emerging virus evolves and spreads in space and time.

  • Primaquine pharmacokinetics in lactating women and breastfed infant exposures

    Posted 25/04/2018. Mary-Ellen Gilder and colleagues at SMRU demonstrate low levels of primaquine in breast milk, findings that should change treatment policy allowing more breastfeeding women to be cured of P.vivax. This will potentially reduce the global burden of this infection which has significant negative consequences for pregnant mothers and infants.

  • Malaria

    Posted 17/04/2018. This new Lancet malaria seminar, by Elizabeth Ashley and Charlie Woodrow, is one of a series of clinically focused, structured, up-to-date reviews which are grouped together in The Lancet Clinic with other relevant content. The aim of the seminars is to give a comprehensive overview of diseases to practising clinicians, emphasising recent advances, controversies and uncertainties.

  • Study analyses antimicrobial resistance surveillance networks in LMICs

    Posted 10/04/2018. Antimicrobial resistance (AMR) is a serious threat to public health. A new report by Elizabeth Ashley and colleagues describes the role of supranational networks in AMR surveillance in low- and middle-income countries (LMICs); Liz Ashley and colleagues analysed networks that were in existence between January 2000 and August 2017. This study reveals the challenges of establishing sustainable and effective networks to tackle resistance to antimicrobial medicines.

  • Acetaminophen as a renoprotective adjunctive treatment for patients with malaria

    Posted 29/03/2018. This randomised controlled trial, by Katherine Plewes and colleagues, of acetaminophen (paracetamol) in Bangladeshi patients with severe and moderately severe malaria shows that acetaminophen reduces kidney dysfunction and risk of developing acute kidney injury, particularly in patients with significant haemolysis. This proof-of-principle study supports the underlying hypothesis that acetaminophen inhibits cell-free haemoglobin-mediated oxidative kidney damage.

  • Tools for surveillance of anti-malarial drug resistance

    Posted 27/03/2018. This study proposes path for improving surveillance of antimalarial resistance through new technologies to produce molecular assays and capacity strengthening among national reference laboratories. After identifying deficiencies in method standardisation, study authors said a range of affordable techniques, combined with improved access to standardized protocols, training and proficiency testing, could boost surveillance efforts.

  • Mass drug administration to stop multi drug resistant malaria in Cambodia

    Posted 20/03/2018. A clinical trial in Cambodia evaluated the safety and effectiveness of mass drug administration (MDA) to interrupt multi-drug resistant falciparum malaria. Coverage with at least one round was 88%, no severe adverse events were reported, and MDA was associated with the absence of clinical P. falciparum cases for at least one year.

  • Promising approach to reducing Malaria transmission by ivermectin

    Posted 14/03/2018. Blood from patients treated with ivermectin can kill mosquitos. Our results indicate that ivermectin mass drug administration to humans could be a potential malaria control tool to aid malaria elimination efforts in South America.

  • Single low-dose primaquine for blocking transmission of Plasmodium falciparum malaria

    Posted 06/03/2018. Primaquine is being promoted actively to block the transmission of falciparum malaria parasites between humans and mosquitoes to reduce the spread of highly resistant malaria ‘superbugs.’ In response, Bob Taylor and colleagues developed a primaquine dosing scheme based on age. This will be useful where there are no functioning weighing scales and when primaquine mass drug treatment will be given.

  • Incidence and clearance of anal high-risk human papillomavirus in HIV-positive men who have sex with men

    Posted 27/02/2018. The human papilloma virus is primarily known as the causative agent of cervical cancer, but it also causes anal cancer. It is easily transmitted, but often cleared, and only few infections develop

  • Adaptation of Plasmodium falciparum to its transmission environment Adaptation of Plasmodium falciparum to its transmission environment

    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.

  • Community participation in mass anti-malarial administrations in Cambodia

    Posted 13/02/2018. Two mass drug administrations against falciparum malaria were conducted in 2015–16, one as operational research in northern Cambodia, and the other as a clinical trial in western Cambodia. During an April 2017 workshop in Phnom Penh the field teams from Médecins Sans Frontières and the Mahidol-Oxford Tropical Medicine Research Unit discussed lessons for future mass drug administrations.

  • Access to emergency hospital in sub-Saharan Africa

    Posted 06/02/2018. Timely access to emergency care can substantially reduce mortality. Work undertaken in Professor Bob Snow’s group in Kenya, has developed the first ever geocoded inventory of public hospitals in Africa. Spatial analysis across 48 countries showed that 29% of people are located more than 2-h travel time from the nearest hospital. With substantial variations within and between countries, innovative targeting of emergency care services is necessary to reduce inequities.

  • Estimating the number of cases of podoconiosis in Ethiopia using geostatistical methods

    Posted 30/01/2018. Podoconiosis, also known as nonfilarial elephantiasis, is a poorly understood neglected tropical disease. Using a combination of currently available epidemiological data as well as nationwide mapping survey and geostatistical modelling, Dr Abdisalan Noor and colleagues demonstrated that podoconiosis is highly endemic in Ethiopia and interventions need to be scaled-up rapidly.

  • Paediatric Admission Quality of Care (PAQC) score and mortality in Kenyan hospitals

    Posted 23/01/2018. The search is on for good measures of healthcare quality as LMIC health systems focus on effective coverage. In a new publication the Health Services team in Nairobi recently validated the Paediatric Admission Quality of Care (PAQC) score they had earlier developed, showing higher quality scores were associated with lower mortality for hospitalised children in Kenya.

  • Ethics, regulation, and beyond: the landscape of research with pregnant women

    Posted 16/01/2018. Ethics guidelines have evolved to protect vulnerable groups such as pregnant women from research. This has resulted in a lack of research in these populations making them even more vulnerable because of the lack of evidence-based medical care. In this paper, Professor Phaik Yeong Cheah and her collaborators discuss how regulatory frameworks can sometimes lead to a generalized exclusion of pregnant women from research.

  • Estimates of Wolbachia-mediated blocking of dengue virus transmission in Aedes aegypti mosquitoes

    Posted 09/01/2018. OUCRU researcher Lauren Carrington has provided evidence supporting the introduction of Wolbachia, a bacteria that manipulates its host reproductive system, into areas where there are dengue virus-transmitting mosquitoes, as a biocontrol method to reduce the transmission of dengue and other arboviruses.

  • The struggle for digital inclusion: Phones, healthcare, and marginalisation in rural India

    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.

  • Snakebite envenoming Snakebite envenoming

    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.

  • The breadth of viruses in human semen

    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.

  • Statistical methods to estimate efficacy of anti-malarials for uncomplicated malaria

    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.

  • Estimating the burden of scrub typhus Estimating the burden of scrub typhus

    Posted 21/11/2017. Scrub typhus is a serious mite-transmitted and difficult-to-diagnose infectious disease increasingly recognised as a major treatable cause of febrile illnesses with a wider distribution beyond Asia. Despite many limitations on the amount and quality of available reports to date, scrub typhus remains a severely underappreciated tropical disease, deserving more attention.

  • Drama as a community engagement strategy for malaria in rural Cambodia

    Posted 15/11/2017. Professor Phaik Yeong Cheah and colleagues published a paper on the evaluation of a community engagement project using drama in Western Cambodia. They demonstrated that the project was feasible in promoting awareness of malaria prevention and control. Audience members perceived drama as entertaining and as the preferred choice of engagement activity.

  • The eBioKit, a stand-alone educational platform for bioinformatics

    Posted 07/11/2017. Bioinformatics skills have become essential for many research areas and building these skills has many challenges. Dr Etienne de Villiers and colleagues develop the eBioKit as a stand-alone bioinformatics educational and research platform that hosts numerous tools and databases for both bioinformatics research and training in a controlled environment

  • Antimicrobial resistance among children in sub-Saharan Africa

    Posted 31/10/2017. Antimicrobial resistance is a clear and present threat to international health. Dr Phoebe Williams and Professor Jay Berkley reviewed recent data on antimicrobial resistance among children in sub-Saharan Africa since 2005. Research needs to focus on reporting community versus hospital-acquired infections, including patient outcomes, and needs pragmatic clinical trials.

  • No clinical benefit of empirical antimicrobial therapy for pediatric diarrhea

    Posted 25/10/2017. Professor Stephen Baker recruited more than 3,000 children with severe diarrhoea in high usage, high resistance settings in Ho Chi Minh City, Vietnam. He found that antimicrobial usage did not result in reducing the time of symptoms, and actually prolonged it in most cases.

  • Quantification of the association between malaria in pregnancy and stillbirth

    Posted 17/10/2017. Plasmodium falciparum and Plasmodium vivax malaria in pregnancy both increase stillbirth risk, which is likely to increase as endemicity declines. A study by SMRU and University of Melbourne researchers shows that better P. falciparum malaria control efforts could prevent up to 1 in 5 to 8 stillbirths in sub-Saharan Africa.

  • Local, national, and regional viral haemorrhagic fever pandemic potential in Africa

    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.

  • Severe childhood malnutrition

    Posted 10/10/2017. Severe malnutrition remains common in low-income countries, principally among young children. It usually arises from poor sanitation and infections, besides food insecurity. This comprehensive review by Professor James Berkley describes how research is needed, using modern clinic and laboratory tools, to better understand changes in metabolism, infections and the immune system to improve treatment.

  • Infection with Burkholderia pseudomallei – immune correlates of survival in acute melioidosis

    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.

  • Community engagement for the rapid elimination of malaria

    Posted 26/09/2017. Professor Phaik Yeong Cheah and colleagues published a paper describing their experience and challenges engaging with communities involved in the Targeted Malaria Elimination initiative in Karen State, Myanmar. The report gives a detailed account of the activities conducted and challenges encountered which included difficulties explaining concepts like drug resistance and submicroscopic infection.

  • Unsupervised primaquine for the treatment of Plasmodium vivax malaria relapses in southern Papua

    Posted 20/09/2017. Ric Price shows that that primaquine is substantially less effective for preventing relapses of vivax malaria in real-world practice than is predicted by clinical efficacy trials and that this is a likely consequence of incomplete adherence to treatment. Efforts to improve adherence to primaquine and to develop alternative drugs with shorter dosing regimens and greater patient tolerability are needed to achieve the significant public health benefits of P. vivax radical cure.

  • How the Ebola outbreak can shape innovation in research for emerging and epidemic infections How the Ebola outbreak can shape innovation in research for emerging and epidemic infections

    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.

  • How can we implement paediatric care practices in Kenyan hospitals?

    Posted 08/09/2017. Changing the practices of health care workers in multiple hospitals in low-income settings is a major contemporary challenge that requires people to think about the complex set of influences that affect clinicians’ behaviour. In this report, Professor Mike English describes a multi-layered strategy utilising a new implementation typology linked to overarching theories of change.

  • Geographic resource allocation based on cost effectiveness

    Posted 05/09/2017. Can faster progress be made in the fight against malaria by targeting interventions to where they will have the most impact? Health economists and mathematical modellers from the Mahidol-Oxford Tropical Medicine Research Unit have developed an approach to use maps of disease risk together with models of the transmission of disease and the costs and effectiveness of malaria interventions to help local decision makers design more impactful malaria control and elimination programmes.

  • Influence of number and timing of malaria episodes during pregnancy on prematurity and birthweight

    Posted 25/08/2017. In more than 50,000 pregnancies where 16% of women had malaria infection, the odds of small for gestational age and preterm birth following falciparum, and vivax malaria, were quantified. These newborn effects have life-long implications and efforts to effectively prevent malaria in pregnancy must be pursued.

  • Clinical Trials of Therapeutics for the Prevention of Congenital Zika Virus Disease: Challenges and Potential Solutions

    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.

  • Effect of transmission intensity on hotspots and micro-epidemiology of malaria in sub-Saharan Africa

    Posted 18/08/2017. Malaria transmission is patchy at local levels, and when a group of houses is located in a high transmission patch this is labelled a "hotspot". Looking at 19 studies in 7 African Countries, we see that hotspots are the norm, and especially prominent when malaria transmission falls.

  • Migration histories of multidrug-resistant tuberculosis patients from the Thailand-Myanmar border, 2012–2014

    Posted 14/08/2017. Through history and attributes of migration of Multi Drug Resistant Tuberculosis patients before diagnosis and treatment, and spatial analysis of their travelling patterns, the study highlights links between human migration and dispersal of multi-drug resistant Tuberculosis across wide geographic areas. It confirms needs for interventions suited to migrants’ life circumstances.

  • Developing guidelines in low-income and middle-income countries: lessons from Kenya

    Posted 01/08/2017. For more than a decade, Professor Mike English and his team have worked with the Kenyan Ministry of Health and professionals to develop national clinical guidelines. This paper describes how this approach has become both more rigorous and more collaborative while offering lessons to other LMIC on how to develop high quality guidelines with limited resources.

  • Comparative genomics of Cryptococcus neoformans associated with meningitis and HIV in Vietnam

    Posted 25/07/2017. Professor Jeremy Day and fellow researchers from OUCRU, in collaboration with colleagues from the Genome Institute Singapore, have published the first whole genome sequences of Vietnamese isolates of the yeast Cryptococcus neoformans, in an attempt to better understand the genes that enable some families of this usually accidental pathogen to cause disease in people with normal immune systems.

  • Online mapping database for Plasmodium vivax clinical trials

    Posted 18/07/2017. The WWARN Vivax Surveyor provides an interactive map that summarises the prevalence and degree of chloroquine resistance in Plasmodium vivax parasites across the world. This tool provides a clear and standardised visualisation of vivax clinical trials to date to inform key international, regional and national monitoring strategies.

  • Hospitals as complex adaptive systems: factors influencing priority setting practices in Kenya

    Posted 11/07/2017. We used a qualitative approach to study how public hospitals in Kenya make resource allocation decisions. We found that these decisions were influenced by (1) scarcity of financial resources, and poorly designed financing processes, (2) limited flexibility in resource allocation decisions, and (3) inadequate management and leadership capacity in the hospitals. Read more on Improving priority settting practices in Kenya's hospitals.

  • Prophylactic acetaminophen or ibuprofen result in equivalent acute mountain sickness incidence at high altitude

    Posted 30/06/2017. Acute mountain sickness is a potentially life-threatening illness for sojourners to high altitude (> 2500m). Where pharmacological prophylaxis is indicated, Diamox is the drug of choice, but it has distressing side-effects. This Everest-based, double-blind, randomized controlled trial revealed that paracetamol, like ibuprofen, could potentially replace Diamox for prophylaxis.

  • First-trimester artemisinin derivatives and quinine treatments and the risk of adverse pregnancy outcomes in Africa and Asia

    Posted 13/06/2017. It has been maintained for decades that quinine is the safest drug for treatment of malaria in the first trimester of pregnancy. In the largest analysis of data from Thailand and Africa, artemisinins are reported to be at least as safe as quinine. This will simplify treatment protocols worldwide.

  • New sequencing method for rotavirus from human fecal samples to help epidemiology and surveillance

    Posted 30/05/2017. Rotavirus is a complex RNA virus with a genome comprised of multiple segments. The virus causes diarrhoea and extracting pure virus from stool samples limits our ability to sequence its genome. A team led by Professor Stephen Baker developed a new capture/purification method for rotavirus allowing us to perform whole genome sequencing from stool samples for the first time.

  • Treatment Response in Enteric Fever in an Era of Increasing Antimicrobial Resistance

    Posted 25/04/2017. South Asia, which includes Nepal, is a hub for typhoid fever. Trials conducted in Nepal since 2005 confirm that fluoroquinolones are failing for typhoid fever treatment. The WHO and health ministries in the region recommend fluroquionolones as the drugs of choice for typhoid fever. This recommendation needs to be changed.

  • Picturing health: making malaria visible in Asia-Pacific

    Posted 07/04/2017. Collaboration between photographer Pearl Gan and Professor Kevin Baird from our EOCRU unit in Jakarta, Indonesia, this photographic project aims to raise public awareness of malaria as a serious health problem for the region by telling the human story of Asia’s invisible malaria burden.

  • Zoonotic Transmission of mcr-1 Colistin Resistance Gene from Small-Scale Poultry Farms, Vietnam

    Posted 31/03/2017. Using epidemiological and microbiological approaches and sequencing data, this study, led by Prof. Constance Schultsz of the Academic Medical Center and Assoc. Prof. Ngo Thi Hoa, shows that usage of antimicrobials in food animal production selects for antimicrobial resistant bacteria (AMRB) in animals, which increases the risk for faecal colonisation of AMRB in humans.

  • An epidemic of dystonic reactions in central Africa

    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.

  • Malaria superbugs threaten global malaria control

    Posted 03/02/2017. Led by Professor Arjen Dondorp, researchers have found that a dominant strain of drug resistant falciparum malaria, first detected in 2008 in Cambodia, has spread to other countries in the Greater Mekong Sub-region of Southeast Asia. This causes treatment failure rates for the main falciparum malaria medicines, artemisinin combination therapies (ACTs)

  • Harmonised Zika virus research protocols published

    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.

  • Birth attendant training course may be global model for safer birth care in poor communities

    Posted 17/10/2016. Training local Karen and Burman women as skilled birth attendants in refugee settings resulted in no adverse perinatal outcomes and many positive outcomes such as a drop in stillbirths and infant deaths and more babies being born in clinics rather than at home, says a new study, led by Professor Rose McGready and published in PLOS ONE.