Research Highlights

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 09/02/2023. 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.

Plasmodium falciparum adapts its investment into replication versus transmission according to the host environment

Posted 21/03/23. A collaborative study between Abdirahman Abdi's lab at KEMRI-Wellcome Trust, Kenya, and Prof Marti’s Lab of Glasgow University, UK, has characterised the human environmental factors that drive malaria parasites, Plasmodium falciparum to invest into the transmission to the next host or continued replication within the current host to maximise survival.

Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review

Posted 15/03/2023. In this systematic review, Abdulazeez Imam and colleagues summarise the evidence on missed nursing care in low-income and middle-income countries (LMIC). Missed nursing care undermines nursing standards of care, and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept remains understudied in LMIC settings which have 90% of the global nursing workforce shortages.

Determinants of Implementation of a Critical Care Registry in Asia: Lessons From a Qualitative Study

Posted 10/03/2023. Timo Tolppa and CCAA colleagues conducted a qualitative study across 4 South Asian countries to understand the implementation of a critical care registry, which is used to enable quality improvement and research. Implementation was possible due to motivated champions, a supportive community of practice and efforts to fit the registry with existing practice.

Respecting relational agency in the context of vulnerability: What can research ethics learn from the social sciences?

Posted 08/03/2023. Research ethics struggles in practice to adequately account for and respond to the agency and autonomy of people considered vulnerable in the research context. Jennifer Roest and colleagues discuss some of the core concepts and critiques emerging from the literature on women and children's agency in under-resourced settings.

Glucose-6-Phosphate Dehydrogenase (G6PD) Measurement Using Biosensors by Community-Based Village Malaria Workers and Hospital Laboratory Staff in Cambodia: A Quantitative Study

Posted 07/03/2023. Understanding the Glucose-6-Phosphate Dehydrogenase (G6PD) activity of vivax patients is critical for the appropriate choice of radical cure regimens for vivax malaria. Village malaria workers (VMWs) in rural Cambodia are frequently the first and only health care providers for malaria patients but lack G6PD diagnostics. Bipin Adhikari and colleagues found that after training VMWs can use biosensors to assess G6PD activity just as well as laboratory technicians.

A framework for managing health research capacity strengthening consortia: addressing tensions and enhancing capacity outcomes

Posted 03/03/2023. Nadia Tagoe, Sassy Molyneux and colleagues conducted a case study involving three health research capacity strengthening (HRCS) consortia to critically examine their decision-making processes, strategies for resolving management tensions and potential implications for consortia outcomes. The researchers propose an evidence-informed management framework for consortia leaders to use to support decision-making to optimise research capacity gains.

Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): a multicentre, prospective, observational study

Posted 28/02/2023. Researchers from Heidelberg and Oxford worked with partners from eight countries across Asia and Latin America to develop an algorithm to improve early diagnosis of dengue; simple clinical and laboratory variables were collected daily from 5189 patients presenting with undifferentiated fever, among whom 2694 were subsequently confirmed to have dengue. Results will help to improve case management and use of limited resources in dengue-endemic areas. By Ronald Geskus

Awareness of Antibiotics and Antibiotic Resistance in a Rural District of Ha Nam Province, Vietnam: A Cross-Sectional Survey

Posted 17/02/2023. Low awareness of antibiotics and antibiotic resistance may lead to inappropriate antibiotic use and contribute to the problem of antibiotic resistance. Sonia Lewycka and colleagues found that most people in a rural community in northern Vietnam had heard of antibiotics, but practical knowledge about antibiotics and antibiotic resistance was limited. Type of health facility, distance from health facility, media use, and health information sources were associated with knowledge.

Outpatient antibiotic prescribing for acute respiratory infections in Vietnamese primary care settings by the WHO AWaRe (Access, Watch and Reserve) classification: an analysis using routinely collected electronic prescription data

Posted 10/02/2023. Over 97% of primary care patients with acute respiratory infections are prescribed antibiotics, and children under 5-years old are more likely to be prescribed antibiotics with higher resistance potential. This study in northern Vietnam by Nam Nguyen Vinh, Sonia Lewycka and colleagues highlights the urgent need for antimicrobial stewardship interventions in primary care settings.

Monkeypox Virus Infection in 2 Female Travelers Returning to Vietnam from Dubai, United Arab Emirates, 2022

Posted 08/02/2023. Dr Anh used metagenomics to whole-genome sequence monkeypox virus in 2 women with mpox returning to Vietnam from the United Arab Emirates. The viruses belonged to an emerging sublineage, A.2.1, distinct from B.1 which is responsible for the ongoing multicountry outbreak. Enhanced genomic surveillance is needed to clarify pathogen evolution.

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 07/02/2023. Rachel Greer and team in Chiangrai, Thailand found that the challenges research participants face in their daily lives, such as, language barriers and limited access to healthcare can influence their experiences of taking part in research. Researchers need to be responsive towards these specific vulnerabilities in order to reduce the burdens and maximize the benefits of research for participants.

Flexible resources and experiences of racism among a multi-ethnic adolescent population in Aotearoa, New Zealand: an intersectional analysis of health and socioeconomic inequities using survey data

Posted 03/02/2023. As societies become increasingly diverse, understanding the complex nature of racism for multiple ethnic, social, and economic identities is required. Sonia Lewycka and colleagues in New Zealand showed that indigenous and minority experiences of racism are heterogeneous, and flexible resources such as wealth and perceived whiteness can mitigate against some forms of systemic and interpersonal racism.

A global core outcome measurement set for snakebite clinical trials

Posted 24/01/2023. Snakebite is a priority NTD that causes 94,000 deaths each year and many more cases of severe disability. In research led by PhD student Michael Abouyannis at KWTRP and LSTM, global academics, policy makers, and the Kilifi snakebite patient group developed a globally relevant set of core outcome measures to support future clinical trials.

Group photo of the 2022 Conference, The Global Health Network

After sharing how we do research, build teams, transfer know-how and build research careers and systems, what next?

Posted 17/01/2023. PLOS Global Public Health features a blog on The Global Health Network Conference 2022 that took place at the University of Cape Town, South Africa from 24 – 25 November 2022. The theme of the conference was Enabling Health Research in Every Healthcare Setting and 10 Years of addressing inequity in where research happens, who leads and who benefits. There were almost 900 abstract submissions and researchers, clinicians, practitioners, donors, and policymakers from across the world attended.

How does power shape district health management team responsiveness to public feedback in low- and middle-income countries: an interpretive synthesis

Posted 13/01/2023. Nancy Kagwanja and colleagues highlight the influence of social norms, structures, and actor power practices on responsiveness. Power practices were rooted in actors’ lived experiences which included social and organizational power relationships, personal characteristics, and worldviews. Our findings emphasize the need to consider actors’ lived experiences when intervening to strengthen responsiveness.

Screening for monkeypox virus infections in men who have sex with men in a sexual health clinic in Hanoi, Viet Nam

Posted 11/01/2023. A collaborative work between the Hanoi Medical University, UCLA, and OUCRU, showed no evidence of circulation of monkeypox virus among men who have sex with men attending a sexual health clinic in Hanoi, Vietnam in 2022. So far, the single case of monkeypox described in Vietnam was imported. By Thomas Kesteman

Louis Pasteur, COVID-19, and the social challenges of epidemics

Posted 23/12/2022. December 2022 sees two notable anniversaries: the 200th anniversary of the birth of Louis Pasteur and the third anniversary of China's announcement of the COVID-19 outbreak. On these coinciding events, Phaik Yeong Cheah and colleagues reflect on past and current global challenges to bring epidemics under control.

The wrongful indictment of pre-referral rectal artesunate further delays the roll-out of this lifesaving drug

Posted 22/12/2022. On Jan 27, 2022, WHO recommended a moratorium on the deployment of rectal artesunate suppositories for severe malaria and in doing so stopped the roll-out of a lifesaving intervention. The decision is based on data from a large demonstration project CARAMAL. Lorenz von Seidlein discusses the project and its consequences with two leaders of the project in a point- counterpoint published in the Lancet infectious Diseases.

Kinetics of Neutralizing Antibodies against Omicron Variant in Vietnamese Healthcare Workers after Primary Immunization with ChAdOx1-S and Booster Immunization with BNT162b2

Posted 20/12/2022. Tan and colleagues showed that booster vaccination by BNT162b2 induced cross-neutralizing activities against Omicron variant sub-lineages BA.1 and BA.2 in Vietnamese health care workers completing primary immunization with ChAdOx1-S. These responses however significantly reduced at month 3 post booster doses. The need for a second booster merits further research.

Technical evaluation and usability of a quantitative G6PD POC test in cord blood: a mixed-methods study in a low-resource setting

Posted 20/12/2022. G6PD deficiency is a major risk factor for severe neonatal jaundice among neonates born at the Thailand-Myanmar border. Early identification of G6PD deficiency can dramatically improve clinical care. In this study Germana Bancone and colleagues showed that a new point-of-care quantitative G6PD test used by trained midwives can reliably identify neonates with abnormal G6PD at birth.

Village malaria workers for the community-based management of vivax malaria

Posted 16/12/2022. Radical cure of vivax malaria with primaquine requires testing for glucose-6-phosphate dehydrogenase deficiency, which is currently not provided at the community level in Cambodia. In this article, Bipin Adhikari and colleagues describe the core components needed for implementing radical cure at the community, which will increase coverage important for rapid vivax malaria elimination.

Malaria outbreak in Laos driven by a selective sweep for Plasmodium falciparum kelch13 R539T mutants: a genetic epidemiology analysis

Posted 14/12/2022. Malaria outbreaks can be driven by genetic selection rather than environmental or behavioural causes. Varanya Wasakul, Olivo Miotto and colleagues investigated a Plasmodium falciparum outbreak in Attapeu, Laos, in 2020-2021, using genomic epidemiology methods to elucidate parasite population dynamics, identify the outbreak’s causes and reconstruct the origin of the circulating strains.

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

Posted 13/12/2022. Pregnant women in sub-Saharan Africa experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. However, Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. To inform planning, Peter Macharia and colleagues modelled ANC4+ coverage stratified by household wealth, maternal education, and spatial access to healthcare in East Africa.

Genomic epidemiology, antimicrobial resistance and virulence factors of Enterobacter cloacae complex causing potential community-onset bloodstream infections in a tertiary care hospital of Nepal

Posted 09/12/2022. Community-onset bloodstream infections caused by multidrug resistant Enterobacter cloacae complex (ECC) species are increasing, underscoring their potential emerging role. This study by Abhilasha Karkey and colleagues elucidated detailed genomic epidemiology of ECC isolates showing complex transmission dynamics within the community. Genomic evidence of resistance to several major antimicrobial classes including carbapenems was detected.

Antibody Responses and Reactogenicity of a Heterologous, Full-Dose Messenger RNA-1273 Booster in Heavily SARS-CoV-2–Exposed CoronaVac-Vaccinated Health-Care Workers in Indonesia: A Real-World Observational Study

Posted 07/12/2022. In this real-world cohort study in Indonesia, Raph Hamers and colleagues found high antibody responses and good tolerability of a heterologous, full-dose mRNA-1273 (Moderna) booster after two doses of inactivated vaccine (CoronaVac) in healthcare workers in Indonesia, with and without previous SARS-CoV-2 infection, including in those who had very low antibody levels.

Orientia tsutsugamushi in Chiggers and Small Mammals in Laos

Posted 06/12/2011. Scrub typhus is an important cause of febrile illness in Laos. Ivo Elliott and colleagues collected, identified and tested small mammals hosts and vector chigger mites for Orientia tsutsugamushi, the causative pathogen. A single pool of chiggers tested PCR positive and 16/52 (31%) of small mammals were seropositive. These are the first molecular and serological data on O. tsutsugamushi in vectors and non-human hosts from Laos.

Moderate and transient impact of antibiotic use on the gut microbiota in a rural Vietnamese cohort

Posted 02/12/22. PhD research from Vu Thi Ngoc Bich at OUCRU Hanoi (with NIHE, Radboud and Maastricht University) on samples from our longitudinal community cohort in Ha Nam, Vietnam, shows that frequent antibiotic exposure may push microbiota to different steady state that is less diverse but more resilient to disruption by subsequent antibiotic use.

Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: a systematic review and individual patient data meta-analysis

Posted 29/11/22. Makoto Saito and colleagues evaluated the fetal safety of antimalarials in the first trimester of pregnancy. Pregnant women who were treated with artemisinin-based combination therapy (ACT) in the first trimester had fewer fetal losses and congenital anomalies than quinine-treated women. Updated WHO guidelines recommend ACT, particularly artemether-lumefantrine, for all trimesters.

Ownership of individual-level health data, data sharing, and data governance

Posted 22/11/2022. Who owns individual-level health data collected from health research and clinical care? In this paper Phaik Yeong Cheah and Jan Piasecki argues that neither public ownership nor private ownership will allow us to resolve all the problems associated with effective, equitable, and ethical use of data.

Balancing uncertainty and proactivity in care seeking for hepatitis C: qualitative research with participants enrolled in a treatment trial in Ho Chi Minh City, Vietnam

Posted 16/11/2022. In this qualitative study, Jennifer Van Nuil and colleagues explored care seeking and treatment experiences for participants enrolled in hepatitis C clinical trials in Ho Chi Minh City, Vietnam. They found that experiences included the following themes: navigating uncertainty, proactivity in the face of challenges, living in fear with faith, and dynamic support systems.

Improving in-patient neonatal data quality as a pre-requisite for monitoring and improving quality of care at scale: A multisite retrospective cohort study in Kenya

Posted 11/11/2022. In this study, Timothy Tuti and colleagues discuss the characteristics of a neonatal inpatient dataset from a network of Kenyan hospitals that allows for exploration of trends in performance and could support better impact evaluation, exploration of links between health system inputs and outcomes, and scrutiny of variation in quality of hospital care.

Evaluating the effects of supplementing ward nurses on quality of newborn care in Kenyan neonatal units: protocol for a prospective workforce intervention study

Posted 09/11/2022. Abdul Imam and colleagues studied the effect on the quality of patient care of prospectively adding extra nursing staff to newborn units in a resource constrained LMIC setting in Kenya and described the relationship between staffing and quality of care.

Cardiovascular Concentration-Effect Relationships of Amodiaquine and its Metabolite Desethylamodiaquine: Clinical and Pre-clinical Studies

Posted 21/10/2022. Amodiaquine is an important antimalarial widely used for the treatment and prevention of malaria, protecting millions of African children every year. Xin Hui Chan and colleagues characterised the concentration-dependency of the bradycardic, hypotensive, and QT-prolonging effects of amodiaquine and its active metabolite desethylamodiaquine in clinical and pre-clinical studies, providing evidence of their causal role.

Trust is the common denominator for COVID-19 vaccine acceptance: A literature review

Posted 18/10/2022. Trust is perhaps the most frequently attributed element in decision making for vaccine uptake. But what is trust, and how does it affect vaccine decision? In this qualitative review, Bipin Adhikari and colleagues explored how decisions on vaccine uptake are made, the role of trust and ways to build it.

Glucose 6 Phosphate Dehydrogenase (G6PD) quantitation using biosensors at the point of first contact: a mixed method study in Cambodia

Posted 07/10/2022. G6PD measurement is critical before including primaquine or tafenoquine in the treatment for vivax malaria. Bipin Adhikari and colleagues explored whether first line health care providers can safely handle G6PD biosensors in the rural Cambodia. Our findings suggest that the radical cure for vivax malaria can be safely administered at the point of first contact, thus preventing relapse and continued transmission in a much larger population than through hospital based management.

Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study

Posted 05/10/2022. Sutharshan Vengadasalam, Timo Tolppa and colleagues employed pathway mapping, ethnography, and interviews in Colombia, South Africa, Sri Lanka, Tanzania and Uganda, and found four common barriers to the delivery of quality perioperative care - Fragmented care pathways, limited human and structural resources, direct and indirect costs, and patients' low expectations of care.

A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials

Posted 27/09/2022. In this study, Sophie Yacoub and colleagues at OUCRU evaluated whether using a dynamic delta modified SOFA score might be a feasible endpoint for future therapeutic trials in dengue. They found that the delta mSOFA performed well, and was associated with requirement for organ support, duration of treatment and mortality.

Combining school-catchment area models with geostatistical models for analysing school survey data from low-resource settings: Inferential benefits and limitations

Posted 23/09/2022. Peter Macharia and colleagues propose a geostatistical modelling framework that accounts for the uncertainty in the residence location of students from school-based infection sample surveys when only school location data are available. The proposed framework offers inferential benefits by leveraging spatial access and school catchment models to improve standard geostatistical approaches.

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Research Highlights