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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.

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.

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.

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.

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


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

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


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

Leadership in global health


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

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


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

Vaccine mandates and public trust do not have to be antagonistic


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

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


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

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


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

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


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

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


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

An artesunate pharmacometric model to explain therapeutic responses in falciparum malaria


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

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


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

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


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

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


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

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


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

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


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

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


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

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