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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.

Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders’ perspectives in Burkina Faso and Nigeria


Posted 21/09/2022. Phaik Yeong Cheah and colleagues asked malaria stakeholders in Burkina Faso and Nigeria: What are the key ethical considerations to be considered in the deployment of Triple Artemisinin-based Combination Therapies for malaria in Africa when artemisinin combination therapies are effective in most of Africa?

Outdoor residual spraying for malaria vector-control in Kayin (Karen) state, Myanmar: A cluster randomized controlled trial


Posted 14/09/2022. Victor Chaumeau and colleagues evaluated the efficacy of outdoor residual spraying for malaria vector control on the Thailand-Myanmar border. Intervention was showed to rapidly interrupt transmission in a setting where the vectors bite mostly outdoors and at a time when people are not protected by mosquito bed nets.

The quality of veterinary medicines and their implications for One Health


Posted 31/08/2022. Substandard and falsified anti-infectives used in human and animals are common, especially in Low- and Middle-Income countries, leading to poor clinical outcomes, adverse drug reactions, economic losses, mistrust in health systems and potentially leading to AMR emergence and spread. One Health research is needed to assess their impact on AMR, by Celine Caillet and colleagues.

A family cluster of cutaneous Leishmania major infection unresponsive to intralesional meglumine antimonial: Case reports


Posted 12/08/2022. This small series describes four family members who contracted cutaneous leishmaniasis due to Leishmania major that did not improve in two patients and worsened in the other two despite 4 weeks of intralesional meglumine antimoniate. All responded to a 4-week course of oral ketoconazole. The paper provides an interesting discussion, by Bob Taylor and colleagues

Perioperative Care Pathways in Low- and Lower-Middle-Income Countries: Systematic Review and Narrative Synthesis


Posted 09/08/2022. Timo Tolppa and CCAA colleagues reviewed the literature on perioperative care pathways in resource-poor settings and found that pathways are increasingly used there with an aim to improve care quality. Patient and clinician beliefs were a major challenge in care pathway implementation, whereas facilitators included context-relevant adaptations, strong evidence-base and teamwork.

Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya


Posted 05/08/2022. During a rapidly unfolding catastrophic pandemic, research is most needed to inform on nature, containment and prevention of the pandemic. Ethics review and regulatory authorities are important gatekeepers for research, and can facilitate scientifically rigorous and ethically sound relevant research. Alex Hinga, Dorcas Kamuya and colleagues examined how research review was undertaken during COVID19 in one of the review systems in Kenya, factors that enabled and/or hindered accelerated review including the political landscape, and make some recommendations for review systems in LMICs.

Implementing a comprehensive newborn monitoring chart: Barriers, enablers, and opportunities


Posted 03/08/2022. Naomi Muinga and colleagues report on a process of implementing a co-designed, paper-based newborn monitoring chart in a network of hospitals in Kenya. While the chart was well-received, challenges with full uptake persist and offer opportunities to strengthen the process as well as future implementations.

Improving the diagnosis of severe malaria in African children using platelet counts and plasma PfHRP2 concentrations


Posted 02/08/2022. Severe malaria is difficult to diagnose in high malaria transmission areas because of the high coincidence of malaria with other febrile illnesses. James Watson and colleagues analysed platelet counts and plasma PfHRP2 concentrations from >2000 severely ill children and show that around a third of children diagnosed with severe malaria have in fact another cause of illness.

Phagocytosis of Plasmodium falciparum ring-stage parasites predicts protection against malaria


Posted 29/07/2022. Ring-stages are the predominant parasite forms detected in the blood of humans infected with Plasmodium falciparum. Fauzia Musasia, Faith Osier and colleagues found that their active destruction through antibody-dependent phagocytosis predicted how well individuals responded to an experimental malaria infection. Targeting ring-stages may limit exponential parasite multiplication and prevent the progression to clinical malaria

Decentralised hepatitis C testing and treatment in rural Cambodia: evaluation of a simplified service model integrated in an existing public health system


Posted 28/07/2022. Meiwen Zhang and Tom Peto start a prevalence survey, including Hepatitis B and Hepatitis C, among the rural population in Bangladesh, Cambodia, and Thailand. In 2021 Meiwen and colleagues published a pilot implementation project on hepatitis C testing and treatment in rural Cambodia.

“Like a wake-up call for humankind”: Views, challenges, and coping strategies related to public health measures during the first COVID-19 lockdown in Thailand


Posted 26/07/2022. In this paper, Phaik Yeong Cheah and colleagues describe the challenges and coping strategies related to public health measures during the first COVID-19 lockdown in Thailand. Major challenges identified included financial hardship, social isolation and loneliness. Coping strategies included turning to religion, practicing acceptance and ‘making merit’ (Tham-bun in Thai).

The European & Developing Countries Clinical Trials Partnership (EDCTP) Knowledge Hub: developing an open platform for facilitating high-quality clinical research


Posted 22/07/2022. In recognition of emergent data on what the barriers and enablers are to long-term, sustainable capabilities to run studies, The Global Health Network and EDCTP developed the ‘EDCTP Knowledge Hub’: a set of online, open access, cross-cutting tools and resources to support the planning, writing and delivery of high-quality health research studies, available to research staff wherever they are in the world, especially those in low-resource settings. By Samuel Driver and colleagues

Impact of delayed processing of positive blood cultures on organism detection: a prospective multi-centre study


Posted 19/07/2022. What effect temperature and time have on organism detection from positive blood culture bottles is unknown. Tamalee Roberts, Arjun Chandna and colleagues found that the majority of organisms were recoverable from positive blood culture bottles stored at room temperature. Amies transport swabs also proved effective for transporting blood culture broth and preserving organism viability.

High burden of childhood tuberculosis in migrants: a retrospective cohort study from the Thailand–Myanmar border


Posted 14/07/2022. Children bear a substantial burden of TB disease on the Thai-Myanmar border. Treatment success rate exceeded the WHO End TB target of 90%, suggesting that similar vulnerable populations could benefit from the enhanced support of the residential TB program offered by Francois Nosten and colleagues. However better child-friendly diagnostics are needed to improve the detection of TB in children.

A scoping review of antibiotic use practices and drivers of inappropriate antibiotic use in animal farms in WHO Southeast Asia region


Posted 13/07/2022. Many of the antibiotics used in animal farms in Southeast Asia are critically important for humans. The scarcity of standardised antibiotic and livestock quantification methods limits existing literature. Ease of access to poorly regulate antibiotics, inaccessible quality animal healthcare, and insufficient preventive services likely drive inappropriate antibiotic use, by Aronrag Meeyai and colleagues.

African Plasmodium vivax malaria improbably rare or benign


Posted 08/07/2022. We have long believed most of sub-Saharan Africa to be free of Plasmodium vivax malaria due to the dominance of Duffy blood factor negativity. Recent work nonetheless reveals stable P. vivax transmission across Duffy-negative Africa, very probably causing an infection of deep organs responsible for harm of unrecognized origin. Review by Kevin Baird

Incidence of chikungunya virus infections among Kenyan children with neurological disease, 2014–2018: A cohort study


Posted 06/07/2022. Chikungunya Virus (CHIKV) has been associated with neurological illness in many parts of the world, but there have been no reports of CHIKV-associated neurological illness in Africa. This study by Doris Nyamwaya and George Warimwe reveals that CHIKV infections are relatively more common than cerebral malaria and bacterial meningitis among children hospitalized with neurological disease in coastal Kenya, and systematic surveillance should be an urgent priority.

Tackling typhoid fever burden in south Asia


Posted 28/06/2022. South Asia is a hub for typhoid fever, a biblical disease in the West. The new conjugate vaccine, which we studied and now implemented by the Nepali government, is very important for the control of typhoid fever. But well-done treatment trials with adequate sample size are also of paramount importance. By Buddha Basnyat

Contribution of genetic factors to high rates of neonatal hyperbilirubinaemia on the Thailand-Myanmar border


Posted 22/06/2022. Mutations on the G6PD and UGT1A1 genes play a large role in neonatal jaundice, including the severe forms, among Karen and Burman neonates. Germana Bancone and colleagues show that improved diagnostics are urgently needed and different screening strategies should be considered in populations with a high prevalence of these traits.

Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): a multicentre prospective study


Posted 21/06/2022. The South-East Asia Encephalitis Consortium, coordinated by Institut Pasteur-Paris, published in Lancet Global Health, a large prospective study of childhood encephalitis in Cambodia, Laos, Vietnam and Myanmar. The Lao site was coordinated by LOMWRU/Microbiology Laboratory, Mahosot Hospital. This demonstrated the vital importance of prevention, especially vaccination against Japanese encephalitis, and access to rapid, tiered diagnosis and treatment.

Experience of Kenyan researchers and policy-makers with knowledge translation during COVID-19: a qualitative interview stud


Posted 17/06/2022. Reducing the devastating impact of COVID-19 requires the use of best available evidence to inform responses. Fatuma Guleid, Edwine Barasa and Researchers at the KEMRI-Wellcome Trust carried out knowledge translation (KT) activities to support national COVID-19 policy-making. In the study, we describe our experiences and the impact of KT in responding to public health crises.

Perceptions, views and practices regarding antibiotic prescribing and stewardship among hospital physicians in Jakarta, Indonesia: a questionnaire-based survey


Posted 07/06/2022. This survey among over 1000 hospital physicians found that antimicrobial stewardship (AMS) implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities. Appropriate recognition of the contextual determinants of antibiotic prescribing decision making will be critical to change physicians’ attitudes and develop context-specific AMS interventions. By Ralalicia Limato, Raph Hamers and colleagues.

Optimizing antibiotic use in Indonesia: A systematic review and evidence synthesis to inform opportunities for intervention


Posted 01/06/2022. This review represents a first attempt at systematically assessing human antibiotic use in Indonesia in the past 20 years. Ralalicia Limato, Raph Hamers and colleagues identified critical evidence gaps in the private health care sector, and what are the health system drivers of antibiotic use. Optimisation of antimicrobial use should be a priority of the national agenda for universal health coverage.

Zoonotic pathogens and diseases detected in Vietnam, 2020–2021


Posted 31/05/2022. Via online-survey with 332 clinical- and laboratory- based respondents in human and animal sectors across 61 of 63 provinces, followed by face-to-face interviews and review of 10-year-literature, Ngo Thi Hoa and colleagues identified 24 reported circulating-zoonotic diseases in Vietnam. With additional One-Health surveillance on these diseases, we will understand their animal reservoir and impact on human- and animal-health.

Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: a 2 × 2 factorial randomised controlled trial


Posted 27/05/2022. This randomised controlled trial by Louise Thwaites and colleagues examined two different treatments for adults with tetanus. The first was spinal (intrathecal) injection of antitoxin compared to a sham (dummy) procedure (in addition to normal intramuscular injection) and showed no overall benefit. The second, comparing two types of intramuscular antitoxin (equine and human) also showed no difference between treatments

Cooperation in Countering Artemisinin Resistance in Africa: Learning from COVID-19


Posted 24/05/2022. Drug-resistant malaria is now a critical public health emergency on a global scale. The artemisinin resistance confirmed recently in Rwanda and Uganda is likely just the ‘tip of the spear’, with its spread likely to soon occur widely across endemic countries in sub-Saharan Africa. Philippe Guerin and colleagues make five feasible recommendations, based on learnings from the COVID-19 experience on collecting, sharing and disseminating these critical data efficiently.

Evaluation of an audit and feedback intervention to reduce gentamicin prescription errors in newborn treatment (ReGENT) in neonatal inpatient care in Kenya: a controlled interrupted time series study protocol


Posted 17/05/2022. In this study, leveraging a Kenyan Clinical Information Network, Timothy Tuti, Mike English and colleagues set out to evaluate at the clinical team level, if and how a comprehensive healthcare-specific feedback theory used to design and implement pharmacists-championed feedback strategies could help improve medication prescribing accuracy during inpatient neonatal care.

Low Hemoglobin Levels Are Associated with Reduced Psychomotor and Language Abilities in Young Ugandan Children


Posted 17/05/2022. In this study, Margaret Nampijja, Agnes Mutua, Sarah Atkinson and colleagues found that lower maternal and infant hemoglobin levels were associated with reduced psychomotor scores at 15 months, and lower infant hemoglobin levels were associated with reduced language scores. These findings emphasize the importance of managing maternal and child anemia.

Under the Mask: A Film on Tuberculosis at the Thai-Myanmar Border


Posted 13/05/2022. “Under the Mask” is a 75-min feature film that follows the lives of patients with TB who live on the Thai-Myanmar border. Phaik Yeong Cheah, Michele Vincenti Delmas and colleagues explains the genesis and development of the film, and how it has been used to engage communities at risk of TB.

Characterising Kenyan hospitals’ suitability for medical officer internship training: a secondary data analysis of a cross-sectional study


Posted 11/05/2022. Yingxi Zhao and colleagues used data from a national health facility assessment to understand the capacity of Kenya internship hospital to provide internship training for medical doctors. They highlight the major gaps in staffing, equipment and service availability in those hospitals and call for more stringent and regular review and re-accreditation of internship hospitals to provide appropriate and well-resourced training.

Vitamin D Deficiency and Its Association with Iron Deficiency in African Children


Postes 10/05/2022. In this study, Reagan Mogire and colleagues found that vitamin D deficiency was associated with a 98% increased risk of iron deficiency in African children and also influenced hepcidin and other markers of iron status. Both nutrients should be considered in strategies to manage their deficiencies in Africa.

Effects of iron intake on neurobehavioural outcomes in African children: a systematic review and meta-analysis of randomised controlled trials


Posted 06/05/2022. Animal studies suggest an important role of iron in neurodevelopment. In this systematic review, Agnes Mutua, Sarah Atkinson and colleagues found limited evidence for the effects of iron supplementation on neurodevelopment in African children despite the high burden of iron deficiency in this population. Further well-conducted studies are needed.

Should peer reviewers be paid to review academic papers?


Posted 03/05/2022. We’ve all been there! Waiting forever for reviewers comments after submission our paper to a journal. The system is not working. Should we pay reviewers to review a paper? Will it make a difference? Phaik Yeong Cheah and Jan Piasecki give some arguments why we should. What are your thoughts?

Mycobacterium tuberculosis transmission in Birmingham, UK, 2009–19: An observational study


Posted 20/04/2022. Although seasonality in tuberculosis is seen on all continents, explanations have remained elusive. In a 10-year population study of TB transmission in Birmingham, UK, Timothy Walker and colleagues see seasonality only among patients linked by recent transmission, with diagnoses peaking in spring time. TB’s incubation period may thus be even shorter than hitherto understood.

Mapping for engagement: setting up a community based participatory research project to reach underserved communities at risk for hepatitis C in Ho Chi Minh City, Vietnam


Posted 19/04/2022. Jennifer Van Nuil and colleagues used a community-based participatory research approach to engage in dialogues with underserved groups at risk for hepatitis C in Ho Chi Minh City, Vietnam. We present findings from stakeholder mapping meetings held with representatives from local organizations, including the challenges and dynamics of the communities.

Examining the unit costs of COVID-19 vaccine delivery in Kenya


Posted 12/04/2022. Evidence on the costs of delivering COVID-19 vaccines are useful inputs in planning for resource mobilization, and can inform vaccine priority setting decisions. Stacey Orangi, Edwine Barasa and colleagues present the unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies. These cost estimates can be used to inform local policy and may further inform parameters used in cost-effectiveness models.

The role of albumin and the extracellular matrix on the pathophysiology of oedema formation in severe malnutrition


Posted 08/04/2022. Kwashiorkor, a type of severe malnutrition associated with oedema, has been known for centuries but its mechanism remains elusive. This research by Jay Berkley and colleagues confirmed that low plasma albumin levels are necessary but not sufficient for oedema formation. Our findings suggest that lymphatic drainage may be impaired, which is a new discovery.

Facilitating safe discharge through predicting disease progression in moderate COVID-19: a prospective cohort study to develop and validate a clinical prediction model in resource-limited settings


Posted 29/03/2022. In regions with low Covid-19 vaccine coverage, health systems remain vulnerable to surges in infections. Arjun Chandna and colleagues developed three clinical prediction models to help identify patients safe for community-based management. Each model contains three simple clinical parameters (age, sex, SpO2) and one point-of-care biomarker, and could help protect resource-limited health systems.

Evaluating and engaging: using participatory video with Kenyan secondary school students to explore engagement with health research


Posted 25/03/2022. Alun Davies and colleagues used Participatory Video (PV) to explore how engagement with researchers influenced Kenyan school students’ perceptions of research and aspirations. PV highlighted the complex context in which engagement is situated where students’ time and attention is competed for against curricular, extracurricular, and social-cultural factors. We emphasise the importance of ensuring that engagement benefits students.

Global challenges in preparedness and response to epidemic infectious diseases


Posted 23/03/2022. In this review, Piero Olliaro and colleague Els Torreele analyse the successes and failures with coronavirus disease 2019 and Ebola virus disease in shaping health systems and research for infectious disease epidemics. They highlight that epidemic preparedness means also tackling a series of ongoing outbreaks and make the case for a coordinated, public health-driven, portfolio approach.

Triple therapy with artemether–lumefantrine plus amodiaquine versus artemether–lumefantrine alone for artemisinin-resistant, uncomplicated falciparum malaria: an open-label, randomised, multicentre trial


Posted 22/03/2022. The first randomised trial of artemether-lumefantrine plus amodiaquine for uncomplicated falciparum malaria in areas with a high prevalence of artemisinin resistance shows it is a well-tolerated, effective treatment for multidrug-resistant parasites. Coordinated by Tom Peto, James Callery and Rupam Tripura, the triple therapy provides an alternative first-line treatment in Southeast Asia and elsewhere, with an expected longer therapeutic lifetime than current artemisinin combination therapies.

Quantifying the indirect impact of COVID-19 pandemic on utilisation of outpatient and immunisation services in Kenya: a longitudinal study using interrupted time series analysis


Posted 18/03/2022. Steven Wambua and colleagues analysed monthly reports on utilization of outpatient and immunization services between Jan-2018 and Mar-2021 by all health facilities in Kenya to quantify the impact of COVID-19 on the utilization of the health services. Data was obtained from the District Health Information Software 2 (DHIS 2). We observed varied effects of the pandemic, with significant drops in attendance for most outpatient services while immunisation services remained unaffected.

History and evolution of tuberculosis and global health


Posted 15/03/2022. Bipin Adhikari reviews a book titled ‘Phantom Plague: How Tuberculosis Shaped History’ by Vidya Krishnan--a prominent medical science reporter. The book is a compelling journey into a history of medicine, current development of Tuberculosis epidemiology and treatment, and Global Health and is an essential read in Global Health.

The proxy dilemma: Informed consent in paediatric clinical research - a case study of Thailand


Posted 11/03/2022. In paediatric research, a legal representative must provide consent on behalf of the child. Using Thailand as a case study, Sheila Varadan, Phaik Yeong Cheah and colleagues contemplate how international legal frameworks could be leveraged to navigate legal uncertainty in the informed consent process, enabling more children to participate in paediatric clinical research.

Anopheles salivary antigens as serological biomarkers of vector exposure and malaria transmission: A systematic review with multilevel modelling


Posted 08/03/2022. In this review, Victor Chaumeau and colleagues assessed the level of association between antibody responses to mosquito salivary antigens and the metrics of malaria transmission across different areas of the globe. They identified knowledge gaps that need to be addressed before these serological markers of exposure to vector bites can be used operationally for malaria elimination.

Whole blood versus red cell concentrates for children with severe anaemia: a secondary analysis of the Transfusion and Treatment of African Children (TRACT) trial


Posted 04/03/2022. In a secondary analysis of a transfusion trial, Kathryn Maitland and colleagues showed that of 3188 children with severe anaemia (haemoglobin < 6 g/dl) 41% received a whole blood transfusion. Compared with whole blood, children receiving packed cells had a worse haemoglobin correction by 8 hours, required more additional transfusions and had longer hospital stays. We found no adverse effects of whole blood compared to packed cells.

Unmet need for COVID-19 vaccination coverage in Kenya


Posted 02/03/2022. There are many benefits of vaccinating population against COVID-19 including a reduction in transmission, likelihood of severe disease, and pressure on health system. We assessed geographic inequalities in vaccine access in Kenya over the past year and show that despite on-going efforts, only 30% of adult population will have been vaccinate by April 2022, highlighting the disproportionate access to vaccine is Africa population.

Community engagement for malaria elimination in the Greater Mekong Sub‑region: a qualitative study among malaria researchers and policymakers


Posted 01/03/2022. Nils Kaehler and colleagues, policymakers and researchers involved in malaria offered insights on strategies for community engagement for malaria elimination in the Greater Mekong Subregion. More than ever, sustaining community engagement and engaging with community-based health workers are critical to ensure that the last remaining malaria cases are not left 'untreated'.

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