Research Highlights
Identification of Southeast Asian Anopheles mosquito species with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry using a cross-correlation approach
Posted 17/01/2025. Victor Chaumeau and colleagues developed a reference MALDI-TOF mass spectra database for the identification of Anopheles mosquitoes from the Thailand-Myanmar border allowing rapid, affordable and accurate identification of medically important vector species, an important prerequisite to assess disease transmission and evaluate vector control. This is the first free open-source data analysis pipeline allowing anyone to replicate the analysis and develop reference database in-house.
Sustainable antimicrobial resistance surveillance: time for a global funding mechanism
Posted 07/01/2025. The continued costs of a standard national AMR surveillance system are predicted to account for over 5% of the total domestic general government health expenditure (GGHE-D) for 28 LMICs and more than 2% of GGHE-D for 46 LMICs. This high cost is not sustainable without a long-term global financing mechanism. By Liz Ashley
AmpC β-lactamases detected in Southeast Asian Escherichia coli and Klebsiella pneumoniae
Posted 20/12/2024. AmpC β-lactamases are a neglected cause of third generation cephalosporin resistance in Southeast Asia. This collaboration between COMRU, LOMWRU and SMRU showed that AmpC β-lactamases are an important cause of infection, though infections may be going undetected due to a lack of testing resulting in sub-optimal treatment for patients. By Tamalee Roberts
Population genomics and transcriptomics of Plasmodium falciparum in Cambodia and Vietnam uncover key components of the artemisinin resistance genetic background
Posted 17/12/2024. Tom Peto and colleagues collected Plasmodium falciparum parasites from malaria patients in Cambodia and Vietnam between 2018 and 2020 in the MORU-led TACT-CV study. Novel molecular analyses of these samples at Nanyang Technological University identified new genetic factors that appear under selective pressure and may contribute to artemisinin resistance mechanisms in clinical settings.
Leprosy
Posted 03/12/2024. This comprehensive review, co-authored by Marlous Grijsen and a multidisciplinary team of global experts from leprosy endemic and non-endemic countries, describes the epidemiology, pathophysiology, clinical manifestations and management of leprosy and the impact it has on quality of life. The paper addresses knowledge gaps and research priorities and offers an up-to-date perspective on leprosy.
A hill tribe community advisory board in Northern Thailand: lessons learned one year on
Posted 22/11/2024. Since 2023 the Chiang Rai community advisory board helped researchers understand the many local ethnic minority groups of Northern Thailand and vice-versa, improving cooperation and research activities. Over time, benefits have grown. Carlo Perrone and colleagues present their experience one year on, supporting long-term partnerships over project-based ones.
Community engagement to develop a dialogue-drama on adolescent pregnancy in a marginalised migrant population on the Thailand-Myanmar border: an ethnographic approach to participatory action research
Posted 20/11/2024. A participatory-action approach involving community members and adolescents resulted in a dialogue-drama (Karen and Burmese versions) on adolescent pregnancy, contraception, and choice in the event of an unplanned pregnancy. The dialogue-drama augmented discussion of traditionally taboo issues and this ethnographic method is potentially useful for similar global health settings. By Rose McGready
Prevalence and risk factors of vitamin D deficiency among Afghan primary school children
Posted 19/11/2024. Bob Taylor and colleagues determined that vitamin D deficiency is exceptionally high, 85%, in 510 5-15 years-old school children from Kandahar city, Afghanistan. Half had severe deficiency. Older children from poor families with limited outdoor activity and inadequate sun exposure were more likely to be deficient. These data provide evidence for a mitigation strategy.
Prospective clinical surveillance for severe acute respiratory illness and COVID-19 vaccine effectiveness in Kenyan hospitals during the COVID-19 pandemic
Posted 13/11/2024. Ruth Lucinde, Anthony Etyang and colleagues conducted a prospective longitudinal hospital-based sentinel surveillance at 16 public hospitals in Kenya during the COVID-19 pandemic to describe the clinical and demographic pattern of patients admitted with severe acute respiratory illness (SARI), and evaluate COVID-19 vaccine effectiveness. They identified key risk factors for mortality and reported a moderate vaccine effectiveness of 59% against progression to inpatient mortality.
Changing epidemiology and antimicrobial susceptibility of bloodstream infections at a Vietnamese infectious diseases hospital (2010–2020)
Posted 24/10/2024. Duy Pham’s lab performed comprehensive epidemiological analysis of bloodstream infections (BSI) in Vietnam (2010-2020), revealing an increasing trend of E. coli and K. pneumoniae as predominant pathogens. Both showed rising multidrug resistance, primarily affecting elderly individuals with comorbidities. Antibiotic prescriptions declined significantly following control policies. Their work highlights the needs for community surveillance and antimicrobial stewardship to manage BSIs in Vietnam.
A nationwide mixed methods study of gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Indonesia
Posted 23/10/2024. Robert Sinto, Raph Hamers and colleagues conducted a nationwide evaluation of antimicrobial stewardship programmes (ASP) in Indonesian public and private hospitals. They found that to date most hospitals only reached an inadequate or basic level of ASP implementation, and they identified several globally-relevant and context-specific barriers. The paper formulates actions recommended for sustainable improvement.
Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border
Posted 22/10/2024. Severe neonatal hyperbilirubinaemia is often diagnosed late in low-resources settings because of lack of point-of-care tools. In this study, Germana Bancone and SMRU researchers have evaluated the performance of a transcutaneous bilirubinometer for screening of neonates born along the Thai-Myanmar border. The study was supported by a Wellcome Trust iTPA grant.
Genomic insights unveil the plasmid transfer mechanism and epidemiology of hypervirulent Klebsiella pneumoniae in Vietnam
Posted 22/10/2024. Duy Pham's lab investigated hypervirulent Klebsiella pneumoniae bloodstream infections in Vietnam, uncovering high strain diversity likely driven by horizontal transfer of non-self-transmissible virulence plasmids. Plasmid acquisitions led to the independent emergence of MDR hypervirulent strains. Significant gaps persist in understanding community transmission for targeted interventions, especially in Asia where new strains are emerging.
Artemisinin-resistant malaria
Posted 18/10/2024. Nick White and K. Chotivanich publish a review of mechanisms, genetic associations, phenotyping, epidemiology and current status of artemisinin resistance, and a brief discussion of policies and potential counter-measures.
Fractional Doses of Pneumococcal Conjugate Vaccine — A Noninferiority Trial
Posted 10/10/2024. Pneumococcal Conjugate Vaccines (PCV) have had a tremendous impact on childhood morbidity but only 2/3 of children receive a PCV. One obstacle to wider protection is cost. Kate Gallagher, Anthony Scott and others at KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya, showed that a 40% fractional dose of PCV13 had non-inferior immunogenicity to a full dose, suggesting similar benefits could be delivered for lower cost.
In-host modeling of dengue virus and non-structural protein 1 and the effects of ivermectin in patients with acute dengue fever
Posted 09/10/2024. Junjie Ding and the MORU Clinical Pharmacology Team developed an in-host dengue kinetic model to quantitatively predict drug effects in dengue fever. This model offers valuable insights to inform dengue drug development, and shows that ivermectin reduces NS1 but not viral load. The results are published in a leading PK/PD modelling journal, CPT:PSP.
Emerging Monkeypox Virus Sublineage C.1 Causing Community Transmission, Vietnam, 2023
Posted 02/10/2024. Le Van Tan and colleagues studied a community cluster of mpox in Vietnam caused by emerging MPXV sublineage C.1, imported into Vietnam through 2 independent events; 1 major cluster carried a novel APOBEC3-like mutation. Three patients died; all had advanced HIV co-infection. Viral evolution and its potential consequences should be closely monitored.
Hospital-acquired infections and unvaccinated children due to chronic diseases: an investigation of the 2017–2019 measles outbreak in the northern region of Vietnam
Posted 24/09/2024. Measles-infected children with chronic diseases had lower vaccination rates and a higher proportion of hospital-acquired infections during the 2017–2019 outbreak in northern Vietnam. Early nosocomial transmission was detected before community outbreaks in several provinces. Strengthening hospital infection control and raising awareness about the importance of vaccination for vulnerable groups is essential. By Thinh Ong Phuc
Prevalence and associated risk factors of stunting, wasting/thinness, and underweight among primary school children in Kandahar City, Afghanistan: a cross-sectional analytical study
Posted 17/09/2024. Bob Taylor and colleagues investigated 1205 primary school children in Kandahar and found almost 50% were stunted, 25% were underweight and 20% wasted. Risk factors for stunting in 6–9 year old children were poverty, skipping breakfast, and being a girl from a large family with an uneducated mother and an unemployed father.
Anti-infectivity efficacy and pharmacokinetics of WHO recommended single low-dose primaquine in children with acute Plasmodium falciparum in Burkina Faso: study protocol
Posted 11/09/2024. The Groupe de Recherche Action en Santé, a Developing Paediatric Primaquine project partner, will assess, for the first time, the transmission blocking efficacy of allometrically-scaled, single low-dose primaquine, using the WHO-recommended 0.25 mg/kg target dose, in under-5 Burkinabe children with uncomplicated Plasmodium falciparum. The study protocol is now published. By Bob Taylor.
Public service motivation, public sector preference and employment of Kenyan medical doctor interns: a cross-sectional and prospective study
Posted 11/09/2024. Daniel Mbuthia and colleagues surveyed 356 Kenyan medical doctors, to understand what influences their career choices at labour market entry, specifically understanding the role of public service motivation. They highlighted that nearly all surveyed doctors are public service oriented, many doctors stated intention to work in the public sector but were unable due to lack of job opportunities. Unfortunately, 13% of the doctors were unemployed one year after completing their internship.
Frequency of antimicrobial-resistant bloodstream infections in 111 hospitals in Thailand, 2022
Posted 10/09/2024. Collaborating with the Ministry of Public Health, Direk Limmathurotsakul and colleagues utilised an automated tool, evaluated and reported the frequency of antimicrobial-resistant (AMR) infection in 111 public hospitals in Thailand in 2022. Our approach and findings highlight health regions and hospitals where actions against AMR infection, including antimicrobial stewardship and infection control, should be prioritised.
The mRNA content of plasma extracellular vesicles provides a window into molecular processes in the brain during cerebral malaria
Posted 06/09/2024. Kioko Mwikali, Abdirahman Abdi and colleagues at KEMRI-Wellcome Trust used extracellular vesicles circulating in plasma to noninvasively study the progression of cerebral malaria in children. This provides a mechanism for identifying diagnostic biomarkers and developing therapeutic strategies.
New WHO classification of genetic variants causing G6PD deficiency
Posted 04/09/2024. Over 50 years after its first publication, this revised classification of G6PD genetic variants is the result of the 2022 WHO Global Malaria Programme experts’ consultation led by Professor Lucio Luzzatto. The new classification reconciles biochemical and clinical aspects of the different G6PD mutations and provides a reliable reference for scientists and clinicians. By Germana Bancone.
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems: Findings from an empirical study of medical and nurse interns in Kenya
Posted 03/09/2024. Yingxi Zhao, Stephanie Nzekwu and colleagues examined new Kenyan doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. The research highlighted three dimensions of liminal experiences in professional practice, relational inter- and intra-professional identity and status, and professional careers.
Linking Cerebral Malaria Pathogenesis to APOE-Mediated Amyloidosis: Observations and Hypothesis
Posted 06/08/2024. Kioko Mwikali, Abdirahman Abdi and colleagues found that the CSF proteome of cerebral malaria is more similar to Alzheimer's Disease than to acute bacterial meningitis, with cerebral malaria showing elevated amyloidosis. This finding might benefit the search for treatment and management of both Alzheimer's Disease and cerebral malaria.
Relation Between the Dantu Blood Group Variant and Bacteremia in Kenyan Children: A Population-Based Case-Control Study
Posted 02/08/2024. Plasmodium falciparum malaria is a strong predisposing factor for bacteraemia. Silvia Kariuki and colleagues investigated the impact of the rare malaria-protective Dantu blood group variant on susceptibility to bacteraemia. We found that Dantu was significantly protective against bacteraemia only during a high malaria transmission period. This suggested that the protective effect of Dantu on bacteraemia is secondary to its protective effect against malaria.
Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?
Posted 17/07/2024. A large multidisciplinary team conducted qualitative research in five ICUs in Bangladesh and India. They found that less restrictive ICU visiting policies improved experiences for patients and families – and the family’s presence at the bedside could improve patient care. Supporting nurses to give routine updates promoted better communication with families. By Rebecca Inglis
A randomised trial of malaria vaccine R21/Matrix-M™ with and without antimalarial drugs in Thai adults
Posted 16/07/2024. Borimas Hanboonkunupakarn and coworkers from MORU and the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand have shown that the co administration of the malaria vaccine R21/matrix M combined with the antimalarials drugs DHA/piperaquine and the single low dose primaquine does not interfere with the immunogenicity of the vaccine or the concentrations of piperaquine.
Genetic diversity, determinants, and dissemination of Burkholderia pseudomallei lineages implicated in melioidosis in Northeast Thailand
Posted 15/07/2024. A recent study from northeast Thailand identified three major bacterial lineages responsible for melioidosis in the region. Each lineage carries unique gene sets that likely contribute to successful dissemination. These genes are expressed under environmental rather than infectious conditions, with one lineage showing overexpression under nutrient deprivation, highlighting environmental persistence is a prerequisite for infection. By Claire Chewapreecha
Embedding community and public voices in co-created solutions to mitigate antimicrobial resistance (AMR) in Thailand using the ‘Responsive Dialogues’ public engagement framework
Posted 11/17/2024. Tackling antimicrobial resistance requires collaboration between communities, stakeholders and researchers. In the ‘AMR Dialogues’ project, Tassawan Poomchaichote, Phaik Yeong Cheah and colleagues conducted a series of conversations, bringing together people from different backgrounds. This paper summarises issues identified across Thailand and highlights four locally actionable ‘building blocks’ of co-created solutions.
Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review
Posted 10/07/2024. Physician associate and nurse practitioner roles have been developed largely to meet changing healthcare demand and increasing workforce shortages. Yingxi Zhao and colleagues summarise the factors influencing their development and integration in hospital teams, advocating for organisation context-specific workforce solutions, long-term investment, substantial resources, and transparent processes to meet evolving healthcare challenges.
Estimated global and regional economic burden of genital herpes simplex virus infection among 15–49 year-olds in 2016
Poster 09/07/2024. Genital herpes infections and their related complications lead to billions of dollars in health care expenditures and productivity losses globally, say researchers who calculated the first-ever global estimates of the economic costs of these conditions. The study calls for greater investment in prevention of herpes transmission, including concerted efforts to develop effective vaccines against this common virus. By Puttarin Kulchaitanaroaj; MAEMOD, MORU.
Towards a machine-learning assisted non-invasive classification of dengue severity using wearable PPG data: a prospective clinical study
Posted 05/07/2024. Early warnings of clinical deterioration through continuous non-invasive monitoring could benefit clinical care in dengue-endemic settings. Taking the approach of using low-cost wearables, Chanh Ho Quang and colleagues successfully demonstrate the ability to classify dengue patients with different severity and disease state. The implementation of these models could improve patient outcomes and resource allocation
Obesity differs from diabetes mellitus in antibody and T-cell responses post-COVID-19 recovery
Posted 04/07/2024. Some known risk factors for severe COVID-19 outcomes disproportionately affect South Asian populations. In Bangladesh, Mohammad Ali and colleagues showed that overweight/obesity is linked to lower neutralising antibody levels and higher T-cell responses post-COVID-19 recovery, while type 2 diabetes does not alter antibody or T-cell responses. This research highlights the importance of targeted vaccination and treatment strategies.
Mitigating machine learning bias between high income and low–middle income countries for enhanced model fairness and generalizability
Posted 03/07/2024. Collaborative AI efforts between high-income countries (HICs) and low- to middle-income countries (LMICs) are essential for pooling resources and expertise. Jenny Yang, Louise Thwaites and colleagues show that AI approaches can lead to divergent outcomes across HIC and LMIC settings. Using COVID-19 screening data, we demonstrate that bias mitigation methods improve fairness and maintain diagnostic sensitivity.
Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate–pyronaridine to control malaria outbreaks in Cambodia
Posted 25/06/2024. The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, an effective response to malaria outbreaks becomes the vital strategy. Authors report a programmatic response to a 2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia. By Bipin Adhikari.
Bioequivalence of a new coated 15 mg primaquine formulation for malaria elimination
Posted 21/06/2024. A new study by Bob Taylor and colleagues confirms that a 15 mg generic primaquine tablet, made by IPCA in India, is bioequivalent to the reference Sanofi product. The dossier has been submitted to WHO for prequalification. Once prequalified, it will be used to help eliminate malaria.
A youth advisory group on health and health research in rural Cambodia
Posted 19/06/2024. Bipin Adhikari and colleagues reflect on how engagement with a youth advisory group on health and research engagement is carried out in a remote malaria endemic district of Cambodia. Authors discuss the processes, outputs and outcomes of youth group engagement including their relevance to broader goals of community engagement using a theory of change.
Rectal artesunate: lives not saved
Posted 03/06/2024. Childhood deaths from severe malaria can be prevented by giving rectal artesunate suppositories (RAS) but in January 2022, based on preliminary interpretation of a flawed observational study, WHO issued a moratorium on RAS. This has now been partially lifted, but use of RAS has markedly declined and thousands of malaria deaths have not been prevented. By Nick White.
Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life
Posted 31/05/2024. Tungiasis is a neglected tropical skin disease. Lynne Elson and colleagues aimed to determine its impact on school children in nine counties of Kenya. They found infected children experience considerable pain, itching, difficulty sleeping and feel ashamed, leading to lower school attendance, concentration and exam scores, than uninfected children.
Care seeking for childhood illnesses in rural Mtwara, south-east Tanzania: a mixed methods study
Posted 29/05/2024. In Africa, children < 5 years remain highly vulnerable to infectious diseases. Salum Mshamu and colleagues explored treatment seeking behaviour related to childhood illnesses in rural Mtwara, south-east Tanzania which was a part of community based novel housing intervention. How treatment seeking behaviour was influenced by institutional and community level factors are discussed in the article.
Gender and equity considerations in AMR research: a systematic scoping review
Posted 28/05/2024. Bhensri Naemiratch and colleagues report on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours.
Leprosy identified in Sumba Island, eastern Indonesia: elimination targets under threat
Posted 24/05/2024. Frontline healthcare workers detected 60 persons affected by leprosy in Sumba Island, Indonesia, through teledermatology, over a 3-year period. Marlous Grijsen and colleagues at the Sumba Foundation and Gadjah Mada University highlight the challenges of delivering leprosy care in remote areas, how these translate into population risks of ongoing transmission and disabilities, and how leprosy can re-emerge after reaching national elimination targets.
Nutritional supplementation in children with severe pneumonia in Uganda and Kenya (COAST-Nutrition): a phase 2 randomised controlled trial
Posted 21/05/2024. Severe pneumonia is a leading cause of illness and hospitalization in African children, resulting in poor outcomes. Kathryn Maitland and colleagues tested if adding ready-to-use therapeutic food to diets improves the recovery of children in Uganda and Kenya. The study found no significant benefits, suggesting future research should focus on high-risk, undernourished children.
New Tools and Nuanced Interventions to Accelerate Achievement of 2030 Roadmap for Neglected Tropical Diseases
Posted 15/05/2024. Collection of articles in the Clinical Infectious Disease Journal supplement. NTDs are a major cause of death, disability, and economic hardship, particularly in low- and middle-income countries. The research by Professor Déirdre Hollingsworth et al aims to better understand which interventions are needed to achieve the 2030 NTD targets, determine the best strategies for keeping NTDs under control after target achievement, and assess the costs associated with different options.
Decolonising global health: why the new Pandemic Agreement should have included the principle of subsidiarity
Posted 14/05/2024. The WHO Pandemic Agreement aims to promote a better global response to pandemics. Caesar Atuire and colleagues argue that not including the principle of subsidiarity as a pragmatic strategy was a missed opportunity to decolonise global health governance and promote global solidarity. Subsidiarity empowers local units to make decisions and address issues at their level, fostering collaboration, coordination, and cooperation. We discuss the elements of subsidiarity—agency and non-abandonment—and highlight the need to strike a balance between them.
Climate change, malaria and neglected tropical diseases: a scoping review
Posted 10/05/2024. The NTD Modelling Consortium contributed to the World Health Organization scoping review led by Petra Klepac et al. It highlights the urgent need for collaborative modelling and greater evidence to understand the effects of climate change impacts on neglected tropical diseases and malaria.
Accelerating Progress Towards the 2030 Neglected Tropical Diseases Targets: How Can Quantitative Modeling Support Programmatic Decisions?
Posted 08/05/2024. The NTD Modelling consortium and WHO hosted a stakeholder meeting to identify priority modelling questions that are relevant for decision-makers, especially those designing, implementing and evaluating national and subnational programs, to achieve the ambitious targets set out in the NTD 2021–2030 road map. Future modelling studies should continue to move towards models which support better programmatic action by incorporating local context. By Andreia Vasconcelos.
Comparison of lumefantrine, mefloquine, and piperaquine concentrations between capillary plasma and venous plasma samples in pregnant women with uncomplicated falciparum and vivax malaria
Posted 01/05/2024. Makoto Saito and SMRU colleagues compared capillary and venous plasma concentrations of mefloquine, lumefantrine, and piperaquine in pregnant women with malaria. While there was a strong correlation, direct interchangeability was limited. Predictability within a ±10% precision range varied by drug. Caution is needed when converting capillary samples at the individual level.