Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

Predictors of disease severity in children presenting from the community with febrile illnesses

MORU

Posted 16/04/2021. This systematic review by Arjun Chandna and colleagues identified clinical and laboratory prognostic factors, measured at the point of presentation, that can help identify children at risk of severe febrile illness. Most studies included only hospitalised children and further work is required to identify the best predictors to build data-driven triage tools for use by community healthcare providers.

Guidelines should not pool evidence from uncomplicated and severe COVID-19

OCGHR

Posted 15/04/2021. Philippe Guérin co-authored a letter published in The Lancet drawing attention of the risk of pooling data from uncomplicated illness and more severe ill hospitalised patients in the development of COVID-19 treatment guidelines. Although SARS-CoV-2 is one virus, the COVID-19 disease has a complex and evolving physiopathology pathway and requires different therapeutic approaches depending of the stage of the disease. In low-resource settings, the prevention of hospital admission is the therapeutic priority.

G6PD Variants and Haemolytic Sensitivity to Primaquine and Other Drugs

MORU SMRU

Posted 14/04/2021. Germana Bancone and Cindy Chu review the current knowledge about drug-induced haemolysis in G6PD deficiency, and discuss new clinical and laboratory approaches to understand haemolytic risk in G6PD variants. A more comprehensive genotypic and phenotypic characterization, together with haematologic responses upon exposure to different drugs, will help define a clinically useful classification of G6PD variants

The counterintuitive self-regulated learning behaviours of healthcare providers from low-income settings

OCGHR

Posted 13/04/2021. Self-regulated learning (SRL) remains unexplored for healthcare workers in low-income countries. Tim Tuti, Chris Paton and Niall Winters detail how SRL strategies impact on healthcare providers’ learning gains when using digital learning platforms. We apply Latent Profile Analysis (LPA) to questionnaire responses. We provide insights into the learner factors to consider when implementing technology-mediated learning.

Feasibility of establishing a rehabilitation programme in a Vietnamese intensive care unit

OUCRU

Posted 09/04/2021. Survivorship after an intensive care unit (ICU) stay is associated with long-term disability throughout the world. Nguyen Thi Kim Anh, Louise Thwaites and colleagues designed, implemented and evaluated the feasibility of a sustainable ICU rehabilitation programme in a resource-limited setting with the aim of improving the long-term outcome of critically ill patients.

Improving treatment and outcomes for melioidosis in children, northern Cambodia, 2009–2018

COMRU MORU

Posted 06/04/2021. Melioidosis is an under-recognised disease, and mortality remains unacceptably high. Treatment requires prolonged antibiotic therapy and adherence is challenging, particular in resource-constrained settings. Arjun Chandna and colleagues at Angkor Hospital for Children reviewed the treatment of 355 children with culture-confirmed melioidosis over a decade and found significant gains can be made over time.

How to do no harm: empowering local leaders to make care safer in low-resource settings

KWTRP OCGHR

Posted 31/03/2021. Patient safety is a key goal of WHO but identifying harms and developing strategies to deliver safe care has been given little attention. Mike English and colleague describe a ‘portfolio’ approach to safety improvement in four broad categories: prioritising critical processes, improving the organisation of care, control of risks and enhancing responses to hazardous situations that we believe is relevant to low resource settings. We focus attention on the possible roles of practitioner groups and professional associations as key to advancing patient safety through collaboration and skill development in this field

What is the yield of malaria reactive case detection in the Greater Mekong Sub-region?

MORU

Posted 30/03/2021. Reactive case detection has played a role in the elimination of malaria in China. The approach has been adapted and is used in the Greater Mekong Subregion. Because it requires considerable man power but only few cases are detected the approach is controversial. Jacqueline Deen, Lorenz Von Seidlein and colleagues included 8 articles in a meta-analysis that found the percentage of positive malaria cases among potential contacts using microscopy or rapid diagnostic test was 0.56%.

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting

MORU SMRU

Posted 26/03/2021. Ketamine is an essential drug widely used in low-resource settings, but there was no data on its safety in lactating women until this report. In this study by Mary Ellen Gilder and SMRU colleagues, outcomes for breastfeeding infants whose mothers received ketamine are good, and not affected by ketamine dose. In contrast, high dose maternal intravenous diazepam may be harmful.

Optic nerve sheath ultrasound for the detection and monitoring of raised intracranial pressure in tuberculous meningitis

OUCRU

Posted 23/03/2021. In tuberculous meningitis, raised intracranial pressure often results in irreversible neurological injury. In this study of 107 participants with tuberculous meningitis, Joseph Donovan and colleagues show how optic nerve sheath diameter ultrasound may provide a low-cost point-of-care option for the identification of individuals with raised intracranial pressure in tuberculous meningitis

Vaginal Microbiota and Cytokine Levels Predict Preterm Delivery in Asian Women

MORU SMRU

Posted 19/03/2021. Tobias Brummaier reports that collaborative research efforts with SMRU and SIDRA have demonstrated that vaginal microbial composition and local vaginal immune environment are associated with preterm birth in Asian women from a low-resource setting, possibly providing an avenue towards an early predictive tool for preterm birth

Short maternal stature and gestational weight gain among refugee and migrant women birthing appropriate for gestational age term newborns

MORU SMRU

Posted 16/03/2021. Many women in Southeast Asia are smaller than their Western counterparts. How might this affect an otherwise healthy pregnancy? A recent study from the Thai-Myanmar border by Sue J Lee, Ahmar Hashmi and colleagues suggests that maternal height should be considered when providing advice regarding weight gain during pregnancy.

Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia

EOCRU OUCRU

Posted 12/03/2021. Henry Surendra, Raph Hamers and colleagues report a large retrospective study of patients hospitalised with COVID-19 in Jakarta, Indonesia. In-hospital mortality was lower than reported in high-income countries, likely explained by the younger population, fewer comorbidities and less severe disease. Nonetheless, this study affirmed the vulnerability of elderly and comorbid patients as well as children under 5 years in LMICs

Protective effect of Mediterranean-type glucose-6-phosphate dehydrogenase deficiency against Plasmodium vivax malaria

MORU

Posted 09/03/2021. X-linked glucose-6-phosphate dehydrogenase deficiency is the most common human enzymopathy. Ghulam Awab and colleagues analysed their clinical study and epidemiological data from Afghanistan gathered over the last decade and showed that the G6PD Mediterranean variant provided a marked gene dose proportional protection against P. vivax malaria.

Tenofovir disoproxil fumarate in pregnancy for prevention of mother to child transmission of hepatitis B in a rural setting on the Thailand-Myanmar border

MORU SMRU

Posted 05/03/2021. Prevention of mother to child transmission of Hepatitis B can be challenging in resource limited settings. Marieke Bierhoff and colleagues look at strategies that might be more feasible in these settings. TDF (tenofovir disoproxil fumarate) after rapid diagnostic test may be a more feasible strategy to implement in resource limited settings, TDF after hepatitis B e-antigen test is a cheaper option.

Effectiveness of a sepsis programme in a resource-limited setting

MORU

Posted 02/03/2021. Direk Limmathurotsakul and colleagues show that a Sepsis Fast Track (SFT) programme, implemented in Thailand to screen, initiate sepsis care and fast-track them when applicable to ICU upon admission, are associated with higher chances of survival. We analyzed data of a prospective observational study, having control group from both pre and post-intervention periods.

Malaria is a cause of iron deficiency in African children

KWTRP

Posted 26/02/2021. Malaria and iron deficiency are common in Africa and malaria may cause iron deficiency through a hepcidin-mediated block in iron absorption. Using sickle cell trait to proxy malaria exposure, John Muriuki, Sarah Atkinson and colleagues found that an intervention that halves malaria incidence would also reduce iron deficiency by approximately 50% in African children.

Designing paper‐based records to improve the quality of nursing documentation in hospitals

KWTRP OCGHR

Posted 22/02/2021. Paper continues to be an important medium for recording inpatient care in low‐ and middle‐income countries. Naomi Muinga and colleagues synthesise evidence on how paper‐based nursing records have been developed within inpatient settings to support documentation of nursing care, and that a human‐centred design approach might better meet users' needs

Potential health and economic impacts of dexamethasone treatment for patients with COVID-19

OCGHR

Posted 16/02/2021. Dexamethasone has been shown to reduce mortality in COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Rima Shretta and colleagues estimate that approximately 12,000 lives could be saved in the UK and 650,000 globally between July-December 2020. Dexamethasone is a cost-effective option with an incremental cost of GBP 940 per life-year gained.

Factors influencing the sustainability of digital health interventions in low-resource settings: Lessons from five countries

KWTRP OCGHR

Posted 12/02/2021. The majority of digital health projects have failed to translate into scaled, routine services, leaving many health leaders cautious and uncertain of how to proceed. Chris Paton and colleagues identify factors that can influence successful and sustainable integration of digital health within local health systems in low resource settings.

Human, animal, water source interactions and leptospirosis in Thailand

MORU

Posted 09/02/2021. Wirichada Pan-ngum and colleagues address key knowledge gaps on human-animal-water-source interactions and leptospirosis in high-risk settings, Thailand. Water-source sharing networks and human–animal contact patterns are key information potentially involved in the epidemiology of leptospirosis. Occupations related to animals/environmental water and consuming water from more than two sources increased the risk exposure to leptospirosis.

The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

KWTRP

Posted 05/02/2021. Measles immunity gaps have widened following disruptions of routine immunisation and supplementary activities due to COVID-19 pandemic in Kenya. While COVID-19 restrictions temporarily reduced the risk of a measles outbreak, Caroline Mburu, Ifedayo Adetifa and colleagues estimate that this risk will rapidly rise once the restrictions are lifted. Implementing delayed supplementary immunisation activities will be critical for prevention of measles outbreaks.

Reducing antimicrobial usage in small-scale chicken farms in Vietnam

OUCRU

Posted 02/02/2021. Indiscriminate antimicrobial use (AMU) in animal production is a driver of antimicrobial resistance globally. In this trial, Juan Carrique-Mas and colleague provided regular veterinary advice to chicken farmers in Vietnam aiming to reducing AMU. AMU was quantitatively reduced by 66% and flock mortality by 40%. This study demonstrates that reductions in AMU without compromising health and productivity can be achieved in LMICs.

Tools for measuring medical internship experience: a scoping review

KWTRP OCGHR

Posted 26/01/2021. Appropriate and well-resourced medical internship training is important to ensure psychological health and well-being of doctors in training and also to recruit and retain these doctors. Yingxi Zhao and colleagues identified and described a large number of tools designed for measuring medical internship experience, to help medical educators and human resource managers make an evidence-based decision on designing surveys to understand interns’ experience of training.

Plasma inflammatory biomarkers predict CD4+ T-cell recovery and viral rebound in HIV-1 infected Africans on suppressive antiretroviral therapy

EOCRU OUCRU

Posted 22/01/2021. Raph Hamers and colleagues conducted a multi-country prospective study of Africans with HIV-1 on suppressive antiretroviral therapy. Plasma concentrations of sCD14 and CRP predicted subsequent poor CD4+ T-cell recovery, and CXCL10 and sCD163 predicted viral rebound. Further research is needed to increase our understanding of and to explore the potential for adjunctive therapeutic interventions targeting these pathways.

Viral metagenomic analysis of cerebrospinal fluid from patients with acute central nervous system infections of unknown origin, Vietnam

OUCRU

Posted 19/01/2021. Tan Le Van and colleagues show that metagenomics could detect enteroviruses (n=23), hepatitis B virus (3), HIV (2), molluscum contagiosum virus (1) and germycircularvirus (1) in 14.7% of 204 cerebrospinal fluid from Vietnamese patients presenting with central nervous system infections of unknown origin. It remains a challenge to identify a plausible cause in patients with brain infections.

Immunogenicity and safety of fractional doses of yellow fever vaccines

KWTRP

Posted 15/01/2021. Yellow Fever is a re-emerging disease whose incidence has increased globally in the last three decades. Although very successful, the stocks of the YF vaccine are often insufficient. Derick Kimathi, George Warimwe and colleagues assessed the immunogenicity and safety of fractional (1/5th) doses. Our results support fractional dosing of all four WHO-prequalified YF vaccines in general adult population as a dose-sparing strategy.

The emergence of azithromycin-resistant Salmonella Typhi in Nepal

OUCRU OUCRU-Nepal

Posted 12/01/2021. Azithromycin is effectively the last remaining oral antimicrobial to treat typhoid fever and is widely used for empirical therapy in South Asia. Although azithromycin resistance in Salmonella Typhi has rarely been reported, Abhilasha Karkey and colleagues show that an increasing reliance on this drug has led to the emergence of azithromycin resistant S. Typhi in the region.

First do no harm: practitioners’ ability to ‘diagnose’ system weaknesses and improve safety is a critical initial step in improving care quality

KWTRP OCGHR

Posted 08/01/2021. Patient safety is much less well studied in low-resource settings than in higher income settings. Mike English and colleagues suggest how concepts being employed to advance patient safety thinking in higher income settings could be usefully applied by practitioners in low-resource settings. The ability to diagnose system weaknesses should become a core skill for those leading teams, wards, departments or facilities in low-resource settings

Serological evidence indicates widespread distribution of rickettsioses in Myanmar

LOMWRU MORU

Posted 05/01/2021. Diagnosing rickettsial infections is difficult in low-resource settings; this leads to delays in receiving appropriate treatment. Before this study the distribution of rickettsioses in Myanmar was not known. This report of a serosurvey by Philip Elders, Elizabeth Ashley and colleagues shows rickettsioses are widespread in Myanmar, with high scrub typhus prevalence in central and northern regions.

Old age is associated with decreased wealth in rural villages in Mtwara, Tanzania

MORU

Posted 18/12/2020. Lorenz Von Seidlein and colleagues observed that poorest people in rural Tanzania were the oldest people and especially old people without children. This observation came as a surprise because generation, the baby boomers has accumulated wealth throughout life and ended up wealthier by the time they reached retirement. There is a need to provide more financial and housing security for older people in rural Africa. Currently for many older people in rural Africa the only security are their children.

Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia

COMRU MORU

Posted 15/12/2020. A recent study co-led by Paul Turner and colleagues at COMRU identified extremely high prevalence of antimicrobial resistant (AMR) bacterial carriage in households from Siem Reap, Cambodia. Extended-spectrum beta-lactamase producing Escherichia coli were detected in stool samples from >90% of participants. The results highlight the challenges to AMR control in locations where antibiotic overuse is common.

Crowding has consequences: Prevention and management of COVID-19 in informal urban settlements

MORU

Posted 11/12/2020. COVID-19 has hit informal urban settlements particularly hard. The control and prevention of COVID-19 in slums starts with organizing community infrastructure, provision of basic needs and protection of people at highest risk. Slums are a source for persistent transmission. In view of the constant risk that slums present to the entire population decisive steps need to be taken to rehabilitate and improve informal settlements, Lorenz Von Seidlein and colleagues provide suggestions.

Impact of low blood culture usage on rates of antimicrobial resistance

MORU

Posted 08/12/2020. “No bacterial culture, no drug-resistant infections.” Cherry Lim, Direk Limmathurotsakul and colleagues show that the impact of low blood culture utilization on the observed proportions and incidences of drug-resistant infections could be high. This is likely happening in most of LMICs. A set of recommendations are proposed.

MALDI-TOF mass spectrometry for sub-typing of Streptococcus pneumoniae

COMRU MORU

Posted 04/12/2020. Paul Turner and COMRU researchers, working with Cambodia’s University of Health Sciences and Fondation Merieux, evaluated recently the potential of MALDI-TOF-based serotyping of Streptococcus pneumoniae for vaccine impact surveillance. Despite early promise, the team found that MALDI-TOF performed poorly and should not replace existing serotyping methodologies.

Research ethics in context: understanding the vulnerabilities, agency and resourcefulness of research participants living along the Thai–Myanmar border

MORU SMRU

Posted 01/12/2020. This paper confirms that research is important to inform evidence-based medical care in LMICs settings. Napat Khirikoekkong, Phaik Yeong Cheah and colleagues found that migrants living along the Thai-Myanmar border, who were traditionally deemed vulnerable, exercise their agency and resourcefulness when navigating through their daily challenges, and participating in important health research

TB outcomes and mortality risk factors in adult migrants at the Thailand-Myanmar border

MORU SMRU

Posted 27/11/2020. The migrant-friendly residential TB program of SMRU on the Thailand-Myanmar border has achieved high treatment success rate. However, many TB patients admitted to the centers are in advanced stage of disease. Win Pa Pa Htun and colleagues show that early TB death (in the first month of treatment) is highest among pulmonary TB cases and in particular in HIV co-infected patients and in those with co-morbidity. Early detection and treatment for both TB and HIV are crucial for migrants, if the case fatality rate is to be reduced in this marginalized population.

Malaria Screener: a smartphone application for automated malaria screening

MORU

Posted 24/11/2020. Malaria Screener is a smartphone application developed by the National Library of Medicine, in partnership with Richard Maude and colleagues at MORU Epidemiology, aiming to improve the availability of high quality malaria diagnosis. It is cheap, fast and easy-to-use with a standard smartphone and microscope and detects malaria parasites by machine learning.

Towards a fair and transparent research participant compensation and reimbursement framework in Vietnam

OUCRU

Posted 20/11/2020. Providing compensation for participants in clinical research is well established but defining compensation in low-resource settings is challenging due to ethical concerns and the lack of appropriate frameworks. Evelyne Kestelyn and colleagues at OUCRU Vietnam developed a compensation and reimbursement framework, providing a consistent, fair and transparent decision-making process that will be implemented across all future clinical research.

Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam

OUCRU

Posted 17/11/20. Rogier van Doorn and colleagues show that antibiotics were prescribed to almost all 500 children with mild respiratory infection presenting to an outpatient clinic. They assessed prior antibiotic use by questionnaire and urine testing (HPLC), and reported overuse and overprescription of antibiotics when most respiratory infections are caused by viruses, and selection of resistant Enterobacteriaceae in gutflora with transmission potential.

Antimicrobial use in food animals and human health: time to implement ‘One Health’ approach

MORU OCGHR

Posted 13/11/2020. Use of antimicrobials in animals and the environment has been established to contribute to the global antimicrobial resistance (AMR), and yet there have been inadequate collaborative efforts to tackle this problem. Sunil Pokharel, Bipin Adhikari and colleagues discuss how and why ‘One health’ approach is important to tackle antimicrobial resistance.

Transmission of artemisinin-resistant malaria parasites to mosquitoes under antimalarial drug pressure

MORU

Posted 10/11/20. Artemisinin-based combination therapies are not only effectively curing malaria, they also impact male malaria parasites in their capacity for onward transmission to the mosquito. Here, Andrea Ruecker and colleagues provide clear evidence that artemisinin resistant parasites overcome this sterilising effect to successfully infect mosquitoes under drug pressure, facilitating the spread of artemisinin resistance.

Impact of outdoor residual spraying on the biting rate of malaria vectors in Myanmar

MORU SMRU

Posted 06/11/20. Victor Chaumeau and colleagues assessed the impact of outdoor residual spraying on the biting rate of malaria mosquitoes in four villages in Kayin state, Myanmar. They reported a 10-fold decrease in mosquito biting rate immediately after the intervention and concluded that outdoor residual spraying can be used to control malaria mosquitoes in this area.

Prediction modelling of inpatient neonatal mortality in high-mortality settings

KWTRP

Posted 31/10/2020. Existing neonatal prognostic models are suited for advanced care settings; however, they use parameters that are not available in low-resource settings. Jalemba Aluvaala and colleagues demonstrate that two novel models - NETS and SENSS - using basic routine data can accurately predict in-hospital mortality which may allow us to better understand neonatal mortality.

How many human pathogens are there in Laos? An estimate of national human pathogen diversity and analysis of historical trends

LOMWRU MORU OCGHR

Posted 27/10/2020. Madeleine Clarkson, Paul Newton and colleagues reviewed when individual species of human pathogens were described in Laos, and estimated the in-country diversity and how many more pathogens there may be. Combining modelling with historical assessment improved understanding of the factors affecting pathogen description. During the last decade there has been a 33-fold increase in the description rate, coinciding with the strengthening of medical research in Laos.

Trimethoprim-sulfamethoxazole (SXT) versus azithromycin for the treatment of undifferentiated febrile illness in Nepal

OUCRU OUCRU-Nepal

Posted 20/10/2020. Buddha Basnyat and colleagues describe findings from NUFIT, the Nepal Undifferentiated Febrile Illness Trial, a randomized, double blind, placebo controlled trial. The trial revealed that 7 days of sulphamethoxazole-trimethoprim (Bactrim) is inferior to azithromycin in the treatment of undifferentiated febrile illness (fever without a focus) and enteric fever in Nepal and the wider region in South Asia.

Preparing for a pandemic: highlighting themes for research funding and practice

OCGHR

Posted 16/10/2020. In December 2019, The Global Research Collaboration for Infectious Disease Preparedness (GloPID-R) convened a Frontiers meeting to identify how to enable a coordinated research response in the event of an epidemic or pandemic. Alice Norton, Louise Sigfrid, Gail Carson and colleagues here highlight findings to strengthen the ongoing response for COVID-19.

The efficacy of PPE for COVID-19-type respiratory illnesses in primary and community care staff

MORU

Posted 13/10/2020. Xin Hui Chan and colleagues summarise their rapid reviews on the efficacy of personal protective equipment for preventing COVID-19 in primary and community care. They highlight how PPE is designed for use as an ensemble, is a complex intervention which should include appropriate training and support, and is the least effective of the hierarchy of controls.

How severe anaemia might influence the risk of invasive bacterial infections in African children

KWTRP

Posted 09/10/2020. Children with severe anaemia are more likely to get bacterial infections. Kelvin Mokaya, Sarah Atkinson and colleagues discuss how severe anaemia interferes with iron regulation, and how this promotes bacterial growth in blood and dampens immune responses to these bacteria. The authors also suggest possible studies that can be used to explore their hypothesis.

Implementing parasite genotyping into national surveillance frameworks

MORU

Posted 07/10/2020. The Asia-Pacific region is the epicentre of the emergence of resistance against frontline antimalarials, and also faces a high proportion of non-falciparum malaria. Sarah Auburn and colleagues review novel approaches for molecular surveillance that can help track drug resistant parasites and the spread of parasites across the region, discussed at a recent APMEN workshop in Jakarta, and how these approaches can provide important information for policy makers in malaria-endemic regions.

Load More