An observational study of breakthrough SARS-CoV-2 Delta variant infections among vaccinated healthcare workers in Vietnam
Posted 15/10/2021. Tan Le Van and colleagues showed Delta variant breakthrough infections may cause asymptomatic or mild disease, but are associated with high viral loads and low levels of vaccine-induced neutralizing antibodies. The data suggested ongoing transmission had occurred between fully-vaccinated individuals. Social distancing measures remain critical to reduce the transmission of SARS-CoV-2.
A descriptive study of Forcefully Displaced Myanmar Nationals (FDMN) presenting for care at public health sector hospitals in Bangladesh
Posted 01/10/2021. In 2017 hundreds of thousands of ‘Rohingya’ fled from Myanmar to refugee camps in Cox’s Bazar, Bangladesh. Health centre data were reviewed to estimate the increase in health care utilization. The presence of a large migrant population relative to a smaller host community burdens the limited facilities and resources of the public health sector, by Lorenz Von Seidlein and colleagues
The cardiovascular effects of amodiaquine and structurally related antimalarials: An individual patient data meta-analysis
Posted 29/09/2021. Xin Hui Chan and colleagues report a large individual patient data meta-analysis of malaria clinical trials supporting the cardiovascular safety of amodiaquine and structurally related antimalarials at WHO-recommended dosing regimens alone or in ACTs for the treatment and prevention of malaria, and propose a potential mechanism for amodiaquine-related asthenia.
Saving babies’ lives (SBL) – a programme to reduce neonatal mortality in rural Cambodia: study protocol for a stepped-wedge cluster-randomised trial
Posted 28/09/2021. Despite most neonatal deaths being preventable, neonatal mortality remains unacceptably high globally. Saving Babies’ Lives (SBL) is a stepped-wedge cluster-randomised trial, which will develop, implement, and assess an iterative package of neonatal interventions combining community and primary care strategies to reduce neonatal mortality in a rural Cambodian province, by Claudia Turner and colleagues
24/09/2021. Plasmodium vivax in SE Asia and Oceania is less sensitive to primaquine compared to other regions and needs a higher target dose - 0.5 mg/kg. Bob Taylor and colleagues propose a new regimen that was designed using pharmacokinetic simulation and takes into account that children need higher mg/kg doses compared to adults.
Posted 22/09/2021. Kelvin Mokaya, Sarah Atkinson and colleagues found that children with severe malaria anaemia have higher risk of non-typhoidal Salmonella bacteraemia, and lower levels of the iron-regulating hormone, hepcidin (even with Salmonella coinfection) compared to other forms of malaria. Reduced hepcidin may increase iron availability for bacterial growth in the Salmonella-containing vacuole.
Posted 21/09/2021. The WHO's ‘5 moments’ is the dominant paradigm for hand hygiene globally. While ‘5 moments' has many benefits and has had a significant clinical impact, it also has many weaknesses. Jacob McKnight and colleagues explore how this important paradigm can be improved to reflect the latest research in hand hygiene.
Clustering of malaria in households in the Greater Mekong Subregion: operational implications for reactive case detection
Posted 17/09/2021. One of the policies to achieve malaria elimination in the near future is reactive case detection. A secondary analysis of a large dataset of mass drug administrations in Greater Mekong Subregion found that reactive case detection in this setting is costly but results only in minimal benefits, by Lorenz Von Seidlein and colleagues
Dynamics of G6PD activity in patients receiving weekly primaquine for therapy of Plasmodium vivax malaria
Posted 15/09/2021. In Cambodian G6PD deficient variants, G6PD enzyme activity is unaffected by baseline reticulocyte counts but rises and correlates with posttreatment reticulocytosis. Qualitative G6PD tests are unlikely to misdiagnose G6PD deficient males at presentation. Too few G6PD heterozygous females preclude drawing inferences; more research is needed in this group.
A spatio-temporal analysis of scrub typhus and murine typhus in Laos; implications from changing landscapes and climate
Posted 14/09/2021. Little is known about why scrub typhus and murine typhus vary through time and space. Tamalee Roberts and colleagues investigated the impacts of climate and environment on both neglected diseases in Laos. The results suggest that global heating will increase their incidence and distribution, requiring interventions to reduce their burden.
Genotypes and phenotypes of G6PD deficiency among Indonesian females across diagnostic thresholds of G6PD activity guiding safe primaquine therapy of latent malaria
Posted 02/09/2021. A cross-sectional survey of G6PD deficiency genotypes and phenotypes of nearly two thousand girls and women living on malarious Sumba island in eastern Indonesia assessed risk of hemolytic crisis with primaquine therapy against latent malaria with G6PD screening technologies. These findings by Kevin Baird and colleagues will help guide the selection of G6PD screening methodology and practice.
Posted 01/09/2021. Rob Paton, Alice Kamau and colleagues analysed a data series of over 6000 hospital records of malaria admissions among children aged 3 months to 9 years. A 25% reduction in transmission halved the rate of severe malaria hospitalization. Severe malaria remains a burden predominantly in children under 5 years, regardless of the level of malaria transmission.
Feasibility study of a field survey to measure antimicrobial usage in humans and animals in the Mekong Delta region of Vietnam
Posted 31/08/2021. Using a simple One Health survey design, this pilot study by Juan Carrique-Mas and colleagues measured AMU in the four commonly farmed animal species in the Mekong Delta (Vietnam) and compared it to human AMU using different metrics. Lessons from this study can be used in the formulation of One Health surveillance systems.
Task-sharing to support paediatric and child health service delivery in low- and middle-income countries: current practice and a scoping review of emerging opportunities
Posted 27/08/2021. Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for paediatric complex and chronic conditions, however such expansion is threatened by workforce shortages. Yingxi Zhao and colleagues reviewed how task sharing could support expanded paediatrics services provision in LMICs, especially beyond acute infectious diseases and malnutrition that are widely and historically shifted.
Posted 24/08/2021. Suicide is a leading cause of maternal death globally. On the Thailand-Myanmar border, 8% of refugee women and 3% of migrant women experienced suicidal thoughts during pregnancy and postnatally. The greatest risk factors for suicidal thoughts were unplanned pregnancy and past trauma. Community interventions and targeted prevention initiatives are urgently needed to help lower the rates of people dying by suicide, by Gracia Fellmeth and colleagues.
Posted 06/08/2021. Preprints are increasingly being used to share non-peer-reviewed manuscripts to enable the rapid dissemination of research. In particular, they have become an important source of information for wider audiences keen to follow COVID-19 research developments, including news, social media and policymakers. This practice raises several challenges in publication ethics and integrity. Paul Newton and colleagues set out the need for good practice.
Posted 03/08/2021. Ribavirin is the only available Lassa fever treatment. The rationale for using ribavirin is based on one clinical study conducted in the early 1980s. However, reanalysis by Alex Salam and colleagues of previous unpublished data reveals that ribavirin may actually be harmful in some Lassa fever patients. An urgent reevaluation of ribavirin is therefore needed.
Posted 30/07/2021. A reliable catchment area is essential to define community needs (education, health care and social care) and population denominators. However, catchments are often implemented based on convenience disregarding implications on accuracy, planning and service seeking behaviour. Peter Macharia and colleagues revisit the issue by considering common approaches, key issues, and best practices in defining a reliable service catchment area
Posted 27/07/2021. This qualitative study by Mira Schneiders and colleagues discusses the important nutrition-related roles and responsibilities of grandparents caring for grandchildren in rural Cambodian ‘skip-generation’ households. Grandparents appear highly motivated to improve grandchildren’s health and nutrition, but lack necessary resources, leading to frequent moral dilemmas and ethical trade-offs. Interventions to improve child health and nutrition should be designed to be inclusive of older caregivers.
An innovative leadership development initiative to support building everyday resilience in health systems
Posted 23/07/2021. Effective management and leadership are essential for everyday health system resilience, but health managers are often under-prepared and under-supported in these roles. Particular challenges have been observed in communication skills, emotional competence and supportive oversight. Jacinta Nzinga and colleagues share their learning from implementing a package of leadership development interventions in Kenya
Model for developing context-sensitive responses to vulnerability in research: managing ethical dilemmas faced by frontline research staff in Kenya
Posted 20/07/2021. The ethical dilemmas faced by frontline staff conducting health research among ‘vulnerable’ populations are increasingly recognized. However, there is little documented on how staff might be supported in identifying and handling these dilemmas. Sassy Molyneux and colleagues share an approach and tools they developed in Kenya, centred on group reflections linked to a set of policy responses tailored to the context. They encourage further adaptation and evaluation of the approach
Identifying prognostic factors of severe metabolic acidosis and uraemia in African children with severe falciparum malaria
Posted 16/07/2021. Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. What prognostic factors are associated with severe metabolic acidosis and uraemia in African children with severe falciparum malaria? Secondary analysis of a randomized trial by Mavuto Mukaka and colleagues
Temporal trends of SARS-CoV-2 seroprevalence during the first wave of the COVID-19 epidemic in Kenya
Posted 13/07/2021. The overwhelming COVID-19 case numbers and deaths expected in African countries, as seen elsewhere following identification of the first COVID-19 cases, have not materialised. However, through serosurveillance of blood donors, Ifedayo Adetifa, Sophie Uyoga and colleagues demonstrate widespread SARS-CoV-2 infection in Kenya despite the lower COVID-19 cases and associated mortality.
Posted 09/07/2021. Dr Tan and his colleagues showed that only subgenogroup B1a of coxsackievirus A16, a common cause of the ongoing Hand Foot and Mouth Disease epidemic in Asia was circulating in southern Vietnam between 2011-2017. Active surveillance for viral circulation is critical to informing outbreak response and vaccine development.
Mass drug administration for the acceleration of malaria elimination in a region of Myanmar with artemisinin-resistant falciparum malaria
Posted 07/07/2021. Frank Smithuis and colleagues conducted a large cluster randomized evaluation of mass drug administration (MDA) with dihydroartemisinin-piperaquine for malaria elimination in an area with high artemisinin resistant Plasmodium falciparum. MDA was a safe and effective tool to accelerate P. falciparum elimination, alongside routine community-based malaria control measures. It was well tolerated and well accepted. MDA did not select for drug resistant parasites.
Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries
Posted 06/07/2021. Surveillance of Antimicrobial resistance (AMR) is important in generating evidence to support efforts in controlling the infection. Cherry Lim and colleagues discuss the strengths, potential sources of bias, and challenges of routine microbiology data and different surveillance strategies and solutions used in low- and middle-income countries. Areas requiring support and improvement are highlighted.
Chemoprophylaxis trial designs in epidemics: insights from a systematic review of COVID-19 study registrations
Posted 02/07/2021. Chemoprophylaxis against emerging and pandemic infections offer potential for prevention. Lakshmi Manoharan and colleagues evaluated significant design features of COVID-19 chemoprophylaxis trial registrations. The findings illustrate that the majority of trials were underpowered to detect clinically meaningful protection at epidemiologically informed attack rates. Future trials should be large enough to generate strong evidence and allow structured entry and exit of candidate agents. International trial coordination mechanisms and collaboration is required.
Gametocyte carriage of Plasmodium falciparum (pfs25) and Plasmodium vivax (pvs25) during mass screening and treatment in West Timor, Indonesia
Posted 30/06/202. In a cluster-randomised trial of mass microscopic diagnostic screening and treatment for malaria in eastern Indonesia, Kevin Baird and colleagues show that the intervention had no impact on the prevalence of carriage of gametocytes infectious to mosquitoes. The findings highlight the requirement for much greater sensitivity of diagnostics for this intervention to provide benefit to communities.
Case Report: Children with Severe Nutritional Rickets in the Naga Region in Northwest Myanmar, on the border with India
Posted 29/06/2021. Frank Smithuis and colleagues describe a cluster of 29 children with severe, painful bone deformities living in very remote Nagaland, northwest Myanmar. They had low 25-hydroxyvitamin D, elevated parathyroid hormone, and elevated alkaline phosphatase levels, consistent with nutritional rickets secondary to vitamin D deficiency, calcium deficiency, or a combination of both. After treatment with vitamin D3 and calcium carbonate, we saw significant improvement in symptoms, biochemistry, and radiography. This is the first report of nutritional rickets in Myanmar in over 120 years.
Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study
Posted 25/06/2021. In the ISARIC multicentre, cohort of 48 902 patients, admitted to UK hospital with COVID-19 during the first pandemic wave (6 Feb-8 June 2020), bacterial infections were uncommon. 85% of patients were prescribed antibiotics, with substantial regional variations highlighting that antimicrobial stewardship should be prioritised and integrated into Covid19 care pathways, by Louise Sigfrid and colleagues.
A randomized controlled trial of dihydroartemisinin-piperaquine, artesunate-mefloquine and extended artemether-lumefantrine treatments for malaria in pregnancy on the Thailand-Myanmar border
Posted 23/06/2021. In an RCT of three artemisinin-based combination therapies in pregnancy on the Thailand-Myanmar border where artemisinin resistance is widespread, only dihydroartemisinin-piperaquine provided satisfactory efficacy for P. falciparum, in this study by Makoto Saito & colleagues. Mefloquine-artesunate provided the longest recurrence-free period for P. vivax. Vivax recurrence was so common, chloroquine prophylaxis is warranted after malaria of any species.
Posted 22/06/2021. Diagnosis of bacterial meningitis in low- and middle-income countries is challenging due to limited laboratory capacity. Christina Obiero and colleagues conducted a revalidation study of previously identified signs of meningitis in children aged ≥60 days and found that KCH-2002 signs had lower sensitivity. Although bacterial meningitis is now uncommon following conjugate vaccination in Kenya, identifying cases is more difficult and support for basic cerebrospinal fluid analysis is crucial.
Posted 18/06/2021. Grace Irimu and colleagues show that newborns account for 46% of admissions and 66% of deaths among children 0-13years in Kenyan hospitals. Most deaths are caused by preventable and treatable causes. The authors call for need to prioritize newborn care for Kenya to achieve the SDGs target.
Arterolane–piperaquine–mefloquine versus arterolane–piperaquine and artemether–lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children
Posted 16/06/2021. The progress made in treatment of malaria is threatened by the emergence of resistance to current first line treatments artemisinin-based combination therapies (ACTs). There are currently no good alternatives for the treatment of uncomplicated malaria in the African setting in the event of resistance emerging to antimalarials that are in the ACTs. Mainga Hamaluba, Rob van der Pluijm and colleagues demonstrate that triple artemisinin combination therapies (TACTs) can potentially be used safely to prevent, delay or manage uncomplicated malaria in our setting.
Global economic costs due to vivax malaria and the potential impact of its radical cure: A modelling study
Posted 15/06/2021. Plasmodium vivax caused an estimated 14 million malaria cases in 2017. By collating economic and epidemiological data, Angela Devine and colleagues estimated an economic cost of $359 million associated with these episodes. A scenario analysis explored how costs might change with global access to safe radical cure, estimating cost savings of $17-93 million.
Posted 11/06/2021. Burkholderia pseudomallei, a bacterium found in soil, can cause melioidosis, a potentially fatal disease. Melioidosis was first described in Myanmar but rarely reported over the past decades due to lack of awareness and limited diagnostic facilities. Frank Smithuis and colleagues report a widespread distribution of the organism in Myanmar soil. This should alert clinicians to consider melioidosis as a potential cause of sepsis, pneumonia or abscesses.
Improving the Usability and Safety of Digital Health Systems: The Role of Predictive Human-Computer Interaction Modeling
Posted 09/06/2021. Chris Paton and colleagues describe how predictive human-computer interaction (HCI) modelling could be used to improve the safety and usability of digital health systems. We reviewed the history of predictive modelling in HCI and describe how modelling could be integrated with the human-centred design techniques used when developing digital health interventions.
Spatial–temporal clustering of malaria using routinely collected health facility data on the Kenyan Coast
Posted 08/06/2021. Alice Kamau and colleagues show that passively collected routine health facility data does offer opportunities to detect malaria ‘hotstops’ down to the village level, at an affordable cost. It will be important, however, to refine the current surveillance tools such that they have the potential of collecting information at sufficiently precise scale.
Posted 28/05/2021. Reagan Mogire, Sarah Atkinson and colleagues show that the prevalence of vitamin D deficiency (<50 nmol/L) is low (7.8%) in African children, although 37.1% have insufficient levels (50–75 nmol/L). Risk factors for vitamin D deficiency include high latitude, older age, winter and rainy seasons, Gc2 vitamin D binding protein genotype and malaria.
Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal
Posted 25/05/2021. Seeking treatment including antibiotics without prescription at drug shops is a common practice in Nepal which can contribute to rising antibiotic resistance. This may leave us without effective antibiotics for future infections. In this study, Bipin Adhikari and colleagues explore why people buy antibiotics over the counter in Nepal and implications for its control.
Posted 21/05/2021. Based on the analysis of a large volume of observational data on disease (diarrhea, nervous and respiratory signs, legs lesions) and antimicrobial usage (from 13 classes), Marc Choisy and colleagues highlight the absence or negative effects from prophylactic antimicrobial use in small-scale chicken farms in the Mekong Delta of Vietnam.
Falciparum but not vivax malaria increases the risk of hypertensive disorders of pregnancy in women followed prospectively from the first trimester
Posted 18/05/2021. Rose McGready and colleagues show a strong association between P. falciparum infection and hypertension, in a large prospective cohort of women followed from the first trimester of pregnancy. Falciparum malaria which sequesters in the placenta most likely drives the development of chronic placental hypoxia, eventually progressing to clinical gestational hypertension or pre-eclampsia. This is important given hypertension is in the top 3 killers of pregnant women and that most pregnancy related hypertensive deaths occur in sub-Saharan Africa where malaria prevention strategies are not implemented until the beginning of second trimester or later.
Ambulatory induction phase treatment of cryptococcal meningitis in HIV integrated primary care clinics, Yangon, Myanmar
Posted 14/05/2021. Cryptococcal meningitis is a common serious HIV-associated infection, responsible for 15% of AIDS related deaths globally. Patients are usually treated as in-patients. Frank Smithuis and colleagues reviewed 76 patients treated with amphotericin and fluconazole as out-patients in primary care clinics in Yangon, Myanmar. One-year survival (86%) was higher than existing hospital-based treatment studies and 1029 hospitals days were saved.
Posted 12/05/2021. Jacob Kazungu, Edwine Barasa and colleagues examined the level and inequality in health insurance coverage in 36 sub-Saharan African countries. They found that insurance coverage in sub-Saharan Africa is both low and pro-rich; only 8 of the 36 countries examined had a mean level of insurance coverage of above 10%.
Laboratory informatics capacity for effective antimicrobial resistance surveillance in resource-limited settings
Posted 11/05/2021. Microbiology laboratory data management is complex and is a rate-limiting step for AMR surveillance in low- and middle-income countries. Paul Turner, Liz Ashley, and colleagues summarise the urgent IT infrastructure requirements needed to ensure that the substantial ongoing efforts to develop capacity for AMR surveillance in LMICs realise their full potential.
Assessing the impacts of short-course multidrug-resistant tuberculosis treatment in the Southeast Asia Region using a mathematical modeling approach
Posted 07/05/2021. Multidrug-resistant tuberculosis (MDR-TB) remains a significant burden in the Southeast Asia region. Using mathematical modelling approach, Wirichada Pan-Ngum and colleagues assessed the population-level impacts of short-course MDR-TB treatment compared to the conventional therapy. Early initiation of treatment and good level of treatment eligibility are identified to be important determinants to the success of MDR-TB control programmes.
Perinatal depression in migrant and refugee women on the Thai–Myanmar border: does social support matter?
Posted 05/05/2021. On the Thailand-Myanmar border, 39% of migrant women and 47% of refugee women experience maternal depression. Gracia Fellmeth and colleagues show that among migrant women, higher levels of social support are associated with lower depression. The perinatal period offers a valuable opportunity to ask women about depression and support networks and offer help to those who need it.
A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals
Posted 04/05/2021. This survey in Jakarta, Indonesia, led by Licia Limato & Raph Hamers, evaluated patterns and quality indicators of antibiotic prescribing in six public and private hospitals. The study reported a high rate of empirical use of broad-spectrum antibiotics, coupled with poor documentation and guideline adherence, suggesting important areas for antimicrobial stewardship interventions.
Prediction of disease severity in young children presenting with acute febrile illness in resource-limited settings: a protocol for a prospective observational study
Posted 30/04/2021. In many low- and middle-income countries febrile children are managed by health workers with limited training, in settings where referrals can confer substantial costs and risks. Spot Sepsis, a multi-centre study being implemented by MORU and MSF, aims to develop a practical prognostic tool to help community healthcare providers identify febrile children who may benefit from referral for facility-based medical care.
Towards an appropriate ethics framework for Health and Demographic Surveillance Systems (HDSS): learning from issues faced in diverse HDSS in sub-Saharan Africa
Posted 28/04/2021. While Health and Demographic Surveillance Systems (HDSS) involving verbal autopsy provide essential data on deaths, births and other health-related events in LMICs where alternative sources are limited, Vicki Marsh and colleagues argue that current regulatory frameworks do not sufficiently recognise their nature as a form of non-traditional epidemiological research. Ethical challenges include risks of uncompensated burdens that alternative regulatory approaches may more successfully identify.