Research Highlights
Central Nervous System Involvement by Novel Clade 2.3.2.1e H5N1 Avian Influenza Virus in a Pediatric Patient
Posted 14/10/2026. Nguyen Thi Thu Hong and colleagues reported on an 8-year-old Vietnamese boy with H5N1 avian influenza-associated meningoencephalitis without respiratory symptoms. The virus was detected in cerebrospinal fluid, highlighting the importance of considering emerging H5N1 clade 2.3.2.1e in unexplained paediatric neurological infections.
Estimation of the global burden of tungiasis in endemic countries using a disability adjusted life-years modelling approach
Posted 13/10/2026. Tungiasis is an extremely neglected tropical skin disease caused by sand fleas (Tunga penetrans) mostly affecting resource-poor, marginalised populations. Using a prevalence-based DALY model, Alistair Antonopoulos, Lynne Elson and colleagues have estimated 379,645 Disability Adjusted Life Years (DALYS) are lost annually to tungiasis with the main burden in Sub-Saharan Africa. This positions the burden of tungiasis in the range of other NTDs and yet it remains under-recognised in global health agendas.
Balancing altruism, risk and ethics: Vietnamese students’ views on human challenge studies
Posted 09/10/2026. How do Vietnamese medical and public health students view human challenge studies? While students recognise their potential value, support is cautious and conditional. Altruism is important, but safety, fair compensation, informed consent, institutional trust and strong ethical oversight are key to making such research acceptable. Understanding local perspectives is essential to ensuring that research implementation is ethical and responsive to context. By Evelyne Kestelyn
Paraprofessionals as liminal professionals: The case of physician associates / assistants in the UK NHS hospitals
Posted 07/10/2026. Physician associates/assistants (PAs) have become the focus of intense debate about their role in the NHS. Drawing on 126 interviews across five hospitals and using sociological and organisational theory, Yingxi Zhao and colleagues show how professional and organisational uncertainty leaves PAs ‘in limbo’, and how they navigate this uncertainty in everyday healthcare work.
Fear of clofazimine-induced skin discoloration as a barrier to leprosy treatment: urgent need for alternative therapeutic options
Posted 02/10/2026. This Letter highlights how clofazimine-induced skin discoloration can hinder leprosy treatment acceptance and adherence. Two case studies illustrate how concerns about visible pigmentation, stigma, and potential social or family consequences may lead individuals affected by leprosy to refuse or discontinue treatment, emphasising the need for effective counselling and alternative therapeutic options. By Marlous Grijsen
Community perceptions, trust, and experiences of malaria clinical research and participation in rural Cambodia
Posted 30/09/2026. How are malaria clinical trials perceived in rural Cambodia? Phaik Yeong Cheah and colleagues explored the trust communities place in such trials. In rural Cambodia, sustained engagement and attentive care built strong trust in malaria research, but sometimes blurred the boundary between research and healthcare. Our study shows why ethical research must not only build community trust, but continually steward it through transparent communication and engagement.
Why are shorter antibiotics courses not widely used in low- and middle-income countries?
Posted 29/09/2026. If shorter antibiotic courses can be just as effective, why are longer courses still so common? The answer is more complicated than it seems—especially in low- and middle-income countries. Our analysis looks beyond familiar explanations of antibiotic overuse and asks what really shapes decisions about when to stop treatment. By Bipin Adhikari
Beyond rescue: building a resilient health system after Nepal's 2026 flood
Posted 24/09/2026. This Comment is a comprehensive write up which highlights the vulnerabilities of Nepal’s health system after the heart-wrenching devastation caused by the Bhote Koshi floods in central Nepal on Aug 26 2026. The genuine rescue effort and mobilisation by the Nepali government is praiseworthy, but Nepal clearly needs robust disaster preparedness in multiple sectors.
Genomic epidemiology of coxsackievirus A24 variant during the 2024 acute hemorrhagic conjunctivitis outbreak in Coastal Kenya
Posted 23/09/2026. Coxsackievirus A24 variant (CVA24v) causes recurring acute haemorrhagic conjunctivitis epidemics in tropical and subtropical regions. In the largest CVA24v genomic study, Morobe and colleagues analysed 245 sequences from Kenya’s 2024 outbreak. They identified two co-circulating lineages with a recombination history involving an unidentified Enterovirus C, distinct from lineages responsible for outbreaks in parts of Asia during 2022–23. By Charles Agoti
Azithromycin with or without cefixime for suspected or culture-confirmed uncomplicated typhoid fever in Nepal, Bangladesh, and Pakistan (ACT-South Asia): a double-blind, parallel-group, randomised, placebo-controlled, phase 4 trial
Posted 22/09/2026. This trial is the largest placebo-controlled, multi-country RCT in typhoid fever whose findings (Azithromycin alone is the treatment for uncomplicated typhoid fever) may be generalizable for all of South Asia, population 2.1 billion, where typhoid is rampant. This has important implications for AMR stewardship, especially regarding third generation cephalosporins. By Buddha Basnyat
They are all inter-related, like a cycle: an exploratory qualitative study of climate change, chronic stressors and mental health among displaced populations on the Thailand-Myanmar border
Posted 18/09/2026. Against a backdrop of many legal and economic stressors, climate-related distress was perceived as an indirect stressor, impacting livelihoods and exacerbating structural precarity. Addressing the inter-related challenges of climate change, displacement, poverty and mental health requires integrative, climate-sensitive and migrant-inclusive health policies and care, including for adolescents. By Gracia Fellmeth
Community engagement strategies for preventing recurrent Nipah virus outbreaks in Bangladesh and India: adapting a framework for outbreak preparedness and response
Posted 17/09/2026. What if preventing the next Nipah outbreak depends as much on communities as on science? With no approved vaccines or treatments yet, Shuma Banik and colleagues argue that communities must move from being recipients of information to partners in preparedness—shaping locally grounded prevention, early detection, trust, and responses to recurrent outbreaks in Bangladesh and India.
Determining intracellular and extracellular activities of azithromycin against azithromycin-resistant Salmonella Typhi and their association with clinical treatment responses
Posted 16/09/2026. Duy Pham’s lab and international partners combined laboratory and clinical data, providing evidence that azithromycin is unlikely to cure infections caused by emerging azithromycin-resistant Salmonella Typhi. Their findings highlight the urgent need to strengthen public health prevention efforts and reduce reliance on azithromycin, one of the last effective oral treatments.
Prevention of altitude illness in adults: preparing people for travel to high altitude
Posted 15/09/2026. Altitude illness is potentially life-threatening; however, it is preventable with adequate pre-travel planning and preparation. Sudeep Adhikari and colleagues recommend pre-travel clinical consultation for all high-altitude travel, and clinicians assess planned itinerary, stratify the risk of altitude illness, advise for gradual ascent, and prescribe preventive medicines when gradual ascent is not possible.
Use of procalcitonin point-of-care testing to guide de-escalation of antibiotic therapy in adults with suspected bacterial sepsis in a tertiary hospital in Bangladesh: a randomised controlled open-label trial
Posted 10/09/2026. The PROCALBAN randomised controlled trial in Bangladesh demonstrated that daily, affordable point-of-care procalcitonin testing safely guides antibiotic de-escalation in adults with suspected bacterial sepsis. The biomarker-guided protocol significantly reduced median antibiotic therapy duration from 9.0 to 4.7 days without increasing patient mortality or infection recurrence rates. By Forhad Chowdhury
Repositioning Responsibility in Antibiotic Stewardship to Prescribers
Posted 08/09/2026. In this commentary, Phaik Yeong Cheah and colleagues respond to an article advocating shorter antibiotic courses. They support its call for action, particularly its shift in antibiotic-stewardship responsibility from patients and other antibiotic users to prescribers. They emphasise that, although antimicrobial resistance is a collective global problem, the capacity to influence it is unevenly distributed; therefore, responsibility should correspond to control and agency.
Community engagement strategies for antimicrobial resistance control and interventions
Posted 05/08/2026. How can engagement across the AMR literature be better understood, and how can it be used to support equitable interventions? This review demonstrates how community engagement can serve multiple purposes, functioning both as a means of implementing interventions and as an end in itself for AMR interventions. By Bipin Adhikari
Community willingness towards a hypothetical new TB vaccine: a qualitative study to explore the enablers and barriers for vaccine acceptability in Nepal
Posted 29/07/2026. Will communities embrace a new TB vaccine? This qualitative study from Nepal reveals how trust in health systems, prior vaccination experiences, knowledge, misinformation, access barriers, and social inequalities influence vaccine acceptance, offering practical insights for equitable TB vaccine introduction and community-centred implementation. By Ashata Dahal
Antimicrobial resistance as a multicultural challenge: a decolonized approach to science communication in the Global South
Posted 28/07/2026. Current public communication efforts about antimicrobial resistance (AMR) often emphasise awareness-raising. This Viewpoint, written from a Southeast/East Asian perspective, suggests decolonised communication strategies that challenge hierarchies of knowledge and are receptive to local insights. Moving away from disseminating unactionable messages, decolonised communication would foster equitable approaches and context-sensitive solutions towards AMR. By Han Tran Dong Thai
Generative AI-enabled clinical decision support system in primary care: a pragmatic, cluster-randomized trial
Posted 23/07/2026. Generative AI promises to improve healthcare, but evidence from real-world trials remains limited. Ambrose Agweyu and colleagues conducted a pragmatic cluster-randomised trial involving 103 clinical officers and 9,691 patients across 16 primary care clinics in Kenya. Treatment failure was similar among patients managed by LLM-assisted and unassisted clinicians, while LLM assistance improved clinical documentation, reduced antibiotic-related costs and showed no safety signal.
Use of the “STANDARD G6PD-TM” quantitative point-of-care test in neonates and infants
Posted 21/07/2026. This study was carried out at SMRU clinics using a G6PD Biosensor. The results demonstrated that the device can be used in both cord blood and capillary neonatal blood collected during the first week of life to provide reliable identification of G6PD abnormal neonates who are at increased risk of neonatal hyperbilirubinaemia. By Germana Bancone
Severe anaemia and invasive bacterial infections in Kenyan children: a 26-year hospital surveillance observational study
Posted 08/07/2026. Severe anaemia remains a major cause of childhood hospitalisation and death. Analysis of >80,000 paediatric admissions in Kilifi, Kenya, shows that severe anaemia is associated with bacteraemia, with specific bacterial pathogens, and the burden is shifting towards older children in the era of declining malaria transmission. By Kelvin Mokaya
The burden of antimicrobial-resistant bacterial infections: a causal perspective
Posted 07/07/2026. Accurate estimates of preventable antimicrobial resistance (AMR) burden are essential for informing health policy. This perspective outlines key challenges in AMR burden estimation and highlights how adopting a causal framework can identify and mitigate bias, improve evidence synthesis, and generate more robust and policy-relevant estimates of AMR burden. By Cherry Lim
Community perspectives on mass malaria vaccine and drug administration in the Chittagong Hill Tracts, Bangladesh: a qualitative study
Posted 01/07/2026. How do indigenous and ethnic minority communities in Bangladesh’s Chittagong Hill Tracts perceive ongoing mass vaccine and drug administration for malaria elimination? In a region shaped by a complex social and political history, trust is both critical and contested. Rupam Tripura and colleagues explore how local beliefs, historical mistrust, health-seeking practices, and experiences during the COVID-19 pandemic influence acceptance of these interventions.
Transmission of rifampicin-resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective genomic epidemiology study
Posted 30/06/2026. Our study sequenced 1,491 rifampicin-resistant Mycobacterium tuberculosis isolates from Ho Chi Minh City (2020–2024) and used phylogenetic methods to distinguish transmitted from acquired resistance. We estimated 72-87% of RR-TB was attributable to transmission of already-resistant strains, with 13-28% reflecting de novo acquisition. The findings highlight the need for both transmission-interruption strategies and investigation into drivers of acquired resistance. By Ruan Spies
Altered pharmacokinetics and delayed sputum conversion in tuberculosis patients co-infected with HIV
Posted 26/06/2026. A new study by SMRU/MORU researchers found that HIV co-infection was associated with slower elimination and altered early exposure to first-line tuberculosis drugs in patients on the Thailand–Myanmar border. HIV-positive status and higher baseline sputum bacillary burden were associated with delayed sputum conversion, highlighting important TB–HIV interactions. By Aung Pyae Phyo
‘Responsive Dialogues’, an engagement framework for antimicrobial resistance: a cross-country qualitative evaluation in Thailand and Malawi
Posted 24/06/2026. How can community engagement help tackle antimicrobial resistance? Our new cross-country study led by MWL & MORU demonstrates how Responsive Dialogues created spaces for communities, policymakers, and experts to co-create solutions to AMR. The study highlights the value of trust, inclusive participation, and community-generated solutions, while revealing the challenges of translating local voices into national policy action. By Bhensri Naemiratch
Co-designing a study on a health interventions with Myanmar migrant workers to address work-related musculoskeletal disorders in Thailand’s seafood industry
Postes 19/06/2026. In this paper, Phaik Yeong Cheah and collaborators at Chulalongkorn University, Thailand co-designed a digital health intervention with Myanmar migrant seafood workers in Thailand to address work-related musculoskeletal disorders. They developed a culturally appropriate and practical intervention. This initiative demonstrates how meaningful community engagement can improve the relevance, feasibility, and equity of health research.
A snapshot of selected neglected tropical disease research using the World Health Organization International Clinical Trials Registry Platform database, 1999–2023
Posted 17/06/2026. Neglected tropical diseases affect more than one billion people, yet research activity is unevenly distributed. By analysing clinical study registrations, researchers at IDDO identified gaps in evidence generation, including limited studies in several high-burden countries, few multi-country trials, and lack of paediatric studies in Chagas disease research. This study highlights priorities for future investment and collaboration. By Rhys Peploe
Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research
Posted 12/06/2026. This review summarises 25 years of rickettsial disease research led by the MORU network across Southeast Asia. Advances in surveillance, diagnostics, genomics and clinical research have transformed understanding of these neglected infections, improved patient management, and established rickettsioses as major causes of febrile illness throughout the region. By Stuart Blacksell
Mortality and Length of Stay Associated With Community-Acquired Escherichia coli and Staphylococcus aureus Bloodstream Infections: An Observational Study in 9 Low- and Middle-Income Countries Open Access
Posted 10/06/2026. Using prospective clinical surveillance (ACORN2), Jill Hopkins and colleagues found no evidence of AMR-related mortality in E. coli or S. aureus. The study included adults and children with culture-confirmed community-acquired E. coli or S. aureus bloodstream infections from nine low- and middle-income countries in Asia and Africa.
Community and stakeholder engagement in national priority setting and participatory research for HIV, Tuberculosis, and Malaria programs in Nepal
Posted 05/06/2026. Bipin Adhikari and colleagues examine how priority setting was conducted for TB, HIV and malaria. The engagement involved over 2,000 community members including people living with HIV, TB survivors, sex workers, and migrants across 700 sessions to shape national strategies. Conducted during COVID-19 and a federal transition in Nepal, the study shows inclusive engagement can shift health policy in measurable ways.
CRISPR-based environmental detection of Burkholderia pseudomallei identifies sanitation gaps and melioidosis risk in northeast Thailand
Posted 03/06/2026. Sukritpong Pakdeerat and colleagues developed CRISPR-BEEPs, a CRISPR-based assay to improve environmental detection of Burkholderia pseudomallei, the bacterium causing melioidosis. Applying this tool to water samples across northeast Thailand, the team identified a significant association between environmental exposure and nearby melioidosis cases that conventional detection methods failed to detect, highlighting the need for improved water sanitation. By Claire Chewapreecha
Willingness to accept paediatric blood sample collection for clinical research purposes in Nepal: a qualitative study
Posted 27/05/2026. Why do parents agree or refuse to let researchers collect blood samples from their children? This qualitative study from Nepal uncovers the complex pathways underpinning trust, fear, cultural beliefs, communication, and community relationships shape paediatric research participation, offering insights for ethical global health research and meaningful community engagement. By Ashata Dahal
Antibiotic and healthcare exposure impact on dynamics of third-generation cephalosporin-resistant Enterobacterales colonisation in Cambodian children: a six-month cohort study
Posted 26/05/2026. The COMRU-META longitudinal cohort study in Cambodia showed a high prevalence of 3rd-generation cephalosporin-resistant (3GC-R) E. coli and K. pneumoniae colonisation in young children. Healthcare and antibiotic exposure increased acquisition and persistence of 3GC-R K. pneumoniae over time, with no effect on 3GC-R E. coli colonisation dynamics. By Cristina Ardura
Reduction of stillbirth rate in refugee and migrant populations living on the Thailand Myanmar border: A retrospective study 1986–2023
Posted 22/05/2026. From 1986-2023 SMRU documented a 3-fold reduction in stillbirth among marginalized refugee and migrant women demonstrating progress in a challenging context. Efforts were directed towards maintaining access to basic, quality driven, ANC and birthing services. Stillbirth rates remained higher than the host population, indicating persistent disparities. By Rose McGready
Impact analysis of flood-induced changes in geographical accessibility and coverage to healthcare in both public and private sector, 2024, Kenya
Posted 20/05/2026. Bibian Robert, Samuel Muchiri and colleagues examined the compounded impact of flooding and a public hospital doctors' strike on geographic access to health facilities in Kenya in 2024. They demonstrated that population coverage within 30 minutes fell from 94% to 73%, with arid northern counties disproportionately affected, underscoring the urgent need for climate-resilient infrastructure and decentralised health services.
Antimicrobial resistance in bacterial pathogens causing community-acquired and hospital-acquired lower respiratory tract infections (2010–24): a systematic review and meta-analysis
Posted 19/05/2026. Gilbert Lazarus and Raph Hamers conducted a systematic review of >336,000 respiratory isolates across 51 countries, showing concerningly high prevalence of antimicrobial resistance in bacteria causing lower respiratory tract infections, particularly in hospital-acquired infections and LMICs, with variations across regions. The study highlights the need for stronger AMR surveillance, and health systems strengthening worldwide.
Population pharmacokinetics of DNDI-6148 in healthy adults
Posted 13/05/2026. Towards new treatments for leishmaniasis and Chagas disease. DNDI-6148 is a promising oral drug candidate for leishmaniasis and Chagas disease. In a first-in-human trial, single oral doses up to 380 mg were well tolerated in healthy adults. Frauke Assmus and colleagues developed a population pharmacokinetic model, demonstrating dose-dependent non-linear behaviour and supporting dose selection for future patient trials.
Methods for estimating the burden of acute tropical infectious diseases: A scoping review
Posted 12/05/2026. This scoping review synthesised methods used to estimate the burden of acute tropical infectious diseases, particularly neglected tropical diseases. Reviewing 60 studies, Qian and colleagues identified major advances in machine learning and geospatial modelling, while highlighting persistent challenges including underreporting, data sparsity, and methodological uncertainty that limit evidence-based public health decision-making.
Predicting referral need for febrile children in low-resource community settings in South and Southeast Asia
Posted 08/05/2026. A new multi-country study implemented across South and Southeast Asia, led by MORU and MSF, shows that triage tools combining simple clinical assessments with pulse oximetry or a targeted blood test outperform current globally recognised danger signs in identifying febrile children at highest risk, while substantially reducing unnecessary hospital referrals. By Arjun Chandna
A repetitive nucleotide insertion in the rplV gene is associated with in vitro resistance to azithromycin in Rickettsia typhi
Posted 07/05/2026. Weerawat Phuklia and colleagues showed that reduced susceptibility to azithromycin in Rickettsia typhi can be induced under laboratory drug pressure. A small genetic change in a ribosomal protein likely affects how the drug binds. The change was reversible without antibiotic pressure, helping improve laboratory methods for studying antibiotic susceptibility in this bacterium.
Effect of external cephalic version in a resource-limited setting on the Thailand-Myanmar border: a retrospective cohort with propensity score analysis
Posted 06/05/2026. Pregnant women with breech presentation are offered external cephalic version (ECV) to avoid breech birth. Nay Win Tun, Sue Lee and colleagues found no difference in presentation at birth between women who were offered ECV or not. However, successful ECV was associated with significantly better outcomes, highlighting the importance of improving practitioner skill and ECV success rates to maximise clinical benefit.
Plasmodium vivax malaria relapse risk depends on transmission intensity: evidence from a longitudinal study in Northwest Thailand
Posted 05/05/2026. A prospective longitudinal cohort study in Thailand (2010-2014) showed declining incidence (0.19 to 0.09 per person-year) of Plasmodium vivax infections after primaquine radical cure. Primaquine efficacy at 4 months was 75% less than predicted in a previously published taylor-made probability model. This suggests higher doses of 8-aminoquinolines may not be needed in pre-elimination settings. By Cindy Chu
A sustainable house design to improve child health in rural Africa: a cluster-randomized controlled trial
Posted 28/04/2026. Children in Tanzania that lived in novel design houses were less likely to get malaria, diarrhoea and respiratory infections than were those living in conventional homes during a 3-year trial. The two-storey ‘Star Home’ puts bedrooms on the upper floor, where mosquitoes abundance is lower, and the latrine outside to help reduce the spread of diarrhoeal diseases. The design is a proof of concept to demonstrate that research can inform architecture that improves health outcomes. By Lorenz Von Seidlein
Missed at birth: a cross-sectional analysis of national determinants and subnational changes in birth registration coverage in Kenya, using 2014 and 2022 Demographic and Health Survey (DHS) data
Posted 27/04/2026. Bibian Robert, Emelda Okiro and colleagues examine national and subnational trends in birth registration in Kenya using 2014 and 2022 Demographic and Health Surveys data. They identify persistent gaps and key determinants of under-registration, highlighting inequities by geography and socio-economic status, and underscores the need for targeted policies to improve civil registration system coverage and inclusivity.
A four-item risk score to target acute HIV infection testing among men who have sex with men in Indonesia: development and validation in the INTERACT prospective cohort
Posted 23/04/2026. Gilbert Lazarus, Raph Hamers and colleagues developed a simple four-item risk score accurately identified acute HIV infection among Indonesian men who have sex with men. The risk score enables targeted resource-efficient testing for acute HIV infection. Early diagnosis and prompt treatment are critical steps to reduce onward transmission and curb the escalated HIV epidemic among key populations in Indonesia.
Sustaining community-based malaria services through stakeholder engagement: lessons from co-creation in northeastern Thailand
Posted 22/04/2026. This public engagement project explored how active participation by malaria post workers and community members can maintain malaria awareness and elimination advocacy in low-transmission settings. Through iterative stakeholder engagement in northeastern Thailand bordering Laos and Cambodia, Monnaphat Jongdeepaisal and colleagues co-created locally owned health education tools integrating malaria with local health priorities to support a stronger and sustainable community-based health care in the Greater Mekong Subregion.
Mapping the global prevalence and socioecological drivers of child sexual abuse: a systematic review and synthesis
Posted 14/04/2026. Child sexual abuse affects millions of children worldwide yet remains largely underreported. Salum Mshamu and colleagues highlight its global prevalence and key risk factors across individual, family and societal levels. Prompted by field experiences, they explore how child sexual abuse may surface in global health research, helping researchers better recognize and respond during fieldwork.
A mixed-methods evaluation of outreach service provision by the “Strengthening Migrant Access to Reproductive Health in Thailand” Initiative, 2020–2024
Posted 13/04/2026. Beginning in 2020, SMRU set out on something bold. It completely restructured maternal health services to incorporate outreach delivery—meeting migrant women where they are. Through COVID and a coup in Myanmar, this program delivered and offset the structural barriers migrant women face in accessing care. By Rose McGready