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The paediatrician workforce and its role in addressing neonatal, child and adolescent healthcare in Kenya

@Oxford KWTRP

Posted 07/07/2020. In a country with 25 million newborns, children and adolescents, how many paediatricians are there and where are they? This paper by Mike English and colleagues seeks to start a debate on how to deliver paediatric services in LMIC in the future.

Malaria infection, disease and mortality among children and adults on the coast of Kenya

KWTRP

Posted 03/06/2020. Under declining malaria transmission on the Kenyan coast Kilifi, Alice Kamau, Bob Snow and colleagues show that children continue to bear the brunt of mild and severe disease. There was no significant malaria disease or mortality burden in adults. This is contrary to current modelled approaches to malaria disease burden among African adults.

Interferon-gamma polymorphisms and risk of iron deficiency and anaemia in Gambian children

KWTRP

Posted 30/06/2020. Interferon-gamma (IFN-g) is upregulated during malaria infection and influences erythropoiesis and iron status. Kelvin Mokaya, Sarah Atkinson and colleagues found that children carrying the IFNG+2200C allele, a variant previously associated with higher IFN-g levels, had a modestly increased risk of anaemia and iron deficiency after the malaria season. Larger studies are needed to validate this finding.

Quantifying antibiotic impact on within-patient dynamics of extended-spectrum beta-lactamase resistance

@Oxford

Posted 25/06/2020. Antibiotic-resistant bacteria are a growing global health crisis. In order to develop a quantitative understanding of how antibiotics affect drug-resistant bacteria within the human gut, Ben Cooper and colleagues developed a data-driven model of the within-host dynamics of blaCTX-M, one of the most important gene families for antibiotic resistance.

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries

KWTRP

Posted 23/06/2020. As the COVID-19 global pandemic escalates in low-income and middle-income countries (LMICs), locally tailored responses addressing socio-economic and health inequities are essential. Edwine Barasa, Sassy Molyneux and colleagues offer five key considerations grounded in principles of social justice to inform decision making, and call for countries to act together, in cooperation, to build resilience.

Routine data for malaria morbidity estimation in Africa: challenges and prospects

KWTRP

Posted 19/06/2020. The true burden of malaria in sub-Saharan Africa remains challenging to measure. In Africa, there is increasing use of routine surveillance data to define national strategic targets, estimate malaria case burdens and measure control progress to identify financing priorities. Victor Alegana and colleagues address some of the challenges and prospects related to using routine data which equally apply to other disease surveillance.

Iron deficiency is associated with reduced levels of Plasmodium falciparum-specific antibodies in African children

KWTRP

Posted 15/06/2020. Iron deficiency and malaria are common among African children and studies suggest that iron may be critical for the development of humoral immunity. Sarah Atkinson and colleagues found that in 1,794 community-based children in Kenya and Uganda, iron-deficiency was associated with lower levels of P. falciparum-specific antibodies even after adjusting for malaria exposure.

Pregnancy outcomes and risk of placental malaria after artemisinin-based and quinine-based treatment for uncomplicated falciparum malaria in pregnancy

@Oxford MORU

Posted 12/06/2020. Safety of drugs is important, particularly during pregnancy. Makoto Saito and colleagues have pooled the data of 4503 women who had malaria in pregnancy and found that the currently used artemisinin-based combination therapies are equally safe for fetus. This study also highlights that risk of small-for-gestational-age (SGA) is high after malaria in pregnancy even treated with highly efficacious drugs, suggesting that prevention is important for reducing SGA in malaria endemic areas.

The natural history and transmission potential of asymptomatic SARS-CoV-2 infection

OUCRU

Posted 09/06/2020. Dr Le Van Tan and colleagues from OUCRU, Vietnam, demonstrate that 43% of quarantined people who were RT-PCR positive for SARS-CoV-2 were asymptomatic, but potentially contagious. The results emphasize the importance of contact tracing, airport quarantine and RT-PCR screening for SARS-CoV-2 among isolated people in controlling the ongoing pandemic.

Quantification of glucose-6-phosphate dehydrogenase activity by spectrophotometry

MORU

Posted 08/06/2020. Safe and effective radical cure of malaria will require better ways of testing for G6PD deficiency. In a large collaborative study a paper in PLoS Medicine, Daniel Pfeffer, Ric Price and colleagues highlight substantial variation between research laboratories using the current gold standard method (spectrophotometry). The study highlights challenges but also opportunities for new point of care tests.

Performance of metagenomic next-generation sequencing for the diagnosis of viral meningoencephalitis in a resource-limited setting

OUCRU

Posted 05/06/2020. Tan Le Van and colleagues showed that metagenomics can accurately detect a wide range of neurotropic viruses, especially vaccine-preventable-disease causing viruses such as mumps, in CSF of 66 consecutively treated adults with meningoencephalitis. Prospective study is needed to demonstrate the benefit metagenomics may add to the management of devastating diseases such as meningoencephalitis.

Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens

MORU

Posted 02/06/2020. Thomas Althaus and colleagues identified Influenza and dengue viruses as key pathogens in febrile children and adults attending primary care in Thailand and Myanmar. CRP performance for distinguishing bacterial from viral pathogens was average while patients recovered regardless of antibiotic prescription. This suggests that most primary care infections do not require an antibiotic.

Scope, quality, and inclusivity of clinical guidelines produced early in the covid-19 pandemic: rapid review

@Oxford

Posted 29/05/2020. In an emergency, we all look for guidance, be that from experts, trusted authorities or professional bodies. The COVID-19 has been the most significant health care emergency for a generation. And yet the very characteristics of an emergency - uncertainty, time pressure - challenge the ability of experts to respond with the rigour that caused us to turn to them in the first place. In this rapid review, Andrew Dagens, Louise Sigfrid, Peter Horby and colleagues took clinical guidelines published in the early COVID-19 and appraised them. They highlight how international organizations can better produce guidelines for future emergencies.

HIV-1 transmission patterns within and between risk groups in coastal Kenya

KWTRP

Posted 21/05/2020. HIV-1 transmission patterns within and between risk groups (men who have sex with men, injecting drug users, female sex workers, and heterosexuals) in Kenya are not well understood. Based on 658 HIV-1 pol sequences, George Makau, Eduard Sanders and colleagues showed that 85% of transmission clusters was within risk groups, whereas 15% was shared between risk groups.

COVID-19 lung injury is different from high altitude pulmonary edema

OUCRU

Posted 18/05/2020. The etiology of high altitude pulmonary edema (HAPE), a disease sometimes seen in sojourners to high altitude, is lack of adequate oxygen and not an inflammation provoked by an infectious agent like the novel coronavirus. Except for supplemental oxygen, Buddha Basnyat and colleagues strongly caution against managing COVID-19 lung injury with treatments that are used for HAPE.

Tuberculous meningitis: where to from here?

OUCRU

Posted 15/05/2020. Tuberculous meningitis is the most severe form of tuberculosis. Here Joseph Donovan and colleagues review tuberculous meningitis research during the last 2 years, focusing on that considered to have a major impact in advancing understanding, diagnosis, treatment of this disease in children and adults

Carriage of the zoonotic organism Streptococcus suis in chicken flocks in Vietnam

OUCRU

Posted 12/05/2020. Exposure to pigs may not be the only source of Streptococcus suis infection. In a study in Vietnam by Juan Carrique-Mas and colleagues, 33.9% healthy chickens investigated carried this organism. Sequencing data indicated that chicken S.suis were generally different from human/pig isolates, although 10% chicken S.suis were identical to pig isolates from the same area.

A systematic review of changing malaria disease burden in sub-Saharan Africa since 2000

KWTRP

Posted 07/05/2020. Information on malaria burden should progressively be based on empirical data rather than models. Alice Kamau and colleagues show that although, in many locations, both local surveillance data and modelled estimates showed declines in malaria burden, there was weak association where stalling in progress or resurgence of malaria burden was observed empirically.

Barriers and facilitators to healthcare workers’ adherence with infection prevention and control guidelines for respiratory infectious diseases

MORU

Posted 05/05/2020. In this Cochrane qualitative review to inform the 2020 COVID19 pandemic, Xin Hui Chan and colleagues identify key barriers and facilitators to healthcare workers’ adherence to infection prevention and control (IPC) guidelines for respiratory infectious diseases to support policymakers and healthcare leaders in designing and implementing IPC guidelines. These include organisational factors (safety climate, design & communication of consistent PPE guidelines, availability of training programmes), physical environment (space, facility design, administrative controls, personal protective equipment availability), and individual factors (knowledge, beliefs, attitudes).

Efficacy and tolerability of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy

@Oxford

Posted 01/05/2020. Although effective treatment for malaria in pregnancy is needed for preventing adverse impact on both mother and fetus, quinine is still widely used in pregnancy. Makoto Saito and 41 other collaborators worldwide put their individual patient data together to summarise the currently available evidence showing that quinine is inferior to ACT and further research on dose optimization of ACT is warranted.

Plasmodium falciparum ATP4 inhibitors to treat malaria: worthy successors to artemisinin?

MORU

Posted 28/04/2020. In this comment Elizabeth Ashley and Aung Pyae Phyo discuss two recent studies of SJ733, a PFATP4 inhibitor. Compounds from this promising novel class of antimalarials kill parasites rapidly, a property previously unique to the artemisinin derivatives among antimalarials in use, and one that underpins their enormous success.

The estimated burden of scrub typhus in Thailand from national surveillance data (2003-2018)

MORU

Posted 24/04/2020. Scrub typhus is a major cause of fever in the tropics. Tri Wangrangsimakul and colleagues estimated the disease burden in Thailand and showed that the number of cases rose significantly over the last two decades. Age, sex and occupation along with meteorological and geographical factors may be important determinants of disease incidence.

Longevity of the insecticidal effect of three pyrethroid formulations applied to outdoor vegetation on a laboratory-adapted colony of the Southeast Asian malaria vector Anopheles dirus

MORU

Posted 21/04/2020. This study by Victor Chaumeau and colleagues was carried out in order to assess the longevity of insecticide mists applied to outdoor vegetation. Insecticidal effect of sprayed plant material against malaria mosquitoes lasted for several weeks. These results provide a strong rationale for using outdoor residual spraying against the mosquito vectors that rest outside premises.

COVID-19 and risks to the supply and quality of tests, drugs, and vaccines

@Oxford MORU

Posted 14/04/2020. Enormous emergency efforts are underway to find optimal medical products, to prevent, diagnose, and treat COVID-19, that 7.8 billion people will depend on. With dire disruption of pharmaceutical production and supply and increasing falsified and substandard products, we need strategic planning now to ensure global access to quality-assured medical products and monitoring of supply chains

Data for tracking SDGs: challenges in capturing neonatal data from hospitals in Kenya

@Oxford

Posted 07/04/2020. Data are needed to track progress towards the target to end preventable deaths of newborns in LMICs. Christiane Hagel and colleagues report on the challenges of neonatal data capture and the wider health information system in LMICs. With use cases from Kenyan hospitals and visualisations of neonatal information flow they show the complex people- and paper-based subsystem of the District Health Information Software, version 2 (DHIS2) - a widely used data platform which forms part of the health information system in LMICs

Sources of multi-drug resistance in patients with previous isoniazid resistant tuberculosis identified using whole genome sequencing

OUCRU

Posted 27/03/2020. Nguyen Thuy Thuong Thuong and colleagues in OUCRU, Vietnam, investigated the sources of multi-drug resistant TB in patients with undiagnosed isoniazid-resistant TB treated with first-line anti-TB therapy. They found that re-infection with a new multi-drug resistant TB strain was just as common as the emergence of rifampicin resistance.

Examining which clinicians provide admission hospital care in a high mortality setting and their adherence to guidelines

KWTRP

Posted 24/03/2020. This study by Morris Ogero and colleagues was based on over 50,000 patients from 13 referral hospitals in Kenya. Results suggest that >85% of admissions are conducted by pre-registration clinicians who are under experiential training. Although clinical assessment was according to guidelines, there was a major challenge in classification of illness severity leading to overuse of treatment.

A trial of lopinavir–ritonavir in adults hospitalized with severe covid-19

@Oxford

Posted 20/03/2020. 199 patients received standard care, of which 99 received lopinavir-ritonavir for 14 days. Lopinavir-ritonavir didn’t induce significant clinical improvement, and mortality was similar in both groups. However, patients treated with lopinavir-ritonavir spent less time in hospital and in intensive care. The trial enrolled severely ill patients and was not big enough to detect modest benefits. Much larger studies are warranted to confirm or exclude if lopinavir-ritonavir treatment can help.

Parenting interventions to prevent violence against children in low- and middle-income countries in East and Southeast Asia

MORU

Posted 17/03/2020. This systematic review and meta-analysis by Amalee McCoy and colleagues synthesizes available evidence on the effectiveness of parenting interventions in preventing violence against children in the East and Southeast Asian region. The results suggest that parenting interventions can reduce rates of particular forms of violence against children, as well as promote positive parent-child interactions.

Mapping the travel patterns of people with malaria in Bangladesh

MORU

Posted 13/03/2020. New research by Ipsita Sinha and colleagues provides a framework for identifying key traveler groups and their origins and destinations of travel combination with knowledge of local epidemiology to inform malaria control and elimination efforts. This publication is based on travel information collected from over 2000 patients from 57 study sites in South-East Bangladesh, in collaboration with the National Malaria Elimination Control programme of Bangladesh.

Estimation of incidence of typhoid and paratyphoid fever in Vientiane, Lao People’s Democratic Republic

MORU

Posted 10/03/2020. Incidence data about infectious diseases are needed to inform decisions about vaccine introduction. Using data from health-seeking behaviour survey for fever and data from hospital bloodstream infection, Mayfong Mayxay and colleagues estimated typhoid and paratyphoid fever incidence in Vientiane, the capital of Laos, and found that the incidence is low, with an annual incidence of 4.7 and 0.5 per 100,000 persons, for typhoid and paratyphoid fever, respectively.

Factors affecting the electrocardiographic QT interval in malaria

MORU

Posted 06/03/2020. Prolongation of the electrocardiographic QT interval is a widely-used marker of the risk of developing abnormal heart rhythms. Several antimalarial drugs are associated with QT interval prolongation. Xin Hui Chan and colleagues found that malaria and fever also affect QT interval. To improve cardiac safety assessments, adjustment for QT interval prolongation occurring after recovery is needed. This would prevent unnecessary withdrawal of lifesaving antimalarial treatment.

Prevalence of group A Streptococcus in primary care patients and the utility of C-reactive protein and clinical scores for its identification in Thailand

MORU

Posted 03/03/2020. It is challenging to know who needs antibiotics for a sore throat and fever. In Thailand, Rachel Greer and colleagues found a bacteria (group A Streptococcus) in less than 1 out 10 patients. These patients had a raised C-reactive protein blood test but it was not able to predict who had the bacteria.

Estimating the burden of iron deficiency among African children

KWTRP

Posted 28/02/2020. Estimating the burden of iron deficiency in sub-Saharan Africa is challenging because infections influence iron biomarkers. After correcting for the effects of malaria and inflammation on iron biomarkers, Sarah Atkinson and colleagues show that over half of children are iron deficient and transferrin saturation may more accurately estimate the burden of iron deficiency in African children.

Prolonged health worker strikes in Kenya - perspectives and experiences of frontline health managers and local communities in Kilifi County

KWTRP

Posted 25/02/2020. The effects of health worker strikes vary depending on strike duration, alternative healthcare available and responses adopted by management. Most strike-related research has focussed on ethical issues and impacts on mortality. Dennis Waithaka, Nancy Kagwanja, Sassy Molyneux and colleagues explore the experience of health managers and community members during two prolonged strike periods, lasting 250 days.

Estimating hospital catchments from in-patient admission records

KWTRP

Posted 14/02/2020. The delineation of disease-specific hospital catchments is important to identify populations marginalized from health services, but rarely investigated. Victor Alegana and colleagues set out to estimate the extent of malaria catchments and investigate hospitalisation for two severe malaria syndromes in children. Results suggest distinct geographic catchment for malaria and a reduced rate of hospitalisation outside of this catchment. These findings are useful in identifying communities where very sick children may require emergency care.

Neutralizing antibodies against enteroviruses in patients with hand, foot and mouth disease

OUCRU

Posted 11/02/2020. Hand, foot and mouth disease is an emerging infection with pandemic potential. To inform vaccine development, Tan Le Van and colleagues studied the antibody responses in 120 infected patients. Results support previous reports about the potential benefit of enterovirus-A71 vaccine, but emphasize the requirement for multivalent vaccines to control this emerging infection.

Researcher and study participants’ perspectives of consent in clinical studies in four referral hospitals in Vietnam

OUCRU

Posted 07/02/2020. Within the research community, it is generally accepted that consent processes for research should be culturally appropriate and tailored to the context, yet researchers continue to grapple with what valid consent means within specific stakeholder groups. Evelyne Kestelyn and colleagues explored the consent practices and attitudes within hospital-based trial communities from four referral hospitals in Vietnam.

Performance of the Access Bio/CareStart rapid diagnostic test for the detection of glucose-6-phosphate dehydrogenase deficiency

MORU

Posted 04/02/2020. Primaquine radical cure for treatment of Plasmodium vivax is contraindicated in patients with G6PD deficiency. Ric Price, Benedikt Ley and colleagues review evidence from 11 studies of a novel point of care diagnostic (CareStart RDT) and show overall good performance under research conditions. Further feasibility studies are under way to assess its reliability under field conditions.

Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country

MORU

Posted 31/01/2020. Drug-resistant strains of the bacterial pathogen Klebsiella pneumoniae are an important and increasing cause of infant mortality in developing countries. In this study led by Professor Ben Cooper, researchers used mathematical modelling and whole genome sequencing to quantify the effects of antibiotics and other factors in driving the hidden transmission of this pathogen within a Cambodian neonatal unit.

Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal

@Oxford

Posted 28/01/2020. Delay in access to health services, diagnosis and treatment completion for TB patients is a major problem in Nepal and can contribute to severity of diseases, antimicrobial resistance, and economic burden. In this large qualitative work, Bipin Adhikari and colleagues discuss the factors impeding the access, diagnosis and treatment completion for TB patients in Nepal.

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis

OUCRU

Posted 24/01/2020. Tuberculous meningitis is the most severe form of tuberculosis. Late diagnosis leads to worse patient outcomes, however currently available diagnostic tests are insufficiently sensitive, and new tests are urgently needed. Joseph Donovan, Guy Thwaites, and colleagues present a randomised diagnostic accuracy study demonstrating that new GeneXpert Ultra is not superior to standard GeneXpert for the diagnosis of tuberculous meningitis in Vietnam.

Digital health Systems in Kenyan Public Hospitals

KWTRP

Posted 21/01/2020. Naomi Muinga and colleagues report on challenges and the progress made in implementing digital health systems in Kenyan public hospitals. Their focus is on systems used primarily for financial management but are also being used for clinical services. They show that the available infrastructure needs to be strengthened to achieve the full benefits of electronic systems.

Economic considerations support C-reactive protein testing alongside malaria rapid diagnostic tests to guide antimicrobial therapy for patients with febrile illness in settings with low malaria endemicity

MORU

Posted 17/01/2020. Malaria is no longer a common cause of febrile illness in many regions of the tropics. Yoel Lubell and colleagues consider the costs and benefits of multiplex malaria/CRP tests that are now commercially available in terms of (i) the improved health outcomes for patients with bacterial illnesses; (ii) the costs of antimicrobial resistance averted; or (iii) the economic benefits of better management of remaining malaria cases and shorter malaria elimination campaigns. They conclude that a multiplexed malaria/CRP test could be highly cost-effective and utilize the well-established funding and distribution systems already in place for malaria RDTs.

An exploration of the gut and environmental resistome in a community in northern Vietnam in relation to antibiotic

OUCRU

Posted 14/01/2020. Vu Thi Ngoc Bich and colleagues analyse the antibiotic resistance gene profiles among humans, animals, and their food and water in a rural Vietnamese community. Colistin resistance genes are predominantly found in both human and animal faeces, and a higher positive proportion of carbapenemase is reported – encoding genes among water and food samples when compared to human and animal faeces. This work is a collaboration between OUCRU and Radboudumc, Maastricht University in the Netherlands and NIHE in Vietnam.

Collective strategies to cope with work related stress among nurses in resource constrained settings

@Oxford KWTRP

Posted 10/01/2020. Our ethnography aimed to describe Nairobi’s inpatient newborn wards and the busy lives of the nurses who work there. They work long hours with little supervision in ill-designed wards, staffed by far too few nurses given the pressing need. Under these difficult conditions, the collective model of nursing that develops reduces nurses’ exposure to stress and anxiety. Jacob McKnight and colleagues describe how these coping methods have implications for the quality of care and limit the potential for a patient-centred approach.

Sensitivity of C‐reactive protein for the identification of bacterial infections in northern Tanzania

MORU

Posted 07/01/2020. Identifying bacterial infections in sub-Saharan Africa is a challenge because of limited access to laboratory infrastructure. Thomas Althaus and colleagues measured high sensitivity of C-reactive protein (CRP) in detecting bacterial blood stream infections and zoonotic bacterial pathogens among febrile patients both in primary levels of care and hospitals in Moshi, northern Tanzania

Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border

MORU

Posted 20/12/2019. How do birth outcomes, a mother’s nutrition, and how a mother feeds her infant relate to chronic undernutrition among refugee and migrant infants along the Thailand-Myanmar border? Why do these mothers feed their infants as they do? Come learn more from a recent study by Ahmar Hashmi and colleagues at the Shoklo Malaria Research Unit.

Phase 3 Efficacy Analysis of a Typhoid Conjugate Vaccine Trial in Nepal

OUCRU

Posted 17/12/2019. Typhoid fever is rampant in South Asia. This new typhoid vaccine (studied in Kathmandu, Nepal, by Buddha Basnyat and colleagues) appears to be very effective in the prevention of typhoid. Administration of the new vaccine, especially in children, will revolutionize the prevention of this disease. And, crucially, help fight typhoid treatment resistance, a burgeoning problem.

Dealing with indeterminate outcomes in antimalarial drug efficacy trials

@Oxford

Posted 10/12/2019. In antimalarial efficacy trial, researchers often encounter situation where recurrence due to new infection cannot be differentiated from recrudescence (indeterminate). In this study, Prabin Dahal and colleagues consider indeterminate outcomes as missing and recommend using statistically principled approaches that are more efficient and accurate than current practice of excluding them.

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