Posted 22/09/2023. The transformation of village malaria workers (VMWs) into community health workers with roles beyond malaria is a promising approach for sustaining health care provision in remote areas. Rupam Tripura and colleagues discuss on how training on health education could be optimized for VMWs.
Posted 08/09/2023. Sharing results with participants from research studies is largely underappreciated. Bipin Adhikari and colleagues explore the perception and practice of results-sharing in malaria related clinical trials among researchers. Although there was a consensus on the rationale of result sharing to participants, most researchers thought that disseminating results to policymakers and stakeholders for research translation was more important.
Posted 06/09/2023. Sompob Saralamba and colleagues have proposed a new model explaining why increased dosing of antimalarial drug artemisinin doesn't speed up parasite clearance. It suggests that exposure to the drug makes some malaria parasites temporarily resistant, leading to either delayed death or reactivation. This could revolutionize treatment strategies for this deadly disease.
Posted 05/09/2023. Arjun Chandna and colleagues show that a point-of-care test for the soluble urokinase plasminogen activator receptor (suPAR) has good prognostic accuracy to predict oxygen requirement in patients presenting with moderate Covid-19 and suggest that suPAR should be explored for risk stratification of other infectious diseases.
Posted 31/08/2023. Vendors at wet markets in Laos may be exposed to different zoonotic pathogens depending on the types of food they sell. A one-year serological survey by Matthew Robinson and colleagues identified that individuals selling vegetables, domestic farmed meat, or wildlife meat, were potentially infected by important bacterial pathogens associated with both farmed animals and wildlife.
Posted 30/08/2023. Alternative Design Trials (ADTs) and Adaptive Platform Trials (APTs) have enabled efficient large-scale testing of biomedical interventions during recent Public Health Emergencies (PHEs). Alun Davies and colleagues aimed to rapidly review evidence on engagement and informed consent for ADTs and APTs during PHE to consider what (if any) recommendations can inform practice.
Posted 30/08/2023. This study by Makoto Saito and colleagues analysing 213 severe malaria cases in pregnancy at SMRU, MORU and OUCRU showed vital organ dysfunction led to high maternal and fetal mortality. In contrast, severe anaemia or hyperparasitaemia alone did not. This marked difference may explain the variation of mortality reported in the literature. Early diagnosis and treatment of malaria and anaemia in antenatal care should be promoted.
Posted 18/08/2023. Fever is a common reason to seek healthcare in Southeast Asia, and the decline of malaria has further complicated fever perceptions and actions taken. This mixed-methods study from 2019, on Thai-Myanmar border revealed diverse range of fever conceptions, symptoms and believed causes. Napat Khirikoekkong, Supa-at Asarath and colleagues mapped out context-specific healthcare seeking strategies and discussed its influencing key determinants.
Posted 16/08/2023. Tools for safe community-based childhood pneumonia management are needed. Studies often do not include outpatients or consider whether laboratory tests add value to clinical assessment. Arjun Chandna and colleagues found that Angiopoietin-2 improved performance of a validated risk score (LqSOFA) to predict oxygen requirement amongst refugee children with pneumonia on the Thailand-Myanmar border.
Posted 30/06/2023. Millions of affordable healthy homes are needed for the rapidly expanding population of sub-Saharan Africa. A pilot project in northern Tanzania demonstrates the potential of novel house designs to reduce infectious disease transmission in homes. Lorenz von Seidlein and colleagues describe the challenges experienced during the construction and initial evaluation of the novel homes.
Posted 20/06/2023. The SEBCOV study reveals captivating insights into the Malaysian experience during the COVID-19 pandemic. With a nationwide Movement Control Order and a race to administer vaccines, Malaysians faced unprecedented challenges. Phaik Kin Cheah, Phaik Yeong Cheah and colleagues highlight the coping strategies, economic impacts, lifestyle changes, and evolving perceptions of the COVID-19 vaccine.
Posted 16/06/2023. The decline of malaria in Southeast Asia means other causes of fever are increasingly relevant, but often undiagnosed. Deployment of novel point-of-care tests for acute febrile illnesses in primary care settings is feasible if tests are user-friendly, well-selected for local pathogens, accompanied by disease-specific education, and have simple management algorithms. By Thomas Peto and Bipin Adhikari
Posted 08/06/2023. Richard Maude and colleagues investigated dengue in Myanmar, focusing on its epidemiology, association with climate, and short-term prediction. Dengue was observed to be widespread across the country, with an increasing spatial reach. Incidence was influenced by climate factors, but varied across different regions. Utilizing time series analysis, researchers also forecasted dengue incidence one month ahead at subnational levels. The findings highlight the potential of spatiotemporal modelling to quantify risk factor associations and generate short-term predictions, assisting in intervention planning.
Posted 26/05/2023. In a recent study from Angkor Hospital for Children, Paul Turner and colleagues recruited over 2,000 Cambodian children with clinical pneumonia in the first three years following pneumococcal conjugate vaccine (PCV13) introduction nationally. PCV13 vaccinated children were less likely to have severe presentations, i.e. x-ray confirmed or hypoxic pneumonia, compared to non-vaccinated children.
Posted 23/05/2023. Napat Khirikoekkong, Supa-at Asarath, Phaik Yeong Cheah, and colleagues analyse how the socio-cultural norm of Arr-nar or Kreng-jai influences the research experiences of individuals taking part in research on the Thai-Myanmar border. Arr-nar (in Burmese/Karen) or Kreng-jai (in Thai) encompasses multiple meanings including consideration for others and graciousness.
Posted 09/05/2023. Implementation of evidence-based newborn care interventions in low-resource settings works! Very and moderate preterm neonatal mortality reduced by 68% and 53% between 2008-2017 in refugees and migrants. Find out how Ahmar Hashmi, Verena Carrara, Rose McGready and SMRU colleagues achieved this.
Posted 02/05/2023. The \u2018Antibiotic footprint\u2019 concept supports a global reduction in antibiotic overuse. In this paper, Direk Limmathurotsakul and colleagues describe \u2018antibiotic footprint calculator\u2019, an open-access, web-based application that lets anyone calculate how different individual decisions can reduce or increase their own personal antibiotic footprint.
Posted 10/03/2023. Timo Tolppa and CCAA colleagues conducted a qualitative study across 4 South Asian countries to understand the implementation of a critical care registry, which is used to enable quality improvement and research. Implementation was possible due to motivated champions, a supportive community of practice and efforts to fit the registry with existing practice.
Posted 07/03/2023. Understanding the Glucose-6-Phosphate Dehydrogenase (G6PD) activity of vivax patients is critical for the appropriate choice of radical cure regimens for vivax malaria. Village malaria workers (VMWs) in rural Cambodia are frequently the first and only health care providers for malaria patients but lack G6PD diagnostics. Bipin Adhikari and colleagues found that after training VMWs can use biosensors to assess G6PD activity just as well as laboratory technicians.
Posted 07/02/2023. Rachel Greer and team in Chiangrai, Thailand found that the challenges research participants face in their daily lives, such as, language barriers and limited access to healthcare can influence their experiences of taking part in research. Researchers need to be responsive towards these specific vulnerabilities in order to reduce the burdens and maximize the benefits of research for participants.
Posted 23/12/2022. December 2022 sees two notable anniversaries: the 200th anniversary of the birth of Louis Pasteur and the third anniversary of China's announcement of the COVID-19 outbreak. On these coinciding events, Phaik Yeong Cheah and colleagues reflect on past and current global challenges to bring epidemics under control.
Posted 22/12/2022. On Jan 27, 2022, WHO recommended a moratorium on the deployment of rectal artesunate suppositories for severe malaria and in doing so stopped the roll-out of a lifesaving intervention. The decision is based on data from a large demonstration project CARAMAL. Lorenz von Seidlein discusses the project and its consequences with two leaders of the project in a point- counterpoint published in the Lancet infectious Diseases.
Posted 20/12/2022. G6PD deficiency is a major risk factor for severe neonatal jaundice among neonates born at the Thailand-Myanmar border. Early identification of G6PD deficiency can dramatically improve clinical care. In this study Germana Bancone and colleagues showed that a new point-of-care quantitative G6PD test used by trained midwives can reliably identify neonates with abnormal G6PD at birth.
Posted 16/12/2022. Radical cure of vivax malaria with primaquine requires testing for glucose-6-phosphate dehydrogenase deficiency, which is currently not provided at the community level in Cambodia. In this article, Bipin Adhikari and colleagues describe the core components needed for implementing radical cure at the community, which will increase coverage important for rapid vivax malaria elimination.
Posted 14/12/2022. Malaria outbreaks can be driven by genetic selection rather than environmental or behavioural causes. Varanya Wasakul, Olivo Miotto and colleagues investigated a Plasmodium falciparum outbreak in Attapeu, Laos, in 2020-2021, using genomic epidemiology methods to elucidate parasite population dynamics, identify the outbreak\u2019s causes and reconstruct the origin of the circulating strains.
Posted 06/12/2011. Scrub typhus is an important cause of febrile illness in Laos. Ivo Elliott and colleagues collected, identified and tested small mammals hosts and vector chigger mites for Orientia tsutsugamushi, the causative pathogen. A single pool of chiggers tested PCR positive and 16/52 (31%) of small mammals were seropositive. These are the first molecular and serological data on O. tsutsugamushi in vectors and non-human hosts from Laos.
Posted 29/11/22. Makoto Saito and colleagues evaluated the fetal safety of antimalarials in the first trimester of pregnancy. Pregnant women who were treated with artemisinin-based combination therapy (ACT) in the first trimester had fewer fetal losses and congenital anomalies than quinine-treated women. Updated WHO guidelines recommend ACT, particularly artemether-lumefantrine, for all trimesters.
Posted 22/11/2022. Who owns individual-level health data collected from health research and clinical care? In this paper Phaik Yeong Cheah and Jan Piasecki argues that neither public ownership nor private ownership will allow us to resolve all the problems associated with effective, equitable, and ethical use of data.
Posted 21/10/2022. Amodiaquine is an important antimalarial widely used for the treatment and prevention of malaria, protecting millions of African children every year. Xin Hui Chan and colleagues characterised the concentration-dependency of the bradycardic, hypotensive, and QT-prolonging effects of amodiaquine and its active metabolite desethylamodiaquine in clinical and pre-clinical studies, providing evidence of their causal role.
Posted 18/10/2022. Trust is perhaps the most frequently attributed element in decision making for vaccine uptake. But what is trust, and how does it affect vaccine decision? In this qualitative review, Bipin Adhikari and colleagues explored how decisions on vaccine uptake are made, the role of trust and ways to build it.
Posted 07/10/2022. G6PD measurement is critical before including primaquine or tafenoquine in the treatment for vivax malaria. Bipin Adhikari and colleagues explored whether first line health care providers can safely handle G6PD biosensors in the rural Cambodia. Our findings suggest that the radical cure for vivax malaria can be safely administered at the point of first contact, thus preventing relapse and continued transmission in a much larger population than through hospital based management.
Posted 05/10/2022. Sutharshan Vengadasalam, Timo Tolppa and colleagues employed pathway mapping, ethnography, and interviews in Colombia, South Africa, Sri Lanka, Tanzania and Uganda, and found four common barriers to the delivery of quality perioperative care - Fragmented care pathways, limited human and structural resources, direct and indirect costs, and patients' low expectations of care.
Posted 21/09/2022. Phaik Yeong Cheah and colleagues asked malaria stakeholders in Burkina Faso and Nigeria: What are the key ethical considerations to be considered in the deployment of Triple Artemisinin-based Combination Therapies for malaria in Africa when artemisinin combination therapies are effective in most of Africa?
Posted 14/09/2022. Victor Chaumeau and colleagues evaluated the efficacy of outdoor residual spraying for malaria vector control on the Thailand-Myanmar border. Intervention was showed to rapidly interrupt transmission in a setting where the vectors bite mostly outdoors and at a time when people are not protected by mosquito bed nets.
Posted 31/08/2022. Substandard and falsified anti-infectives used in human and animals are common, especially in Low- and Middle-Income countries, leading to poor clinical outcomes, adverse drug reactions, economic losses, mistrust in health systems and potentially leading to AMR emergence and spread. One Health research is needed to assess their impact on AMR, by Celine Caillet and colleagues.
Posted 12/08/2022. This small series describes four family members who contracted cutaneous leishmaniasis due to Leishmania major that did not improve in two patients and worsened in the other two despite 4 weeks of intralesional meglumine antimoniate. All responded to a 4-week course of oral ketoconazole. The paper provides an interesting discussion, by Bob Taylor and colleagues
Posted 09/08/2022. Timo Tolppa and CCAA colleagues reviewed the literature on perioperative care pathways in resource-poor settings and found that pathways are increasingly used there with an aim to improve care quality. Patient and clinician beliefs were a major challenge in care pathway implementation, whereas facilitators included context-relevant adaptations, strong evidence-base and teamwork.
Posted 02/08/2022. Severe malaria is difficult to diagnose in high malaria transmission areas because of the high coincidence of malaria with other febrile illnesses. James Watson and colleagues analysed platelet counts and plasma PfHRP2 concentrations from >2000 severely ill children and show that around a third of children diagnosed with severe malaria have in fact another cause of illness.
Posted 28/07/2022. Meiwen Zhang and Tom Peto start a prevalence survey, including Hepatitis B and Hepatitis C, among the rural population in Bangladesh, Cambodia, and Thailand. In 2021 Meiwen and colleagues published a pilot implementation project on hepatitis C testing and treatment in rural Cambodia.
Posted 26/07/2022. In this paper, Phaik Yeong Cheah and colleagues describe the challenges and coping strategies related to public health measures during the first COVID-19 lockdown in Thailand. Major challenges identified included financial hardship, social isolation and loneliness. Coping strategies included turning to religion, practicing acceptance and \u2018making merit\u2019 (Tham-bun in Thai).
Posted 19/07/2022. What effect temperature and time have on organism detection from positive blood culture bottles is unknown. Tamalee Roberts, Arjun Chandna and colleagues found that the majority of organisms were recoverable from positive blood culture bottles stored at room temperature. Amies transport swabs also proved effective for transporting blood culture broth and preserving organism viability.
Posted 14/07/2022. Children bear a substantial burden of TB disease on the Thai-Myanmar border. Treatment success rate exceeded the WHO End TB target of 90%, suggesting that similar vulnerable populations could benefit from the enhanced support of the residential TB program offered by Francois Nosten and colleagues. However better child-friendly diagnostics are needed to improve the detection of TB in children.
Posted 22/06/2022. Mutations on the G6PD and UGT1A1 genes play a large role in neonatal jaundice, including the severe forms, among Karen and Burman neonates. Germana Bancone and colleagues show that improved diagnostics are urgently needed and different screening strategies should be considered in populations with a high prevalence of these traits.
Posted 21/06/2022. The South-East Asia Encephalitis Consortium, coordinated by Institut Pasteur-Paris, published in Lancet Global Health, a large prospective study of childhood encephalitis in Cambodia, Laos, Vietnam and Myanmar. The Lao site was coordinated by LOMWRU/Microbiology Laboratory, Mahosot Hospital. This demonstrated the vital importance of prevention, especially vaccination against Japanese encephalitis, and access to rapid, tiered diagnosis and treatment.
Posted 13/05/2022. \u201cUnder the Mask\u201d is a 75-min feature film that follows the lives of patients with TB who live on the Thai-Myanmar border. Phaik Yeong Cheah, Michele Vincenti Delmas and colleagues explains the genesis and development of the film, and how it has been used to engage communities at risk of TB.
Posted 03/05/2022. We\u2019ve all been there! Waiting forever for reviewers comments after submission our paper to a journal. The system is not working. Should we pay reviewers to review a paper? Will it make a difference? Phaik Yeong Cheah and Jan Piasecki give some arguments why we should. What are your thoughts?
Posted 29/03/2022. In regions with low Covid-19 vaccine coverage, health systems remain vulnerable to surges in infections. Arjun Chandna and colleagues developed three clinical prediction models to help identify patients safe for community-based management. Each model contains three simple clinical parameters (age, sex, SpO2) and one point-of-care biomarker, and could help protect resource-limited health systems.
Posted 22/03/2022. The first randomised trial of artemether-lumefantrine plus amodiaquine for uncomplicated falciparum malaria in areas with a high prevalence of artemisinin resistance shows it is a well-tolerated, effective treatment for multidrug-resistant parasites. Coordinated by Tom Peto, James Callery and Rupam Tripura, the triple therapy provides an alternative first-line treatment in Southeast Asia and elsewhere, with an expected longer therapeutic lifetime than current artemisinin combination therapies.
Posted 15/03/2022. Bipin Adhikari reviews a book titled \u2018Phantom Plague: How Tuberculosis Shaped History\u2019 by Vidya Krishnan--a prominent medical science reporter. The book is a compelling journey into a history of medicine, current development of Tuberculosis epidemiology and treatment, and Global Health and is an essential read in Global Health.
Posted 11/03/2022. In paediatric research, a legal representative must provide consent on behalf of the child. Using Thailand as a case study, Sheila Varadan, Phaik Yeong Cheah and colleagues contemplate how international legal frameworks could be leveraged to navigate legal uncertainty in the informed consent process, enabling more children to participate in paediatric clinical research.
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