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.
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
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
Posted 20/03/2020. 199 patients received standard care, of which 99 received lopinavir-ritonavir for 14 days. Lopinavir-ritonavir didn\u2019t 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.
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.
Posted 10/01/2020. Our ethnography aimed to describe Nairobi\u2019s 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\u2019 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.
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.
Posted 19/11/2019. Emergence and spread of antimicrobial resistance can lead us to a dead end! It is important to understand factors to its emergence. In this editorial, Bipin Adhikari and colleagues discuss how to broaden our current gaze at tackling the growing antimicrobial resistance in low- and middle- income countries.
Posted 08/11/2019. Nzelle Delphine Kayem, Peter Horby and colleagues at the University of Oxford report on the first training course specifically designed for clinical research during outbreaks and tailored to low and middle-income countries. Following a very positive evaluation by the first cohort of trainees, the Oxford team plan to franchise out the course through a variety of providers.
Posted 01/10/2019. In the light of the alarming global increase in diabetes, Kartika Saraswati and colleagues at the LOMWRU-IDDO Medicine Quality team found few investigations on the quality of antidiabetics and supplies for self-monitoring of blood glucose. However, poor quality medical products were identified on four continents. This important public health issue should thus be further investigated.
Posted 18/09/2019. A protocol for carrying out a systematic rapid research needs appraisal of existing evidence within five days, to rapidly inform clinical research prioritize in response to emerging outbreaks globally. This protocol was developed and successfully piloted by Louise Sigfrid and colleagues using a fictitious Lassa fever outbreak scenario. The protocol is optimized by effective use of global time-zones.
Posted 23/07/2019. Professor Peter Horby and colleagues at the University of Oxford have compiled data from over 6000 patients to provide a comprehensive clinical description of Ebola virus disease. The team also assessed the quality of the published data and found it to be partial, overlapping, and in many instance non-comparable. For high-threat diseases such as Ebola, the authors recommend the establishment of global, anonymised patient registries as a resource for improving patient care.
Posted 02/07/2019. Highly efficacious treatment can limit the cumulative deleterious impact of malaria during pregnancy on the mother and fetus. Correct assessment of treatment efficacy with an adequate length of follow up is required. Makoto Saito and colleagues at the Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border suggest that pregnant women need to be followed up longer than the currently recommended duration of follow-up to assess antimalarial drug efficacy.
Posted 01/03/2019. Peter Horby and colleagues highlight the essential importance of standardised biological reference materials (such as antibodies) for the development of new diagnostic tests, treatments and vaccines, yet their widespread absence for dangerous diseases such as viral haemorrhagic fevers. They suggest a framework for developing these materials that addresses practical as well as ethical and equity issues
Posted 05/02/2019. In this study, the WWARN K13 genotype-phenotype Study Group gathered 18 studies from Africa and Asia to explore the relationships between identified Kelch 13 mutant alleles and delayed parasite clearance. Results show one P. falciparum specific mutant and 20 pfk13 propeller region mutant alleles strongly associated with the slow clearance phenotype, including 15 mutations that have not been confirmed before. It was reassuring that no pfk13 alleles associated with slow parasite clearance were observed in the parasites from African studies gathered between 2000-2017.
Posted 29/01/2019. Gail Carson, Peter Horby, Laura Merson and colleagues promote the importance of developing clinical research networks in low-resource settings as a pillar to epidemic preparedness in a Letter to Lancet Global Health. The CTM&GH researchers are focused on developing capacity and partnerships across settings at highest risk of infectious disease outbreaks.
Posted 08/01/19. Four out of five people in the world with diabetes now live in low and middle income countries. Professor Susanna Dunachie and her Thai collaborator Parinya Chamnan describe how diabetes leads to increased risk and worse outcomes for global infections such as TB, melioidosis and dengue, alongside discussing potential mechanisms and interventions.
Posted 05/12/2018. A WWARN team recently completed a large systematic literature review to understand whether undernutrition places children at higher, lower, or no differential risk for getting malaria. We raise the concern whether an adapted antimalarial treatment strategy is needed in malnourished children. The results present the risks associated with chronic and severe acute malnutrition and the impact on sub-optimal drug exposure, poor patient outcomes and the potential contribution towards an increased risk of antimalarial drug resistance. Photo credit: Albert Gonz\u00e1lez Farran, UNAMID, 2013
Posted 20/11/18. Malaria in pregnancy affects both mothers and fetuses. Safe and efficacious antimalarials are needed for treating pregnant and breastfeeding mothers to protect them from devastating outcomes due to malaria. Dr Makoto Saito, Professor Fran\u00e7ois Nosten and colleagues at the Shoklo Malaria Research Unit have reviewed and summarised the maternal and fetal safety of the currently available antimalarials in pregnancy and postpartum, spotlighting this neglected and vulnerable population.
Posted 12/09/2018. The Infectious Diseases Data Observatory (IDDO) has answered a call from the Editors at Lancet Global Health to inform future policy and expectations on authorship of publications based on secondary use of data. The IDDO position, based on the promotion of equity, effectiveness and sustainability in global health research, serves as an excellent example of the collaborative approach endemic to the Center for Tropical Medicine and Global Health.
Posted 05/06/2018. Children suffering from malaria and malnutrition might experience diminished height growth when treated for both conditions simultaneously. Philippe Guerin and colleagues found that children treated for both falciparum malaria and uncomplicated severe acute malnutrition in Niger experienced a reduction in height gains while increasing their weight at the same time.
Posted 27/03/2018. This study proposes path for improving surveillance of antimalarial resistance through new technologies to produce molecular assays and capacity strengthening among national reference laboratories. After identifying deficiencies in method standardisation, study authors said a range of affordable techniques, combined with improved access to standardized protocols, training and proficiency testing, could boost surveillance efforts.
Posted 20/02/2018. The malaria parasite is a major cause of illness and deaths throughout the tropics. To survive, the malaria parasite needs to be transmitted by mosquitos form person to person. In this paper Martin Rono and colleagues show at the cellular and molecular level how the parasite balances its investment between growing efficiently in humans and maximising the chances of being transmitted by mosquitos, depending on the local environment.
Posted 02/01/2018. Technological potentials have raised high hopes on healthcare access in LMICs like India. However, five years of research by Dr Marco Haenssgen paint a less optimistic picture and show adverse consequences of mobile phone diffusion, which creates more competition and new divisions and leaves the poorest strata of population worse off than before.
Posted 12/12/2017. Snakebite envenoming is a neglected tropical disease that kills 100,000 people and maims 400,000 every year. Impoverished populations living in the rural tropics are particularly vulnerable; snakebite envenoming perpetuates the cycle of poverty. Intravenous administration of antivenom is the only specific treatment to counteract envenoming. Confronting snakebite envenoming at a global level demands the implementation of an integrated intervention strategy involving local, national and international organisations.
Posted 05/12/2017. Zika virus RNA is frequently detected in the semen after Zika virus infection. To learn more about persistence of viruses in genital fluids, Dr Alex Salam and Professor Peter Horby searched PubMed and found evidence that 27 viruses can be found in human semen. This may have implications for the risk of sexual transmission, embryonic infection, congenital disease, miscarriage, and infection transmission models.
Posted 28/11/2017. Prabin Dahal reviewed the evolution of statistical methods used to understand and define antimalarial drug efficacy in uncomplicated P. falciparum malaria. The article gives a thorough insight into the historical practices and critically reviews the challenges and limitations associated with current approaches and offers alternative methodologies leading to improved study design and analysis.
Posted 13/10/2017. Professor Peter Horby outlines potential epidemics in Africa. It is difficult to predict when and where new epidemics might occur so we can be better prepared and have a proactive response. This modelling is based on information on each virus as well as governance, communication, infrastructure and health care provision. Some areas remain at high risk and would benefit from improved surveillance, diagnostic capabilities and better health systems and local policies.
Posted 04/10/2017. Recruiting 183 acute melioidosis patients and 21 control subjects in order to explore immune factors associated with survival status and diabetes, this study identified two class I HLA alleles associated with increased risk of death during melioidosis. Stronger T cell responses to nine immunodominant antigens were observed in those who survived, with responses to one of these \u2013 GroEL \u2013 observed to be impaired in patients with diabetes.
Posted 13/09/2017. Amanda Rojek and Peter Horby published a review aimed at clinicians who may treat patients with Ebola Virus Disease. This review outlines advances in understanding the clinical presentation, outcomes and long term sequelae of the disease, and outlines the status of experimental vaccines and treatments.
Posted 22/08/2017. Selecting and trialling therapeutics for preventing congenital Zika disease is challenging. The target product should be low risk, acceptable to the mother, highly effective in preventing adverse fetal outcomes, and practical for widespread clinical use in resource-limited settings. Professor Peter Horby and fellow researchers discuss strategies for addressing these challenges in a recent paper.
Posted 18/07/2017. The WWARN Vivax Surveyor provides an interactive map that summarises the prevalence and degree of chloroquine resistance in Plasmodium vivax parasites across the world. This tool provides a clear and standardised visualisation of vivax clinical trials to date to inform key international, regional and national monitoring strategies.
Posted 17/03/2017. An investigation conducted by the international medical organisation M\u00e9decins Sans Fronti\u00e8res revealed that over a thousand people in a remote area of the Democratic Republic of Congo suffered toxic effects after ingesting fake diazepam pills. The research was published in The Lancet Global Health with contribution from Prof Paul Newton from IDDO and LOMWRU.
Posted 03/11/2016. Six harmonised protocols to capture Zika-related data to help public health professionals, clinicians and clinical researchers to gain a better understanding of the disease has been published on the WHO website. A number of partners - under the leadership of Institut Pasteur and WHO, including ISARIC and CONSISE have contributed to the development of these protocols to address key public health concerns associated with the Zika virus outbreak. The Working Group on ZIKV Harmonized Research, which included Dr Gail Carson and Professor Peter Horby, published a commentary on the project in the Lancet Global Health yesterday.
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