Posted 16/04/2019. Lorenz Von Seidlein and colleagues in Thailand, Myanmar, Vietnam, Cambodia, and Laos explored what happens to malaria transmission when all people residing in a village are treated with antimalarials at the same time, whether they are sick or not. They demonstrated that providing the necessary information is important, but building trust between residents and the team providing the antimalarials is most critical for success.
Posted 12/04/2019. Tetanus continues to be a significant problem in many countries. This seminar, written by OUCRU researchers Lam Minh Yen and Louise Thwaites describes the evidence base for tetanus treatment, current vaccination challenges and research questions for the future.
Posted 09/04/2019. An ethnography work on neonatal nursing, led by Jacinta Nzinga in Nairobi, shows that to cope with incredibly high workloads, informal task shifting is already happening where non-clinical tasks are delegated to students, mothers and support staff. However, nurses are anxious about professional boundaries and the added responsibilities of supervising a potential new cadre.
Posted 05/04/2019. Until World War II the only Plasmodium vivax malaria generally recognised had either a long (8\u20139 months) incubation period or a similarly long interval between initial illness and the first relapse. Long-latency P. vivax \u2018strains\u2019 were the first in which relapse, drug resistance and liver stage development were described, yet in recent years they have been largely forgotten.
Posted 02/04/2019: Underdiagnosed in South Asia, melioidosis is caused by a bacterium called Burkholderia pseudomallei which is often referred to as a remarkable imitator. Pulmonary involvement including infections mimicking tuberculosis is a common form of presentation. In this case report, Buddha Basnyat and colleagues show that if a South Asian patient does not respond to anti tuberculosis treatment, melioidosis should be considered.
Posted 29/03/19. This qualitative study documents how clinical interventions are influenced by their local context. Factors like health policies or physicians\u2019 fears of under-treating infectious diseases can influence adherence to the intervention and potentially hamper efforts to reduce antibiotic use in developing countries. The work was led by former CTMGH member Marco J Haenssgen, drawing on clinical trials in Southeast Asia by Yoel Lubell and Heiman Wertheim.
Posted 26/03/19. Lorenz Von Seidlein and colleagues wanted to know whether well-resourced mass drug administrations (MDA) can accelerate malaria elimination in the Greater Mekong Subregion. They randomised 16 villages in Myanmar, Vietnam, Cambodia, and Laos to receive MDAs with antimalarial drugs. The intervention had a substantial impact on the prevalence of P. falciparum infections by month 3 after the start of the MDAs. Over the subsequent 9 months, P. falciparum infections returned but stayed below baseline levels.
Posted 18/03/2019. Tailored interventions that specifically target at-risk populations, such as forest-goers, will be crucial for achieving malaria elimination in Southeast Asia. This review By Tom Peto and colleagues highlights the behaviours and attitudes of forest-goers towards malaria prevention and control interventions to identify what changes can be made to reduce the malaria incidence in this population.
Posted 15/03/2019. There is increasing recognition that children remain at increased risk of death following discharge from hospital in resource-poor settings. Alison Talbert and colleagues found that admission in children aged under 5 years with diarrhoea alone does not increase 12-month post-discharge mortality compared to admission with other conditions excluding severe pneumonia.
Posted 12/03/2019. Large case-control studies have reported that glucose-6-phosphate dehydrogenase deficiency exists due to its opposing effects on falciparum malaria: protection against cerebral malaria but an increased propensity to develop severe malarial anaemia. A reanalysis of these claims by James Watson and colleagues shows they are likely explained by 'collider bias', as case definitions excluded patients with both anaemia and coma on presentation.
Posted 08/03/2019. Peter Macharia and colleagues used all available census and survey data in Kenya to evaluate subnational changes in child mortality rates between 1965 and 2015. Although Kenya has made huge gains in reducing child mortality, with a 62% reduction, the success remains uneven with considerable disparity. The study also demonstrates suboptimal performance to meet global milestones in child survival. The results are key in tracking SDG 3.2
Posted 05/03/2019. Seasonal malaria is common in the Sahel, resulting in malaria-related morbidity and mortality, particularly in young children. Seasonal chemoprevention with the antimalarial drug dihydroartemisinin-piperaquine is effective and safe. However, results presented here by Palang Chotsiri and colleagues show that malaria incidence could be reduced substantially by using an increased and extended dosage in young children.
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 26/02/2019. In this multi-center randomized controlled trial, Cindy Chu and colleagues assess the safety of a single dose tafenoquine for Plasmodium vivax radical cure. With appropriate G6PD testing, the number of adverse events, frequency and severity of haemoglobin reduction are similar to primaquine. Anti-relapse efficacy of tafenoquine is similar to primaquine; 69.1% vs 73.2%, respectively.
Posted 19/02/2019. Germana Bancone and colleagues characterized glucose-6-phosphate dehydrogenase deficiency in over 10 thousand samples collected in 138 villages in Cambodia, Lao PDR, Myanmar, Thailand and Vietnam, showing a country-level prevalence in males ranging from 7.3% to 18.8%. Given this high prevalence, G6PD testing should be carried out in the Greater Mekong Subregion before P. vivax radical cure with 8-aminoquinolines.
Posted 12/02/2019. In this study, Professor Ric Price, Rob Commons and colleagues show a high risk of vivax parasitaemia after treatment of falciparum malaria, particularly in areas with short relapse periodicity and after rapidly eliminated treatment. In co-endemic regions, universal radical cure for all patients with uncomplicated malaria has the potential to prevent recurrent parasitaemia, reduce ongoing transmission, and enhance malaria elimination efforts.
Posted 08/02/2019. Dengue has been estimated to cause a substantial health and economic burden globally. However, the specific estimates from different studies vary significantly. This review by Dr Hugo Turner and colleagues provides an overview of the different dengue burden estimates, using Vietnam as a case study. Understanding the methodology behind these calculations is vital when interpreting economic evaluations of novel dengue interventions.
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 01/02/2019. In many low- and middle-income countries, putting a critically ill patient on a ventilator is associated with a high risk of the patient dying or developing additional problems. In this paper, Rebecca Inglis and colleagues explore measures avert to the need for a ventilator. They also look at ways to improve the safety of ventilators in low-resource settings.
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 22/01/2019. Scientists don\u2019t know which of the malaria parasites\u2019 ~6000 proteins make good vaccines. Conflicting results abound partly due to a lack of standardized tests. To make better vaccines, Professor Faith Osier and colleagues designed KILchip v1.0: a glass slide imprinted with 384 proteins using microarray technology. Coupled with human samples from the SMART Network, we used KILchip to generate data spanning close to 30 years in 3 months.
Posted 15/01/2019. Dr Thomal Althaus and colleagues managed to reduce antibiotic prescription using the C-reactive protein (CRP) test among 2,410 children and adults presented with a fever in primary care centres in Thailand & Myanmar. The perspective of a rapid and affordable test for CRP, identifying febrile patients who really need an antibiotic, is now possible!
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 21/12/18. A photo from Pearl Gan, Photographer In Residence for OUCRU, was selected for The Lancet Highlights 2018. The picture shows Senior Nurse Shikh Rema changing the dressing for Jabeda Begom, a 65-year-old woman with leprosy, at the Jalchatra Hospital in Bangladesh. Treatment of leprosy is a lengthy process, but thanks to dedicated staff, patients are given the care and attention they need.
Posted 18/12/18. Various drivers of treatment-seeking behaviour contribute to disease outcomes. Victor Alegana and colleagues set out to quantify the probability of seeking treatment for fever in 29 sub-Saharan African countries. The probability of seeking-treatment for fever was less than 50% in half the countries. Findings provide insights into public sector utilization at national and subnational levels, and aim to improve planning, resource allocation and disease burden estimation.
Posted 11/12/2018. Phaik Yeong Cheah and colleagues report a qualitative study on how best to seek broad consent to sharing individual level health research data beyond research collaborations. Their findings demonstrated that research participants prioritise information about the potential benefits and harms of data sharing. The researchers also found that explaining data sharing to research participants was challenging.
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 27/11/2018. Since January 2018 there has been a significant increase in hospital admissions due to hand, foot and mouth disease across Vietnam. In collaboration with Children\u2019s Hospital 1 in Ho Chi Minh City, Dr Tan and colleagues set out to describe the etiology, clinical characteristics and demographics of the affected patients.
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 13/11/2018. Quinoline and related antimalarial drugs are vital tools in the fight against malaria. However, concerns about their possible effects on the heart rhythm may limit their use. Dr Ilsa Haeusler, Dr Xin Hui Chan, and colleagues found that these serious side effects are reassuringly rare in the treatment of malaria
Posted 06/11/18, review by Professor Nick White. Malaria, a parasitic infection of red blood cells, is a leading cause of anaemia in the tropics. Where malaria transmission is intense patients, typically children, may die from severe anaemia. However when falciparum malaria causes other vital organs to fail, moderate anaemia appears to protect against death.
Posted 30/10/18. Isabella Ochola-Oyier and colleagues investigated what impact individuals who carry parasites and show no malaria symptoms (asymptomatics) has on developing clinical malaria. They identified age and transmission intensity as factors that increase the risk of clinical infection. Asymptomatic individuals irrespective of age were at increased risk of clinical malaria at low transmission.
Posted 23/10/18. A plethora of innovative portable devices to screen for poor quality medicines has become available. In a review of the scientific evidence regarding their performances, Dr Celine Caillet and colleagues show that there is a vitally important lack of independent evaluation of the majority of the 41 devices (most being spectrophotometers) found in our search, particularly in field settings. Intensive research is needed in order to inform national medicines regulatory authorities of the optimal choice of device to combat poor quality medicines.
Posted 16/10/18. Clinical research is a crucial component of outbreak response as it provides evidence to improve the prevention and treatment of diseases with epidemic potential. However, disease epidemics are unpredictable and often short-lived, and this adds many challenges to the conduct of clinical research. Professor Peter Horby and colleagues have evaluated some commonly used clinical trial designs in order to determine the optimal design for this context.
Posted 10/10/2018. Community volunteers are used to deliver a number of healthcare interventions. Although these volunteers are not paid, their time still has an economic value, known as an opportunity cost. Dr Hugo Turner and colleagues found that this economic value is significant for mass drug administration programs: for the African Programme for Onchocerciasis Control alone it would be valued at US$60-90 million.
Posted 02/10/2018. Rising prevalence of HIV drug resistance in low and middle-income countries poses a growing threat to the HIV response. To curb resistance, enhanced strategies are needed that improve quality of ART care and treatment. Raph Hamers reviews contemporary data and highlights the potential impact and resistance risks of novel ART strategies and knowledge gaps.
Posted 25/09/2018. Invasive non-typhoidal Salmonella disease is common in parts of Africa; there is an ill-defined burden in Asia. Stephen Baker and colleagues describe a new variant of Multi-Drug Resistant Salmonella associated with invasive disease in Vietnam. The identification of this organism highlights new ways zoonotic pathogens can exploit human niches to cause serious infections.
Posted 18/09/2018. Let by Professor Yoel Lubell, researchers from MORU and IDDO estimated the economic costs of AMR associated with the consumption of a range of antibiotic classes in high and lower-middle income countries. These estimates are essential for economic evaluations of interventions that affect antibiotic consumption to reflect the full costs and benefits of their use.
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 04/09/2018. DHA-piperaquine is an important antimalarial recommended by the WHO for the treatment of malaria, and an ideal candidate for mass use in malaria elimination. In a large meta-analysis of ~200,000 subjects, Dr Xin Hui Chan and colleagues find the risk of sudden unexplained death after DHA-piperaquine is extremely low and not higher than baseline, confirming the drug\u2019s safety for the treatment and prevention of malaria.
Posted 21/08/18. Globally, approximately 40-75% tuberculosis cases are missed, mostly due to under-reporting and under-diagnosis. Jacquie Oliwa and colleagues describe TB case notification rates, patterns of distribution and use of diagnostic tests as per Kenyan guidelines. There is an under-use of TB diagnostics tests, especially in children, which results in a notification rate eight times smaller than that of adults. New strategies are needed to increase the use of diagnostics, including innovations to improve access and overcome local barriers to the adoption of guidelines and technologies.
Posted 24/07/18. A study from Bangkok by Professor Wirichada Pan-Ngum and colleagues shows accessing households for proper spraying was a problem for control dengue outbreaks. In addition, inefficient communications among the sectors from hospital to district offices led to inaccurate or missing patient addresses for spraying. Involving community networks help to improve public engagement with and participation in the programmes.
Posted 17/07/2018. This paper by Professor Stuart Blacksell and colleagues describes the first update to the WHO Laboratory Biosafety Manual in 15 years. The need to update international lab biosafety guidance is part of a broader initiative to globalize biosafety, emphasizing principles and approaches that are accessible to countries spanning a broad range of financial, technical and regulatory resources.
Posted 10/07/2018. The decline of malaria in Vietnam can largely be attributed to the use of artemisinin-combination therapy (ACT) for case management. Recent analyses from Africa showed that insecticide-treated nets had the greatest effect on lowering malaria prevalence, suggesting that the success of interventions is region-specific. Malaria elimination efforts should focus on both vector control and increased access to ACT.
Posted 03/07/2018. Chloroquine, the recommended treatment for vivax malaria, delays but does not prevent relapses. Primaquine is the only widely available drug that prevents relapses but it can induce haemolysis in patients with G6PD deficiency. Cindy Chu and colleagues showed that added to chloroquine, primaquine is very effective for relapse prevention, but should be used alongside quantitative G6PD testing.
Posted 27/06/2018. Current recommended treatment regimens for the most widely used medicine for uncomplicated Plasmodium falciparum malaria may be sub-optimal for small children and pregnant women according to a study led by Professor Joel Tarning.
Posted 19/06/2018. Many people with pre-existing heart problems (including heart attack, pacemaker implantation, arrhythmia), high blood pressure and even past history of a stroke seek advice regarding high altitude travel ( > 2500m) for recreation, meetings or pilgrimages. Dr Buddha Basnyat and colleagues succinctly try to address these conditions at altitude and make reasonable recommendations in the face of limited data.
Posted 12/06/2018. Among people with HIV infection who are starting antitretroviral treatment in Africa, both the amount of HIV virus in the body and the person's nutritional status are risk factors for dying. Professor Jay Berkley and colleagues found that giving a supplementary diet led to weight gain, but did not improve survival or illness. Malnutrition, rather than the severity of HIV, should guide the use of supplementary food.
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 30/05/2018. Drug resistant bacterial infections are becoming a major problem. Genomics has become a fundamental tool for tracking bacteria and provides us with the data and knowledge to begin to initiate a response. Stephen Baker and colleagues discuss how resistant bacteria emerge and spread and outline some approaches and knowledge gaps that can help us tackle this global heath emergency.
![\"\"](\"https://www.tropicalmedicine.ox.ac.uk/news/research-highlights/community-engagement-social-context-and-coverage-of-mass-anti-malarial-administration/responsive_image?ratio=r16x9&scale=w760\")
\n \n \n\n\n