Posted 22/05/2018. A new Case Study by Naomi Muinga from the Global Health Informatics Group reports on the challenges faced implementing an Open Source Electronic Health Record system in Kenya and the strategies employed by the Ministry of Health and development teams for increasing user adoption as the system is scaled up.
Posted 15/05/2018. Kartika Karaswati, Stuart Blacksell and colleagues reviewed the diagnostic accuracy of the available scrub typhus point-of-care tests, feasible to be used in resource limited settings. Although the available evidence is varied in methodology and quality, POCTs appear to have low false positive rates, thus confidence in interpreting a positive result can be high.
Posted 08/05/2018. Is it ethical to withhold a recommended treatment from a patient in clinical trial? In this paper we evaluate whether exchanging placebo for an active drug is ethical. We use the example of a randomised control trial of primaquine to determine its anti-relapse efficacy against vivax malaria and conclude that in some cases a placebo arm is imperative.
Posted 01/05/2018. Hand, foot and mouth disease is a major public-health issue in Asia. Herein, Dr Tan and colleagues at OUCRU report the first detection of emerging coxsackievirus A6 among hand, foot and mouth disease patients in Vietnam, and document how this emerging virus evolves and spreads in space and time.
Posted 25/04/2018. Mary-Ellen Gilder and colleagues at SMRU demonstrate low levels of primaquine in breast milk, findings that should change treatment policy allowing more breastfeeding women to be cured of P.vivax. This will potentially reduce the global burden of this infection which has significant negative consequences for pregnant mothers and infants.
Posted 17/04/2018. This new Lancet malaria seminar, by Elizabeth Ashley and Charlie Woodrow, is one of a series of clinically focused, structured, up-to-date reviews which are grouped together in The Lancet Clinic with other relevant content. The aim of the seminars is to give a comprehensive overview of diseases to practising clinicians, emphasising recent advances, controversies and uncertainties.
Posted 10/04/2018. Antimicrobial resistance (AMR) is a serious threat to public health. A new report by Elizabeth Ashley and colleagues describes the role of supranational networks in AMR surveillance in low- and middle-income countries (LMICs); Liz Ashley and colleagues analysed networks that were in existence between January 2000 and August 2017. This study reveals the challenges of establishing sustainable and effective networks to tackle resistance to antimicrobial medicines.
Posted 29/03/2018. This randomised controlled trial, by Katherine Plewes and colleagues, of acetaminophen (paracetamol) in Bangladeshi patients with severe and moderately severe malaria shows that acetaminophen reduces kidney dysfunction and risk of developing acute kidney injury, particularly in patients with significant haemolysis. This proof-of-principle study supports the underlying hypothesis that acetaminophen inhibits cell-free haemoglobin-mediated oxidative kidney damage.
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 20/03/2018. A clinical trial in Cambodia evaluated the safety and effectiveness of mass drug administration (MDA) to interrupt multi-drug resistant falciparum malaria. Coverage with at least one round was 88%, no severe adverse events were reported, and MDA was associated with the absence of clinical P. falciparum cases for at least one year.
Posted 14/03/2018. Blood from patients treated with ivermectin can kill mosquitos. Our results indicate that ivermectin mass drug administration to humans could be a potential malaria control tool to aid malaria elimination efforts in South America.
Posted 06/03/2018. Primaquine is being promoted actively to block the transmission of falciparum malaria parasites between humans and mosquitoes to reduce the spread of highly resistant malaria \u2018superbugs.\u2019 In response, Bob Taylor and colleagues developed a primaquine dosing scheme based on age. This will be useful where there are no functioning weighing scales and when primaquine mass drug treatment will be given.
Posted 27/02/2018. The human papilloma virus is primarily known as the causative agent of cervical cancer, but it also causes anal cancer. It is easily transmitted, but often cleared, and only few infections develop
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 13/02/2018. Two mass drug administrations against falciparum malaria were conducted in 2015\u201316, one as operational research in northern Cambodia, and the other as a clinical trial in western Cambodia. During an April 2017 workshop in Phnom Penh the field teams from M\u00e9decins Sans Fronti\u00e8res and the Mahidol-Oxford Tropical Medicine Research Unit discussed lessons for future mass drug administrations.
Posted 06/02/2018. Timely access to emergency care can substantially reduce mortality. Work undertaken in Professor Bob Snow\u2019s group in Kenya, has developed the first ever geocoded inventory of public hospitals in Africa. Spatial analysis across 48 countries showed that 29% of people are located more than 2-h travel time from the nearest hospital. With substantial variations within and between countries, innovative targeting of emergency care services is necessary to reduce inequities.
Posted 30/01/2018. Podoconiosis, also known as nonfilarial elephantiasis, is a poorly understood neglected tropical disease. Using a combination of currently available epidemiological data as well as nationwide mapping survey and geostatistical modelling, Dr Abdisalan Noor and colleagues demonstrated that podoconiosis is highly endemic in Ethiopia and interventions need to be scaled-up rapidly.
Posted 23/01/2018. The search is on for good measures of healthcare quality as LMIC health systems focus on effective coverage. In a new publication the Health Services team in Nairobi recently validated the Paediatric Admission Quality of Care (PAQC) score they had earlier developed, showing higher quality scores were associated with lower mortality for hospitalised children in Kenya.
Posted 16/01/2018. Ethics guidelines have evolved to protect vulnerable groups such as pregnant women from research. This has resulted in a lack of research in these populations making them even more vulnerable because of the lack of evidence-based medical care. In this paper, Professor Phaik Yeong Cheah and her collaborators discuss how regulatory frameworks can sometimes lead to a generalized exclusion of pregnant women from research.
Posted 09/01/2018. OUCRU researcher Lauren Carrington has provided evidence supporting the introduction of Wolbachia, a bacteria that manipulates its host reproductive system, into areas where there are dengue virus-transmitting mosquitoes, as a biocontrol method to reduce the transmission of dengue and other arboviruses.
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 21/11/2017. Scrub typhus is a serious mite-transmitted and difficult-to-diagnose infectious disease increasingly recognised as a major treatable cause of febrile illnesses with a wider distribution beyond Asia. Despite many limitations on the amount and quality of available reports to date, scrub typhus remains a severely underappreciated tropical disease, deserving more attention.
Posted 15/11/2017. Professor Phaik Yeong Cheah and colleagues published a paper on the evaluation of a community engagement project using drama in Western Cambodia. They demonstrated that the project was feasible in promoting awareness of malaria prevention and control. Audience members perceived drama as entertaining and as the preferred choice of engagement activity.
Posted 07/11/2017. Bioinformatics skills have become essential for many research areas and building these skills has many challenges. Dr Etienne de Villiers and colleagues develop the eBioKit as a stand-alone bioinformatics educational and research platform that hosts numerous tools and databases for both bioinformatics research and training in a controlled environment
Posted 31/10/2017. Antimicrobial resistance is a clear and present threat to international health. Dr Phoebe Williams and Professor Jay Berkley reviewed recent data on antimicrobial resistance among children in sub-Saharan Africa since 2005. Research needs to focus on reporting community versus hospital-acquired infections, including patient outcomes, and needs pragmatic clinical trials.
Posted 25/10/2017. Professor Stephen Baker recruited more than 3,000 children with severe diarrhoea in high usage, high resistance settings in Ho Chi Minh City, Vietnam. He found that antimicrobial usage did not result in reducing the time of symptoms, and actually prolonged it in most cases.
Posted 17/10/2017. Plasmodium falciparum and Plasmodium vivax malaria in pregnancy both increase stillbirth risk, which is likely to increase as endemicity declines. A study by SMRU and University of Melbourne researchers shows that better P. falciparum malaria control efforts could prevent up to 1 in 5 to 8 stillbirths in sub-Saharan Africa.
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 10/10/2017. Severe malnutrition remains common in low-income countries, principally among young children. It usually arises from poor sanitation and infections, besides food insecurity. This comprehensive review by Professor James Berkley describes how research is needed, using modern clinic and laboratory tools, to better understand changes in metabolism, infections and the immune system to improve treatment.
Posted 04/10/2017. Melioidosis is a neglected tropical disease estimated to kill 89,000 people a year across tropical regions and a vaccine is urgently required. In this collaboration with Imperial College, Professor Susanna Dunachie report for the first time a link between people with the HLA-B*46 genotype and around a three-fold increased risk of death. Survival from melioidosis is correlated with immune responses to nine key proteins from the causative bacteria, Burkholderia pseudomallei. This gives the foundation for development of an effective vaccine.
Posted 26/09/2017. Professor Phaik Yeong Cheah and colleagues published a paper describing their experience and challenges engaging with communities involved in the Targeted Malaria Elimination initiative in Karen State, Myanmar. The report gives a detailed account of the activities conducted and challenges encountered which included difficulties explaining concepts like drug resistance and submicroscopic infection.
Posted 20/09/2017. Ric Price shows that that primaquine is substantially less effective for preventing relapses of vivax malaria in real-world practice than is predicted by clinical efficacy trials and that this is a likely consequence of incomplete adherence to treatment. Efforts to improve adherence to primaquine and to develop alternative drugs with shorter dosing regimens and greater patient tolerability are needed to achieve the significant public health benefits of P. vivax radical cure.
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 08/09/2017. Changing the practices of health care workers in multiple hospitals in low-income settings is a major contemporary challenge that requires people to think about the complex set of influences that affect clinicians\u2019 behaviour. In this report, Professor Mike English describes a multi-layered strategy utilising a new implementation typology linked to overarching theories of change.
Posted 05/09/2017. Can faster progress be made in the fight against malaria by targeting interventions to where they will have the most impact? Health economists and mathematical modellers from the Mahidol-Oxford Tropical Medicine Research Unit have developed an approach to use maps of disease risk together with models of the transmission of disease and the costs and effectiveness of malaria interventions to help local decision makers design more impactful malaria control and elimination programmes.
Posted 25/08/2017. In more than 50,000 pregnancies where 16% of women had malaria infection, the odds of small for gestational age and preterm birth following falciparum, and vivax malaria, were quantified. These newborn effects have life-long implications and efforts to effectively prevent malaria in pregnancy must be pursued.
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 18/08/2017. Malaria transmission is patchy at local levels, and when a group of houses is located in a high transmission patch this is labelled a \"hotspot\". Looking at 19 studies in 7 African Countries, we see that hotspots are the norm, and especially prominent when malaria transmission falls.
Posted 14/08/2017. Through history and attributes of migration of Multi Drug Resistant Tuberculosis patients before diagnosis and treatment, and spatial analysis of their travelling patterns, the study highlights links between human migration and dispersal of multi-drug resistant Tuberculosis across wide geographic areas. It confirms needs for interventions suited to migrants\u2019 life circumstances.
Posted 01/08/2017. For more than a decade, Professor Mike English and his team have worked with the Kenyan Ministry of Health and professionals to develop national clinical guidelines. This paper describes how this approach has become both more rigorous and more collaborative while offering lessons to other LMIC on how to develop high quality guidelines with limited resources.
Posted 25/07/2017. Professor Jeremy Day and fellow researchers from OUCRU, in collaboration with colleagues from the Genome Institute Singapore, have published the first whole genome sequences of Vietnamese isolates of the yeast Cryptococcus neoformans, in an attempt to better understand the genes that enable some families of this usually accidental pathogen to cause disease in people with normal immune systems.
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 11/07/2017. We used a qualitative approach to study how public hospitals in Kenya make resource allocation decisions. We found that these decisions were influenced by (1) scarcity of financial resources, and poorly designed financing processes, (2) limited flexibility in resource allocation decisions, and (3) inadequate management and leadership capacity in the hospitals. Read more on Improving priority settting practices in Kenya's hospitals.
Posted 30/06/2017. Acute mountain sickness is a potentially life-threatening illness for sojourners to high altitude (> 2500m). Where pharmacological prophylaxis is indicated, Diamox is the drug of choice, but it has distressing side-effects. This Everest-based, double-blind, randomized controlled trial revealed that paracetamol, like ibuprofen, could potentially replace Diamox for prophylaxis.
Posted 13/06/2017. It has been maintained for decades that quinine is the safest drug for treatment of malaria in the first trimester of pregnancy. In the largest analysis of data from Thailand and Africa, artemisinins are reported to be at least as safe as quinine. This will simplify treatment protocols worldwide.
Posted 30/05/2017. Rotavirus is a complex RNA virus with a genome comprised of multiple segments. The virus causes diarrhoea and extracting pure virus from stool samples limits our ability to sequence its genome. A team led by Professor Stephen Baker developed a new capture/purification method for rotavirus allowing us to perform whole genome sequencing from stool samples for the first time.
Posted 25/04/2017. South Asia, which includes Nepal, is a hub for typhoid fever. Trials conducted in Nepal since 2005 confirm that fluoroquinolones are failing for typhoid fever treatment. The WHO and health ministries in the region recommend fluroquionolones as the drugs of choice for typhoid fever. This recommendation needs to be changed.
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