Posted 14/03/2025. This commentary explores whether there is epistemic injustice in global antimicrobial resistance (AMR) research \u2013 who sets priorities, who produces knowledge, and which types of knowledge are valued. Prof Phaik Yeong Cheah and colleagues argue that epistemic injustice may have created blind spots in policy. Addressing this requires a commitment to diversity, equity, and inclusion.
Posted 11/03/2025. Malaria is known to be dangerous for pregnant women and their developing babies. But how much malaria is too much malaria? Using an ultra-sensitive PCR method that detects one parasite per drop of blood, Mary Ellen Gilder and SMRU colleagues found that even infections with very few parasites are associated with adverse pregnancy outcomes.
Posted 07/03/2025. Reducing antibiotic duration is key to antimicrobial stewardship. A review of 315 trials found strong evidence for shorter courses in common infections but limited data for severe infections and low-income settings. Only 15% had low bias risk. More research is needed in critical care and resource-limited environments. By Mo Yin
Posted 05/03/2025. Marlous Grijsen and colleagues highlight the challenges associated with dapsone for leprosy treatment in Indonesia. Dapsone, a key drug in multi-drug therapy, can cause life-threatening adverse drug reactions, including dapsone hypersensitivity syndrome and hemolytic anemia. Routine screening could prevent these complications, but in many leprosy-endemic areas, testing and alternative regimens are inaccessible or unaffordable. We call for better diagnostics and alternative treatments to ensure safer care.
Posted 04/03/2025. Previously, the REGARD-VAP trial found that giving patients with ventilator-associated pneumonia (VAP) a personalised, shorter antibiotic treatment was just as effective as usual care. Mo Yin and colleagues showed this approach is also cost-effective in Nepal, Singapore, and Thailand. This approach could save money, reduce antibiotic use, and help policymakers make better healthcare decisions despite some uncertainties.
Posted 18/02/2025. Emerging artemisinin-resistance in Africa threatens our ability to treat malaria. Joel Tarning and colleagues developed an optimal weight-based dosing of a fixed-dose artemether-lumefantrine-amodiaquine formulation using population pharmacokinetic modelling. Dosing was designed to achieve consistent drug exposure across all body weights. This formulation should simplify manufacturing and improve adherence, when treating resistant malaria.
Posted 05/02/2025. Neglected tropical diseases (NTD) affect >1 billion people, disproportionally affecting under-resourced communities. While the term \u2018NTD\u2019 has been instrumental in driving critical funding and policy initiatives, it may also carry unintended negative consequences. Marlous Grijsen and colleagues explore the term NTD to foster dialogue and advocate for more inclusive and equitable language.
Posted 04/02/2025. In Kenya and Uganda, hospital care for under-fives is intended to be free. James Berkley and colleagues studied families\u2019 healthcare, travel, other costs, and loss of earnings due to child admissions at six hospitals. 74% to 92% of households experienced \u2018catastrophic\u2019 expenditure (depending on the definition used) in relation to monthly income.
Posted 31/01/2025. This is an important finding for Kenya, artemisinin resistance k13 mutations previously identified in Uganda (C469Y and A675V) and SE Asia (P553L) are described. Though at low frequencies, 4%, 1.7% and 1.2%, respectively, they sound the alarm for studies to determine their impact on the efficacy of artemisinin-based combination therapies. By Isabella Oyier
Posted 29/01/2025. Conducting research in LMICs is undeniably challenging, with brain drain often surpassing reverse brain drain. We share an opinion discussing both the difficulties and rewards of working in this space. Claire Chewapreecha and Thongchai Chewprecha hope it will encourage international and national funding agencies to invest in LMIC talent, and drive meaningful, lasting impact.
Posted 28/01/2025. Each year, 15 million babies are born prematurely, with Sub-Saharan Africa and Asia accounting for over half. Weak healthcare systems and poverty in SSA worsen outcomes for mothers and babies. This study by Justinah Maluni and Dorothy Oluoch explores the challenges mothers face post-discharge and suggests strategies to improve care and reduce mortality and readmission rates.
Posted 24/01/2025. Salum Mshamu and colleagues evaluate community responses to novel design homes in Mtwara, Tanzania, aimed at reducing childhood diseases such as malaria, respiratory infections, and diarrhoea. Using qualitative research, the study explores how residents and neighbours interact with the novel housing design including its impact on residents' lives, social, cultural, and health-related issues. The findings offer insights for future community wide novel housing interventions.
Posted 22/01/2025. Nancy Kagwanja and colleagues examined public feedback in health systems, focusing on its forms, channels, processing, and responses. Feedback mechanisms often operated in isolation, excluding vulnerable groups. Organisational challenges, such as inadequate resources, weak policies and power dynamics limited effectiveness. Integrating diverse mechanisms and addressing system capacities are vital for improved responsiveness.
Posted 21/01/2025. Novel housing interventions (Star Homes) in Tanzania aim to prevent childhood diarrhea, malaria, and respiratory infections by addressing multiple aspects of housing\u2014one of which is cooking stoves. Our research on Star Homes in rural Tanzania revealed inconsistent use of improved cookstoves, sparking a systematic review into factors influencing stove acceptability globally. By Bipin Adhikari
Posted 17/01/2025. Victor Chaumeau and colleagues developed a reference MALDI-TOF mass spectra database for the identification of Anopheles mosquitoes from the Thailand-Myanmar border allowing rapid, affordable and accurate identification of medically important vector species, an important prerequisite to assess disease transmission and evaluate vector control. This is the first free open-source data analysis pipeline allowing anyone to replicate the analysis and develop reference database in-house.
Posted 07/01/2025. The continued costs of a standard national AMR surveillance system are predicted to account for over 5% of the total domestic general government health expenditure (GGHE-D) for 28 LMICs and more than 2% of GGHE-D for 46 LMICs. This high cost is not sustainable without a long-term global financing mechanism. By Liz Ashley
Posted 20/12/2024. AmpC \u03b2-lactamases are a neglected cause of third generation cephalosporin resistance in Southeast Asia. This collaboration between COMRU, LOMWRU and SMRU showed that AmpC \u03b2-lactamases are an important cause of infection, though infections may be going undetected due to a lack of testing resulting in sub-optimal treatment for patients. By Tamalee Roberts
Posted 17/12/2024. Tom Peto and colleagues collected Plasmodium falciparum parasites from malaria patients in Cambodia and Vietnam between 2018 and 2020 in the MORU-led TACT-CV study. Novel molecular analyses of these samples at Nanyang Technological University identified new genetic factors that appear under selective pressure and may contribute to artemisinin resistance mechanisms in clinical settings.
Posted 03/12/2024. This comprehensive review, co-authored by Marlous Grijsen and a multidisciplinary team of global experts from leprosy endemic and non-endemic countries, describes the epidemiology, pathophysiology, clinical manifestations and management of leprosy and the impact it has on quality of life. The paper addresses knowledge gaps and research priorities and offers an up-to-date perspective on leprosy.
Posted 22/11/2024. Since 2023 the Chiang Rai community advisory board helped researchers understand the many local ethnic minority groups of Northern Thailand and vice-versa, improving cooperation and research activities. Over time, benefits have grown. Carlo Perrone and colleagues present their experience one year on, supporting long-term partnerships over project-based ones.
Posted 20/11/2024. A participatory-action approach involving community members and adolescents resulted in a dialogue-drama (Karen and Burmese versions) on adolescent pregnancy, contraception, and choice in the event of an unplanned pregnancy. The dialogue-drama augmented discussion of traditionally taboo issues and this ethnographic method is potentially useful for similar global health settings. By Rose McGready
Posted 19/11/2024. Bob Taylor and colleagues determined that vitamin D deficiency is exceptionally high, 85%, in 510 5-15 years-old school children from Kandahar city, Afghanistan. Half had severe deficiency. Older children from poor families with limited outdoor activity and inadequate sun exposure were more likely to be deficient. These data provide evidence for a mitigation strategy.
Posted 13/11/2024. Ruth Lucinde, Anthony Etyang and colleagues conducted a prospective longitudinal hospital-based sentinel surveillance at 16 public hospitals in Kenya during the COVID-19 pandemic to describe the clinical and demographic pattern of patients admitted with severe acute respiratory illness (SARI), and evaluate COVID-19 vaccine effectiveness. They identified key risk factors for mortality and reported a moderate vaccine effectiveness of 59% against progression to inpatient mortality.
Posted 24/10/2024. Duy Pham\u2019s lab performed comprehensive epidemiological analysis of bloodstream infections (BSI) in Vietnam (2010-2020), revealing an increasing trend of E. coli and K. pneumoniae as predominant pathogens. Both showed rising multidrug resistance, primarily affecting elderly individuals with comorbidities. Antibiotic prescriptions declined significantly following control policies. Their work highlights the needs for community surveillance and antimicrobial stewardship to manage BSIs in Vietnam.
Posted 23/10/2024. Robert Sinto, Raph Hamers and colleagues conducted a nationwide evaluation of antimicrobial stewardship programmes (ASP) in Indonesian public and private hospitals. They found that to date most hospitals only reached an inadequate or basic level of ASP implementation, and they identified several globally-relevant and context-specific barriers. The paper formulates actions recommended for sustainable improvement.
Posted 22/10/2024. Severe neonatal hyperbilirubinaemia is often diagnosed late in low-resources settings because of lack of point-of-care tools. In this study, Germana Bancone and SMRU researchers have evaluated the performance of a transcutaneous bilirubinometer for screening of neonates born along the Thai-Myanmar border. The study was supported by a Wellcome Trust iTPA grant.
Posted 22/10/2024. Duy Pham's lab investigated hypervirulent Klebsiella pneumoniae bloodstream infections in Vietnam, uncovering high strain diversity likely driven by horizontal transfer of non-self-transmissible virulence plasmids. Plasmid acquisitions led to the independent emergence of MDR hypervirulent strains. Significant gaps persist in understanding community transmission for targeted interventions, especially in Asia where new strains are emerging.
Posted 18/10/2024. Nick White and K. Chotivanich publish a review of mechanisms, genetic associations, phenotyping, epidemiology and current status of artemisinin resistance, and a brief discussion of policies and potential counter-measures.
Posted 10/10/2024. Pneumococcal Conjugate Vaccines (PCV) have had a tremendous impact on childhood morbidity but only 2/3 of children receive a PCV. One obstacle to wider protection is cost. Kate Gallagher, Anthony Scott and others at KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya, showed that a 40% fractional dose of PCV13 had non-inferior immunogenicity to a full dose, suggesting similar benefits could be delivered for lower cost.
Posted 09/10/2024. Junjie Ding and the MORU Clinical Pharmacology Team developed an in-host dengue kinetic model to quantitatively predict drug effects in dengue fever. This model offers valuable insights to inform dengue drug development, and shows that ivermectin reduces NS1 but not viral load. The results are published in a leading PK/PD modelling journal, CPT:PSP.
Posted 02/10/2024. Le Van Tan and colleagues studied a community cluster of mpox in Vietnam caused by emerging MPXV sublineage C.1, imported into Vietnam through 2 independent events; 1 major cluster carried a novel APOBEC3-like mutation. Three patients died; all had advanced HIV co-infection. Viral evolution and its potential consequences should be closely monitored.
Posted 24/09/2024. Measles-infected children with chronic diseases had lower vaccination rates and a higher proportion of hospital-acquired infections during the 2017\u20132019 outbreak in northern Vietnam. Early nosocomial transmission was detected before community outbreaks in several provinces. Strengthening hospital infection control and raising awareness about the importance of vaccination for vulnerable groups is essential. By Thinh Ong Phuc
Posted 17/09/2024. Bob Taylor and colleagues investigated 1205 primary school children in Kandahar and found almost 50% were stunted, 25% were underweight and 20% wasted. Risk factors for stunting in 6\u20139 year old children were poverty, skipping breakfast, and being a girl from a large family with an uneducated mother and an unemployed father.
Posted 11/09/2024. The Groupe de Recherche Action en Sant\u00e9, a Developing Paediatric Primaquine project partner, will assess, for the first time, the transmission blocking efficacy of allometrically-scaled, single low-dose primaquine, using the WHO-recommended 0.25 mg/kg target dose, in under-5 Burkinabe children with uncomplicated Plasmodium falciparum. The study protocol is now published. By Bob Taylor.
Posted 11/09/2024. Daniel Mbuthia and colleagues surveyed 356 Kenyan medical doctors, to understand what influences their career choices at labour market entry, specifically understanding the role of public service motivation. They highlighted that nearly all surveyed doctors are public service oriented, many doctors stated intention to work in the public sector but were unable due to lack of job opportunities. Unfortunately, 13% of the doctors were unemployed one year after completing their internship.
Posted 10/09/2024. Collaborating with the Ministry of Public Health, Direk Limmathurotsakul and colleagues utilised an automated tool, evaluated and reported the frequency of antimicrobial-resistant (AMR) infection in 111 public hospitals in Thailand in 2022. Our approach and findings highlight health regions and hospitals where actions against AMR infection, including antimicrobial stewardship and infection control, should be prioritised.
Posted 06/09/2024. Kioko Mwikali, Abdirahman Abdi and colleagues at KEMRI-Wellcome Trust used extracellular vesicles circulating in plasma to noninvasively study the progression of cerebral malaria in children. This provides a mechanism for identifying diagnostic biomarkers and developing therapeutic strategies.
Posted 04/09/2024. Over 50 years after its first publication, this revised classification of G6PD genetic variants is the result of the 2022 WHO Global Malaria Programme experts\u2019 consultation led by Professor Lucio Luzzatto. The new classification reconciles biochemical and clinical aspects of the different G6PD mutations and provides a reliable reference for scientists and clinicians. By Germana Bancone.
Posted 03/09/2024. Yingxi Zhao, Stephanie Nzekwu and colleagues examined new Kenyan doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. The research highlighted three dimensions of liminal experiences in professional practice, relational inter- and intra-professional identity and status, and professional careers.
Posted 06/08/2024. Kioko Mwikali, Abdirahman Abdi and colleagues found that the CSF proteome of cerebral malaria is more similar to Alzheimer's Disease than to acute bacterial meningitis, with cerebral malaria showing elevated amyloidosis. This finding might benefit the search for treatment and management of both Alzheimer's Disease and cerebral malaria.
Posted 02/08/2024. Plasmodium falciparum malaria is a strong predisposing factor for bacteraemia. Silvia Kariuki and colleagues investigated the impact of the rare malaria-protective Dantu blood group variant on susceptibility to bacteraemia. We found that Dantu was significantly protective against bacteraemia only during a high malaria transmission period. This suggested that the protective effect of Dantu on bacteraemia is secondary to its protective effect against malaria.
Posted 17/07/2024. A large multidisciplinary team conducted qualitative research in five ICUs in Bangladesh and India. They found that less restrictive ICU visiting policies improved experiences for patients and families \u2013 and the family\u2019s presence at the bedside could improve patient care. Supporting nurses to give routine updates promoted better communication with families. By Rebecca Inglis
Posted 16/07/2024. Borimas Hanboonkunupakarn and coworkers from MORU and the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand have shown that the co administration of the malaria vaccine R21/matrix M combined with the antimalarials drugs DHA/piperaquine and the single low dose primaquine does not interfere with the immunogenicity of the vaccine or the concentrations of piperaquine.
Posted 15/07/2024. A recent study from northeast Thailand identified three major bacterial lineages responsible for melioidosis in the region. Each lineage carries unique gene sets that likely contribute to successful dissemination. These genes are expressed under environmental rather than infectious conditions, with one lineage showing overexpression under nutrient deprivation, highlighting environmental persistence is a prerequisite for infection. By Claire Chewapreecha
Posted 11/17/2024. Tackling antimicrobial resistance requires collaboration between communities, stakeholders and researchers. In the \u2018AMR Dialogues\u2019 project, Tassawan Poomchaichote, Phaik Yeong Cheah and colleagues conducted a series of conversations, bringing together people from different backgrounds. This paper summarises issues identified across Thailand and highlights four locally actionable \u2018building blocks\u2019 of co-created solutions.
Posted 10/07/2024. Physician associate and nurse practitioner roles have been developed largely to meet changing healthcare demand and increasing workforce shortages. Yingxi Zhao and colleagues summarise the factors influencing their development and integration in hospital teams, advocating for organisation context-specific workforce solutions, long-term investment, substantial resources, and transparent processes to meet evolving healthcare challenges.
Poster 09/07/2024. Genital herpes infections and their related complications lead to billions of dollars in health care expenditures and productivity losses globally, say researchers who calculated the first-ever global estimates of the economic costs of these conditions. The study calls for greater investment in prevention of herpes transmission, including concerted efforts to develop effective vaccines against this common virus. By Puttarin Kulchaitanaroaj; MAEMOD, MORU.
Posted 05/07/2024. Early warnings of clinical deterioration through continuous non-invasive monitoring could benefit clinical care in dengue-endemic settings. Taking the approach of using low-cost wearables, Chanh Ho Quang and colleagues successfully demonstrate the ability to classify dengue patients with different severity and disease state. The implementation of these models could improve patient outcomes and resource allocation
Posted 04/07/2024. Some known risk factors for severe COVID-19 outcomes disproportionately affect South Asian populations. In Bangladesh, Mohammad Ali and colleagues showed that overweight/obesity is linked to lower neutralising antibody levels and higher T-cell responses post-COVID-19 recovery, while type 2 diabetes does not alter antibody or T-cell responses. This research highlights the importance of targeted vaccination and treatment strategies.
Posted 03/07/2024. Collaborative AI efforts between high-income countries (HICs) and low- to middle-income countries (LMICs) are essential for pooling resources and expertise. Jenny Yang, Louise Thwaites and colleagues show that AI approaches can lead to divergent outcomes across HIC and LMIC settings. Using COVID-19 screening data, we demonstrate that bias mitigation methods improve fairness and maintain diagnostic sensitivity.
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