Posted 18/02/2022. Integrating digital health innovations to the public hospital system in Vietnam requires understanding of the local technical and regulation landscape to avoid abandonment and ensure sustainability. Duc Minh Tran and colleagues mapped the relevant policy and academic publications, providing a big picture to inform the adoption of hospital-based digital health systems in Vietnam.
Posted 16/02/2022. Severe malaria is a medical emergency requiring prompt supportive and parenteral (intravenous/intramuscular) treatment. Beatrice Amboko and colleagues showed the inadequacy of the readiness of primary public health facilities to deliver appropriate pre-referral care to children with severe malaria in Kenya between 2017 and 2021.
Posted 15/02/2022. In this cost of illness study, Aishatu Adamu and colleagues found that in children aged <5 years, a week-long hospitalisation with pneumonia or invasive pneumococcal disease resulted in substantial costs to the health provider and households. Expenses were catastrophic for a third of the households, and for over half of the poorest households.
Posted 10/02/2022. In many countries, strict public health measures characterised the first wave of the pandemic, disrupting and changing everyday lives. But how were these measures individually experienced? This qualitative study by Mira Schneiders and colleagues provides a rich account of the challenges, opportunities and coping strategies of people living through the first COVID lockdown in Thailand, Malaysia, Italy, and the UK.
Posted 09/02/2022. To understand how complex social and programmatic interventions work, a mix of methods that entailed a blend of literature review, reflections from experiential and disciplinary expertise were utilized. This review by Bipin Adhikari and colleagues highlights the complexity of Nepal\u2019s primary health care system (PHC), how it has evolved over the decades and through the current federalization, and challenges and opportunities to transform the PHC.
Posted 08/02/2022. There has been very little research on the epidemiology of severe malaria for over 20 years. Alice Kamau and colleagues analysed 52,000 malaria admissions from 49 settings across East Africa. Under high transmission, malaria hospitalisation was concentrated in children <5. Severe malaria anaemia is currently the most common severe disease presentation. Spatially and age targeting interventions, including chemoprevention and vaccines, will have the maximum benefit in areas where prevalence of infection is \u226510%.
Posted 04/02/2022. Current knowledge of P. falciparum artemisinin resistance evolution in Asia is as old as 4yrs ago. For swift policy decisions, rapid sharing of data collected over extended periods in the same areas is highly needed. Frank Kagoro and colleagues found a steady increase in geographic locations and the proportion of artemisinin resistance from 2002 to 2018. Using the latest WHO classification, the authors map all published K13 markers in Asia by province and district.
Posted 01/02/2022. Pham Thanh Duy and colleagues at OUCRU have revealed the endemic circulation of fluoroquinolone-resistant extra-intestinal pathogenic Escherichia coli ST1193 in Vietnam, driven by multiple strain importations and sustained transmissions between humans. These organisms have developed resistance to multiple drugs of choice and are major causes of sepsis in neonates and bloodstream infections in adults in this setting.
Posted 28/01/2022. This case-control study by Koukeo Phommasone and colleagues aimed to determine the causes of acute respiratory infection (ARI) in patients presenting to a hospital in Laos. ARI was commonly attributed to influenza A and B, human metapneumovirus and respiratory syncytial virus. Other organisms were detected at similar frequency in cases and controls.
Posted 26/01/2022. Though Shigella flexneri serotype 6 has been proposed as a target for vaccine development against shigellosis, it is currently understudied. Hao Chung The and colleagues analyzed the genomes of 96 bacteria isolated from Asia, and showed that this pathogen\u2019s dominant lineage likely emerged in 1970s, and predicted that resistance against first-line antimicrobials was rare.
Posted 25/01/2022. This latest addition by Elizabeth Ashley and colleagues to the PLOS Medicine Vivax Malaria Collection describes the clinical impacts of Plasmodium vivax malaria, and incorporates a rapid systematic review of severe disease. Reports of severe vivax malaria are increasing, however the literature is dominated by case reports and case series, impeding accurate estimation of incidence.
Posted 19/01/2022. Rita Njeru, Sassy Molyneux and colleagues examine the role of community health workers in supporting post-discharge recovery in young undernourished children. The authors argue that a targeted and multi-pronged approach initiated before or on discharge is needed, supported by clear guidance and training. The ways in which any new tasks or personnel are incorporated into hospital and broader health system hierarchies and systems need careful planning and tracking.
Posted 13/01/2022. Associate Professor Tan and colleagues demonstrated that Oxford-AstraZeneca COVID-19 vaccine is immunogenic in Vietnamese health-care workers. Neutralizing antibodies were detectable in 98.1% and 94.7% of the study participants at 14 days and month 3 after vaccination, respectively. These data are critical to informing the deployment of the COVID-19 vaccine.
Posted 23/12/2021. Marcus Schultz and colleagues analysed 4 large prospective observational studies conducted in 534 ICUs in 54 countries. Patients in middle\u2013income countries were younger, shorter with a slightly lower BMI, had more often diabetes and active cancer, but less often COPD and heart failure. Sequential organ failure assessment scores were similar. ICU mortality was higher in middle\u2013income countries, and inversely associated with GDP.
Posted 08/12/2021. The prevalence of malaria parasite in the population is a key metric used for disease stratification. At sub-national levels, this prevalence is strikingly heterogenous, transcending national borders in Kenya, Tanzania and Uganda. Approximately 12.7 million people in East Africa continue to live in areas with over 30% prevalence. This mapping by Victor Alegana and colleagues highlights why countries must work together to reduce burden and prevent further malaria deaths.
Posted 26/11/2021. Steven Wambua and colleagues analysed monthly reports in 204 Kenyan hospitals and quantified the impact of COVID-19 on utilization of inpatient services. Data was obtained from the District Health Information Software 2 (DHIS 2). We observed significant drops in monthly volumes of live-births, over-fives admissions for medical, and surgical care with the greatest declines in the under-five\u2019s admissions.
Posted 16/11/2021. In response to the Zika epidemic the Research Preparedness Network (REDe) engaged local health research communities to enhance long-term research capacity building. This publication is based on a call to fund research training workshops in Brazil and captures the process and impact of this approach. REDe also developed an implementation toolkit to foster similar initiatives and ultimately contribute to local ownership in global health.
Posted 12/11/2021. Global antibiotic consumption rates increased by 46 percent in the last two decades, according to the first study to provide longitudinal estimates of human consumption in 204 countries from 2000 to 2018. Annie Browne, Christiane Dolecek and colleagues used a novel approach that deployed statistical modelling techniques and incorporated multiple data sources, to help us address a number of public health challenges, from combating drug resistant infections to providing access to basic treatment
Posted 05/11/2021. Generation of quality surveillance data is one of the pillars of the WHO response to the global AMR problem. However, work by LOMWRU\u2019s Tamalee Roberts and colleagues estimates that laboratory setup and running costs for hospital-based AMR surveillance in Southeast Asia are likely to be prohibitive in many resource-limited settings.
Posted 02/11/2021. Claire Chewapreecha and colleagues employ a powerful combination of genome-wide epistasis and co-selection study (GWES); gene expression analyses and gene knockout assays to identify the key genes that have been repeatedly selected through Burkholderia pseudomallei evolution. The study indicates that the bacterium is evolutionarily primed to survive nutrient-depleted soils and highlights the need to protect environmental health as part of disease prevention.
Posted 20/10/2021. Scrub typhus infects over a million people a year across the Asia-Pacific. The ecology of this important disease, transmitted by chigger mites, remains poorly understood. Ivo Elliott and colleagues report on the identification of key risk factors that determine foci of high disease transmission at 3 sites in Northern Thailand.
Posted 19/10/2021. The search for more effective and affordable treatments for cryptococcal meningitis must go on, as results of a trial repurposing tamoxifen, a drug developed for breast cancer, found it had no effect in a trial in Vietnam, by Nguyen Thi Thuy Ngan and Jeremy Day. Although tamoxifen shows activity against Cryptococcus neoformans in vitro, there was no evidence of benefit in patients. The OUCRU team will keep looking for better treatments for cryptococcosis.
Posted 15/10/2021. Tan Le Van and colleagues showed Delta variant breakthrough infections may cause asymptomatic or mild disease, but are associated with high viral loads and low levels of vaccine-induced neutralizing antibodies. The data suggested ongoing transmission had occurred between fully-vaccinated individuals. Social distancing measures remain critical to reduce the transmission of SARS-CoV-2.
Posted 01/10/2021. In 2017 hundreds of thousands of \u2018Rohingya\u2019 fled from Myanmar to refugee camps in Cox\u2019s Bazar, Bangladesh. Health centre data were reviewed to estimate the increase in health care utilization. The presence of a large migrant population relative to a smaller host community burdens the limited facilities and resources of the public health sector, by Lorenz Von Seidlein and colleagues
Posted 29/09/2021. Xin Hui Chan and colleagues report a large individual patient data meta-analysis of malaria clinical trials supporting the cardiovascular safety of amodiaquine and structurally related antimalarials at WHO-recommended dosing regimens alone or in ACTs for the treatment and prevention of malaria, and propose a potential mechanism for amodiaquine-related asthenia.
Posted 28/09/2021. Despite most neonatal deaths being preventable, neonatal mortality remains unacceptably high globally. Saving Babies\u2019 Lives (SBL) is a stepped-wedge cluster-randomised trial, which will develop, implement, and assess an iterative package of neonatal interventions combining community and primary care strategies to reduce neonatal mortality in a rural Cambodian province, by Claudia Turner and colleagues
24/09/2021. Plasmodium vivax in SE Asia and Oceania is less sensitive to primaquine compared to other regions and needs a higher target dose - 0.5 mg/kg. Bob Taylor and colleagues propose a new regimen that was designed using pharmacokinetic simulation and takes into account that children need higher mg/kg doses compared to adults.
Posted 22/09/2021. Kelvin Mokaya, Sarah Atkinson and colleagues found that children with severe malaria anaemia have higher risk of non-typhoidal Salmonella bacteraemia, and lower levels of the iron-regulating hormone, hepcidin (even with Salmonella coinfection) compared to other forms of malaria. Reduced hepcidin may increase iron availability for bacterial growth in the Salmonella-containing vacuole.
Posted 21/09/2021. The WHO's \u20185 moments\u2019 is the dominant paradigm for hand hygiene globally. While \u20185 moments' has many benefits and has had a significant clinical impact, it also has many weaknesses. Jacob McKnight and colleagues explore how this important paradigm can be improved to reflect the latest research in hand hygiene.
Posted 17/09/2021. One of the policies to achieve malaria elimination in the near future is reactive case detection. A secondary analysis of a large dataset of mass drug administrations in Greater Mekong Subregion found that reactive case detection in this setting is costly but results only in minimal benefits, by Lorenz Von Seidlein and colleagues
Posted 15/09/2021. In Cambodian G6PD deficient variants, G6PD enzyme activity is unaffected by baseline reticulocyte counts but rises and correlates with posttreatment reticulocytosis. Qualitative G6PD tests are unlikely to misdiagnose G6PD deficient males at presentation. Too few G6PD heterozygous females preclude drawing inferences; more research is needed in this group.
Posted 14/09/2021. Little is known about why scrub typhus and murine typhus vary through time and space. Tamalee Roberts and colleagues investigated the impacts of climate and environment on both neglected diseases in Laos. The results suggest that global heating will increase their incidence and distribution, requiring interventions to reduce their burden.
Posted 02/09/2021. A cross-sectional survey of G6PD deficiency genotypes and phenotypes of nearly two thousand girls and women living on malarious Sumba island in eastern Indonesia assessed risk of hemolytic crisis with primaquine therapy against latent malaria with G6PD screening technologies. These findings by Kevin Baird and colleagues will help guide the selection of G6PD screening methodology and practice.
Posted 01/09/2021. Rob Paton, Alice Kamau and colleagues analysed a data series of over 6000 hospital records of malaria admissions among children aged 3 months to 9 years. A 25% reduction in transmission halved the rate of severe malaria hospitalization. Severe malaria remains a burden predominantly in children under 5 years, regardless of the level of malaria transmission.
Posted 31/08/2021. Using a simple One Health survey design, this pilot study by Juan Carrique-Mas and colleagues measured AMU in the four commonly farmed animal species in the Mekong Delta (Vietnam) and compared it to human AMU using different metrics. Lessons from this study can be used in the formulation of One Health surveillance systems.
Posted 27/08/2021. Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for paediatric complex and chronic conditions, however such expansion is threatened by workforce shortages. Yingxi Zhao and colleagues reviewed how task sharing could support expanded paediatrics services provision in LMICs, especially beyond acute infectious diseases and malnutrition that are widely and historically shifted.
Posted 24/08/2021. Suicide is a leading cause of maternal death globally. On the Thailand-Myanmar border, 8% of refugee women and 3% of migrant women experienced suicidal thoughts during pregnancy and postnatally. The greatest risk factors for suicidal thoughts were unplanned pregnancy and past trauma. Community interventions and targeted prevention initiatives are urgently needed to help lower the rates of people dying by suicide, by Gracia Fellmeth and colleagues.
Posted 06/08/2021. Preprints are increasingly being used to share non-peer-reviewed manuscripts to enable the rapid dissemination of research. In particular, they have become an important source of information for wider audiences keen to follow COVID-19 research developments, including news, social media and policymakers. This practice raises several challenges in publication ethics and integrity. Paul Newton and colleagues set out the need for good practice.
Posted 03/08/2021. Ribavirin is the only available Lassa fever treatment. The rationale for using ribavirin is based on one clinical study conducted in the early 1980s. However, reanalysis by Alex Salam and colleagues of previous unpublished data reveals that ribavirin may actually be harmful in some Lassa fever patients. An urgent reevaluation of ribavirin is therefore needed.
Posted 30/07/2021. A reliable catchment area is essential to define community needs (education, health care and social care) and population denominators. However, catchments are often implemented based on convenience disregarding implications on accuracy, planning and service seeking behaviour. Peter Macharia and colleagues revisit the issue by considering common approaches, key issues, and best practices in defining a reliable service catchment area
Posted 27/07/2021. This qualitative study by Mira Schneiders and colleagues discusses the important nutrition-related roles and responsibilities of grandparents caring for grandchildren in rural Cambodian \u2018skip-generation\u2019 households. Grandparents appear highly motivated to improve grandchildren\u2019s health and nutrition, but lack necessary resources, leading to frequent moral dilemmas and ethical trade-offs. Interventions to improve child health and nutrition should be designed to be inclusive of older caregivers.
Posted 23/07/2021. Effective management and leadership are essential for everyday health system resilience, but health managers are often under-prepared and under-supported in these roles. Particular challenges have been observed in communication skills, emotional competence and supportive oversight. Jacinta Nzinga and colleagues share their learning from implementing a package of leadership development interventions in Kenya
Posted 20/07/2021. The ethical dilemmas faced by frontline staff conducting health research among \u2018vulnerable\u2019 populations are increasingly recognized. However, there is little documented on how staff might be supported in identifying and handling these dilemmas. Sassy Molyneux and colleagues share an approach and tools they developed in Kenya, centred on group reflections linked to a set of policy responses tailored to the context. They encourage further adaptation and evaluation of the approach
Posted 16/07/2021. Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. What prognostic factors are associated with severe metabolic acidosis and uraemia in African children with severe falciparum malaria? Secondary analysis of a randomized trial by Mavuto Mukaka and colleagues
Posted 13/07/2021. The overwhelming COVID-19 case numbers and deaths expected in African countries, as seen elsewhere following identification of the first COVID-19 cases, have not materialised. However, through serosurveillance of blood donors, Ifedayo Adetifa, Sophie Uyoga and colleagues demonstrate widespread SARS-CoV-2 infection in Kenya despite the lower COVID-19 cases and associated mortality.
Posted 09/07/2021. Dr Tan and his colleagues showed that only subgenogroup B1a of coxsackievirus A16, a common cause of the ongoing Hand Foot and Mouth Disease epidemic in Asia was circulating in southern Vietnam between 2011-2017. Active surveillance for viral circulation is critical to informing outbreak response and vaccine development.
Posted 07/07/2021. Frank Smithuis and colleagues conducted a large cluster randomized evaluation of mass drug administration (MDA) with dihydroartemisinin-piperaquine for malaria elimination in an area with high artemisinin resistant Plasmodium falciparum. MDA was a safe and effective tool to accelerate P. falciparum elimination, alongside routine community-based malaria control measures. It was well tolerated and well accepted. MDA did not select for drug resistant parasites.
Posted 06/07/2021. Surveillance of Antimicrobial resistance (AMR) is important in generating evidence to support efforts in controlling the infection. Cherry Lim and colleagues discuss the strengths, potential sources of bias, and challenges of routine microbiology data and different surveillance strategies and solutions used in low- and middle-income countries. Areas requiring support and improvement are highlighted.
Posted 02/07/2021. Chemoprophylaxis against emerging and pandemic infections offer potential for prevention. Lakshmi Manoharan and colleagues evaluated significant design features of COVID-19 chemoprophylaxis trial registrations. The findings illustrate that the majority of trials were underpowered to detect clinically meaningful protection at epidemiologically informed attack rates. Future trials should be large enough to generate strong evidence and allow structured entry and exit of candidate agents. International trial coordination mechanisms and collaboration is required.
Posted 30/06/2021. In a cluster-randomised trial of mass microscopic diagnostic screening and treatment for malaria in eastern Indonesia, Kevin Baird and colleagues show that the intervention had no impact on the prevalence of carriage of gametocytes infectious to mosquitoes. The findings highlight the requirement for much greater sensitivity of diagnostics for this intervention to provide benefit to communities.
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