Posted 29/06/2021. Frank Smithuis and colleagues describe a cluster of 29 children with severe, painful bone deformities living in very remote Nagaland, northwest Myanmar. They had low 25-hydroxyvitamin D, elevated parathyroid hormone, and elevated alkaline phosphatase levels, consistent with nutritional rickets secondary to vitamin D deficiency, calcium deficiency, or a combination of both. After treatment with vitamin D3 and calcium carbonate, we saw significant improvement in symptoms, biochemistry, and radiography. This is the first report of nutritional rickets in Myanmar in over 120 years.
Posted 25/06/2021. In the ISARIC multicentre, cohort of 48\u2009902 patients, admitted to UK hospital with COVID-19 during the first pandemic wave (6 Feb-8 June 2020), bacterial infections were uncommon. 85% of patients were prescribed antibiotics, with substantial regional variations highlighting that antimicrobial stewardship should be prioritised and integrated into Covid19 care pathways, by Louise Sigfrid and colleagues.
Posted 23/06/2021. In an RCT of three artemisinin-based combination therapies in pregnancy on the Thailand-Myanmar border where artemisinin resistance is widespread, only dihydroartemisinin-piperaquine provided satisfactory efficacy for P. falciparum, in this study by Makoto Saito & colleagues. Mefloquine-artesunate provided the longest recurrence-free period for P. vivax. Vivax recurrence was so common, chloroquine prophylaxis is warranted after malaria of any species.
Posted 22/06/2021. Diagnosis of bacterial meningitis in low- and middle-income countries is challenging due to limited laboratory capacity. Christina Obiero and colleagues conducted a revalidation study of previously identified signs of meningitis in children aged \u226560 days and found that KCH-2002 signs had lower sensitivity. Although bacterial meningitis is now uncommon following conjugate vaccination in Kenya, identifying cases is more difficult and support for basic cerebrospinal fluid analysis is crucial.
Posted 18/06/2021. Grace Irimu and colleagues show that newborns account for 46% of admissions and 66% of deaths among children 0-13years in Kenyan hospitals. Most deaths are caused by preventable and treatable causes. The authors call for need to prioritize newborn care for Kenya to achieve the SDGs target.
Posted 16/06/2021. The progress made in treatment of malaria is threatened by the emergence of resistance to current first line treatments artemisinin-based combination therapies (ACTs). There are currently no good alternatives for the treatment of uncomplicated malaria in the African setting in the event of resistance emerging to antimalarials that are in the ACTs. Mainga Hamaluba, Rob van der Pluijm and colleagues demonstrate that triple artemisinin combination therapies (TACTs) can potentially be used safely to prevent, delay or manage uncomplicated malaria in our setting.
Posted 15/06/2021. Plasmodium vivax caused an estimated 14 million malaria cases in 2017. By collating economic and epidemiological data, Angela Devine and colleagues estimated an economic cost of $359 million associated with these episodes. A scenario analysis explored how costs might change with global access to safe radical cure, estimating cost savings of $17-93 million.
Posted 11/06/2021. Burkholderia pseudomallei, a bacterium found in soil, can cause melioidosis, a potentially fatal disease. Melioidosis was first described in Myanmar but rarely reported over the past decades due to lack of awareness and limited diagnostic facilities. Frank Smithuis and colleagues report a widespread distribution of the organism in Myanmar soil. This should alert clinicians to consider melioidosis as a potential cause of sepsis, pneumonia or abscesses.
Posted 09/06/2021. Chris Paton and colleagues describe how predictive human-computer interaction (HCI) modelling could be used to improve the safety and usability of digital health systems. We reviewed the history of predictive modelling in HCI and describe how modelling could be integrated with the human-centred design techniques used when developing digital health interventions.
Posted 08/06/2021. Alice Kamau and colleagues show that passively collected routine health facility data does offer opportunities to detect malaria \u2018hotstops\u2019 down to the village level, at an affordable cost. It will be important, however, to refine the current surveillance tools such that they have the potential of collecting information at sufficiently precise scale.
Posted 28/05/2021. Reagan Mogire, Sarah Atkinson and colleagues show that the prevalence of vitamin D deficiency (<50\u2009nmol/L) is low (7.8%) in African children, although 37.1% have insufficient levels (50\u201375\u2009nmol/L). Risk factors for vitamin D deficiency include high latitude, older age, winter and rainy seasons, Gc2 vitamin D binding protein genotype and malaria.
Posted 25/05/2021. Seeking treatment including antibiotics without prescription at drug shops is a common practice in Nepal which can contribute to rising antibiotic resistance. This may leave us without effective antibiotics for future infections. In this study, Bipin Adhikari and colleagues explore why people buy antibiotics over the counter in Nepal and implications for its control.
Posted 21/05/2021. Based on the analysis of a large volume of observational data on disease (diarrhea, nervous and respiratory signs, legs lesions) and antimicrobial usage (from 13 classes), Marc Choisy and colleagues highlight the absence or negative effects from prophylactic antimicrobial use in small-scale chicken farms in the Mekong Delta of Vietnam.
Posted 18/05/2021. Rose McGready and colleagues show a strong association between P. falciparum infection and hypertension, in a large prospective cohort of women followed from the first trimester of pregnancy. Falciparum malaria which sequesters in the placenta most likely drives the development of chronic placental hypoxia, eventually progressing to clinical gestational hypertension or pre-eclampsia. This is important given hypertension is in the top 3 killers of pregnant women and that most pregnancy related hypertensive deaths occur in sub-Saharan Africa where malaria prevention strategies are not implemented until the beginning of second trimester or later.
Posted 14/05/2021. Cryptococcal meningitis is a common serious HIV-associated infection, responsible for 15% of AIDS related deaths globally. Patients are usually treated as in-patients. Frank Smithuis and colleagues reviewed 76 patients treated with amphotericin and fluconazole as out-patients in primary care clinics in Yangon, Myanmar. One-year survival (86%) was higher than existing hospital-based treatment studies and 1029 hospitals days were saved.
Posted 12/05/2021. Jacob Kazungu, Edwine Barasa and colleagues examined the level and inequality in health insurance coverage in 36 sub-Saharan African countries. They found that insurance coverage in sub-Saharan Africa is both low and pro-rich; only 8 of the 36 countries examined had a mean level of insurance coverage of above 10%.
Posted 11/05/2021. Microbiology laboratory data management is complex and is a rate-limiting step for AMR surveillance in low- and middle-income countries. Paul Turner, Liz Ashley, and colleagues summarise the urgent IT infrastructure requirements needed to ensure that the substantial ongoing efforts to develop capacity for AMR surveillance in LMICs realise their full potential.
Posted 07/05/2021. Multidrug-resistant tuberculosis (MDR-TB) remains a significant burden in the Southeast Asia region. Using mathematical modelling approach, Wirichada Pan-Ngum and colleagues assessed the population-level impacts of short-course MDR-TB treatment compared to the conventional therapy. Early initiation of treatment and good level of treatment eligibility are identified to be important determinants to the success of MDR-TB control programmes.
Posted 05/05/2021. On the Thailand-Myanmar border, 39% of migrant women and 47% of refugee women experience maternal depression. Gracia Fellmeth and colleagues show that among migrant women, higher levels of social support are associated with lower depression. The perinatal period offers a valuable opportunity to ask women about depression and support networks and offer help to those who need it.
Posted 04/05/2021. This survey in Jakarta, Indonesia, led by Licia Limato & Raph Hamers, evaluated patterns and quality indicators of antibiotic prescribing in six public and private hospitals. The study reported a high rate of empirical use of broad-spectrum antibiotics, coupled with poor documentation and guideline adherence, suggesting important areas for antimicrobial stewardship interventions.
Posted 30/04/2021. In many low- and middle-income countries febrile children are managed by health workers with limited training, in settings where referrals can confer substantial costs and risks. Spot Sepsis, a multi-centre study being implemented by MORU and MSF, aims to develop a practical prognostic tool to help community healthcare providers identify febrile children who may benefit from referral for facility-based medical care.
Posted 28/04/2021. While Health and Demographic Surveillance Systems (HDSS) involving verbal autopsy provide essential data on deaths, births and other health-related events in LMICs where alternative sources are limited, Vicki Marsh and colleagues argue that current regulatory frameworks do not sufficiently recognise their nature as a form of non-traditional epidemiological research. Ethical challenges include risks of uncompensated burdens that alternative regulatory approaches may more successfully identify.
Posted 27/04/2021. The complete treatment of vivax malaria requires a radical cure with a course of 8-aminoquinolines. Bipin Adhikari and colleagues interviewed policymakers in Asia why the radical cure is currently so poorly implemented and what can be done to improve the uptake of the radical cure.
Posted 23/04/2021. COVID-19 case management is one of the key interventions in country responses to the pandemic. Angela Kairu, Edwine Barasa and colleagues estimate the unit costs for COVID-19 case management in Kenya useful in informing policy decisions around resource allocation, planning and budgeting, and development of appropriate healthcare purchasing arrangements. The findings illustrate that COVID-19 case management costs are substantial, ranging between two and four times the average claims value reported by Kenya\u2019s public health insurer.
Posted 21/04/2021. Tobias Brummaier and colleagues report a high burden of soil-transmitted helminth infections and an association with maternal anaemia in pregnant migrant and refugee women on the Thai-Myanmar border. Whether the protective effect of Ascaris lumbricoides infection against miscarriage observed in this retrospective dataset results from helminth immune modulation remains to be determined.
Posted 20/04/2021. Artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated falciparum malaria, but the ACT drugs are starting to fail. Triple artemisinin-based combination therapy (TACT) is being studied to replace ACTs. In this paper, Phaik Yeong Cheah and colleagues discuss the most important ethical and practical considerations in the potential deployment of TACT.
Posted 16/04/2021. This systematic review by Arjun Chandna and colleagues identified clinical and laboratory prognostic factors, measured at the point of presentation, that can help identify children at risk of severe febrile illness. Most studies included only hospitalised children and further work is required to identify the best predictors to build data-driven triage tools for use by community healthcare providers.
Posted 15/04/2021. Philippe Gu\u00e9rin co-authored a letter published in The Lancet drawing attention of the risk of pooling data from uncomplicated illness and more severe ill hospitalised patients in the development of COVID-19 treatment guidelines. Although SARS-CoV-2 is one virus, the COVID-19 disease has a complex and evolving physiopathology pathway and requires different therapeutic approaches depending of the stage of the disease. In low-resource settings, the prevention of hospital admission is the therapeutic priority.
Posted 14/04/2021. Germana Bancone and Cindy Chu review the current knowledge about drug-induced haemolysis in G6PD deficiency, and discuss new clinical and laboratory approaches to understand haemolytic risk in G6PD variants. A more comprehensive genotypic and phenotypic characterization, together with haematologic responses upon exposure to different drugs, will help define a clinically useful classification of G6PD variants
Posted 13/04/2021. Self-regulated learning (SRL) remains unexplored for healthcare workers in low-income countries. Tim Tuti, Chris Paton and Niall Winters detail how SRL strategies impact on healthcare providers\u2019 learning gains when using digital learning platforms. We apply Latent Profile Analysis (LPA) to questionnaire responses. We provide insights into the learner factors to consider when implementing technology-mediated learning.
Posted 09/04/2021. Survivorship after an intensive care unit (ICU) stay is associated with long-term disability throughout the world. Nguyen Thi Kim Anh, Louise Thwaites and colleagues designed, implemented and evaluated the feasibility of a sustainable ICU rehabilitation programme in a resource-limited setting with the aim of improving the long-term outcome of critically ill patients.
Posted 06/04/2021. Melioidosis is an under-recognised disease, and mortality remains unacceptably high. Treatment requires prolonged antibiotic therapy and adherence is challenging, particular in resource-constrained settings. Arjun Chandna and colleagues at Angkor Hospital for Children reviewed the treatment of 355 children with culture-confirmed melioidosis over a decade and found significant gains can be made over time.
Posted 31/03/2021. Patient safety is a key goal of WHO but identifying harms and developing strategies to deliver safe care has been given little attention. Mike English and colleague describe a \u2018portfolio\u2019 approach to safety improvement in four broad categories: prioritising critical processes, improving the organisation of care, control of risks and enhancing responses to hazardous situations that we believe is relevant to low resource settings. We focus attention on the possible roles of practitioner groups and professional associations as key to advancing patient safety through collaboration and skill development in this field
Posted 30/03/2021. Reactive case detection has played a role in the elimination of malaria in China. The approach has been adapted and is used in the Greater Mekong Subregion. Because it requires considerable man power but only few cases are detected the approach is controversial. Jacqueline Deen, Lorenz Von Seidlein and colleagues included 8 articles in a meta-analysis that found the percentage of positive malaria cases among potential contacts using microscopy or rapid diagnostic test was 0.56%.
Posted 26/03/2021. Ketamine is an essential drug widely used in low-resource settings, but there was no data on its safety in lactating women until this report. In this study by Mary Ellen Gilder and SMRU colleagues, outcomes for breastfeeding infants whose mothers received ketamine are good, and not affected by ketamine dose. In contrast, high dose maternal intravenous diazepam may be harmful.
Posted 23/03/2021. In tuberculous meningitis, raised intracranial pressure often results in irreversible neurological injury. In this study of 107 participants with tuberculous meningitis, Joseph Donovan and colleagues show how optic nerve sheath diameter ultrasound may provide a low-cost point-of-care option for the identification of individuals with raised intracranial pressure in tuberculous meningitis
Posted 19/03/2021. Tobias Brummaier reports that collaborative research efforts with SMRU and SIDRA have demonstrated that vaginal microbial composition and local vaginal immune environment are associated with preterm birth in Asian women from a low-resource setting, possibly providing an avenue towards an early predictive tool for preterm birth
Posted 16/03/2021. Many women in Southeast Asia are smaller than their Western counterparts. How might this affect an otherwise healthy pregnancy? A recent study from the Thai-Myanmar border by Sue J Lee, Ahmar Hashmi and colleagues suggests that maternal height should be considered when providing advice regarding weight gain during pregnancy.
Posted 12/03/2021. Henry Surendra, Raph Hamers and colleagues report a large retrospective study of patients hospitalised with COVID-19 in Jakarta, Indonesia. In-hospital mortality was lower than reported in high-income countries, likely explained by the younger population, fewer comorbidities and less severe disease. Nonetheless, this study affirmed the vulnerability of elderly and comorbid patients as well as children under 5 years in LMICs
Posted 09/03/2021. X-linked glucose-6-phosphate dehydrogenase deficiency is the most common human enzymopathy. Ghulam Awab and colleagues analysed their clinical study and epidemiological data from Afghanistan gathered over the last decade and showed that the G6PD Mediterranean variant provided a marked gene dose proportional protection against P. vivax malaria.
Posted 05/03/2021. Prevention of mother to child transmission of Hepatitis B can be challenging in resource limited settings. Marieke Bierhoff and colleagues look at strategies that might be more feasible in these settings. TDF (tenofovir disoproxil fumarate) after rapid diagnostic test may be a more feasible strategy to implement in resource limited settings, TDF after hepatitis B e-antigen test is a cheaper option.
Posted 02/03/2021. Direk Limmathurotsakul and colleagues show that a Sepsis Fast Track (SFT) programme, implemented in Thailand to screen, initiate sepsis care and fast-track them when applicable to ICU upon admission, are associated with higher chances of survival. We analyzed data of a prospective observational study, having control group from both pre and post-intervention periods.
Posted 26/02/2021. Malaria and iron deficiency are common in Africa and malaria may cause iron deficiency through a hepcidin-mediated block in iron absorption. Using sickle cell trait to proxy malaria exposure, John Muriuki, Sarah Atkinson and colleagues found that an intervention that halves malaria incidence would also reduce iron deficiency by approximately 50% in African children.
Posted 22/02/2021. Paper continues to be an important medium for recording inpatient care in low\u2010 and middle\u2010income countries. Naomi Muinga and colleagues synthesise evidence on how paper\u2010based nursing records have been developed within inpatient settings to support documentation of nursing care, and that a human\u2010centred design approach might better meet users' needs
Posted 16/02/2021. Dexamethasone has been shown to reduce mortality in COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Rima Shretta and colleagues estimate that approximately 12,000 lives could be saved in the UK and 650,000 globally between July-December 2020. Dexamethasone is a cost-effective option with an incremental cost of GBP 940 per life-year gained.
Posted 12/02/2021. The majority of digital health projects have failed to translate into scaled, routine services, leaving many health leaders cautious and uncertain of how to proceed. Chris Paton and colleagues identify factors that can influence successful and sustainable integration of digital health within local health systems in low resource settings.
Posted 09/02/2021. Wirichada Pan-ngum and colleagues address key knowledge gaps on human-animal-water-source interactions and leptospirosis in high-risk settings, Thailand. Water-source sharing networks and human\u2013animal contact patterns are key information potentially involved in the epidemiology of leptospirosis. Occupations related to animals/environmental water and consuming water from more than two sources increased the risk exposure to leptospirosis.
Posted 05/02/2021. Measles immunity gaps have widened following disruptions of routine immunisation and supplementary activities due to COVID-19 pandemic in Kenya. While COVID-19 restrictions temporarily reduced the risk of a measles outbreak, Caroline Mburu, Ifedayo Adetifa and colleagues estimate that this risk will rapidly rise once the restrictions are lifted. Implementing delayed supplementary immunisation activities will be critical for prevention of measles outbreaks.
Posted 02/02/2021. Indiscriminate antimicrobial use (AMU) in animal production is a driver of antimicrobial resistance globally. In this trial, Juan Carrique-Mas and colleague provided regular veterinary advice to chicken farmers in Vietnam aiming to reducing AMU. AMU was quantitatively reduced by 66% and flock mortality by 40%. This study demonstrates that reductions in AMU without compromising health and productivity can be achieved in LMICs.
Posted 26/01/2021. Appropriate and well-resourced medical internship training is important to ensure psychological health and well-being of doctors in training and also to recruit and retain these doctors. Yingxi Zhao and colleagues identified and described a large number of tools designed for measuring medical internship experience, to help medical educators and human resource managers make an evidence-based decision on designing surveys to understand interns\u2019 experience of training.
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