Posted 16/07/2019. Worrying nutritional trends in possibly the longest and largest cohort of nearly 50,000 refugee and migrant pregnant women in a LMIC setting. Ahmar Hashmi and colleagues at SMRU summarise trends in under- and over-nutrition among pregnant women, and show a double burden of malnutrition in these marginalised and vulnerable communities from the Myanmar-Thailand border.
Posted 19/07/2019. Pro-poor health financing reforms have the potential to improve access to health services among the poor in Kenya. However, Evelyn Kabia and colleagues show that, for these reforms to be effective, they need to be accompanied by interventions that address barriers across other access dimensions such as geographical accessibility, availability, and acceptability of care.
Posted 12/07/2019. Sepsis is a devastating clinical condition. However, the etiology remains unknown in the majority of the patients. Herein, Dr Tan and colleagues set out to apply metagenomic next generation sequencing to look for viral contents in ~400 Vietnamese patients presenting with sepsis of unknown cause.
Posted 09/07/2019. On behalf of the Cambodian Ministry of Health Technical Working Group on Antimicrobial Resistance, Paul Turner and colleagues at COMRU recently led a review of published data on AMR in Cambodia. Significant AMR was identified in a range of priority pathogens although data were limited. On-going national AMR surveillance will address this data gap.
Posted 05/07/2019. Health information can be life-saving, but how can it be conveyed to those who could benefit most? Through analysis of an unsuccessful public health campaign, Mary Ellen Gilder and SMRU colleagues learned from migrant women valuable lessons about health messaging in communities where most women do not complete the fourth grade.
Posted 02/07/2019. Highly efficacious treatment can limit the cumulative deleterious impact of malaria during pregnancy on the mother and fetus. Correct assessment of treatment efficacy with an adequate length of follow up is required. Makoto Saito and colleagues at the Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border suggest that pregnant women need to be followed up longer than the currently recommended duration of follow-up to assess antimalarial drug efficacy.
Posted 28/06/2019. Children with severe disease seen at an outpatient department of Kenyan hospital often have elevated procalcitonin, a biomarker for bacterial infection. Samuel Akech and colleagues show that it\u2019s still premature to recommend the use of procalcitonin to guide antibiotic administration unless clinical trials investigating the use of procalcitonin levels to guide antibiotic treatment are done.
Posted 25/06/2019. As investments in health research capacity strengthening (HRCS) consortia increase, it is essential to consider the role of management approaches used. Nadia Tagoe and colleagues present current evidence and discourse on HRCS consortium management, and show that it is critical to pay attention to both relational and operational aspects of consortia to achieve desired outcomes.
Posted 18/06/2019. How should we communicate to the public the magnitude of antibiotic use in humans and animals? Led by Direk Limmathurotsakul, our scientists and global partners propose the concept of \u2018antibiotic footprint\u2019. It could support individual, national and global actions against superbugs as 'carbon footprint' has done for climate change
Posted 21/06/2019: Neglected tropical skin disease caused by sand fleas (tungiasis) inflicts misery on millions of children across the Tropics. Lynne Elson and colleagues show that tungiasis could be controlled through strengthening hygiene practices and sealing house and school floor
Posted 14/06/2019. Insufficient nurses caring for sick babies on hospitals\u2019 neonatal units in Kenya seriously undermine efforts to deliver high quality, safe care and make reducing neonatal mortality rates very difficult. Led by David Gathara, the Kenyan and Oxford team conducted the first ever direct observational study of which tasks nurses were able to perform and quantified how much care is missed. Previous work on missed nursing care largely conducted in rich countries has relied on questionnaires so this new work is an important advance.
Posted 11/06/2019. Remaining foci of malaria transmission are often in forests, where vectors tend to bite during daytime and outdoors thus reducing the effectiveness of insecticide treated bednets. Limited periods of exposure suggest that chemoprophylaxis could be a promising strategy to protect forest workers against malaria. Lorenz Von Seidlein and colleagues discuss which antimalarial drug regimens are most appropriate, how frequently the chemoprophylaxis should be delivered, and how to motivate forest workers to use and adhere to malaria prophylaxis.
Posted 07/06/2019. Juan Carrique-Mas and colleagues quantified the retail prices of the most common antimicrobials used in chicken farms in Vietnam. By comparing these costs with antibiotics for human use, they conclude that extreme low prices of antimicrobials for animal production may be a major factor driving excessive use. The authors advocate for a taxing system that restricts the use of critically important antimicrobials in agriculture.
Posted 04/06/2019. In Papua, where multidrug resistant P. falciparum and P. vivax are coendemic, the introduction of a universal policy of ACT plus IV artesunate for all patients with malaria halved hospital admissions and malarial deaths. However the reduction in P. vivax was far less than that for P. falciparum. This study by Ric Price and colleagues emphasizes the need for better drug regimens to clear the liver stages of P. vivax.
Posted 31/05/2019. Drug-resistant infections caused by Enterobacteriaceae, a family of Gram-negative bacteria, account for a high and increasing disease burden amongst hospitalised neonates in Southeast Asia; carbapenem-resistant strains are particularly important because of limited antibiotic treatment options. Tamalee Roberts and colleagues found that nearly two thirds of infants in a neonatal unit in Thailand became asymptomatic carriers with carbapenem-resistant Enterobacteriaceae during their hospital stays. This work indicates a critical need for interventions to reduce this usually hidden reservoir of drug-resistant bacteria.
Posted 28/05/2019. Kevin Baird calls attention to the importance of local expertise in anopheline mosquito ecology as an essential weapon in striving to eliminate malaria. Slight but very specific modifications to environments that disfavour those mosquitoes achieved very significant gains before the advent of DDT insecticide and synthetic antimalarial commodities in the middle of the 20th century. Loss of those commodities, and a lack of alternative strategies, led to the great malaria resurgence of the latter 20th century.
Posted 24/05/2019. As low-income countries\u2019 economies grow and financial support from Gavi (the Vaccine Alliance) diminishes, governments need to consider the value of continuing previously-subsidized vaccine programmes at full cost. Anthony Scott and colleagues assess the incremental cost-effectiveness of continuing pneumococcal vaccination use between 2022 and 2032, and found the programme to be highly cost effective.
Posted 21/05/2019. Wirichada Pan-ngum and colleagues explore how decreasing trends reflect the achievements of malaria control efforts on the Thai\u2013Myanmar border. However, one of the main challenges facing elimination programs in this low transmission setting is maintaining a strong system for early diagnosis and treatment, even when malaria cases are very close to zero, whilst preventing re-importation of cases.
Posted 17/05/2019. Undernourished children sustain a high risk of death after discharge from hospital. By examining blood samples taken when children were clinically stable and ready for discharge, Jay Berkley and colleagues found that children who died in the next 60 days had infection-related responses despite following treatment guidelines. Incomplete treatment may underly later mortality.
Posted 15/05/2019. Tetanus antitoxin is a vital component of tetanus treatment. In this clinical trial currently running at OUCRU Ho Chi Minh City, Louise Thwaites and colleagues test whether, in addition to standard intramuscular injection of antitoxin, antitoxin given directly into the central nervous system is beneficial in adult patients with tetanus.
Posted 10/05/2019. Previously, Ronald Geskus and colleagues developed a model based on information at diagnosis that provides mortality risk prediction for patients with tuberculosis meningitis. Prediction improves when we use time-updated Glasgow coma score and plasma sodium collected during the disease course. Our model and accompanying app help define patients with poor prognosis.
Posted 07/05/2019. Developed by Paul Turner and fellow members of the Oxford Tropical Network, the MICRO framework provides the scientific community with clear guidance on reporting and interpretation of clinical microbiology and antimicrobial resistance (AMR) data. Use of the framework will result in publication of better quality data for use in the global fight against AMR. The MICRO guideline is also posted on the EQUATOR website www.equator-network.org/reporting-guidelines
Posted 03/05/2019. Jeremy Day and colleagues sequenced the genomes of 699 Cryptococcus neoformans isolates from meningitis patients from southeast Asia and Africa. The phylogenetic structure demonstrates a recent, exponential, population expansion, driven almost entirely by three sub-clades (VNIa-4, VNIa-5 and VNIa-93). Mitochondrial recombination seen in VNIa-5 may be important in its ability to infect immunocompetent people. VNIa-93, previously associated with poorer outcomes, is in fact associated with a significantly reduced risk of death.
Posted 30/04/2019. The Oxford University Clinical Research Unit in Ho Chi Minh City investigated gender-related issues associated with career progression within a LMIC. Ngo Thi Hoa, Louise Thwaites and colleagues surveyed 120 scientists, the majority Vietnamese. They describe barriers to female career progressions such as caring duties and home environments, as well as the specific initiatives launched to increases female leadership.
Posted 25/04/2019. It has been almost 30 years since clinicians from northern Thailand first raised the issue of severe scrub typhus and poor responses to treatment in patients. Tri Wangrangsimakul and colleagues show that paediatric scrub typhus is frequently severe, potentially fatal, and associated with high rates of treatment failure. A lack of awareness leading to delays in treatment may have contributed. Investigating the determinants of treatment failure and raising the awareness of this neglected disease remains a priority.
Posted 23/04/2019. Human population movement can lead to the persistence of malaria along the Thai\u2013Myanmar border. Lisa White, Wirichada Pan-ngum and colleagues show that malaria risk is related to the number of days doing outdoor activities in the dry season, especially trips to Myanmar, to forest areas and overnight trips. Understanding movement patterns is important when considering targeted public health interventions, especially during the elimination phase.
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.
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