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Oxford Centre for Tropical Medicine and Global Health
Rectal artesunate: lives not saved
MORU NDM-CGHR
Posted 03/06/2024. Childhood deaths from severe malaria can be prevented by giving rectal artesunate suppositories (RAS) but in January 2022, based on preliminary interpretation of a flawed observational study, WHO issued a moratorium on RAS. This has now been partially lifted, but use of RAS has markedly declined and thousands of malaria deaths have not been prevented. By Nick White.
Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life
KWTRP
Posted 31/05/2024. Tungiasis is a neglected tropical skin disease. Lynne Elson and colleagues aimed to determine its impact on school children in nine counties of Kenya. They found infected children experience considerable pain, itching, difficulty sleeping and feel ashamed, leading to lower school attendance, concentration and exam scores, than uninfected children.
Care seeking for childhood illnesses in rural Mtwara, south-east Tanzania: a mixed methods study
MORU
Posted 29/05/2024. In Africa, children < 5 years remain highly vulnerable to infectious diseases. Salum Mshamu and colleagues explored treatment seeking behaviour related to childhood illnesses in rural Mtwara, south-east Tanzania which was a part of community based novel housing intervention. How treatment seeking behaviour was influenced by institutional and community level factors are discussed in the article.
Gender and equity considerations in AMR research: a systematic scoping review
MORU
Posted 28/05/2024. Bhensri Naemiratch and colleagues report on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours.
Leprosy identified in Sumba Island, eastern Indonesia: elimination targets under threat
OUCRU OUCRU-Indonesia
Posted 24/05/2024. Frontline healthcare workers detected 60 persons affected by leprosy in Sumba Island, Indonesia, through teledermatology, over a 3-year period. Marlous Grijsen and colleagues at the Sumba Foundation and Gadjah Mada University highlight the challenges of delivering leprosy care in remote areas, how these translate into population risks of ongoing transmission and disabilities, and how leprosy can re-emerge after reaching national elimination targets.
Nutritional supplementation in children with severe pneumonia in Uganda and Kenya (COAST-Nutrition): a phase 2 randomised controlled trial
KWTRP
Posted 21/05/2024. Severe pneumonia is a leading cause of illness and hospitalization in African children, resulting in poor outcomes. Kathryn Maitland and colleagues tested if adding ready-to-use therapeutic food to diets improves the recovery of children in Uganda and Kenya. The study found no significant benefits, suggesting future research should focus on high-risk, undernourished children.
Decolonising global health: why the new Pandemic Agreement should have included the principle of subsidiarity
NDM-CGHR
Posted 14/05/2024. The WHO Pandemic Agreement aims to promote a better global response to pandemics. Caesar Atuire and colleagues argue that not including the principle of subsidiarity as a pragmatic strategy was a missed opportunity to decolonise global health governance and promote global solidarity. Subsidiarity empowers local units to make decisions and address issues at their level, fostering collaboration, coordination, and cooperation. We discuss the elements of subsidiarity—agency and non-abandonment—and highlight the need to strike a balance between them.
Accelerating Progress Towards the 2030 Neglected Tropical Diseases Targets: How Can Quantitative Modeling Support Programmatic Decisions?
NDM-CGHR
Posted 08/05/2024. The NTD Modelling consortium and WHO hosted a stakeholder meeting to identify priority modelling questions that are relevant for decision-makers, especially those designing, implementing and evaluating national and subnational programs, to achieve the ambitious targets set out in the NTD 2021–2030 road map. Future modelling studies should continue to move towards models which support better programmatic action by incorporating local context. By Andreia Vasconcelos.
Comparison of lumefantrine, mefloquine, and piperaquine concentrations between capillary plasma and venous plasma samples in pregnant women with uncomplicated falciparum and vivax malaria
MORU NDM-CGHR SMRU
Posted 01/05/2024. Makoto Saito and SMRU colleagues compared capillary and venous plasma concentrations of mefloquine, lumefantrine, and piperaquine in pregnant women with malaria. While there was a strong correlation, direct interchangeability was limited. Predictability within a ±10% precision range varied by drug. Caution is needed when converting capillary samples at the individual level.
Strategies for Deploying Pediatric Death Audit to Improve Quality of Care
NDM-CGHR
Posted 26/04/2024. Pediatric death audits can be used to improve health care quality and outcomes for children. In this report, MOMENTUM Country and Global Leadership examined the use of death audits in Kenya, Nigeria, Sierra Leone, South Africa, and Zambia. These experiences suggested both challenges in the use of death audits for improving pediatric quality care as well as options to begin developing effective systems that incorporate audits, even in low-resource settings. Three HSC researchers are members of the Momentum team.
IQID short course
The Investigating Quality and Safety and Intervention Design in Health Services (IQID) course explores the 'diagnosis' of health care delivery challenges, explains interventions as change processes and supports participants to develop practical strategies for evaluation and intervention. December 9th to 13th 2024 at Christ Church, Oxford.
Cost-effectiveness analysis of a multiplex lateral flow rapid diagnostic test for acute non-malarial febrile illness in rural Cambodia and Bangladesh
MORU
Posted 09/04/2024. Using data collected in the SEACTN Rural Febrile Illness project, Christopher Chew and colleagues evaluate the cost-effectiveness of a putative multiplex rapid diagnostic test able to diagnose enteric fever and dengue, coupled with CRP measurement to guide antibiotic prescribing for respiratory tract infections, in rural Cambodian and Bangladeshi primary care settings.
Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries
MORU
Posted 05/04/2024. There are complex ethical tensions and competing interests that surround interventions to mitigate antimicrobial resistance (AMR). In this paper, Phaik Yeong Cheah, Bipin Adhikari and colleagues have identified how these are especially reflected in low- and middle-income countries. They highlight that these ethical tensions need to be kept in mind when designing AMR policies.
Feasibility of wearable monitors to detect heart rate variability in children with hand, foot and mouth disease
OUCRU
Posted 26/03/2024. Dr Le Nguyen Thanh Nhan and colleagues at the Oxford University Clinical Research Unit showed that wearable devices could be used to monitor heart activity in children with hand foot and mouth disease. This monitoring method was feasible even in young children, and the heart activity measured was linked with the virus causing the disease.
Effectiveness of a multi-country implementation-focused network on quality of care: Delivery of interventions and processes for improved maternal, newborn and child health outcomes
NDM-CGHR
Posted 12/03/2024. The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) works with healthcare professionals to improve quality of care at global, national and local levels. In this evaluation Mike English and colleagues explore QCN’s effectiveness in Bangladesh, Ethiopia, Malawi and Uganda and provide useful knowledge for future multi-country global health networks.
Vulnerability and agency in research participants’ daily lives and the research encounter: A qualitative case study of participants taking part in scrub typhus research in northern Thailand
MORU
Posted 12/03/2024. Phaik Yeong Cheah and colleagues conducted a qualitative study in northern Thailand among hilltribe ethnic minority groups to understand their challenges related to participating in research. These challenges included language barriers, travel difficulties, uncertain legal status and lack of access to healthcare. Researchers need to be aware of these to minimise the burdens of research participation.
Breaking the silence on first referral hospitals and universal health coverage
NDM-CGHR
Posted 01/03/2024. First referral hospitals (FRHs) are neglected in the current discourse on universal health coverage (UHC) in low-income and middle-income countries. Mike English and colleagues propose a comprehensive approach that increases the focus on FRHs in the UHC discourse and shows that they are integral to enhancing primary health care (PHC) in low-income and middle-income countries.
First referral hospitals in low- and middle-income countries: the need for a renewed focus
NDM-CGHR
Posted 28/02/2024. First referral hospitals (FRHs) fulfil important functions in health systems in low- and middle-income countries. Through three reviews Rosanna Mazhar and colleagues found confusion around the definition and function of FRHs and called for renewed interest and investment in FRHs from the global health academic and policy-making community.
Emerging Enterovirus A71 Subgenogroup B5 Causing Severe Hand, Foot, and Mouth Disease, Vietnam, 2023
OUCRU
Posted 14/02/2024. Le Van Tan and colleagues describe a 2023 outbreak of severe hand, foot, and mouth disease in Vietnam caused by an emerging lineage of enterovirus A71 subgenogroup B5. Affected children were significantly older than those reported during previous outbreaks. The virus should be closely monitored to assess its potential for global dispersal.
Characteristics and clinical outcomes of patients with pre-delta, delta and omicron SARS-CoV-2 infection in Indonesia (2020–2023): a multicentre prospective cohort study
OUCRU OUCRU-Indonesia
Posted 26/01/2024. A recent prospective study among Indonesian patients hospitalised with COVID-19, from 2020 to 2023, demonstrated that, despite lower disease severity than delta, the omicron variant still caused substantial patient burdens. Older and unvaccinated individuals remained at higher risk of adverse outcomes, warranting optimised treatment and vaccine booster strategies for this setting. By Raph Hamers