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Anti-malaria drug resistance is spreading throughout Southeast Asia and we need to find new treatments. Our researchers at MORU use a combination of artemisinin and two partner drugs instead of one. If confirmed safe and tolerable, triple artemisinin combination therapies might be a good option to treat multi-drug resistant malaria, as well as slow down the emergence and spread of anti-malarial resistance.

Rob van der Pluijm: Tracking antimalarial resistance and treatment of malaria using Triple ACTs

In the falciparum malaria parasite cycle, the gametocyte stages are responsible for the transmission from person to mosquito, then to other persons. A better understanding of how gametocytes respond to malaria treatments would help us block transmission and ultimately eliminate malaria.

Andrea Ruecker: Blocking malaria transmission

Although malaria is decreasing in Myanmar, resistance to anti-malarials is on the rise in the region and the focus is now to treat people early, particularly in remote communities. MOCRU has set up a network of community health workers, trained and supplied with diagnostics, bednets and treatments, to help improve access to healthcare as well as produce the evidence to encourage policy changes.

Frank Smithuis: Fighting malaria in Myanmar

Primaquine is a drug used to eliminate vivax malaria from the liver and prevent relapses. However, it causes anaemia in patients with G6PD deficiency. A new, slightly longer regimen with increasing doses of primaquine could allow to safely treat all patients with vivax malaria.

James Watson: Primaquine and vivax malaria

Malaria is the most important parasitic infection to still affect humans, and a safe use of antimalarial drugs is paramount. The current explosion of clinical data is causing a jungle of data; making sense of all this data will greatly help us in our fight to eliminate malaria.

Xin Hui Chan: Using big data to eliminate malaria

Multidrug resistant bacteria are a major problem in Southeast Asia, particularly for infections acquired in hospitals. Patients data and bacteria sequence allow the reconstruction of transmission networks. Using these date, we can also build simulations to investigate the impact of possible interventions, which then inform future clinical trials.

Tom Crellen: Transmission dynamics of hospital acquired infections

Although malaria has greatly declined in Southeast Asia this century, treating clinical cases won’t be sufficient to eliminate it from the region. Mass drug administration allows to eliminate parasites from asymptomatic carriers, and careful engagement with whole communities is key.

Tom Peto: Malaria elimination and mass drug administration

Prescription of antibiotics at the point of care is very high in Southeast Asia. Simple tests can help health workers determine which patients actually need antibiotics, but we need to ensure that the benefits and advantages are clearly explained. In the long term, those tests could represent a sustainable alternative to the massive prescription of antibiotics in developing countries.

Thomas Althaus: Antibiotic prescription in primary care

Primaquine can be used both to treat vivax malaria and to prevent the transmission of falciparum malaria from human to mosquito. A shorter and age-based primaquine regimen would reduce the burden of vivax malaria. It would also allow primaquine to be used more widely to block the transmission of falciparum malaria.

Bob Taylor: Primaquine for vivax and falciparum malaria

Pratap Kumar works at the Strathmore University in Nairobi, Kenya, and has a strong interest in Global Health. He uses health technology and entrepreneurship to support frontline health care workers in doing a better job, and even through remote support where patients present complicated cases.

Pratap Kumar: Supporting frontline healthcare workers

Dorothy Oluoch is a researcher working at the KEMRI Wellcome Trust Research Programme. Her main area of research involves documenting the roles and perceptions of mothers of hospitalized sick newborns with an aim of learning how they cope with the stress of caring for a sick newborn and how their experiences and voices could be formally engaged into care provision strategies.

Dorothy Oluoch: Roles and perceptions of mothers of hospitalized sick newborns

Dr Chris Paton works at the Centre for Tropical Medicine in Global Health, University of Oxford. His work around the LIFE project offers simulation based training in low income countries and is aimed at saving lives through innovative use of smartphones and mobile devices.

Chris Paton: Simulation based training

David Gathara is an epidemiologist working with the KEMRI Wellcome Trust Research Programme in Nairobi, Kenya. David works on assessment of quality of clinical care in nursing. He was previously involved in clinical trials using statistical models and on human resources for health with a bias in nursing care.

David Gathara: Assessing clinical care in nursing

Jacinta Nzinga, a researcher in health systems at the KEMRI Wellcome Trust Research Programme, works on the health work force, particularly in nursing. She explores the main issues that impact on the quality of nursing care provided to sick newborns in hospitals in Nairobi City County.

Jacinta Nzinga: Quality of nursing care for sick newborns

Gregory Omondi talks about his interest in research while highlighting the work he does at the KEMRI Wellcome Trust Research Programme. He works on Health Systems Research - Improving quality of new-born services in Kenyan health facilities. His main area is on ergonomics that unpack the complex tasks performed by nurses in the newborn units.

Gregory Omondi: Improving quality of newborn care

Dr Georgina Murphy, health systems researcher was working at the University Oxford and the KEMRI Wellcome Trust Research Programme in Kenya. She is an epidemiologist by training and has been working on health systems strengthening on the Health Services that Deliver for newborns (HSD-N) programme in Kenya with her main focus on neonatal care.

Georgina Murphy: Health systems strengthening

Multidrug resistant P. falciparum malaria is now established in parts of Thailand, Laos and Cambodia, causing high treatment failure rates for artemisinin combination therapies, the main falciparum malaria medicines.
A further spread from Myanmar to India then sub-Saharan Africa would be a global public health disaster. TME seeks the best ways to eliminate drug-resistant malaria, using both technical solutions and novel ways that engage entire communities.

Lorenz von Seidlein: Malaria elimination in the Greater Mekong sub-region

A molecular microbiologist, Dr Janjira’s research focusses on using bacterial typing based on genome to confirm which disease is present in a patient. She aims to develop a single whole genome sequence type test using mutliple-PCR assays that can determine from a single sample of blood what bacteria or viruses are present in a patient’s blood – thereby speeding up diagnosis and potentially saving lives in resource-limited settings.

Janjira Thaipadungpanit: Molecular diagnosis and bacterial genotyping

Having a background in malaria physiology and biochemistry, Markus Winterberg’s research focus is on the interaction between host, pathogen and drug, the metabolism of antimalarial drugs and discovering biomarkers for tropical diseases. Markus aims to use these biomarkers to develop non-invasive, field-based rapid diagnostic tests for tropical diseases that quickly identify pathogens, thereby improving diagnostics and the treatment of patients.

Markus Winterberg: Biomarkers for tropical diseases

To prevent relapse or reinfection, melioidosis requires a specific and prolonged treatment. Melioidosis is endemic at least 45 countries, but greatly under-reported, with a microbiological culture required to confirm diagnosis. This can take 2-7 days. In Thailand, up to 40 percent of hospital admitted melioidosis patients die. Premjit works with MORU researchers who have produced a rapid diagnostic test that aims to improve both diagnosis and public awareness of melioidosis.

Premjit Amornchai: MORU Biosafety Level 3 and melioidosis in Thailand

Quality data is vital to design better malaria control programmes. This project helps various African countries gather epidemiological evidence to better control malaria. Professor Bob Snow shows how sub-regional, evidence-based platforms can effectively change malaria treatment policies.

Bob Snow: Malaria control in Africa

Delivering health care in Indonesia is a challenge, made more difficult by the geography and distances. Our EOCRU unit specialises in clinical trials on tropical infections, particularly Plasmodium vivax malaria. Current treatments with primaquine are effective but very toxic for patients with G6PD deficiency. Better point of care diagnostics can help us treat all patients safely.

Kevin Baird: Infectious diseases in Indonesia

High altitude illness can be prevented by a simple rule: don't go too high, too fast. Drugs can also be used, and Dr Basnyat showed that a much lower dose of Diamox, a commonly used drug, is as effective. His research also focusses on the effect of high altitude on pilgrims, an older, poorer and more vulnerable population.

Buddha Basnyat: High altitude illness

A quick and efficient response to an outbreak requires strong central communication and coordination. Information needs to be shared quickly and then fed into patient care and policy. A wider approach, cutting across disciplines and specialities, helps limit the number of infected people and the impact on the economy.

Gail Carson: Outbreak, the clinical research response

Laos is seing a growing number of melioidosis, a bacterial infection caused by a bacterium that lived in the environment. Meliolidosis is a disease greatly under-recognised and treatment is specific, making it a major threat to farmers in developing countries. A better understanding of the prevalence of this infection and how it spreads allows us to better target prevention and treatment.

David Dance: Bacterial infections in Laos

WWARN is a network of research that analyses pooled data of numerous clinical trials. The sheer size of those data sets allows study groups to answer questions that couldn't be asked of a normal size clinical trial, such as the efficacy of an anti-malarial drug on malnourished or severely anaemic children. This research helps design policies to maintain the efficacy of current anti-malaria drugs, current

Georgina Humphreys: Optimising malaria treatment

Poor quality medicines are a serious threat to our health. Falsified medicines and substandards medicines are a problem for all countries, but particularly for low and middle income countries where we see, for example, a large epidemic of fake anti-malarial drugs. Globally, better medicine regulatory authorities will help improve the quality of our medicines.

Read more about poor quality medicines on the Asia Development Bank blog.

Paul Newton: Poor quality medicines

Resistance to antibiotics is a growing issue worldwide. Mapping where the resistance is as well as its distribution and diversity is hampered by the lack of laboratory facilities in many parts of the world. New technologies allow the characterisation of whole pathogen communities, giving us clues where multi-drug resistant organisms come from. This can help set up a better public health perspective surveillance.

Olga Tosas-Auguet: Mapping bacterial antibiotic resistance

Nurses in Kenyan hospitals are very busy, with high nurse to patients ratios. They face an extremely stressful enviroment, exacerbated by bad reports in the press.
Babies are particularly vulnerable during their first two days of life. A better understanding of the coping mechanisms put in place by those nurses could help us ensure a better survival rate for these babies.

Jacob McKnight: Neonatal nursing in Kenya

Antibiotic resistance is one of today's major global health problems. Mathematical models help us answer what if questions and evaluate the impact of specific interventions such as hands hygiene on the spread of bacterial drug resistance. Effective solutions are then translated into policy changes or changes in practice at national or international level.

Ben Cooper: Modelling bacterial drug resistance

Melioidosis is endemic in at least 45 countries, but greatly under-reported. Up to 50% of cases seen in hospital die. Our Researchers at MORU have produced a rapid diagnostic test that aims to improve both diagnosis and public awareness. Better coordination between researchers and policy makers is needed to face upcoming emerging infectious diseases.

Direk Limmathurotsakul: Microbiology research in SE Asia

Research is only as good as the evidence it generates, and data management is a critical part of this process since it supports findings. High quality data must be preserved for long term use and available to the research community. Ultimately, data is not about numbers, but about people's lives and health.

Naomi Waithira: Why data management matters

For malaria, parasite resistance and treatment efficacy is dynamic. Resistance to artemisinin, sometimes induced by poor quality medicines, causes artemisinin-based combination therapies (ACTs) to start failing. A robust system for surveillance of resistance can help ensure people get the right treatment at the right time.

Mehul Dhorda: Finding the best malaria treatments

Malaria epidemiology focuses on two main challenges to malaria elimination: antimalarial drug resistance and the movement of people that are spreading the malaria parasite. Travel surveys and cellphone records, combined with population parasite genetics help predict the spread of malaria and of drug resistance. Close coordination with all groups and agencies involved is crucial to malaria surveillance and elimination strategies.

Richard Maude: Epidemiology and malaria elimination

More effective diagnosis and treatments are needed to reduce the morbidity and mortality affecting malaria patients. Researchers at the Malaria Laboratory at MORU study the pathophysiology of the disease, and test new compound drugs for anti-malarial activity. In the context of growing artemisinin resistance, this research will have a global impact.

Kesinee Chotivanich: Malaria laboratory at MORU

The majority of people infected with the dengue virus experience a flu-like febrile illness, but in a small proportion of patients, particularly children, the virus causes the blood vessels to become leaky which can induce shock and lead to death. Improved diagnosis and understanding of the disease process enable better outcomes for patients with severe dengue.

Bridget Wills: Dengue diagnosis and management

In a learning health system, health care providers use electronic health records to identify problems, implement local solutions and check if the solutions are effective. Health informatics, or the use of IT in healthcare, needs to find innovative solutions for low income settings, such as the use of open-source softwares and mobile technology. This approach has been used to deliver training to rural healthcare workers in Kenya.

Chris Paton: Global health informatics

Whereas children mortality has dramatically decreased over the past 15 years, almost half the remaining mortality still occurs during the first 4 weeks of age. Neonatology, or care of newborns, doesn't need to be difficult or expensive. Low cost intervertions involving communities, such as keeping babies warm, save lives.

Claudia Turner: Tropical neonatology

Infectious diseases are prevalent in Cambodia, a country that is struggling with poor infrastructure. Streptococcus pneumoniae causes the most severe form of pneumonia and is now targeted by the pneumococcal conjugate vaccine. Dr Paul Turner is studying the effect of this vaccine in field conditions in SE Asia, as well as other direct applications such as the evaluation of a new diagnostic test for Typhoid and interventions to reduce the burden of infections acquired within hospitals.

Paul Turner: Microbiology in the tropics

In pregnant women, severe malaria is responsible for high maternal mortality, and uncomplicated malaria results in in high morbidity. Careful documentation of treatments showed that, although not all drugs are available for pregnant women, early treatment can greatly increase the outcome of the pregnancy, and give that child a better chance at a productive life.

Rose McGready: Malaria in pregnancy

Men who have sex with men (MSM) are a stigmatised group in Africa, but a predominant actor in the transmission of HIV. Recognising this vulnerability and developing better prevention programmes targeted to this population will ultimately reduce the wider public health impact of HIV epidemic.

Eduard Sanders: Reducing HIV

Understanding the variation of malaria risk between houses, villages or region, and how malaria is transmitted in and around that variability helps develop better malaria control programmes and use their resources more wisely. Since malaria control tools are becoming less effective with time, progress in vaccine design is essential.

Philip Bejon: Malaria in Kenya

Over 250 Institutions participate in the effort of sharing data on the efficacy of antimalarial drugs, which involves standardising and re-analysing data. Bringing all this data together creates new evidence that can be translated into policy practice, offering new therapeutic options for particular populations.

Philippe Guérin: Sharing data to fight malaria

Melioidosis is a neglected tropical disease, and a major infectious killer in South East Asia. Melioidosis particularly affects people with diabetes. Dr Dunachie studies how the patients' own immune system fight the disease, with the aim of designing a vaccine that could stop people getting sick and dying.

Susanna Dunachie: Tropical Immunology

Too high a dose can result in toxicity and side-effects, too low a dose can cause the illness to come back and at worse develop resistance. In the case of malaria, it is particularly important to get the dosage right for more vulnerable patients such as children and pregnant women. Professor Joel Tarning's findings have now been adopted by the World Health Organisation.

Joel Tarning: Getting the dose right

Artemisinins are very poweful tools in the treatment of malaria, and the emerging loss of their activity has the potential to create a major public health problem. Understanding how this resistance has developed and spread helps better treat patients, treat populations and eliminate malaria, which is the new goal in South East Asia.

Charlie Woodrow: Artemisinin Resistance

Identifying and addressing ethical issues are key to the success of any clinical trials, particularly when working with vulnerable populations. Tackling these issues helps improve the quality of research and translate the evidence of clinical trials into improvement of management of patients.

Phaik Yeong Cheah: The ethics of research

In settings with high level of poverty and over-stretched health services, researchers have even greater responsibilities to the communities and study participants. Strenghtening the ethics of research will help address the burden of disease and death born by low to middle income countries.

Vicki Marsh: Science and Society

Economics and health are interlinked in many ways, as seen in the vicious cycle between poverty and ill health. Merging data from various research areas within economic models allows a more efficient use of scarce resources. Economic evaluation helps ensure that cost effective interventions are included in policy recommendations.

Yoel Lubell: The economics of tropical diseases

Enteric fever, an infection caused by either Salmonella typhi or Salmonella paratyphi, has been eliminated in most industrialised countries but is an increasing burden in developing countries, particularly in South East Asia. Antibiotics resistance limits safe and affordable treatment options. Training the next generation of doctors and scientists in the worst hit countries will help develop a successful and sustainable partnership.

Christiane Dolecek: Enteric fever

Research on emerging infectious diseases can only be conducted during outbreaks. Although virology has improved, a well calibrated and effective public health response is often lacking. Epidemiological and clinical research as well as mathematical modelling will give us answers during the epidemics and help us provide better diagnostics and better treatments.

Peter Horby: Emerging infectious diseases

The number of people who die from tuberculous meningitis depends on how early you get treatment for the disease. There are therefore two approaches to improving clinical outcomes, the first is to diagnose the condition faster so clinical intervention can happen sooner. The second is to improve treatments so that they are more effective.

Guy Thwaites: Tuberculous meningitis

Healthcare and research at the Thai-Burma border: Combining healthcare and research allow Professor Nosten to implement a new treatment regimen as soon as the results from clinical trials are available, which is beneficial to patients and highly rewarding for researchers.

François Nosten: Between research and humanitarian

Professor Mike English leads the Health Services Unit at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya. This unit aims to strengthen equality in access to affordable quality health care in Africa. Studies are based on health systems clustered around five main topics: malaria, service delivery & access, information for decision making, governance and financing. Professor English leads efforts to develop multidisciplinary links with Oxford through the Oxford Health Systems Research Collaboration (OHSCAR).

Mike English: Better hospitals for children

Professor Sassy Molyneux's main interests reside in Social science and Ethics in Public Health. Over the years, social scientists have developed a programme of empirical work on research ethics. This work is based on an understanding that while the ethics of human subjects research may be universal, there can be big differences across contexts and circumstances in key ethical issues or principles.

Sassy Molyneux: Governance in practice

Dr Ben Tsofa examines the effects of political decentralisation in Kenya, on sub-national level health sector governance and accountability.

Benjamin Tsofa: Translating research into policy

Edwine Barasa is a DPhil student at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya. He describes and evaluates the priority setting practices in county hospitals in Kenya.

Edwine Barasa: Economics of hospitals

Dr Grace Irimu evaluates the effect of introducing Ministry of Health basic pediatric protocols and ETAT+ in a university teaching hospital.

Grace Irimu: Improving quality of care

Dr Philip Ayieko works for SIRCLE, a Consortium for National Health Research, collaboration between KEMRI-Wellcome Trust Research Programme, the University of Nairobi, College of Health Sciences and the Ministry of Medical Services. SIRCLE aims to build capacity for high quality health services and implementation research, and promote clinical excellence by engaging trainee researchers in policy relevant research.

Philip Ayieko: Child health interventions

Jacinta Nzinga is a DPhil student at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya. She examines how efforts to improve service delivery through adoption of recommended practices in Kenyan hospitals depend on health workers’ responses to improvement efforts, hospital context, actions of unit heads and the interaction between them.

Jacinta Nzinga: Hospitals, health workers and service delivery in Kenya

Dr Jalemba Aluvaala works for SIRCLE, a Consortium for National Health Research, collaboration between KEMRI - Wellcome Trust Research Programme, the University of Nairobi, College of Health Sciences and the Ministry of Medical Services. SIRCLE aims to build capacity for high quality health services and implementation research, and promote clinical excellence by engaging trainee researchers in policy relevant research.

Jalemba Aluvaala: Newborn care in Kenyan hospitals

Malaria is the most important parasitic disease of man. Although most of the deaths occur in Africa, drug resistance has emerged from South-East Asia. Artemisinins, which are plant-derived compounds originally from the Chinese Materia Medica, are still today the best treatment for malaria, however, other drugs are also showing promising results. Clinical trials are also undertaken to find out the correct doses. All these developments contribute to our progress in getting malaria under control.

Nick White: Artemisinin therapy for malaria

The Global Health Network is a successful and growing online science park comprised of varied research communities for different health research groups and cross-cutting health topics. It is built for the research and wider health community by researchers and public health practitioners themselves. It is a trusted source of quality information, education and research tools.

Trudie Lang: The Global Health Network

Rickettsial diseases such as scrub typhus are important causes of fever in southeast Asia especially in rural communities. Discovered quite recently and not big killers, these diseases are among the most under-reported and under-diagnosed illnesses that are both treatable and preventable. Rickettsial studies at he Mahidol Oxford Tropical Medicine Research Unit (MORU) focus on the epidemiology and incidence of the disease using hospital-based fever studies in Thailand and Laos. Our research unit has developed highly improved acute diagnosis of rickettsial illness. MORU also has ongoing studies to determine the pathophysiological mechanisms of scrub typhus infection.

Daniel Paris: Rickettsial Disease

The Mahidol Oxford Tropical Medicine Research Unit (MORU) is a collaboration between the University of Oxford and Mahidol University, and was established with the Wellcome Trust in 1979. MORU aims to fight the infectious tropical diseases affecting rural communities in Asia and elsewhere in the developing world.
MORU's malaria research aims to directly improve the treatment of the disease globally. It's researchers focus on the treatment of severe malaria, the spread of antimalarial drug resistance, and the pathophysiology of falciparum and vivax malaria. These studies are used to formulate novel adjuvant therapies, and have been translated into recommendations for the use of artemisinin based combination therapies.

Nick Day: Infectious diseases in South East Asia

Acurately diagnosing infections is particularly challenging in tropical environments. Researchers at the Mahidol Oxford Tropical Medicine Research Unit (MORU) are working to develop effective and practical means of diagnosing and treating malaria and other neglected tropical diseases, such as dengue fever. The development of rapid tests for dengue, similar to pregnancy tests, allow rapid and acurate diagnostics in the field.

Stuart Blacksell: Microbiology in Thailand

In both livestock and humans, Rift Valley Fever is caused by a virus that was first isolated in Kenya in 1930, but has since spread throughout Africa and parts of the Middle East. There are fears that it might spread to Europe as the mosquitoes which transmit the disease are widespread. Although it mainly affects livestock, it can also cause infection in humans.

George Warimwe: Rift Valley Fever

Malnutrition underlies between a quarter and a third of childhood mortality worldwide. It increases susceptibility to infectious diseases such as pneumonia and diarrhoea. A better understanding of the relationship between the child and the bacteria in their gut helps develop better treatments such as food supplementation or preventive treatment with low dose antibiotics.

Jay Berkley: Childhood Nutrition & Immunity

Successful malaria control has meant a drop in mortality rates worldwide but it is still an important disease. Therapies using artesunate, a derivative of artemisinin drugs, aim to kill malaria parasites before they mature. These therapies have high success rates and need to be developed. General care of malaria patients also needs to be improved.

Arjen Dondorp: The treatment of severe malaria

Malaria is a major problem for children in Africa. Over the last 10 years there has been a massive international investment for malaria control. This has driven major changes in the delivery of new drugs, ways of preventing malaria and also the basic research that aims to develop vaccines.

Kevin Marsh: Tropical Medicine in Kenya