Research Highlights

Community engagement to develop a dialogue-drama on adolescent pregnancy in a marginalised migrant population on the Thailand-Myanmar border: an ethnographic approach to participatory action research

Posted 20/11/2024. A participatory-action approach involving community members and adolescents resulted in a dialogue-drama (Karen and Burmese versions) on adolescent pregnancy, contraception, and choice in the event of an unplanned pregnancy. The dialogue-drama augmented discussion of traditionally taboo issues and this ethnographic method is potentially useful for similar global health settings. By Rose McGready

Prevalence and risk factors of vitamin D deficiency among Afghan primary school children

Posted 19/11/2024. Bob Taylor and colleagues determined that vitamin D deficiency is exceptionally high, 85%, in 510 5-15 years-old school children from Kandahar city, Afghanistan. Half had severe deficiency. Older children from poor families with limited outdoor activity and inadequate sun exposure were more likely to be deficient. These data provide evidence for a mitigation strategy.

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border

Posted 22/10/2024. Severe neonatal hyperbilirubinaemia is often diagnosed late in low-resources settings because of lack of point-of-care tools. In this study, Germana Bancone and SMRU researchers have evaluated the performance of a transcutaneous bilirubinometer for screening of neonates born along the Thai-Myanmar border. The study was supported by a Wellcome Trust iTPA grant.

Artemisinin-resistant malaria

Posted 18/10/2024. Nick White and K. Chotivanich publish a review of mechanisms, genetic associations, phenotyping, epidemiology and current status of artemisinin resistance, and a brief discussion of policies and potential counter-measures.

In-host modeling of dengue virus and non-structural protein 1 and the effects of ivermectin in patients with acute dengue fever

Posted 09/10/2024. Junjie Ding and the MORU Clinical Pharmacology Team developed an in-host dengue kinetic model to quantitatively predict drug effects in dengue fever. This model offers valuable insights to inform dengue drug development, and shows that ivermectin reduces NS1 but not viral load. The results are published in a leading PK/PD modelling journal, CPT:PSP.

Prevalence and associated risk factors of stunting, wasting/thinness, and underweight among primary school children in Kandahar City, Afghanistan: a cross-sectional analytical study

Posted 17/09/2024. Bob Taylor and colleagues investigated 1205 primary school children in Kandahar and found almost 50% were stunted, 25% were underweight and 20% wasted. Risk factors for stunting in 6–9 year old children were poverty, skipping breakfast, and being a girl from a large family with an uneducated mother and an unemployed father.

Anti-infectivity efficacy and pharmacokinetics of WHO recommended single low-dose primaquine in children with acute Plasmodium falciparum in Burkina Faso: study protocol

Posted 11/09/2024. The Groupe de Recherche Action en Santé, a Developing Paediatric Primaquine project partner, will assess, for the first time, the transmission blocking efficacy of allometrically-scaled, single low-dose primaquine, using the WHO-recommended 0.25 mg/kg target dose, in under-5 Burkinabe children with uncomplicated Plasmodium falciparum. The study protocol is now published. By Bob Taylor.

Frequency of antimicrobial-resistant bloodstream infections in 111 hospitals in Thailand, 2022

Posted 10/09/2024. Collaborating with the Ministry of Public Health, Direk Limmathurotsakul and colleagues utilised an automated tool, evaluated and reported the frequency of antimicrobial-resistant (AMR) infection in 111 public hospitals in Thailand in 2022. Our approach and findings highlight health regions and hospitals where actions against AMR infection, including antimicrobial stewardship and infection control, should be prioritised.

New WHO classification of genetic variants causing G6PD deficiency

Posted 04/09/2024. Over 50 years after its first publication, this revised classification of G6PD genetic variants is the result of the 2022 WHO Global Malaria Programme experts’ consultation led by Professor Lucio Luzzatto. The new classification reconciles biochemical and clinical aspects of the different G6PD mutations and provides a reliable reference for scientists and clinicians. By Germana Bancone.

Rebecca Inglis and co-workers, in front of a door to the ICU

Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Posted 17/07/2024. A large multidisciplinary team conducted qualitative research in five ICUs in Bangladesh and India. They found that less restrictive ICU visiting policies improved experiences for patients and families – and the family’s presence at the bedside could improve patient care. Supporting nurses to give routine updates promoted better communication with families. By Rebecca Inglis

A randomised trial of malaria vaccine R21/Matrix-M™ with and without antimalarial drugs in Thai adults

Posted 16/07/2024. Borimas Hanboonkunupakarn and coworkers from MORU and the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand have shown that the co administration of the malaria vaccine R21/matrix M combined with the antimalarials drugs DHA/piperaquine and the single low dose primaquine does not interfere with the immunogenicity of the vaccine or the concentrations of piperaquine.

Genetic diversity, determinants, and dissemination of Burkholderia pseudomallei lineages implicated in melioidosis in Northeast Thailand

Posted 15/07/2024. A recent study from northeast Thailand identified three major bacterial lineages responsible for melioidosis in the region. Each lineage carries unique gene sets that likely contribute to successful dissemination. These genes are expressed under environmental rather than infectious conditions, with one lineage showing overexpression under nutrient deprivation, highlighting environmental persistence is a prerequisite for infection. By Claire Chewapreecha

Embedding community and public voices in co-created solutions to mitigate antimicrobial resistance (AMR) in Thailand using the ‘Responsive Dialogues’ public engagement framework

Posted 11/17/2024. Tackling antimicrobial resistance requires collaboration between communities, stakeholders and researchers. In the ‘AMR Dialogues’ project, Tassawan Poomchaichote, Phaik Yeong Cheah and colleagues conducted a series of conversations, bringing together people from different backgrounds. This paper summarises issues identified across Thailand and highlights four locally actionable ‘building blocks’ of co-created solutions.

Estimated global and regional economic burden of genital herpes simplex virus infection among 15–49 year-olds in 2016

Poster 09/07/2024. Genital herpes infections and their related complications lead to billions of dollars in health care expenditures and productivity losses globally, say researchers who calculated the first-ever global estimates of the economic costs of these conditions. The study calls for greater investment in prevention of herpes transmission, including concerted efforts to develop effective vaccines against this common virus. By Puttarin Kulchaitanaroaj; MAEMOD, MORU.

Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate–pyronaridine to control malaria outbreaks in Cambodia

Posted 25/06/2024. The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, an effective response to malaria outbreaks becomes the vital strategy. Authors report a programmatic response to a 2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia. By Bipin Adhikari.

Bioequivalence of a new coated 15 mg primaquine formulation for malaria elimination

Posted 21/06/2024. A new study by Bob Taylor and colleagues confirms that a 15 mg generic primaquine tablet, made by IPCA in India, is bioequivalent to the reference Sanofi product. The dossier has been submitted to WHO for prequalification. Once prequalified, it will be used to help eliminate malaria.

A youth advisory group on health and health research in rural Cambodia

Posted 19/06/2024. Bipin Adhikari and colleagues reflect on how engagement with a youth advisory group on health and research engagement is carried out in a remote malaria endemic district of Cambodia. Authors discuss the processes, outputs and outcomes of youth group engagement including their relevance to broader goals of community engagement using a theory of change.

Rectal artesunate: lives not saved

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.

Care seeking for childhood illnesses in rural Mtwara, south-east Tanzania: a mixed methods study

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

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.

Comparison of lumefantrine, mefloquine, and piperaquine concentrations between capillary plasma and venous plasma samples in pregnant women with uncomplicated falciparum and vivax malaria

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.

Cost-effectiveness analysis of a multiplex lateral flow rapid diagnostic test for acute non-malarial febrile illness in rural Cambodia and Bangladesh

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

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.

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

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.

Individualised, short-course antibiotic treatment versus usual long-course treatment for ventilator-associated pneumonia (REGARD-VAP): a multicentre, individually randomised, open-label, non-inferiority trial

Posted 26/01/2024. Ventilator-associated pneumonia is common amongst critically-ill patients. Mo Yin and colleagues investigated a personalized approach to shorten antibiotic duration, and found it as effective as a longer treatment in terms of death or pneumonia recurrence; it also reduced antibiotic side effects significantly. This study provides crucial evidence to guide antibiotic prescription to reduce resistance emergence.

Early warning systems for malaria outbreaks in Thailand: an anomaly detection approach

Posted 16/01/2024. Oraya Srimokla, Sompob Saralamba and their team developed specialized anomaly detection algorithms and a dashboard to enhance Thailand's malaria surveillance and elimination efforts. This system improves outbreak prediction accuracy and integrates seamlessly with existing infrastructure, aiding in the effective monitoring and identification of potential malaria outbreaks at the provincial level.

Expanding the roles of community health workers to sustain programmes during malaria elimination: a meeting report on operational research in Southeast Asia

Posted 10/01/2024. As malaria progressively declines in Cambodia, there's a concern about the diminishing relevance of village malaria workers (VMWs). In August 2023, a meeting addressed the feasibility and policy implications of VMWs managing non-malarial fevers, part of the operational research in western Cambodia to ensure VMWs remain active until malaria elimination is achieved. From Bipin Adhikari.

Ethical and cultural implications for conducting verbal autopsies in South and Southeast Asia: a qualitative study

Posted 20/12/2023. The verbal autopsy method can be sensitive to the individuals interviewed, their families and communities. Prior to study implementation, Nan Shwe Nwe Htun, Tom Peto and SEACTN colleagues sought to explore local beliefs and practices about death to inform appropriate bioethical practices and found that verbal autopsy is acceptable across a wide range of cultural settings in Bangladesh, Myanmar, Thailand, Laos PDR, and Cambodia.

Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania

Posted 12/12/2023. Bipin Adhikari and colleagues compared community health worker programmes between Southeast Asia and Sub-Saharan Africa using a systematic review of the published literature. This was supplemented by discussions with key informants in Cambodia and mainland Tanzania to inform the existing malaria service delivery strategies in Tanzania.

Accuracy of the direct agglutination test for diagnosis of visceral leishmaniasis: a systematic review and meta-analysis

Posted 01/12/2023. Parasitology is the gold standard for the diagnosis of visceral leishmaniasis (VL), however, other less invasive tests are available such as the direct agglutination test (DAT). As part of the series of systematic reviews and meta-analysis on diagnostic accuracy of diagnostics for FIEBRE infections, Tamalee Roberts and colleagues estimate the diagnostic sensitivity and specificity of DAT for the diagnosis of VL.

A systematic review of neglected tropical diseases (NTDs) in Myanmar

Posted 21/11/2023. Neglected tropical diseases (NTDs) are a group of preventable and treatable diseases common in Myanmar, primarily affecting marginalized rural communities. Myo Swe and colleagues provide an overview of reported NTDs in Myanmar over 100 years, indicating gaps in knowledge about certain diseases to inform future research directions related to NTDs in Myanmar.

A Prognostic Model for Critically Ill Children in Locations With Emerging Critical Care Capacity

Posted 20/11/23. Tools to assess illness severity are often impractical in settings with emerging critical care capacity. A prognostic model developed by Arjun Chandna and colleagues proved effective for triaging critically ill children. The tool provides holistic assessment of critical illness by combining measures of organ dysfunction with important contextual determinants of outcome, such as healthcare accessibility and the nutritional status of a child.

Use of antimicrobials during the COVID-19 pandemic: A qualitative study among stakeholders in Nepal

Posted 17/11/2023. Early critical phase of the COVID-19 pandemic added tremendous pressure to find curative therapies. A lot of empirical treatments, including antimicrobials, were recommended. Drawing on interviews with patients, clinicians and drug dispensers, Bipin Adhikari and colleagues explore how and why antimicrobials may have been used for the management of COVID-19 in Nepal.

The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance

Posted 10/22/2023. Sean Cavany and colleagues publish a new perspective in Nature Communications that describes the possible mechanisms by which substandard and falsified antimicrobials could affect antimicrobial resistance and suggests ways to improve our understanding of this relationship. The article arose from the work of the FORESFA project, funded by a Wellcome Collaborative Award.

A Clinically Oriented antimicrobial Resistance surveillance Network (ACORN): pilot implementation in three countries in Southeast Asia, 2019-2020

Posted 01/11/2023. ACORN (A Clinically Oriented Antimicrobial Resistance Surveillance network) is a WHO GLASS compatible case-based surveillance method for antimicrobial resistance that produces more meaningful and locally actionable data. Rogier van Doorn and colleagues publish the results of a pilot in three countries, showing proof of principle and valuable lessons to be learned going forward. More at: acornamr.net

Leadership in global health

Posted 24/10/2023. In the review of a book ‘Tore Godal and the evolution of global health by Conrad Keating’, Bipin Adhikari and Lorenz von Seidlein discuss Tore Godal’s contributions to Global Health projects while remaining in the background. There are lessons for those aspiring to influence Global Health.

Vaccine mandates and public trust do not have to be antagonistic

Posted 29/10/2023. Historically, vaccine mandates and opposition to vaccines have co-existed, starting with smallpox vaccination mandates in the 1800s. During the COVID-19 pandemic, the benefits of vaccine mandates were weighed against potential damage to public trust. Bipin Adhikari and colleagues discuss whether and how vaccine mandates can co-exist with public trust.

Pharmacokinetics of single low dose primaquine in Ugandan and Congolese children with falciparum malaria

Posted 29/09/2023. This large study on the pharmacokinetics of single low dose primaquine in young Ugandan and Congolese children will help the MORU team develop an optimal dose for children with falciparum malaria to block malaria transmission and contribute to malaria elimination, especially of resistant falciparum parasites. By Bob Taylor

Improving neonatal health in rural Africa: how much do we know about neonatal jaundice?

Posted 26/09/2023. In this pilot study, Caterina Fanello and colleagues evaluated the prevalence of neonatal hyperbilirubinemia and related neonatal and maternal risk factors in a semi-rural area of the Democratic Republic of Congo. They also explored knowledge and practices of expectant mothers regarding this condition. Ways forward to improve diagnosis and treatment in these settings are discussed.

Expanding the role of village malaria workers in Cambodia: Implementation and evaluation of four health education packages

Posted 22/09/2023. The transformation of village malaria workers (VMWs) into community health workers with roles beyond malaria is a promising approach for sustaining health care provision in remote areas. Rupam Tripura and colleagues discuss on how training on health education could be optimized for VMWs.

Sharing results with participants (and community) in malaria related research: Perspectives and experience from researchers

Posted 08/09/2023. Sharing results with participants from research studies is largely underappreciated. Bipin Adhikari and colleagues explore the perception and practice of results-sharing in malaria related clinical trials among researchers. Although there was a consensus on the rationale of result sharing to participants, most researchers thought that disseminating results to policymakers and stakeholders for research translation was more important.

An artesunate pharmacometric model to explain therapeutic responses in falciparum malaria

Posted 06/09/2023. Sompob Saralamba and colleagues have proposed a new model explaining why increased dosing of antimalarial drug artemisinin doesn't speed up parasite clearance. It suggests that exposure to the drug makes some malaria parasites temporarily resistant, leading to either delayed death or reactivation. This could revolutionize treatment strategies for this deadly disease.

Point-of-care prognostication in moderate Covid-19: Analytical validation and prognostic accuracy of a soluble urokinase plasminogen activator receptor (suPAR) rapid test

Posted 05/09/2023. Arjun Chandna and colleagues show that a point-of-care test for the soluble urokinase plasminogen activator receptor (suPAR) has good prognostic accuracy to predict oxygen requirement in patients presenting with moderate Covid-19 and suggest that suPAR should be explored for risk stratification of other infectious diseases.

Longitudinal comparison of bacterial pathogen seropositivity among wet market vendors in the Lao People's Democratic Republic

Posted 31/08/2023. Vendors at wet markets in Laos may be exposed to different zoonotic pathogens depending on the types of food they sell. A one-year serological survey by Matthew Robinson and colleagues identified that individuals selling vegetables, domestic farmed meat, or wildlife meat, were potentially infected by important bacterial pathogens associated with both farmed animals and wildlife.

A rapid review of community engagement and informed consent processes for adaptive platform trials and alternative design trials for public health emergencies

Posted 30/08/2023. Alternative Design Trials (ADTs) and Adaptive Platform Trials (APTs) have enabled efficient large-scale testing of biomedical interventions during recent Public Health Emergencies (PHEs). Alun Davies and colleagues aimed to rapidly review evidence on engagement and informed consent for ADTs and APTs during PHE to consider what (if any) recommendations can inform practice.

Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study

Posted 30/08/2023. This study by Makoto Saito and colleagues analysing 213 severe malaria cases in pregnancy at SMRU, MORU and OUCRU showed vital organ dysfunction led to high maternal and fetal mortality. In contrast, severe anaemia or hyperparasitaemia alone did not. This marked difference may explain the variation of mortality reported in the literature. Early diagnosis and treatment of malaria and anaemia in antenatal care should be promoted.

Drawing by village health volunteers, showing various modes of tranportation to a clinic

Fever and health-seeking behaviour among migrants living along the Thai-Myanmar border: a mixed-methods study

Posted 18/08/2023. Fever is a common reason to seek healthcare in Southeast Asia, and the decline of malaria has further complicated fever perceptions and actions taken. This mixed-methods study from 2019, on Thai-Myanmar border revealed diverse range of fever conceptions, symptoms and believed causes. Napat Khirikoekkong, Supa-at Asarath and colleagues mapped out context-specific healthcare seeking strategies and discussed its influencing key determinants.

Refugee camp on the Thailand-Myanmar border

Defining the role of host biomarkers in the diagnosis and prognosis of the severity of childhood pneumonia: a prospective cohort study

Posted 16/08/2023. Tools for safe community-based childhood pneumonia management are needed. Studies often do not include outpatients or consider whether laboratory tests add value to clinical assessment. Arjun Chandna and colleagues found that Angiopoietin-2 improved performance of a validated risk score (LqSOFA) to predict oxygen requirement amongst refugee children with pneumonia on the Thailand-Myanmar border.

Studying the health benefits of improved housing in rural Tanzania: challenges and progress

Posted 30/06/2023. Millions of affordable healthy homes are needed for the rapidly expanding population of sub-Saharan Africa. A pilot project in northern Tanzania demonstrates the potential of novel house designs to reduce infectious disease transmission in homes. Lorenz von Seidlein and colleagues describe the challenges experienced during the construction and initial evaluation of the novel homes.

Experiences, coping strategies and perspectives of people in Malaysia during the COVID-19 pandemic

Posted 20/06/2023. The SEBCOV study reveals captivating insights into the Malaysian experience during the COVID-19 pandemic. With a nationwide Movement Control Order and a race to administer vaccines, Malaysians faced unprecedented challenges. Phaik Kin Cheah, Phaik Yeong Cheah and colleagues highlight the coping strategies, economic impacts, lifestyle changes, and evolving perceptions of the COVID-19 vaccine.

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Research Highlights