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On 24-25 Jan 2019, investigators met in Bangkok to launch the Developing Triple Artemisinin-based Combination Therapies (DeTACT) Project. Led by MORU and funded by UKaid and the UK Department for International Development (DfID), DeTACT is a large, 14 site trial in 8 African and 5 Asian countries that will study the efficacy, safety and tolerability of two Triple Artemisinin Combination Therapy (TACT) combinations, using combinations of existing antimalarial drugs.
Risk stratification of childhood infection using host markers of immune and endothelial activation in Asia (Spot Sepsis): a multi-country, prospective, cohort study
Posted 24/09/2025. WHO danger signs often misclassify febrile children in resource-limited settings. In the first community-based study across seven Asian sites, Arjun Chandna and colleagues show host-response biomarkers, especially sTREM-1, outperform traditional tools for predicting severe illness. These findings highlight the potential for biomarker-based triage tools to transform childhood infection care.
Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort study
Posted 08/08/2025. Perinatal cause-of-death data in low-resource settings are scarce. Applying the WHO's new ICD-PM classification system to verbal autopsy data in rural Cambodia, Kaajal Patel and colleagues identified hypoxia, prematurity, and infection as leading causes. We found that adaptations to ICD-PM were needed to better classify deaths, especially when the timing of death was unknown.
Sustainable antimicrobial resistance surveillance: time for a global funding mechanism
Posted 07/01/2025. The continued costs of a standard national AMR surveillance system are predicted to account for over 5% of the total domestic general government health expenditure (GGHE-D) for 28 LMICs and more than 2% of GGHE-D for 46 LMICs. This high cost is not sustainable without a long-term global financing mechanism. By Liz Ashley
AmpC β-lactamases detected in Southeast Asian Escherichia coli and Klebsiella pneumoniae
Posted 20/12/2024. AmpC β-lactamases are a neglected cause of third generation cephalosporin resistance in Southeast Asia. This collaboration between COMRU, LOMWRU and SMRU showed that AmpC β-lactamases are an important cause of infection, though infections may be going undetected due to a lack of testing resulting in sub-optimal treatment for patients. By Tamalee Roberts
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.
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.
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.
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
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.
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.
Pneumococcal colonisation and pneumonia severity in hospitalised Cambodian children following introduction of the 13-valent pneumococcal conjugate vaccine
Posted 26/05/2023. In a recent study from Angkor Hospital for Children, Paul Turner and colleagues recruited over 2,000 Cambodian children with clinical pneumonia in the first three years following pneumococcal conjugate vaccine (PCV13) introduction nationally. PCV13 vaccinated children were less likely to have severe presentations, i.e. x-ray confirmed or hypoxic pneumonia, compared to non-vaccinated children.
Impact of delayed processing of positive blood cultures on organism detection: a prospective multi-centre study
Posted 19/07/2022. What effect temperature and time have on organism detection from positive blood culture bottles is unknown. Tamalee Roberts, Arjun Chandna and colleagues found that the majority of organisms were recoverable from positive blood culture bottles stored at room temperature. Amies transport swabs also proved effective for transporting blood culture broth and preserving organism viability.
Facilitating safe discharge through predicting disease progression in moderate COVID-19: a prospective cohort study to develop and validate a clinical prediction model in resource-limited settings
Posted 29/03/2022. In regions with low Covid-19 vaccine coverage, health systems remain vulnerable to surges in infections. Arjun Chandna and colleagues developed three clinical prediction models to help identify patients safe for community-based management. Each model contains three simple clinical parameters (age, sex, SpO2) and one point-of-care biomarker, and could help protect resource-limited health systems.
Saving babies’ lives (SBL) – a programme to reduce neonatal mortality in rural Cambodia: study protocol for a stepped-wedge cluster-randomised trial
Posted 28/09/2021. Despite most neonatal deaths being preventable, neonatal mortality remains unacceptably high globally. Saving Babies’ Lives (SBL) is a stepped-wedge cluster-randomised trial, which will develop, implement, and assess an iterative package of neonatal interventions combining community and primary care strategies to reduce neonatal mortality in a rural Cambodian province, by Claudia Turner and colleagues
Community engagement, social context and coverage of mass anti-malarial administration
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.
The impact of targeted malaria elimination with mass drug administrations on falciparum malaria in Southeast Asia
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.
Laboratory informatics capacity for effective antimicrobial resistance surveillance in resource-limited settings
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.
Improving treatment and outcomes for melioidosis in children, northern Cambodia, 2009–2018
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.
Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia
Posted 15/12/2020. A recent study co-led by Paul Turner and colleagues at COMRU identified extremely high prevalence of antimicrobial resistant (AMR) bacterial carriage in households from Siem Reap, Cambodia. Extended-spectrum beta-lactamase producing Escherichia coli were detected in stool samples from >90% of participants. The results highlight the challenges to AMR control in locations where antibiotic overuse is common.
MALDI-TOF mass spectrometry for sub-typing of Streptococcus pneumoniae
Posted 04/12/2020. Paul Turner and COMRU researchers, working with Cambodia’s University of Health Sciences and Fondation Merieux, evaluated recently the potential of MALDI-TOF-based serotyping of Streptococcus pneumoniae for vaccine impact surveillance. Despite early promise, the team found that MALDI-TOF performed poorly and should not replace existing serotyping methodologies.