Fearing that drug resistant malaria will reach Africa, Prof François Nosten and his team are among those scientists who are scrambling to stop it while they still can. Drug resistance to artemisinin has been steadily increasing in Southeast Asia. Having emerged in Cambodia in 2007, it since has been recorded in Thailand, Vietnam and Myanmar. Artemisinin is the last remaining effective drug against the resistant falciparum strain, and there are no suitable replacements yet.
Posted 17/10/2017. Plasmodium falciparum and Plasmodium vivax malaria in pregnancy both increase stillbirth risk, which is likely to increase as endemicity declines. A study by SMRU and University of Melbourne researchers shows that better P. falciparum malaria control efforts could prevent up to 1 in 5 to 8 stillbirths in sub-Saharan Africa.
Posted 17/10/2016. Training local Karen and Burman women as skilled birth attendants in refugee settings resulted in no adverse perinatal outcomes and many positive outcomes such as a drop in stillbirths and infant deaths and more babies being born in clinics rather than at home, says a new study, led by Professor Rose McGready and published in PLOS ONE.
Posted 22/10/2019. Rose McGready and SMRU colleagues contributed RCT data from the Thailand-Myanmar border to this large review on low- and middle-income countries (21 studies in 20 882 children). The results suggests targeting parental, environmental and nutritional factors from pre-pregnancy through childhood, as a way forward to improve health and development of children in such settings.
Posted 21/04/2020. This study by Victor Chaumeau and colleagues was carried out in order to assess the longevity of insecticide mists applied to outdoor vegetation. Insecticidal effect of sprayed plant material against malaria mosquitoes lasted for several weeks. These results provide a strong rationale for using outdoor residual spraying against the mosquito vectors that rest outside premises.
Posted 06/11/20. Victor Chaumeau and colleagues assessed the impact of outdoor residual spraying on the biting rate of malaria mosquitoes in four villages in Kayin state, Myanmar. They reported a 10-fold decrease in mosquito biting rate immediately after the intervention and concluded that outdoor residual spraying can be used to control malaria mosquitoes in this area.
Posted 16/03/2021. Many women in Southeast Asia are smaller than their Western counterparts. How might this affect an otherwise healthy pregnancy? A recent study from the Thai-Myanmar border by Sue J Lee, Ahmar Hashmi and colleagues suggests that maternal height should be considered when providing advice regarding weight gain during pregnancy.
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 20/12/2019. How do birth outcomes, a mother’s nutrition, and how a mother feeds her infant relate to chronic undernutrition among refugee and migrant infants along the Thailand-Myanmar border? Why do these mothers feed their infants as they do? Come learn more from a recent study by Ahmar Hashmi and colleagues at the Shoklo Malaria Research Unit.
Posted 18/05/2021. Rose McGready and colleagues show a strong association between P. falciparum infection and hypertension, in a large prospective cohort of women followed from the first trimester of pregnancy. Falciparum malaria which sequesters in the placenta most likely drives the development of chronic placental hypoxia, eventually progressing to clinical gestational hypertension or pre-eclampsia. This is important given hypertension is in the top 3 killers of pregnant women and that most pregnancy related hypertensive deaths occur in sub-Saharan Africa where malaria prevention strategies are not implemented until the beginning of second trimester or later.
Posted 05/05/2021. On the Thailand-Myanmar border, 39% of migrant women and 47% of refugee women experience maternal depression. Gracia Fellmeth and colleagues show that among migrant women, higher levels of social support are associated with lower depression. The perinatal period offers a valuable opportunity to ask women about depression and support networks and offer help to those who need it.
Posted 21/04/2021. Tobias Brummaier and colleagues report a high burden of soil-transmitted helminth infections and an association with maternal anaemia in pregnant migrant and refugee women on the Thai-Myanmar border. Whether the protective effect of Ascaris lumbricoides infection against miscarriage observed in this retrospective dataset results from helminth immune modulation remains to be determined.
Posted 14/04/2021. Germana Bancone and Cindy Chu review the current knowledge about drug-induced haemolysis in G6PD deficiency, and discuss new clinical and laboratory approaches to understand haemolytic risk in G6PD variants. A more comprehensive genotypic and phenotypic characterization, together with haematologic responses upon exposure to different drugs, will help define a clinically useful classification of G6PD variants
Posted 26/03/2021. Ketamine is an essential drug widely used in low-resource settings, but there was no data on its safety in lactating women until this report. In this study by Mary Ellen Gilder and SMRU colleagues, outcomes for breastfeeding infants whose mothers received ketamine are good, and not affected by ketamine dose. In contrast, high dose maternal intravenous diazepam may be harmful.
Posted 19/03/2021. Tobias Brummaier reports that collaborative research efforts with SMRU and SIDRA have demonstrated that vaginal microbial composition and local vaginal immune environment are associated with preterm birth in Asian women from a low-resource setting, possibly providing an avenue towards an early predictive tool for preterm birth
Posted 05/03/2021. Prevention of mother to child transmission of Hepatitis B can be challenging in resource limited settings. Marieke Bierhoff and colleagues look at strategies that might be more feasible in these settings. TDF (tenofovir disoproxil fumarate) after rapid diagnostic test may be a more feasible strategy to implement in resource limited settings, TDF after hepatitis B e-antigen test is a cheaper option.
Posted 01/12/2020. This paper confirms that research is important to inform evidence-based medical care in LMICs settings. Napat Khirikoekkong, Phaik Yeong Cheah and colleagues found that migrants living along the Thai-Myanmar border, who were traditionally deemed vulnerable, exercise their agency and resourcefulness when navigating through their daily challenges, and participating in important health research
Posted 27/11/2020. The migrant-friendly residential TB program of SMRU on the Thailand-Myanmar border has achieved high treatment success rate. However, many TB patients admitted to the centers are in advanced stage of disease. Win Pa Pa Htun and colleagues show that early TB death (in the first month of treatment) is highest among pulmonary TB cases and in particular in HIV co-infected patients and in those with co-morbidity. Early detection and treatment for both TB and HIV are crucial for migrants, if the case fatality rate is to be reduced in this marginalized population.
Posted 25/09/2020. Prevention of mother to child transmission of hepatitis B with maternal tenofovir DF is one option to reach elimination of this infection. However, implementing this in a resource limited setting is challenging. Marieke Bierhoff and colleagues describe the most common challenges and possible solutions like transport assistance and local agreements to facilitate access.
Posted 27/08/2020. Germana Bancone and colleagues from EDCD (Nepal) and SMRU conducted this study in malaria endemic districts of Nepal, showing that G6PD deficiency is prevalent among most ethnic groups across the region. G6PD testing will be necessary for safe deployment of 8-aminoquinolines in order to eliminate Plasmodium vivax malaria in Nepal.
Posted 25/04/2018. Mary-Ellen Gilder and colleagues at SMRU demonstrate low levels of primaquine in breast milk, findings that should change treatment policy allowing more breastfeeding women to be cured of P.vivax. This will potentially reduce the global burden of this infection which has significant negative consequences for pregnant mothers and infants.
Which infections are most common in the Chiangrai region? How should we treat them and how can we improve diagnostic? Which strategies are most effective in directing antibiotic treatment? Blog by Carlo Perrone, research physician based at the Chiang Rai Clinical Research Unit in Chiangrai, Thailand.
Millions of children weighing less than 15kg are currently denied access to Ivermectin treatment due to insufficient safety data being available to support a change to the current label indication. The WorldWide Antimalarial Resistance Network’s new meta-analysis provides evidence that supports removing this barrier and improving treatment equity.
Evidence from a new study, initiated by the Primaquine Roll Out Group and conducted at WWARN, supports the World Health Organization (WHO) recommendation for use of 0.25mg/kg dose of primaquine (PQ) combined with artemisinin-based combination therapies (ACT) to block Plasmodium falciparum transmission.
A study to explore the variations of how microscopy methods are reported in published malaria studies has recommended standardised procedures should be implemented for methodological consistency and comparability of clinical trial outcomes.
Blog by Rima Shretta. Preliminary efficacy results from three vaccine candidates currently in Phase 3 trials have shown an efficacy of more than 90% against the development of symptomatic COVID-19. While these results are promising, all vaccines are in relatively early stages of testing. A comprehensive and transparent roadmap is urgently needed, to determine how limited doses of the first vaccines to be licensed will be distributed, together with which groups will initially be prioritized.
A new study quantifying the high risk of Plasmodium vivax parasitaemia after treatment of Plasmodium falciparum malaria aims to identify populations in which a policy of universal radical cure, combining artemisinin-based combination therapy with a hypnozoitocidal antimalarial drug, would be most beneficial.