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\n \n \n \nPosted 15/01/2019. Dr Thomal Althaus and colleagues managed to reduce antibiotic prescription using the C-reactive protein (CRP) test among 2,410 children and adults presented with a fever in primary care centres in Thailand & Myanmar. The perspective of a rapid and affordable test for CRP, identifying febrile patients who really need an antibiotic, is now possible!
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\n \n \n \nPosted 19/02/2019. Germana Bancone and colleagues characterized glucose-6-phosphate dehydrogenase deficiency in over 10 thousand samples collected in 138 villages in Cambodia, Lao PDR, Myanmar, Thailand and Vietnam, showing a country-level prevalence in males ranging from 7.3% to 18.8%. Given this high prevalence, G6PD testing should be carried out in the Greater Mekong Subregion before P. vivax radical cure with 8-aminoquinolines.
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\n \n \n \nPosted 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.
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\n \n \n \nPosted 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.
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\n \n \n \nPosted 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.
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\n \n \n \nPosted 11/08/2020. This very large molecular epidemiology study done over 12 years describes the evolution and spread of antimalarial drug resistance across the entire Greater Mekong subregion (GMS). Mallika Imwong and colleagues show no evidence of spread of artemisinin resistant parasite lineages from the eastern to the western GMS. There is also no evidence for piperaquine resistance in the western GMS.
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\n \n \n \nPosted 21/07/2020. This article by Arjen Dondorp and colleagues provides guidance on respiratory support for patients with severe COVID-19 focusing on low- and middle-income countries, based on current evidence and experience. Rather than the usual focus on mechanical ventilation, it emphasizes the importance of having the right modalities for non-invasive oxygen therapy in place
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\n \n \n \nPosted 14/07/2020. Non-adherence in non-inferiority trials typically dilutes observed treatment effects, leading to a higher probability of claiming non-inferiority. Mo Yin and colleagues describe different patterns of non-adherence and the influence of the confounders on treatment effects. Causal inference methods that account for these confounders can minimise bias and risk of false non-inferiority claims.
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\n \n \n \nPosted 25/06/2020. Antibiotic-resistant bacteria are a growing global health crisis. In order to develop a quantitative understanding of how antibiotics affect drug-resistant bacteria within the human gut, Ben Cooper and colleagues developed a data-driven model of the within-host dynamics of blaCTX-M, one of the most important gene families for antibiotic resistance.
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\n \n \n \nPosted 12/06/2020. Safety of drugs is important, particularly during pregnancy. Makoto Saito and colleagues have pooled the data of 4503 women who had malaria in pregnancy and found that the currently used artemisinin-based combination therapies are equally safe for fetus. This study also highlights that risk of small-for-gestational-age (SGA) is high after malaria in pregnancy even treated with highly efficacious drugs, suggesting that prevention is important for reducing SGA in malaria endemic areas.
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\n \n \n \nPosted 08/06/2020. Safe and effective radical cure of malaria will require better ways of testing for G6PD deficiency. In a large collaborative study a paper in PLoS Medicine, Daniel Pfeffer, Ric Price and colleagues highlight substantial variation between research laboratories using the current gold standard method (spectrophotometry). The study highlights challenges but also opportunities for new point of care tests.
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\n \n \n \nPosted 02/06/2020. Thomas Althaus and colleagues identified Influenza and dengue viruses as key pathogens in febrile children and adults attending primary care in Thailand and Myanmar. CRP performance for distinguishing bacterial from viral pathogens was average while patients recovered regardless of antibiotic prescription. This suggests that most primary care infections do not require an antibiotic.
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\n \n \n \nPosted 13/03/2020. New research by Ipsita Sinha and colleagues provides a framework for identifying key traveler groups and their origins and destinations of travel combination with knowledge of local epidemiology to inform malaria control and elimination efforts. This publication is based on travel information collected from over 2000 patients from 57 study sites in South-East Bangladesh, in collaboration with the National Malaria Elimination Control programme of Bangladesh.
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\n \n \n \nPosted 05/05/2020. In this Cochrane qualitative review to inform the 2020 COVID19 pandemic, Xin Hui Chan and colleagues identify key barriers and facilitators to healthcare workers\u2019 adherence to infection prevention and control (IPC) guidelines for respiratory infectious diseases to support policymakers and healthcare leaders in designing and implementing IPC guidelines. These include organisational factors (safety climate, design & communication of consistent PPE guidelines, availability of training programmes), physical environment (space, facility design, administrative controls, personal protective equipment availability), and individual factors (knowledge, beliefs, attitudes).
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\n \n \n \nPosted 08/10/2019. A rapidly evolving multi-drug resistant lineage of P. falciparum malaria parasites continues to spread in Southeast Asia, leading to alarmingly high treatment failure rates in Cambodia, Thailand and Vietnam for DHA-piperaquine, one of the world\u2019s most important anti-malaria drugs. Rob van der Pluijm and colleagues say that accelerated elimination of P falciparum malaria in this region is urgently needed, to prevent further spread and avoid a potential global health emergency.
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\n \n \n \nPosted 23/04/2019. Human population movement can lead to the persistence of malaria along the Thai\u2013Myanmar border. Lisa White, Wirichada Pan-ngum and colleagues show that malaria risk is related to the number of days doing outdoor activities in the dry season, especially trips to Myanmar, to forest areas and overnight trips. Understanding movement patterns is important when considering targeted public health interventions, especially during the elimination phase.
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\n \n \n \nPosted 16/10/2019. Plasmodium vivax is particularly hard to eliminate because it can relapse from dormant liver stages, weeks to months after the initial infection. Bob Taylor and colleagues present a large multicentred clinical trial showing that a 7 day course with double the daily dose of primaquine is as effective as the traditional 14 day primaquine course, with acceptable tolerability in G6PD normal patients. The trial paves the way for safer and more effective treatment of this parasite.
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\n \n \n \nPosted 18/10/2019. Scrub typhus is a major cause of fever across the Asia Pacific region. Doxycycline resistance, the main antibiotic used for treatment, was described in the 1990s but independent verification was neglected, leading to doubts regarding its efficacy. Assessment of historical evidence and recent reports by Tri Wangrangsimakul and colleagues suggest this finding was a misconception.
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\n \n \n \nPosted 07/01/2020. Identifying bacterial infections in sub-Saharan Africa is a challenge because of limited access to laboratory infrastructure. Thomas Althaus and colleagues measured high sensitivity of C-reactive protein (CRP) in detecting bacterial blood stream infections and zoonotic bacterial pathogens among febrile patients both in primary levels of care and hospitals in Moshi, northern Tanzania
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\n \n \n \nPosted 17/01/2020. Malaria is no longer a common cause of febrile illness in many regions of the tropics. Yoel Lubell and colleagues consider the costs and benefits of multiplex malaria/CRP tests that are now commercially available in terms of (i) the improved health outcomes for patients with bacterial illnesses; (ii) the costs of antimicrobial resistance averted; or (iii) the economic benefits of better management of remaining malaria cases and shorter malaria elimination campaigns. They conclude that a multiplexed malaria/CRP test could be highly cost-effective and utilize the well-established funding and distribution systems already in place for malaria RDTs.
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