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The incidence of malaria has continued to drop dramatically in remote rural villages in Myanmar after community workers trained only to detect and treat malaria began providing basic health care as well as malaria services, researchers affiliated with MOCRU, our Myanmar-Oxford Clinical Research Unit, have said.
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Photo: AFP / Pornchai Kittiwongsakul
Expanding the roles of community health workers to sustain programmes during malaria elimination: a meeting report on operational research in Southeast Asia
COMRU MORU Bangkok
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
COMRU
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
COMRU LOMWRU MORU Bangkok SMRU
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
COMRU MORU Bangkok
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
COMRU MORU Bangkok SMRU
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
COMRU MORU Bangkok
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
COMRU LOMWRU
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
COMRU
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
COMRU
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
COMRU LOMWRU MOCRU MORU Bangkok
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
COMRU LOMWRU MOCRU MORU Bangkok
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
COMRU
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
COMRU
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
COMRU
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
COMRU
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.
Antimicrobial resistance in Cambodia
COMRU MORU Bangkok
Posted 09/07/2019. On behalf of the Cambodian Ministry of Health Technical Working Group on Antimicrobial Resistance, Paul Turner and colleagues at COMRU recently led a review of published data on AMR in Cambodia. Significant AMR was identified in a range of priority pathogens although data were limited. On-going national AMR surveillance will address this data gap.
Antimicrobial-resistant Gram-negative colonization in infants from a neonatal intensive care unit in Thailand
COMRU LOMWRU MORU Bangkok
Posted 31/05/2019. Drug-resistant infections caused by Enterobacteriaceae, a family of Gram-negative bacteria, account for a high and increasing disease burden amongst hospitalised neonates in Southeast Asia; carbapenem-resistant strains are particularly important because of limited antibiotic treatment options. Tamalee Roberts and colleagues found that nearly two thirds of infants in a neonatal unit in Thailand became asymptomatic carriers with carbapenem-resistant Enterobacteriaceae during their hospital stays. This work indicates a critical need for interventions to reduce this usually hidden reservoir of drug-resistant bacteria.
Molecular characterization and mapping of G6PD mutations in the Greater Mekong Subregion
COMRU LOMWRU MOCRU MORU Bangkok
Posted 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.
Microbiology Investigation Criteria for Reporting Objectively (MICRO): a framework for the reporting and interpretation of clinical microbiology data
COMRU LOMWRU
Posted 07/05/2019. Developed by Paul Turner and fellow members of the Oxford Tropical Network, the MICRO framework provides the scientific community with clear guidance on reporting and interpretation of clinical microbiology and antimicrobial resistance (AMR) data. Use of the framework will result in publication of better quality data for use in the global fight against AMR. The MICRO guideline is also posted on the EQUATOR website www.equator-network.org/reporting-guidelines