Research Highlights
Operational evaluation of the deployment of Malaria/CRP Duo and Dengue Duo rapid diagnostic tests for the management of febrile illness by village malaria workers in rural Cambodia
Posted 23/05/2025. Village malaria workers in rural Cambodia provide essential early diagnosis and treatment; however, their importance is diminishing following a significant decline in malaria. James Callery and colleagues explore the potential expansion of their roles to ensure that febrile patients continue to utilise their services until local malaria elimination is achieved and the risk of reimportation subsides.
A comparison of national seasonal influenza treatment guidelines across the Asia Pacific region
Posted 21/05/2025. Seasonal influenza remains a major health burden in Asia. Our new comparative analysis reviews national influenza treatment guidelines across Asia Pacific countries, finding significant variation in availability, rigour, and recommendations. Our findings reveal key opportunities to strengthen evidence-informed, systematic guideline development as part of national and regional influenza preparedness and response. By Ellen Beer.
The impact of mass screening and treatment interventions on malaria incidence and prevalence: a retrospective analysis of a malaria elimination programme in eastern Myanmar, and systematic review and meta-analysis
Posted 20/05/2025. Targeted interventions are often necessary to eliminate malaria, but some are more effective than others. Jade Rae and colleagues investigated the impact of village-level mass screening and treatment interventions, highlighting key factors that influence the effectiveness of targeted malaria interventions, including baseline endemicity, population demographics, and the timing and uptake of the intervention.
Cutaneous leishmaniasis in Afghanistan
Posted 13/05/2025. Cutaneous leishmaniasis (CL) is a very neglected tropical disease. Afghanistan has an exceptionally high CL burden fueled by war and poverty. This review focuses on the clinical and epidemiological aspects of CL and highlights the need to grow the research culture so evidence can inform policy. By Bob Taylor
How do study participants want to be informed about study results: Findings from a malaria trial in Cambodia, Ethiopia, Pakistan, and Indonesia
Posted 13/05/2025. Patient interest in receiving clinical trial results varies widely across countries, underscoring that one-size-fits-all strategies fall short. This study, embedded in an antimalarial trial, explores locally tailored dissemination approaches shaped by patient preferences and stakeholder input offering essential guidance for ethical result sharing in diverse global health settings. By Bipin Adhikari
Placental and cord blood DNA methylation changes associated with gestational diabetes mellitus in a marginalized population: the untold role of saturated fats
Posted 09/05/2025. First report on DNA-methylation changes associated with saturated fat consumption in the context of gestational diabetes in a disadvantaged population. Rose McGready and colleagues suggest that population-specific nutritional interventions to reduce saturated fats, while promoting healthier oil (sunflower or soyabean) intake in pregnancy could mitigate negative consequences of DNA hypomethylation, improving transgenerational health impacts.
Effect of a novel house design (star home) on indoor malaria mosquito abundance in rural Tanzania: secondary outcomes of an open-label, household, randomised controlled trial
Posted 23/04/2025. A novel screened house design with bedrooms on the second storey reduced indoor mosquito abundance (51% less Anopheles gambiae; 61% less Culex species) and were 0·5°C cooler compared with traditional houses in Mtwara, Tanzania. By Lorenz Von Seidlein
Call for a fairer approach to authorship in publishing biomedical research
Posted 11/04/2025. Phaik Yeong Cheah and Michael Parker advocate for fairer authorship in collaborative biomedical research to enhance equity and inclusiveness. They highlight how current practices overlook contributors and discuss challenges in authorship decisions, including project size, multidisciplinary complexity, and the varied roles of researchers at different stages.
Validating a web application’s use of genetic distance to determine helminth species boundaries and aid in identification
Posted 26/03/2025. Helminth species identification is challenging due to their diversity. Abigail Hui En Chan, Sompob Saralamba and their team developed ABIapp, a user-friendly R/Shiny application that helps researchers visualize taxonomic boundaries using genetic distance data. With up to 76% accuracy, ABIapp outperforms existing web-based tools, providing a valuable resource for helminth research.
Comparing HemoCue® and Quantitative Buffy Coat® and Coulter Counter-measured haemoglobin concentrations in African children with acute uncomplicated malaria: a Bland–Altman analysis
Posted 19/03/2025. Malaria studies often involve blood transfusion to severe malarial anaemic children. Accurate Anaemia diagnosis is crucial for effective management. Hence, important to determine the level of agreement among haemoglobin concentrations measurement methods. HemoCue® should be used with caution in settings where decisions about blood transfusions are made. By Mavuto Mukaka
Tracing epistemic injustice in global antimicrobial resistance research
Posted 14/03/2025. This commentary explores whether there is epistemic injustice in global antimicrobial resistance (AMR) research – who sets priorities, who produces knowledge, and which types of knowledge are valued. Prof Phaik Yeong Cheah and colleagues argue that epistemic injustice may have created blind spots in policy. Addressing this requires a commitment to diversity, equity, and inclusion.
Submicroscopic malaria in pregnancy and associated adverse pregnancy events: A case-cohort study of 4,352 women on the Thailand–Myanmar border
Posted 11/03/2025. Malaria is known to be dangerous for pregnant women and their developing babies. But how much malaria is too much malaria? Using an ultra-sensitive PCR method that detects one parasite per drop of blood, Mary Ellen Gilder and SMRU colleagues found that even infections with very few parasites are associated with adverse pregnancy outcomes.
Antibiotic duration for common bacterial infections - a systematic review
Posted 07/03/2025. Reducing antibiotic duration is key to antimicrobial stewardship. A review of 315 trials found strong evidence for shorter courses in common infections but limited data for severe infections and low-income settings. Only 15% had low bias risk. More research is needed in critical care and resource-limited environments. By Mo Yin
Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial
Posted 04/03/2025. Previously, the REGARD-VAP trial found that giving patients with ventilator-associated pneumonia (VAP) a personalised, shorter antibiotic treatment was just as effective as usual care. Mo Yin and colleagues showed this approach is also cost-effective in Nepal, Singapore, and Thailand. This approach could save money, reduce antibiotic use, and help policymakers make better healthcare decisions despite some uncertainties.
Dose-Optimization of a Novel Co-Formulated Triple Combination Antimalarial Therapy: Artemether-Lumefantrine-Amodiaquine
Posted 18/02/2025. Emerging artemisinin-resistance in Africa threatens our ability to treat malaria. Joel Tarning and colleagues developed an optimal weight-based dosing of a fixed-dose artemether-lumefantrine-amodiaquine formulation using population pharmacokinetic modelling. Dosing was designed to achieve consistent drug exposure across all body weights. This formulation should simplify manufacturing and improve adherence, when treating resistant malaria.
Overcoming research challenges in resource-limited settings: perspectives from Thailand
Posted 29/01/2025. Conducting research in LMICs is undeniably challenging, with brain drain often surpassing reverse brain drain. We share an opinion discussing both the difficulties and rewards of working in this space. Claire Chewapreecha and Thongchai Chewprecha hope it will encourage international and national funding agencies to invest in LMIC talent, and drive meaningful, lasting impact.
Community responses to a novel house design: A qualitative study of “Star Homes” in Mtwara, southeastern Tanzania
Posted 24/01/2025. Salum Mshamu and colleagues evaluate community responses to novel design homes in Mtwara, Tanzania, aimed at reducing childhood diseases such as malaria, respiratory infections, and diarrhoea. Using qualitative research, the study explores how residents and neighbours interact with the novel housing design including its impact on residents' lives, social, cultural, and health-related issues. The findings offer insights for future community wide novel housing interventions.
Acceptability of improved cook stoves-a scoping review of the literature
Posted 21/01/2025. Novel housing interventions (Star Homes) in Tanzania aim to prevent childhood diarrhea, malaria, and respiratory infections by addressing multiple aspects of housing—one of which is cooking stoves. Our research on Star Homes in rural Tanzania revealed inconsistent use of improved cookstoves, sparking a systematic review into factors influencing stove acceptability globally. By Bipin Adhikari
Identification of Southeast Asian Anopheles mosquito species with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry using a cross-correlation approach
Posted 17/01/2025. Victor Chaumeau and colleagues developed a reference MALDI-TOF mass spectra database for the identification of Anopheles mosquitoes from the Thailand-Myanmar border allowing rapid, affordable and accurate identification of medically important vector species, an important prerequisite to assess disease transmission and evaluate vector control. This is the first free open-source data analysis pipeline allowing anyone to replicate the analysis and develop reference database in-house.
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
Population genomics and transcriptomics of Plasmodium falciparum in Cambodia and Vietnam uncover key components of the artemisinin resistance genetic background
Posted 17/12/2024. Tom Peto and colleagues collected Plasmodium falciparum parasites from malaria patients in Cambodia and Vietnam between 2018 and 2020 in the MORU-led TACT-CV study. Novel molecular analyses of these samples at Nanyang Technological University identified new genetic factors that appear under selective pressure and may contribute to artemisinin resistance mechanisms in clinical settings.
A hill tribe community advisory board in Northern Thailand: lessons learned one year on
Posted 22/11/2024. Since 2023 the Chiang Rai community advisory board helped researchers understand the many local ethnic minority groups of Northern Thailand and vice-versa, improving cooperation and research activities. Over time, benefits have grown. Carlo Perrone and colleagues present their experience one year on, supporting long-term partnerships over project-based ones.
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.
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.