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Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome

MORU Bangkok

Posted 23/12/2021. Marcus Schultz and colleagues analysed 4 large prospective observational studies conducted in 534 ICUs in 54 countries. Patients in middle–income countries were younger, shorter with a slightly lower BMI, had more often diabetes and active cancer, but less often COPD and heart failure. Sequential organ failure assessment scores were similar. ICU mortality was higher in middle–income countries, and inversely associated with GDP.

Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study

MORU Bangkok

Posted 12/11/2021. Global antibiotic consumption rates increased by 46 percent in the last two decades, according to the first study to provide longitudinal estimates of human consumption in 204 countries from 2000 to 2018. Annie Browne, Christiane Dolecek and colleagues used a novel approach that deployed statistical modelling techniques and incorporated multiple data sources, to help us address a number of public health challenges, from combating drug resistant infections to providing access to basic treatment

Antimicrobial resistance detection in Southeast Asian hospitals is critically important from both patient and societal perspectives, but what is its cost?

LOMWRU

Posted 05/22/2021. Generation of quality surveillance data is one of the pillars of the WHO response to the global AMR problem. However, work by LOMWRU’s Tamalee Roberts and colleagues estimates that laboratory setup and running costs for hospital-based AMR surveillance in Southeast Asia are likely to be prohibitive in many resource-limited settings.

Co-evolutionary signals identify Burkholderia pseudomallei survival strategies in a hostile environment

MORU Bangkok

Posted 02/11/2021. Claire Chewapreecha and colleagues employ a powerful combination of genome-wide epistasis and co-selection study (GWES); gene expression analyses and gene knockout assays to identify the key genes that have been repeatedly selected through Burkholderia pseudomallei evolution. The study indicates that the bacterium is evolutionarily primed to survive nutrient-depleted soils and highlights the need to protect environmental health as part of disease prevention.

Orientia tsutsugamushi dynamics in vectors and hosts: ecology and risk factors for foci of scrub typhus transmission in northern Thailand

MORU Bangkok

Posted 20/10/2021. Scrub typhus infects over a million people a year across the Asia-Pacific. The ecology of this important disease, transmitted by chigger mites, remains poorly understood. Ivo Elliott and colleagues report on the identification of key risk factors that determine foci of high disease transmission at 3 sites in Northern Thailand.

A descriptive study of Forcefully Displaced Myanmar Nationals (FDMN) presenting for care at public health sector hospitals in Bangladesh

MORU Bangkok

Posted 01/10/2021. In 2017 hundreds of thousands of ‘Rohingya’ fled from Myanmar to refugee camps in Cox’s Bazar, Bangladesh. Health centre data were reviewed to estimate the increase in health care utilization. The presence of a large migrant population relative to a smaller host community burdens the limited facilities and resources of the public health sector, by Lorenz Von Seidlein and colleagues

The cardiovascular effects of amodiaquine and structurally related antimalarials: An individual patient data meta-analysis

MORU Bangkok

Posted 29/09/2021. Xin Hui Chan and colleagues report a large individual patient data meta-analysis of malaria clinical trials supporting the cardiovascular safety of amodiaquine and structurally related antimalarials at WHO-recommended dosing regimens alone or in ACTs for the treatment and prevention of malaria, and propose a potential mechanism for amodiaquine-related asthenia.

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

Development of weight and age-based dosing of daily primaquine for radical cure of vivax malaria

MORU Bangkok

24/09/2021. Plasmodium vivax in SE Asia and Oceania is less sensitive to primaquine compared to other regions and needs a higher target dose - 0.5 mg/kg. Bob Taylor and colleagues propose a new regimen that was designed using pharmacokinetic simulation and takes into account that children need higher mg/kg doses compared to adults.

Clustering of malaria in households in the Greater Mekong Subregion: operational implications for reactive case detection

MORU Bangkok

Posted 17/09/2021. One of the policies to achieve malaria elimination in the near future is reactive case detection. A secondary analysis of a large dataset of mass drug administrations in Greater Mekong Subregion found that reactive case detection in this setting is costly but results only in minimal benefits, by Lorenz Von Seidlein and colleagues

Dynamics of G6PD activity in patients receiving weekly primaquine for therapy of Plasmodium vivax malaria

MORU Bangkok

Posted 15/09/2021. In Cambodian G6PD deficient variants, G6PD enzyme activity is unaffected by baseline reticulocyte counts but rises and correlates with posttreatment reticulocytosis. Qualitative G6PD tests are unlikely to misdiagnose G6PD deficient males at presentation. Too few G6PD heterozygous females preclude drawing inferences; more research is needed in this group.

A spatio-temporal analysis of scrub typhus and murine typhus in Laos; implications from changing landscapes and climate

LOMWRU

Posted 14/09/2021. Little is known about why scrub typhus and murine typhus vary through time and space. Tamalee Roberts and colleagues investigated the impacts of climate and environment on both neglected diseases in Laos. The results suggest that global heating will increase their incidence and distribution, requiring interventions to reduce their burden.

Suicidal ideation in the perinatal period: findings from the Thailand–Myanmar border

SMRU

Posted 24/08/2021. Suicide is a leading cause of maternal death globally. On the Thailand-Myanmar border, 8% of refugee women and 3% of migrant women experienced suicidal thoughts during pregnancy and postnatally. The greatest risk factors for suicidal thoughts were unplanned pregnancy and past trauma. Community interventions and targeted prevention initiatives are urgently needed to help lower the rates of people dying by suicide, by Gracia Fellmeth and colleagues.

Preprints in times of COVID19: the time is ripe for agreeing on terminology and good practices

LOMWRU

Posted 06/08/2021. Preprints are increasingly being used to share non-peer-reviewed manuscripts to enable the rapid dissemination of research. In particular, they have become an important source of information for wider audiences keen to follow COVID-19 research developments, including news, social media and policymakers. This practice raises several challenges in publication ethics and integrity. Paul Newton and colleagues set out the need for good practice.

Grandparent caregiving in Cambodian skip-generation households: Roles and impact on child nutrition

MORU Bangkok

Posted 27/07/2021. This qualitative study by Mira Schneiders and colleagues discusses the important nutrition-related roles and responsibilities of grandparents caring for grandchildren in rural Cambodian ‘skip-generation’ households. Grandparents appear highly motivated to improve grandchildren’s health and nutrition, but lack necessary resources, leading to frequent moral dilemmas and ethical trade-offs. Interventions to improve child health and nutrition should be designed to be inclusive of older caregivers.

Identifying prognostic factors of severe metabolic acidosis and uraemia in African children with severe falciparum malaria

MORU Bangkok

Posted 16/07/2021. Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. What prognostic factors are associated with severe metabolic acidosis and uraemia in African children with severe falciparum malaria? Secondary analysis of a randomized trial by Mavuto Mukaka and colleagues

Mass drug administration for the acceleration of malaria elimination in a region of Myanmar with artemisinin-resistant falciparum malaria

MOCRU

Posted 07/07/2021. Frank Smithuis and colleagues conducted a large cluster randomized evaluation of mass drug administration (MDA) with dihydroartemisinin-piperaquine for malaria elimination in an area with high artemisinin resistant Plasmodium falciparum. MDA was a safe and effective tool to accelerate P. falciparum elimination, alongside routine community-based malaria control measures. It was well tolerated and well accepted. MDA did not select for drug resistant parasites.

Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries

MORU Bangkok

Posted 06/07/2021. Surveillance of Antimicrobial resistance (AMR) is important in generating evidence to support efforts in controlling the infection. Cherry Lim and colleagues discuss the strengths, potential sources of bias, and challenges of routine microbiology data and different surveillance strategies and solutions used in low- and middle-income countries. Areas requiring support and improvement are highlighted.

Case Report: Children with Severe Nutritional Rickets in the Naga Region in Northwest Myanmar, on the border with India

MOCRU

Posted 29/06/2021. Frank Smithuis and colleagues describe a cluster of 29 children with severe, painful bone deformities living in very remote Nagaland, northwest Myanmar. They had low 25-hydroxyvitamin D, elevated parathyroid hormone, and elevated alkaline phosphatase levels, consistent with nutritional rickets secondary to vitamin D deficiency, calcium deficiency, or a combination of both. After treatment with vitamin D3 and calcium carbonate, we saw significant improvement in symptoms, biochemistry, and radiography. This is the first report of nutritional rickets in Myanmar in over 120 years.

A randomized controlled trial of dihydroartemisinin-piperaquine, artesunate-mefloquine and extended artemether-lumefantrine treatments for malaria in pregnancy on the Thailand-Myanmar border

SMRU

Posted 23/06/2021. In an RCT of three artemisinin-based combination therapies in pregnancy on the Thailand-Myanmar border where artemisinin resistance is widespread, only dihydroartemisinin-piperaquine provided satisfactory efficacy for P. falciparum, in this study by Makoto Saito & colleagues. Mefloquine-artesunate provided the longest recurrence-free period for P. vivax. Vivax recurrence was so common, chloroquine prophylaxis is warranted after malaria of any species.

Arterolane–piperaquine–mefloquine versus arterolane–piperaquine and artemether–lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children

MORU Bangkok

Posted 16/06/2021. The progress made in treatment of malaria is threatened by the emergence of resistance to current first line treatments artemisinin-based combination therapies (ACTs). There are currently no good alternatives for the treatment of uncomplicated malaria in the African setting in the event of resistance emerging to antimalarials that are in the ACTs. Mainga Hamaluba, Rob van der Pluijm and colleagues demonstrate that triple artemisinin combination therapies (TACTs) can potentially be used safely to prevent, delay or manage uncomplicated malaria in our setting.

Global economic costs due to vivax malaria and the potential impact of its radical cure: A modelling study

MORU Bangkok

Posted 15/06/2021. Plasmodium vivax caused an estimated 14 million malaria cases in 2017. By collating economic and epidemiological data, Angela Devine and colleagues estimated an economic cost of $359 million associated with these episodes. A scenario analysis explored how costs might change with global access to safe radical cure, estimating cost savings of $17-93 million.

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

MOCRU

Posted 11/06/2021. Burkholderia pseudomallei, a bacterium found in soil, can cause melioidosis, a potentially fatal disease. Melioidosis was first described in Myanmar but rarely reported over the past decades due to lack of awareness and limited diagnostic facilities. Frank Smithuis and colleagues report a widespread distribution of the organism in Myanmar soil. This should alert clinicians to consider melioidosis as a potential cause of sepsis, pneumonia or abscesses.

Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal

MORU Bangkok

Posted 25/05/2021. Seeking treatment including antibiotics without prescription at drug shops is a common practice in Nepal which can contribute to rising antibiotic resistance. This may leave us without effective antibiotics for future infections. In this study, Bipin Adhikari and colleagues explore why people buy antibiotics over the counter in Nepal and implications for its control.

Falciparum but not vivax malaria increases the risk of hypertensive disorders of pregnancy in women followed prospectively from the first trimester

SMRU

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.

Ambulatory induction phase treatment of cryptococcal meningitis in HIV integrated primary care clinics, Yangon, Myanmar

MOCRU

Posted 14/05/2021. Cryptococcal meningitis is a common serious HIV-associated infection, responsible for 15% of AIDS related deaths globally. Patients are usually treated as in-patients. Frank Smithuis and colleagues reviewed 76 patients treated with amphotericin and fluconazole as out-patients in primary care clinics in Yangon, Myanmar. One-year survival (86%) was higher than existing hospital-based treatment studies and 1029 hospitals days were saved.

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.

Assessing the impacts of short-course multidrug-resistant tuberculosis treatment in the Southeast Asia Region using a mathematical modeling approach

MORU Bangkok

Posted 07/05/2021. Multidrug-resistant tuberculosis (MDR-TB) remains a significant burden in the Southeast Asia region. Using mathematical modelling approach, Wirichada Pan-Ngum and colleagues assessed the population-level impacts of short-course MDR-TB treatment compared to the conventional therapy. Early initiation of treatment and good level of treatment eligibility are identified to be important determinants to the success of MDR-TB control programmes.

Perinatal depression in migrant and refugee women on the Thai–Myanmar border: does social support matter?

SMRU

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.

Prediction of disease severity in young children presenting with acute febrile illness in resource-limited settings: a protocol for a prospective observational study

MORU Bangkok

Posted 30/04/2021. In many low- and middle-income countries febrile children are managed by health workers with limited training, in settings where referrals can confer substantial costs and risks. Spot Sepsis, a multi-centre study being implemented by MORU and MSF, aims to develop a practical prognostic tool to help community healthcare providers identify febrile children who may benefit from referral for facility-based medical care.

Rolling out the radical cure for vivax malaria in Asia: a qualitative study among policy makers and stakeholders

MORU Bangkok

Posted 27/04/2021. The complete treatment of vivax malaria requires a radical cure with a course of 8-aminoquinolines. Bipin Adhikari and colleagues interviewed policymakers in Asia why the radical cure is currently so poorly implemented and what can be done to improve the uptake of the radical cure.

Burden of soil-transmitted helminth infection in pregnant refugees and migrants on the Thailand-Myanmar border

SMRU

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.

Deploying triple artemisinin-based combination therapy (TACT) for malaria treatment in Africa: ethical and practical considerations

MORU Bangkok

Posted 20/04/2021. Artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated falciparum malaria, but the ACT drugs are starting to fail. Triple artemisinin-based combination therapy (TACT) is being studied to replace ACTs. In this paper, Phaik Yeong Cheah and colleagues discuss the most important ethical and practical considerations in the potential deployment of TACT.

Predictors of disease severity in children presenting from the community with febrile illnesses: a systematic review of prognostic studies

MORU Bangkok

Posted 16/04/2021. This systematic review by Arjun Chandna and colleagues identified clinical and laboratory prognostic factors, measured at the point of presentation, that can help identify children at risk of severe febrile illness. Most studies included only hospitalised children and further work is required to identify the best predictors to build data-driven triage tools for use by community healthcare providers.

G6PD Variants and Haemolytic Sensitivity to Primaquine and Other Drugs

SMRU

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

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.

What is the yield of malaria reactive case detection in the Greater Mekong Sub-region?

MORU Bangkok

Posted 30/03/2021. Reactive case detection has played a role in the elimination of malaria in China. The approach has been adapted and is used in the Greater Mekong Subregion. Because it requires considerable man power but only few cases are detected the approach is controversial. Jacqueline Deen, Lorenz Von Seidlein and colleagues included 8 articles in a meta-analysis that found the percentage of positive malaria cases among potential contacts using microscopy or rapid diagnostic test was 0.56%.

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting

SMRU

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.

Vaginal Microbiota and Cytokine Levels Predict Preterm Delivery in Asian Women

SMRU

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

Short maternal stature and gestational weight gain among refugee and migrant women birthing appropriate for gestational age term newborns

SMRU

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.

Protective effect of Mediterranean-type glucose-6-phosphate dehydrogenase deficiency against Plasmodium vivax malaria

MORU Bangkok

Posted 09/03/2021. X-linked glucose-6-phosphate dehydrogenase deficiency is the most common human enzymopathy. Ghulam Awab and colleagues analysed their clinical study and epidemiological data from Afghanistan gathered over the last decade and showed that the G6PD Mediterranean variant provided a marked gene dose proportional protection against P. vivax malaria.

Tenofovir disoproxil fumarate in pregnancy for prevention of mother to child transmission of hepatitis B in a rural setting on the Thailand-Myanmar border

SMRU

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.

Effectiveness of a sepsis programme in a resource-limited setting

MORU Bangkok

Posted 02/03/2021. Direk Limmathurotsakul and colleagues show that a Sepsis Fast Track (SFT) programme, implemented in Thailand to screen, initiate sepsis care and fast-track them when applicable to ICU upon admission, are associated with higher chances of survival. We analyzed data of a prospective observational study, having control group from both pre and post-intervention periods.

Human, animal, water source interactions and leptospirosis in Thailand

MORU Bangkok

Posted 09/02/2021. Wirichada Pan-ngum and colleagues address key knowledge gaps on human-animal-water-source interactions and leptospirosis in high-risk settings, Thailand. Water-source sharing networks and human–animal contact patterns are key information potentially involved in the epidemiology of leptospirosis. Occupations related to animals/environmental water and consuming water from more than two sources increased the risk exposure to leptospirosis.

Serological evidence indicates widespread distribution of rickettsioses in Myanmar

LOMWRU

Posted 05/01/2021. Diagnosing rickettsial infections is difficult in low-resource settings; this leads to delays in receiving appropriate treatment. Before this study the distribution of rickettsioses in Myanmar was not known. This report of a serosurvey by Philip Elders, Elizabeth Ashley and colleagues shows rickettsioses are widespread in Myanmar, with high scrub typhus prevalence in central and northern regions.

Old age is associated with decreased wealth in rural villages in Mtwara, Tanzania

MORU Bangkok

Posted 18/12/2020. Lorenz Von Seidlein and colleagues observed that poorest people in rural Tanzania were the oldest people and especially old people without children. This observation came as a surprise because generation, the baby boomers has accumulated wealth throughout life and ended up wealthier by the time they reached retirement. There is a need to provide more financial and housing security for older people in rural Africa. Currently for many older people in rural Africa the only security are their children.

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.

Crowding has consequences: Prevention and management of COVID-19 in informal urban settlements

MORU Bangkok

Posted 11/12/2020. COVID-19 has hit informal urban settlements particularly hard. The control and prevention of COVID-19 in slums starts with organizing community infrastructure, provision of basic needs and protection of people at highest risk. Slums are a source for persistent transmission. In view of the constant risk that slums present to the entire population decisive steps need to be taken to rehabilitate and improve informal settlements, Lorenz Von Seidlein and colleagues provide suggestions.

Impact of low blood culture usage on rates of antimicrobial resistance

MORU Bangkok

Posted 08/10/2020. “No bacterial culture, no drug-resistant infections.” Cherry Lim, Direk Limmathurotsakul and colleagues show that the impact of low blood culture utilization on the observed proportions and incidences of drug-resistant infections could be high. This is likely happening in most of LMICs. A set of recommendations are proposed.

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.

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