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Cost-effectiveness analysis of a multiplex lateral flow rapid diagnostic test for acute non-malarial febrile illness in rural Cambodia and Bangladesh

MORU Bangkok

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

MORU Bangkok

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

MORU Bangkok

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

MORU Bangkok

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

MORU Bangkok

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.

Ethical and cultural implications for conducting verbal autopsies in South and Southeast Asia: a qualitative study


Posted 20/12/2023. The verbal autopsy method can be sensitive to the individuals interviewed, their families and communities. Prior to study implementation, Nan Shwe Nwe Htun, Tom Peto and SEACTN colleagues sought to explore local beliefs and practices about death to inform appropriate bioethical practices and found that verbal autopsy is acceptable across a wide range of cultural settings in Bangladesh, Myanmar, Thailand, Laos PDR, and Cambodia.

Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania

MORU Bangkok

Posted 12/12/2023. Bipin Adhikari and colleagues compared community health worker programmes between Southeast Asia and Sub-Saharan Africa using a systematic review of the published literature. This was supplemented by discussions with key informants in Cambodia and mainland Tanzania to inform the existing malaria service delivery strategies in Tanzania.

Accuracy of the direct agglutination test for diagnosis of visceral leishmaniasis: a systematic review and meta-analysis


Posted 01/12/2023. Parasitology is the gold standard for the diagnosis of visceral leishmaniasis (VL), however, other less invasive tests are available such as the direct agglutination test (DAT). As part of the series of systematic reviews and meta-analysis on diagnostic accuracy of diagnostics for FIEBRE infections, Tamalee Roberts and colleagues estimate the diagnostic sensitivity and specificity of DAT for the diagnosis of VL.

A systematic review of neglected tropical diseases (NTDs) in Myanmar


Posted 21/11/2023. Neglected tropical diseases (NTDs) are a group of preventable and treatable diseases common in Myanmar, primarily affecting marginalized rural communities. Myo Swe and colleagues provide an overview of reported NTDs in Myanmar over 100 years, indicating gaps in knowledge about certain diseases to inform future research directions related to NTDs in Myanmar.

A Prognostic Model for Critically Ill Children in Locations With Emerging Critical Care Capacity


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.

Use of antimicrobials during the COVID-19 pandemic: A qualitative study among stakeholders in Nepal

MORU Bangkok

Posted 17/11/2023. Early critical phase of the COVID-19 pandemic added tremendous pressure to find curative therapies. A lot of empirical treatments, including antimicrobials, were recommended. Drawing on interviews with patients, clinicians and drug dispensers, Bipin Adhikari and colleagues explore how and why antimicrobials may have been used for the management of COVID-19 in Nepal.

The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance

MORU Bangkok

Posted 10/22/2023. Sean Cavany and colleagues publish a new perspective in Nature Communications that describes the possible mechanisms by which substandard and falsified antimicrobials could affect antimicrobial resistance and suggests ways to improve our understanding of this relationship. The article arose from the work of the FORESFA project, funded by a Wellcome Collaborative Award.

A Clinically Oriented antimicrobial Resistance surveillance Network (ACORN): pilot implementation in three countries in Southeast Asia, 2019-2020


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:

Leadership in global health

MORU Bangkok

Posted 24/10/2023. In the review of a book ‘Tore Godal and the evolution of global health by Conrad Keating’, Bipin Adhikari and Lorenz von Seidlein discuss Tore Godal’s contributions to Global Health projects while remaining in the background. There are lessons for those aspiring to influence Global Health.

Vaccine mandates and public trust do not have to be antagonistic

MORU Bangkok

Posted 29/10/2023. Historically, vaccine mandates and opposition to vaccines have co-existed, starting with smallpox vaccination mandates in the 1800s. During the COVID-19 pandemic, the benefits of vaccine mandates were weighed against potential damage to public trust. Bipin Adhikari and colleagues discuss whether and how vaccine mandates can co-exist with public trust.

Pharmacokinetics of single low dose primaquine in Ugandan and Congolese children with falciparum malaria


Posted 29/09/2023. This large study on the pharmacokinetics of single low dose primaquine in young Ugandan and Congolese children will help the MORU team develop an optimal dose for children with falciparum malaria to block malaria transmission and contribute to malaria elimination, especially of resistant falciparum parasites. By Bob Taylor

Improving neonatal health in rural Africa: how much do we know about neonatal jaundice?


Posted 26/09/2023. In this pilot study, Caterina Fanello and colleagues evaluated the prevalence of neonatal hyperbilirubinemia and related neonatal and maternal risk factors in a semi-rural area of the Democratic Republic of Congo. They also explored knowledge and practices of expectant mothers regarding this condition. Ways forward to improve diagnosis and treatment in these settings are discussed.

Expanding the role of village malaria workers in Cambodia: Implementation and evaluation of four health education packages

MORU Bangkok

Posted 22/09/2023. The transformation of village malaria workers (VMWs) into community health workers with roles beyond malaria is a promising approach for sustaining health care provision in remote areas. Rupam Tripura and colleagues discuss on how training on health education could be optimized for VMWs.

Sharing results with participants (and community) in malaria related research: Perspectives and experience from researchers

MORU Bangkok

Posted 08/09/2023. Sharing results with participants from research studies is largely underappreciated. Bipin Adhikari and colleagues explore the perception and practice of results-sharing in malaria related clinical trials among researchers. Although there was a consensus on the rationale of result sharing to participants, most researchers thought that disseminating results to policymakers and stakeholders for research translation was more important.

An artesunate pharmacometric model to explain therapeutic responses in falciparum malaria

MORU Bangkok

Posted 06/09/2023. Sompob Saralamba and colleagues have proposed a new model explaining why increased dosing of antimalarial drug artemisinin doesn't speed up parasite clearance. It suggests that exposure to the drug makes some malaria parasites temporarily resistant, leading to either delayed death or reactivation. This could revolutionize treatment strategies for this deadly disease.

Point-of-care prognostication in moderate Covid-19: Analytical validation and prognostic accuracy of a soluble urokinase plasminogen activator receptor (suPAR) rapid test


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.

Longitudinal comparison of bacterial pathogen seropositivity among wet market vendors in the Lao People's Democratic Republic


Posted 31/08/2023. Vendors at wet markets in Laos may be exposed to different zoonotic pathogens depending on the types of food they sell. A one-year serological survey by Matthew Robinson and colleagues identified that individuals selling vegetables, domestic farmed meat, or wildlife meat, were potentially infected by important bacterial pathogens associated with both farmed animals and wildlife.

A rapid review of community engagement and informed consent processes for adaptive platform trials and alternative design trials for public health emergencies

MORU Bangkok

Posted 30/08/2023. Alternative Design Trials (ADTs) and Adaptive Platform Trials (APTs) have enabled efficient large-scale testing of biomedical interventions during recent Public Health Emergencies (PHEs). Alun Davies and colleagues aimed to rapidly review evidence on engagement and informed consent for ADTs and APTs during PHE to consider what (if any) recommendations can inform practice.

Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study


Posted 30/08/2023. This study by Makoto Saito and colleagues analysing 213 severe malaria cases in pregnancy at SMRU, MORU and OUCRU showed vital organ dysfunction led to high maternal and fetal mortality. In contrast, severe anaemia or hyperparasitaemia alone did not. This marked difference may explain the variation of mortality reported in the literature. Early diagnosis and treatment of malaria and anaemia in antenatal care should be promoted.

Fever and health-seeking behaviour among migrants living along the Thai-Myanmar border: a mixed-methods study


Posted 18/08/2023. Fever is a common reason to seek healthcare in Southeast Asia, and the decline of malaria has further complicated fever perceptions and actions taken. This mixed-methods study from 2019, on Thai-Myanmar border revealed diverse range of fever conceptions, symptoms and believed causes. Napat Khirikoekkong, Supa-at Asarath and colleagues mapped out context-specific healthcare seeking strategies and discussed its influencing key determinants.

Defining the role of host biomarkers in the diagnosis and prognosis of the severity of childhood pneumonia: a prospective cohort study


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.

Studying the health benefits of improved housing in rural Tanzania: challenges and progress

MORU Bangkok

Posted 30/06/2023. Millions of affordable healthy homes are needed for the rapidly expanding population of sub-Saharan Africa. A pilot project in northern Tanzania demonstrates the potential of novel house designs to reduce infectious disease transmission in homes. Lorenz von Seidlein and colleagues describe the challenges experienced during the construction and initial evaluation of the novel homes.

Experiences, coping strategies and perspectives of people in Malaysia during the COVID-19 pandemic

MORU Bangkok

Posted 20/06/2023. The SEBCOV study reveals captivating insights into the Malaysian experience during the COVID-19 pandemic. With a nationwide Movement Control Order and a race to administer vaccines, Malaysians faced unprecedented challenges. Phaik Kin Cheah, Phaik Yeong Cheah and colleagues highlight the coping strategies, economic impacts, lifestyle changes, and evolving perceptions of the COVID-19 vaccine.

The feasibility of novel point-of-care diagnostics for febrile illnesses at health centres in Southeast Asia: a mixed-methods study

MORU Bangkok

Posted 16/06/2023. The decline of malaria in Southeast Asia means other causes of fever are increasingly relevant, but often undiagnosed. Deployment of novel point-of-care tests for acute febrile illnesses in primary care settings is feasible if tests are user-friendly, well-selected for local pathogens, accompanied by disease-specific education, and have simple management algorithms. By Thomas Peto and Bipin Adhikari

Dengue in Myanmar: Spatiotemporal epidemiology, association with climate and short-term prediction

MORU Bangkok

Posted 08/06/2023. Richard Maude and colleagues investigated dengue in Myanmar, focusing on its epidemiology, association with climate, and short-term prediction. Dengue was observed to be widespread across the country, with an increasing spatial reach. Incidence was influenced by climate factors, but varied across different regions. Utilizing time series analysis, researchers also forecasted dengue incidence one month ahead at subnational levels. The findings highlight the potential of spatiotemporal modelling to quantify risk factor associations and generate short-term predictions, assisting in intervention planning.

Pneumococcal colonisation and pneumonia severity in hospitalised Cambodian children following introduction of the 13-valent pneumococcal conjugate vaccine


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.

Culturally responsive research ethics: How the socio-ethical norms of Arr-nar/Kreng-jai inform research participation at the Thai-Myanmar border


Posted 23/05/2023. Napat Khirikoekkong, Supa-at Asarath, Phaik Yeong Cheah, and colleagues analyse how the socio-cultural norm of Arr-nar or Kreng-jai influences the research experiences of individuals taking part in research on the Thai-Myanmar border. Arr-nar (in Burmese/Karen) or Kreng-jai (in Thai) encompasses multiple meanings including consideration for others and graciousness.

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border


Posted 09/05/2023. Implementation of evidence-based newborn care interventions in low-resource settings works! Very and moderate preterm neonatal mortality reduced by 68% and 53% between 2008-2017 in refugees and migrants. Find out how Ahmar Hashmi, Verena Carrara, Rose McGready and SMRU colleagues achieved this.

Raising awareness of antimicrobial resistance: development of an ‘antibiotic footprint calculator’

MORU Bangkok

Posted 02/05/2023. The ‘Antibiotic footprint’ concept supports a global reduction in antibiotic overuse. In this paper, Direk Limmathurotsakul and colleagues describe ‘antibiotic footprint calculator’, an open-access, web-based application that lets anyone calculate how different individual decisions can reduce or increase their own personal antibiotic footprint.

Determinants of Implementation of a Critical Care Registry in Asia: Lessons From a Qualitative Study

MORU Bangkok

Posted 10/03/2023. Timo Tolppa and CCAA colleagues conducted a qualitative study across 4 South Asian countries to understand the implementation of a critical care registry, which is used to enable quality improvement and research. Implementation was possible due to motivated champions, a supportive community of practice and efforts to fit the registry with existing practice.

Glucose-6-Phosphate Dehydrogenase (G6PD) Measurement Using Biosensors by Community-Based Village Malaria Workers and Hospital Laboratory Staff in Cambodia: A Quantitative Study

MORU Bangkok

Posted 07/03/2023. Understanding the Glucose-6-Phosphate Dehydrogenase (G6PD) activity of vivax patients is critical for the appropriate choice of radical cure regimens for vivax malaria. Village malaria workers (VMWs) in rural Cambodia are frequently the first and only health care providers for malaria patients but lack G6PD diagnostics. Bipin Adhikari and colleagues found that after training VMWs can use biosensors to assess G6PD activity just as well as laboratory technicians.

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

MORU Bangkok

Posted 07/02/2023. Rachel Greer and team in Chiangrai, Thailand found that the challenges research participants face in their daily lives, such as, language barriers and limited access to healthcare can influence their experiences of taking part in research. Researchers need to be responsive towards these specific vulnerabilities in order to reduce the burdens and maximize the benefits of research for participants.

Louis Pasteur, COVID-19, and the social challenges of epidemics

MORU Bangkok

Posted 23/12/2022. December 2022 sees two notable anniversaries: the 200th anniversary of the birth of Louis Pasteur and the third anniversary of China's announcement of the COVID-19 outbreak. On these coinciding events, Phaik Yeong Cheah and colleagues reflect on past and current global challenges to bring epidemics under control.

The wrongful indictment of pre-referral rectal artesunate further delays the roll-out of this lifesaving drug

MORU Bangkok

Posted 22/12/2022. On Jan 27, 2022, WHO recommended a moratorium on the deployment of rectal artesunate suppositories for severe malaria and in doing so stopped the roll-out of a lifesaving intervention. The decision is based on data from a large demonstration project CARAMAL. Lorenz von Seidlein discusses the project and its consequences with two leaders of the project in a point- counterpoint published in the Lancet infectious Diseases.

Technical evaluation and usability of a quantitative G6PD POC test in cord blood: a mixed-methods study in a low-resource setting


Posted 20/12/2022. G6PD deficiency is a major risk factor for severe neonatal jaundice among neonates born at the Thailand-Myanmar border. Early identification of G6PD deficiency can dramatically improve clinical care. In this study Germana Bancone and colleagues showed that a new point-of-care quantitative G6PD test used by trained midwives can reliably identify neonates with abnormal G6PD at birth.

Village malaria workers for the community-based management of vivax malaria

MORU Bangkok

Posted 16/12/2022. Radical cure of vivax malaria with primaquine requires testing for glucose-6-phosphate dehydrogenase deficiency, which is currently not provided at the community level in Cambodia. In this article, Bipin Adhikari and colleagues describe the core components needed for implementing radical cure at the community, which will increase coverage important for rapid vivax malaria elimination.

Malaria outbreak in Laos driven by a selective sweep for Plasmodium falciparum kelch13 R539T mutants: a genetic epidemiology analysis


Posted 14/12/2022. Malaria outbreaks can be driven by genetic selection rather than environmental or behavioural causes. Varanya Wasakul, Olivo Miotto and colleagues investigated a Plasmodium falciparum outbreak in Attapeu, Laos, in 2020-2021, using genomic epidemiology methods to elucidate parasite population dynamics, identify the outbreak’s causes and reconstruct the origin of the circulating strains.

Orientia tsutsugamushi in Chiggers and Small Mammals in Laos


Posted 06/12/2011. Scrub typhus is an important cause of febrile illness in Laos. Ivo Elliott and colleagues collected, identified and tested small mammals hosts and vector chigger mites for Orientia tsutsugamushi, the causative pathogen. A single pool of chiggers tested PCR positive and 16/52 (31%) of small mammals were seropositive. These are the first molecular and serological data on O. tsutsugamushi in vectors and non-human hosts from Laos.

Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: a systematic review and individual patient data meta-analysis


Posted 29/11/22. Makoto Saito and colleagues evaluated the fetal safety of antimalarials in the first trimester of pregnancy. Pregnant women who were treated with artemisinin-based combination therapy (ACT) in the first trimester had fewer fetal losses and congenital anomalies than quinine-treated women. Updated WHO guidelines recommend ACT, particularly artemether-lumefantrine, for all trimesters.

Ownership of individual-level health data, data sharing, and data governance

MORU Bangkok

Posted 22/11/2022. Who owns individual-level health data collected from health research and clinical care? In this paper Phaik Yeong Cheah and Jan Piasecki argues that neither public ownership nor private ownership will allow us to resolve all the problems associated with effective, equitable, and ethical use of data.

Cardiovascular Concentration-Effect Relationships of Amodiaquine and its Metabolite Desethylamodiaquine: Clinical and Pre-clinical Studies

MORU Bangkok

Posted 21/10/2022. Amodiaquine is an important antimalarial widely used for the treatment and prevention of malaria, protecting millions of African children every year. Xin Hui Chan and colleagues characterised the concentration-dependency of the bradycardic, hypotensive, and QT-prolonging effects of amodiaquine and its active metabolite desethylamodiaquine in clinical and pre-clinical studies, providing evidence of their causal role.

Trust is the common denominator for COVID-19 vaccine acceptance: A literature review

MORU Bangkok

Posted 18/10/2022. Trust is perhaps the most frequently attributed element in decision making for vaccine uptake. But what is trust, and how does it affect vaccine decision? In this qualitative review, Bipin Adhikari and colleagues explored how decisions on vaccine uptake are made, the role of trust and ways to build it.

Glucose 6 Phosphate Dehydrogenase (G6PD) quantitation using biosensors at the point of first contact: a mixed method study in Cambodia

MORU Bangkok

Posted 07/10/2022. G6PD measurement is critical before including primaquine or tafenoquine in the treatment for vivax malaria. Bipin Adhikari and colleagues explored whether first line health care providers can safely handle G6PD biosensors in the rural Cambodia. Our findings suggest that the radical cure for vivax malaria can be safely administered at the point of first contact, thus preventing relapse and continued transmission in a much larger population than through hospital based management.

Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study

MORU Bangkok

Posted 05/10/2022. Sutharshan Vengadasalam, Timo Tolppa and colleagues employed pathway mapping, ethnography, and interviews in Colombia, South Africa, Sri Lanka, Tanzania and Uganda, and found four common barriers to the delivery of quality perioperative care - Fragmented care pathways, limited human and structural resources, direct and indirect costs, and patients' low expectations of care.

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