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TB outcomes and mortality risk factors in adult migrants at the Thailand-Myanmar border

SMRU

Posted 27/11/2020. The migrant-friendly residential TB program of SMRU on the Thailand-Myanmar border has achieved high treatment success rate. However, many TB patients admitted to the centers are in advanced stage of disease. Win Pa Pa Htun and colleagues show that early TB death (in the first month of treatment) is highest among pulmonary TB cases and in particular in HIV co-infected patients and in those with co-morbidity. Early detection and treatment for both TB and HIV are crucial for migrants, if the case fatality rate is to be reduced in this marginalized population.

Malaria Screener: a smartphone application for automated malaria screening

MORU Bangkok

Posted 24/11/2020. Malaria Screener is a smartphone application developed by the National Library of Medicine, in partnership with Richard Maude and colleagues at MORU Epidemiology, aiming to improve the availability of high quality malaria diagnosis. It is cheap, fast and easy-to-use with a standard smartphone and microscope and detects malaria parasites by machine learning.

Antimicrobial use in food animals and human health: time to implement ‘One Health’ approach

MORU Bangkok

Posted 13/11/2020. Use of antimicrobials in animals and the environment has been established to contribute to the global antimicrobial resistance (AMR), and yet there have been inadequate collaborative efforts to tackle this problem. Sunil Pokharel, Bipin Adhikari and colleagues discuss how and why ‘One health’ approach is important to tackle antimicrobial resistance.

Transmission of artemisinin-resistant malaria parasites to mosquitoes under antimalarial drug pressure

MORU Bangkok

Posted 10/11/20. Artemisinin-based combination therapies are not only effectively curing malaria, they also impact male malaria parasites in their capacity for onward transmission to the mosquito. Here, Andrea Ruecker and colleagues provide clear evidence that artemisinin resistant parasites overcome this sterilising effect to successfully infect mosquitoes under drug pressure, facilitating the spread of artemisinin resistance.

Impact of outdoor residual spraying on the biting rate of malaria vectors in Myanmar

SMRU

Posted 06/11/20. Victor Chaumeau and colleagues assessed the impact of outdoor residual spraying on the biting rate of malaria mosquitoes in four villages in Kayin state, Myanmar. They reported a 10-fold decrease in mosquito biting rate immediately after the intervention and concluded that outdoor residual spraying can be used to control malaria mosquitoes in this area.

How many human pathogens are there in Laos? An estimate of national human pathogen diversity and analysis of historical trends

LOMWRU

Posted 27/10/2020. Madeleine Clarkson, Paul Newton and colleagues reviewed when individual species of human pathogens were described in Laos, and estimated the in-country diversity and how many more pathogens there may be. Combining modelling with historical assessment improved understanding of the factors affecting pathogen description. During the last decade there has been a 33-fold increase in the description rate, coinciding with the strengthening of medical research in Laos.

The efficacy of PPE for COVID-19-type respiratory illnesses in primary and community care staff

MORU Bangkok

Posted 13/10/2020. Xin Hui Chan and colleagues summarise their rapid reviews on the efficacy of personal protective equipment for preventing COVID-19 in primary and community care. They highlight how PPE is designed for use as an ensemble, is a complex intervention which should include appropriate training and support, and is the least effective of the hierarchy of controls.

Implementing parasite genotyping into national surveillance frameworks

MORU Bangkok

Posted 07/10/2020. The Asia-Pacific region is the epicentre of the emergence of resistance against frontline antimalarials, and also faces a high proportion of non-falciparum malaria. Sarah Auburn and colleagues review novel approaches for molecular surveillance that can help track drug resistant parasites and the spread of parasites across the region, discussed at a recent APMEN workshop in Jakarta, and how these approaches can provide important information for policy makers in malaria-endemic regions.

Tenofovir for prevention of mother to child transmission of hepatitis B in migrant women in a resource-limited setting on the Thailand-Myanmar border: a commentary on challenges of implementation

SMRU

Posted 25/09/2020. Prevention of mother to child transmission of hepatitis B with maternal tenofovir DF is one option to reach elimination of this infection. However, implementing this in a resource limited setting is challenging. Marieke Bierhoff and colleagues describe the most common challenges and possible solutions like transport assistance and local agreements to facilitate access.

Case-control study of use of personal protective measures and risk for severe acute respiratory syndrome coronavirus 2 infection, Thailand

MORU Bangkok

Posted 22/09/2020. This case-control study, conducted by Direk Limmathurotsakul and colleagues in Thailand, shows that wearing masks all the time, maintaining >1 m distance, having close contact for <15 minutes, and frequent handwashing are independently associated with lower risk for SARS-CoV-2 infection (COVID-19)

Estimating the proportion of Plasmodium vivax recurrences caused by relapse

MORU Bangkok

Posted 18/09/2020. New findings by Ric Price and colleagues highlight that a remarkably high number of P. vivax infections arise from relapses (reactivation of dormant liver stages). This has important implications since almost 85% of recurrent infections could be prevented if more patients were treated with primaquine. The study emphasises the important of work done by the VxWG (Vivax Working Group for the Asia Pacific Malaria Eliminiation Network) in promoting wider access to safe and effective radical cure.

Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE): protocol for a multisite prospective observational study of the causes of fever in Africa and Asia

LOMWRU

Posted 01/09/2020. This paper provides an overview of FIEBRE’s activities. The study aims to identify infections that are treatable and/or preventable, to assess antimicrobial susceptibility of bacterial pathogens and to collect qualitative data on care-seeking and treatment behaviours. Paul Newton and colleagues detail clinical and laboratory assessments, data analysis plan, and outline the study’s strengths and limitations.

G6PD deficiency in malaria endemic areas of Nepal

SMRU

Posted 27/08/2020. Germana Bancone and colleagues from EDCD (Nepal) and SMRU conducted this study in malaria endemic districts of Nepal, showing that G6PD deficiency is prevalent among most ethnic groups across the region. G6PD testing will be necessary for safe deployment of 8-aminoquinolines in order to eliminate Plasmodium vivax malaria in Nepal.

No evidence that chloroquine or hydroxychloroquine induce hemolysis in G6PD deficiency

MORU Bangkok

Posted 25/08/2020. With renewed interest in chloroquine and hydroxychloroquine, much has recently been written and published about the risk of haemolysis in G6PD deficient individuals. William Schilling and colleagues believe many have overlooked the wealth of data which already exists about this very issue. Here presented is an overview of the long-accrued evidence (as well as that from recent COVID-19 publications) that chloroquine and hydroxychloroquine do not induce haemolysis in G6PD deficiency.

Integration of HIV services with primary care in Yangon, Myanmar

MOCRU

Posted 21/08/2020. Frank Smithuis and colleagues did a retrospective cohort analysis looking at integration of HIV care with general health care clinics in Yangon, Myanmar. HIV patient survival was high at 0.95 at 1 year and 0.90 at 5 years. Integration is effective to attain early linkage to care but attention should be given to disengagement from care, in particular for pregnant women.

Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off (ECOFF) values

LOMWRU

Posted 14/08/2020. David Dance and colleagues describe a multi-centre study, co-ordinated by EUCAST, to establish interpretative criteria for Burkholderia pseudomallei disc diffusion tests. Three MORU network sites (Laos, Thailand and Cambodia) participated. The results, based on 361 isolates, will enable laboratories around the world to conduct quality-assured testing of B. pseudomallei susceptibility.

Molecular epidemiology of resistance to antimalarial drugs in the Greater Mekong subregion

MORU Bangkok

Posted 11/08/2020. This very large molecular epidemiology study done over 12 years describes the evolution and spread of antimalarial drug resistance across the entire Greater Mekong subregion (GMS). Mallika Imwong and colleagues show no evidence of spread of artemisinin resistant parasite lineages from the eastern to the western GMS. There is also no evidence for piperaquine resistance in the western GMS.

Evaluation of the forum theatre approach for public engagement around antibiotic use in Myanmar

MOCRU

Posted 31/07/2020. Myo Maung Maung Swe and colleagues describe evaluation and experience of using the forum theatre technique, a novel form of public engagement. Our experience was fun, informative and encouraged widespread participation around the subject of antibiotic use. We believe that this technique will be of great interest to scientists who engage in activities using participatory techniques.

Screening of ectoparasites from domesticated dogs for bacterial pathogens in Vientiane, Lao PDR

LOMWRU

Posted 28/07/2020. Ticks, fleas and lice from dogs in Vientiane (Lao PDR) were shown to carry a variety of zoonotic pathogens including R. felis (cat-flea typhus). Matthew Robinson and colleagues highlight the risk of these pathogens transmitted between dogs and humans within the city, as well as the role of pets in human diseases, and important public health considerations

Respiratory support in COVID-19 patients, with a focus on resource-limited settings

MORU Bangkok

Posted 21/07/2020. This article by Arjen Dondorp and colleagues provides guidance on respiratory support for patients with severe COVID-19 focusing on low- and middle-income countries, based on current evidence and experience. Rather than the usual focus on mechanical ventilation, it emphasizes the importance of having the right modalities for non-invasive oxygen therapy in place

Non-adherence in non-inferiority trials: pitfalls and recommendations

MORU Bangkok

Posted 14/07/2020. Non-adherence in non-inferiority trials typically dilutes observed treatment effects, leading to a higher probability of claiming non-inferiority. Mo Yin and colleagues describe different patterns of non-adherence and the influence of the confounders on treatment effects. Causal inference methods that account for these confounders can minimise bias and risk of false non-inferiority claims.

Quantifying antibiotic impact on within-patient dynamics of extended-spectrum beta-lactamase resistance

MORU Bangkok

Posted 25/06/2020. Antibiotic-resistant bacteria are a growing global health crisis. In order to develop a quantitative understanding of how antibiotics affect drug-resistant bacteria within the human gut, Ben Cooper and colleagues developed a data-driven model of the within-host dynamics of blaCTX-M, one of the most important gene families for antibiotic resistance.

Pregnancy outcomes and risk of placental malaria after artemisinin-based and quinine-based treatment for uncomplicated falciparum malaria in pregnancy

MORU Bangkok SMRU

Posted 12/06/2020. Safety of drugs is important, particularly during pregnancy. Makoto Saito and colleagues have pooled the data of 4503 women who had malaria in pregnancy and found that the currently used artemisinin-based combination therapies are equally safe for fetus. This study also highlights that risk of small-for-gestational-age (SGA) is high after malaria in pregnancy even treated with highly efficacious drugs, suggesting that prevention is important for reducing SGA in malaria endemic areas.

Quantification of glucose-6-phosphate dehydrogenase activity by spectrophotometry

MORU Bangkok

Posted 08/06/2020. Safe and effective radical cure of malaria will require better ways of testing for G6PD deficiency. In a large collaborative study a paper in PLoS Medicine, Daniel Pfeffer, Ric Price and colleagues highlight substantial variation between research laboratories using the current gold standard method (spectrophotometry). The study highlights challenges but also opportunities for new point of care tests.

Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens

MORU Bangkok

Posted 02/06/2020. Thomas Althaus and colleagues identified Influenza and dengue viruses as key pathogens in febrile children and adults attending primary care in Thailand and Myanmar. CRP performance for distinguishing bacterial from viral pathogens was average while patients recovered regardless of antibiotic prescription. This suggests that most primary care infections do not require an antibiotic.

Barriers and facilitators to healthcare workers’ adherence with infection prevention and control guidelines for respiratory infectious diseases

MORU Bangkok

Posted 05/05/2020. In this Cochrane qualitative review to inform the 2020 COVID19 pandemic, Xin Hui Chan and colleagues identify key barriers and facilitators to healthcare workers’ adherence to infection prevention and control (IPC) guidelines for respiratory infectious diseases to support policymakers and healthcare leaders in designing and implementing IPC guidelines. These include organisational factors (safety climate, design & communication of consistent PPE guidelines, availability of training programmes), physical environment (space, facility design, administrative controls, personal protective equipment availability), and individual factors (knowledge, beliefs, attitudes).

Efficacy and tolerability of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy

MORU Bangkok

Posted 01/05/2020. Although effective treatment for malaria in pregnancy is needed for preventing adverse impact on both mother and fetus, quinine is still widely used in pregnancy. Makoto Saito and 41 other collaborators worldwide put their individual patient data together to summarise the currently available evidence showing that quinine is inferior to ACT and further research on dose optimization of ACT is warranted.

Plasmodium falciparum ATP4 inhibitors to treat malaria: worthy successors to artemisinin?

LOMWRU

Posted 28/04/2020. In this comment Elizabeth Ashley and Aung Pyae Phyo discuss two recent studies of SJ733, a PFATP4 inhibitor. Compounds from this promising novel class of antimalarials kill parasites rapidly, a property previously unique to the artemisinin derivatives among antimalarials in use, and one that underpins their enormous success.

The estimated burden of scrub typhus in Thailand from national surveillance data (2003-2018)

MORU Bangkok

Posted 24/04/2020. Scrub typhus is a major cause of fever in the tropics. Tri Wangrangsimakul and colleagues estimated the disease burden in Thailand and showed that the number of cases rose significantly over the last two decades. Age, sex and occupation along with meteorological and geographical factors may be important determinants of disease incidence.

Longevity of the insecticidal effect of three pyrethroid formulations applied to outdoor vegetation on a laboratory-adapted colony of the Southeast Asian malaria vector Anopheles dirus

SMRU

Posted 21/04/2020. This study by Victor Chaumeau and colleagues was carried out in order to assess the longevity of insecticide mists applied to outdoor vegetation. Insecticidal effect of sprayed plant material against malaria mosquitoes lasted for several weeks. These results provide a strong rationale for using outdoor residual spraying against the mosquito vectors that rest outside premises.

COVID-19 and risks to the supply and quality of tests, drugs, and vaccines

LOMWRU

Posted 14/04/2020. Enormous emergency efforts are underway to find optimal medical products, to prevent, diagnose, and treat COVID-19, that 7.8 billion people will depend on. With dire disruption of pharmaceutical production and supply and increasing falsified and substandard products, we need strategic planning now to ensure global access to quality-assured medical products and monitoring of supply chains

Parenting interventions to prevent violence against children in low- and middle-income countries in East and Southeast Asia

MORU Bangkok

Posted 17/03/2020. This systematic review and meta-analysis by Amalee McCoy and colleagues synthesizes available evidence on the effectiveness of parenting interventions in preventing violence against children in the East and Southeast Asian region. The results suggest that parenting interventions can reduce rates of particular forms of violence against children, as well as promote positive parent-child interactions.

Mapping the travel patterns of people with malaria in Bangladesh

MORU Bangkok

Posted 13/03/2020. New research by Ipsita Sinha and colleagues provides a framework for identifying key traveler groups and their origins and destinations of travel combination with knowledge of local epidemiology to inform malaria control and elimination efforts. This publication is based on travel information collected from over 2000 patients from 57 study sites in South-East Bangladesh, in collaboration with the National Malaria Elimination Control programme of Bangladesh.

Estimation of incidence of typhoid and paratyphoid fever in Vientiane, Lao People’s Democratic Republic

LOMWRU

Posted 10/03/2020. Incidence data about infectious diseases are needed to inform decisions about vaccine introduction. Using data from health-seeking behaviour survey for fever and data from hospital bloodstream infection, Mayfong Mayxay and colleagues estimated typhoid and paratyphoid fever incidence in Vientiane, the capital of Laos, and found that the incidence is low, with an annual incidence of 4.7 and 0.5 per 100,000 persons, for typhoid and paratyphoid fever, respectively.

Factors affecting the electrocardiographic QT interval in malaria

MORU Bangkok

Posted 06/03/2020. Prolongation of the electrocardiographic QT interval is a widely-used marker of the risk of developing abnormal heart rhythms. Several antimalarial drugs are associated with QT interval prolongation. Xin Hui Chan and colleagues found that malaria and fever also affect QT interval. To improve cardiac safety assessments, adjustment for QT interval prolongation occurring after recovery is needed. This would prevent unnecessary withdrawal of lifesaving antimalarial treatment.

Prevalence of group A Streptococcus in primary care patients and the utility of C-reactive protein and clinical scores for its identification in Thailand

MORU Bangkok

Posted 03/03/2020. It is challenging to know who needs antibiotics for a sore throat and fever. In Thailand, Rachel Greer and colleagues found a bacteria (group A Streptococcus) in less than 1 out 10 patients. These patients had a raised C-reactive protein blood test but it was not able to predict who had the bacteria.

Performance of the Access Bio/CareStart rapid diagnostic test for the detection of glucose-6-phosphate dehydrogenase deficiency

MORU Bangkok

Posted 04/02/2020. Primaquine radical cure for treatment of Plasmodium vivax is contraindicated in patients with G6PD deficiency. Ric Price, Benedikt Ley and colleagues review evidence from 11 studies of a novel point of care diagnostic (CareStart RDT) and show overall good performance under research conditions. Further feasibility studies are under way to assess its reliability under field conditions.

Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country

MORU Bangkok

Posted 31/01/2020. Drug-resistant strains of the bacterial pathogen Klebsiella pneumoniae are an important and increasing cause of infant mortality in developing countries. In this study led by Professor Ben Cooper, researchers used mathematical modelling and whole genome sequencing to quantify the effects of antibiotics and other factors in driving the hidden transmission of this pathogen within a Cambodian neonatal unit.

Economic considerations support C-reactive protein testing alongside malaria rapid diagnostic tests to guide antimicrobial therapy for patients with febrile illness in settings with low malaria endemicity

MORU Bangkok

Posted 17/01/2020. Malaria is no longer a common cause of febrile illness in many regions of the tropics. Yoel Lubell and colleagues consider the costs and benefits of multiplex malaria/CRP tests that are now commercially available in terms of (i) the improved health outcomes for patients with bacterial illnesses; (ii) the costs of antimicrobial resistance averted; or (iii) the economic benefits of better management of remaining malaria cases and shorter malaria elimination campaigns. They conclude that a multiplexed malaria/CRP test could be highly cost-effective and utilize the well-established funding and distribution systems already in place for malaria RDTs.

Sensitivity of C‐reactive protein for the identification of bacterial infections in northern Tanzania

MORU Bangkok

Posted 07/01/2020. Identifying bacterial infections in sub-Saharan Africa is a challenge because of limited access to laboratory infrastructure. Thomas Althaus and colleagues measured high sensitivity of C-reactive protein (CRP) in detecting bacterial blood stream infections and zoonotic bacterial pathogens among febrile patients both in primary levels of care and hospitals in Moshi, northern Tanzania

Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border

SMRU

Posted 20/12/2019. How do birth outcomes, a mother’s nutrition, and how a mother feeds her infant relate to chronic undernutrition among refugee and migrant infants along the Thailand-Myanmar border? Why do these mothers feed their infants as they do? Come learn more from a recent study by Ahmar Hashmi and colleagues at the Shoklo Malaria Research Unit.

Forest work and its implications for malaria elimination

MORU Bangkok

Posted 03/12/2019. Malaria transmission in Cambodia is concentrated in forest foci. Nou Sannan, Tom Peto and MORU colleagues interviewed forest workers who had recently been infected with malaria to understand their behaviour and perception of risk, establish the efficacy and feasibility of malaria prophylaxis , and identify potential strategies for malaria elimination in these populations.

Genetic variation associated with infection and the environment in the accidental pathogen Burkholderia pseudomallei

MORU Bangkok

Posted 26/11/2019. Claire Chewapreecha and colleagues combined 753 newly sequenced Thai Burkholderia pseudomallei (the bacteria causing melioidosis) isolates with 258 Australian isolates to identify genes associated with either clinical or environmental strains. They found 47 genes that may provide clues to the strategy used by this microbe to adapt to survive in wide range of ecological niches, including human hosts.

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

Early life risk factors of motor, cognitive and language development

SMRU

Posted 22/10/2019. Rose McGready and SMRU colleagues contributed RCT data from the Thailand-Myanmar border to this large review on low- and middle-income countries (21 studies in 20 882 children). The results suggests targeting parental, environmental and nutritional factors from pre-pregnancy through childhood, as a way forward to improve health and development of children in such settings.

Scrub typhus and the misconception of doxycycline resistance

MORU Bangkok

Posted 18/10/2019. Scrub typhus is a major cause of fever across the Asia Pacific region. Doxycycline resistance, the main antibiotic used for treatment, was described in the 1990s but independent verification was neglected, leading to doubts regarding its efficacy. Assessment of historical evidence and recent reports by Tri Wangrangsimakul and colleagues suggest this finding was a misconception.

Short-course primaquine for the radical cure of Plasmodium vivax malaria

MORU Bangkok

Posted 16/10/2019. Plasmodium vivax is particularly hard to eliminate because it can relapse from dormant liver stages, weeks to months after the initial infection. Bob Taylor and colleagues present a large multicentred clinical trial showing that a 7 day course with double the daily dose of primaquine is as effective as the traditional 14 day primaquine course, with acceptable tolerability in G6PD normal patients. The trial paves the way for safer and more effective treatment of this parasite.

Determinants of dihydroartemisinin-piperaquine treatment failure in Plasmodium falciparum malaria in Cambodia, Thailand, and Vietnam

MORU Bangkok

Posted 08/10/2019. A rapidly evolving multi-drug resistant lineage of P. falciparum malaria parasites continues to spread in Southeast Asia, leading to alarmingly high treatment failure rates in Cambodia, Thailand and Vietnam for DHA-piperaquine, one of the world’s most important anti-malaria drugs. Rob van der Pluijm and colleagues say that accelerated elimination of P falciparum malaria in this region is urgently needed, to prevent further spread and avoid a potential global health emergency.

Quality of medical products for diabetes management

LOMWRU

Posted 01/10/2019. In the light of the alarming global increase in diabetes, Kartika Saraswati and colleagues at the LOMWRU-IDDO Medicine Quality team found few investigations on the quality of antidiabetics and supplies for self-monitoring of blood glucose. However, poor quality medical products were identified on four continents. This important public health issue should thus be further investigated.

Investigating causal pathways in severe falciparum malaria

MORU Bangkok

Posted 06/09/2019. A formal causal inference-based analysis of clinical and laboratory data from 9000+ severe falciparum malaria patients from Africa and Asia by James Watson and colleagues suggests that moderate anaemia may be protective against death in severe malaria. The severe anaemia threshold criteria for a definition of severe falciparum malaria should be reconsidered.

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