Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.
Skip to main content

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.

Improving the estimation of the global burden of antimicrobial resistant infections

MORU Bangkok

Posted 03/09/2019. Estimating the global burden of antimicrobial resistance (AMR) is essential for resource allocation and to inform AMR action plans at national and global levels. Direk Limmathurotsakul and colleagues discuss the underlying assumptions, characteristics, limitations, and comparability of the approaches used to quantify mortality from AMR bacterial infections. We define key actions required and call for innovative thinking and solutions to address these problems.

Spatiotemporal epidemiology, environmental correlates, and demography of malaria in Tak Province, Thailand (2012–2015)

MORU Bangkok

Posted 23/08/2019. Tak Province in western Thailand is a significant target area to help achieve nationwide malaria elimination by 2024, and in the Greater Mekong Subregion by 2030. Integrating routine surveillance and publicly available data, Chris Mercado and colleagues demonstrated Tak’s big decline in malaria from 2012 to 2015, a likely result of elimination activities as opposed to climate or forest change.

A population dynamic model to project the burden of undiagnosed diabetes in Thailand

MORU Bangkok

Posted 20/08/2019. Demographics changes result in rapid transformation of population structure; together with other factors such as urbanization, household size decreasing and seasonal movement could greatly influence the prediction of disease burden. Wirichada Pan-ngum and colleagues demonstrated this trend using a mathematical modelling approach.

Nutrition in transition: historical cohort analysis among pregnant women along the Thailand–Myanmar border 1986 - 2016

MORU Bangkok SMRU

Posted 16/07/2019. Worrying nutritional trends in possibly the longest and largest cohort of nearly 50,000 refugee and migrant pregnant women in a LMIC setting. Ahmar Hashmi and colleagues at SMRU summarise trends in under- and over-nutrition among pregnant women, and show a double burden of malnutrition in these marginalised and vulnerable communities from the Myanmar-Thailand border.

Antimicrobial resistance in Cambodia

COMRU MORU Bangkok

Posted 09/07/2019. On behalf of the Cambodian Ministry of Health Technical Working Group on Antimicrobial Resistance, Paul Turner and colleagues at COMRU recently led a review of published data on AMR in Cambodia. Significant AMR was identified in a range of priority pathogens although data were limited. On-going national AMR surveillance will address this data gap.

“I can’t read and don’t understand”: Health literacy and messaging in a migrant population on the Myanmar-Thailand border

SMRU

Posted 05/07/2019. Health information can be life-saving, but how can it be conveyed to those who could benefit most? Through analysis of an unsuccessful public health campaign, Mary Ellen Gilder and SMRU colleagues learned from migrant women valuable lessons about health messaging in communities where most women do not complete the fourth grade.

Optimal duration of follow-up antimalarial efficacy in pregnancy on the Thailand–Myanmar border

SMRU

Posted 02/07/2019. Highly efficacious treatment can limit the cumulative deleterious impact of malaria during pregnancy on the mother and fetus. Correct assessment of treatment efficacy with an adequate length of follow up is required. Makoto Saito and colleagues at the Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border suggest that pregnant women need to be followed up longer than the currently recommended duration of follow-up to assess antimalarial drug efficacy.

‘Antibiotic footprint’ as a communication tool to aid reduction of antibiotic consumption

MORU Bangkok

Posted 18/06/2019. How should we communicate to the public the magnitude of antibiotic use in humans and animals? Led by Direk Limmathurotsakul, our scientists and global partners propose the concept of ‘antibiotic footprint’. It could support individual, national and global actions against superbugs as 'carbon footprint' has done for climate change

Novel approaches to control malaria in forested areas of Southeast Asia

MORU Bangkok

Posted 11/06/2019. Remaining foci of malaria transmission are often in forests, where vectors tend to bite during daytime and outdoors thus reducing the effectiveness of insecticide treated bednets. Limited periods of exposure suggest that chemoprophylaxis could be a promising strategy to protect forest workers against malaria. Lorenz Von Seidlein and colleagues discuss which antimalarial drug regimens are most appropriate, how frequently the chemoprophylaxis should be delivered, and how to motivate forest workers to use and adhere to malaria prophylaxis.

Malaria morbidity and mortality following introduction of a universal policy of artemisinin-based treatment for malaria in Papua, Indonesia

MORU Bangkok

Posted 04/06/2019. In Papua, where multidrug resistant P. falciparum and P. vivax are coendemic, the introduction of a universal policy of ACT plus IV artesunate for all patients with malaria halved hospital admissions and malarial deaths. However the reduction in P. vivax was far less than that for P. falciparum. This study by Ric Price and colleagues emphasizes the need for better drug regimens to clear the liver stages of P. vivax.

Antimicrobial-resistant Gram-negative colonization in infants from a neonatal intensive care unit in Thailand

COMRU LOMWRU MORU Bangkok

Posted 31/05/2019. Drug-resistant infections caused by Enterobacteriaceae, a family of Gram-negative bacteria, account for a high and increasing disease burden amongst hospitalised neonates in Southeast Asia; carbapenem-resistant strains are particularly important because of limited antibiotic treatment options. Tamalee Roberts and colleagues found that nearly two thirds of infants in a neonatal unit in Thailand became asymptomatic carriers with carbapenem-resistant Enterobacteriaceae during their hospital stays. This work indicates a critical need for interventions to reduce this usually hidden reservoir of drug-resistant bacteria.

Spatial heterogeneity and temporal trends in malaria on the Thai–Myanmar border (2012–2017)

MORU Bangkok

Posted 21/05/2019. Wirichada Pan-ngum and colleagues explore how decreasing trends reflect the achievements of malaria control efforts on the Thai–Myanmar border. However, one of the main challenges facing elimination programs in this low transmission setting is maintaining a strong system for early diagnosis and treatment, even when malaria cases are very close to zero, whilst preventing re-importation of cases.

Microbiology Investigation Criteria for Reporting Objectively (MICRO): a framework for the reporting and interpretation of clinical microbiology data

MORU Bangkok

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

Clinical characteristics and outcome of children hospitalized with scrub typhus in an area of endemicity

MORU Bangkok

Posted 25/04/2019. It has been almost 30 years since clinicians from northern Thailand first raised the issue of severe scrub typhus and poor responses to treatment in patients. Tri Wangrangsimakul and colleagues show that paediatric scrub typhus is frequently severe, potentially fatal, and associated with high rates of treatment failure. A lack of awareness leading to delays in treatment may have contributed. Investigating the determinants of treatment failure and raising the awareness of this neglected disease remains a priority.

Human population movement and behavioural patterns in malaria hotspots on the Thai–Myanmar border: implications for malaria elimination

MORU Bangkok

Posted 23/04/2019. Human population movement can lead to the persistence of malaria along the Thai–Myanmar border. Lisa White, Wirichada Pan-ngum and colleagues show that malaria risk is related to the number of days doing outdoor activities in the dry season, especially trips to Myanmar, to forest areas and overnight trips. Understanding movement patterns is important when considering targeted public health interventions, especially during the elimination phase.

Community engagement, social context and coverage of mass anti-malarial administration

COMRU LOMWRU MOCRU MORU Bangkok

Posted 16/04/2019. Lorenz Von Seidlein and colleagues in Thailand, Myanmar, Vietnam, Cambodia, and Laos explored what happens to malaria transmission when all people residing in a village are treated with antimalarials at the same time, whether they are sick or not. They demonstrated that providing the necessary information is important, but building trust between residents and the team providing the antimalarials is most critical for success.

The rise and fall of long-latency Plasmodium vivax

MORU Bangkok

Posted 05/04/2019. Until World War II the only Plasmodium vivax malaria generally recognised had either a long (8–9 months) incubation period or a similarly long interval between initial illness and the first relapse. Long-latency P. vivax ‘strains’ were the first in which relapse, drug resistance and liver stage development were described, yet in recent years they have been largely forgotten.

How context can impact clinical trials

MORU Bangkok

Posted 29/03/19. This qualitative study documents how clinical interventions are influenced by their local context. Factors like health policies or physicians’ fears of under-treating infectious diseases can influence adherence to the intervention and potentially hamper efforts to reduce antibiotic use in developing countries. The work was led by former CTMGH member Marco J Haenssgen, drawing on clinical trials in Southeast Asia by Yoel Lubell and Heiman Wertheim.

The impact of targeted malaria elimination with mass drug administrations on falciparum malaria in Southeast Asia

COMRU LOMWRU MOCRU MORU Bangkok

Posted 26/03/19. Lorenz Von Seidlein and colleagues wanted to know whether well-resourced mass drug administrations (MDA) can accelerate malaria elimination in the Greater Mekong Subregion. They randomised 16 villages in Myanmar, Vietnam, Cambodia, and Laos to receive MDAs with antimalarial drugs. The intervention had a substantial impact on the prevalence of P. falciparum infections by month 3 after the start of the MDAs. Over the subsequent 9 months, P. falciparum infections returned but stayed below baseline levels.

How can interventions that target forest-goers be tailored to accelerate malaria elimination in the Greater Mekong Subregion?

MORU Bangkok

Posted 18/03/2019. Tailored interventions that specifically target at-risk populations, such as forest-goers, will be crucial for achieving malaria elimination in Southeast Asia. This review By Tom Peto and colleagues highlights the behaviours and attitudes of forest-goers towards malaria prevention and control interventions to identify what changes can be made to reduce the malaria incidence in this population.

Collider bias and the apparent protective effect of G6PD deficiency on cerebral malaria

MORU Bangkok

Posted 12/03/2019. Large case-control studies have reported that glucose-6-phosphate dehydrogenase deficiency exists due to its opposing effects on falciparum malaria: protection against cerebral malaria but an increased propensity to develop severe malarial anaemia. A reanalysis of these claims by James Watson and colleagues shows they are likely explained by 'collider bias', as case definitions excluded patients with both anaemia and coma on presentation.

Optimal dosing of dihydroartemisinin-piperaquine for seasonal malaria chemoprevention in young children

MORU Bangkok

Posted 05/03/2019. Seasonal malaria is common in the Sahel, resulting in malaria-related morbidity and mortality, particularly in young children. Seasonal chemoprevention with the antimalarial drug dihydroartemisinin-piperaquine is effective and safe. However, results presented here by Palang Chotsiri and colleagues show that malaria incidence could be reduced substantially by using an increased and extended dosage in young children.

Tafenoquine versus Primaquine to Prevent Relapse of Plasmodium vivax Malaria

MORU Bangkok

Posted 26/02/2019. In this multi-center randomized controlled trial, Cindy Chu and colleagues assess the safety of a single dose tafenoquine for Plasmodium vivax radical cure. With appropriate G6PD testing, the number of adverse events, frequency and severity of haemoglobin reduction are similar to primaquine. Anti-relapse efficacy of tafenoquine is similar to primaquine; 69.1% vs 73.2%, respectively.

Molecular characterization and mapping of G6PD mutations in the Greater Mekong Subregion

COMRU LOMWRU MOCRU MORU Bangkok

Posted 19/02/2019. Germana Bancone and colleagues characterized glucose-6-phosphate dehydrogenase deficiency in over 10 thousand samples collected in 138 villages in Cambodia, Lao PDR, Myanmar, Thailand and Vietnam, showing a country-level prevalence in males ranging from 7.3% to 18.8%. Given this high prevalence, G6PD testing should be carried out in the Greater Mekong Subregion before P. vivax radical cure with 8-aminoquinolines.

Association of mutations in P. falciparum Kelch13 gene with parasite clearance rates after artemisinin-based treatments

MORU Bangkok

Posted 05/02/2019. In this study, the WWARN K13 genotype-phenotype Study Group gathered 18 studies from Africa and Asia to explore the relationships between identified Kelch 13 mutant alleles and delayed parasite clearance. Results show one P. falciparum specific mutant and 20 pfk13 propeller region mutant alleles strongly associated with the slow clearance phenotype, including 15 mutations that have not been confirmed before. It was reassuring that no pfk13 alleles associated with slow parasite clearance were observed in the parasites from African studies gathered between 2000-2017.

Optimizing respiratory management in resource-limited settings

LOMWRU MORU Bangkok

Posted 01/02/2019. In many low- and middle-income countries, putting a critically ill patient on a ventilator is associated with a high risk of the patient dying or developing additional problems. In this paper, Rebecca Inglis and colleagues explore measures avert to the need for a ventilator. They also look at ways to improve the safety of ventilators in low-resource settings.

Effect of point-of-care C-reactive protein testing on antibiotic prescription in febrile patients attending primary care in Thailand and Myanmar

MOCRU MORU Bangkok

Posted 15/01/2019. Dr Thomal Althaus and colleagues managed to reduce antibiotic prescription using the C-reactive protein (CRP) test among 2,410 children and adults presented with a fever in primary care centres in Thailand & Myanmar. The perspective of a rapid and affordable test for CRP, identifying febrile patients who really need an antibiotic, is now possible!

The double burden of diabetes and global infection in low and middle-income countries

MORU Bangkok

Posted 08/01/19. Four out of five people in the world with diabetes now live in low and middle income countries. Professor Susanna Dunachie and her Thai collaborator Parinya Chamnan describe how diabetes leads to increased risk and worse outcomes for global infections such as TB, melioidosis and dengue, alongside discussing potential mechanisms and interventions.

Challenges arising when seeking broad consent for health research data sharing

MORU Bangkok SMRU

Posted 11/12/2018. Phaik Yeong Cheah and colleagues report a qualitative study on how best to seek broad consent to sharing individual level health research data beyond research collaborations. Their findings demonstrated that research participants prioritise information about the potential benefits and harms of data sharing. The researchers also found that explaining data sharing to research participants was challenging.

Complex interactions between malaria and malnutrition

MORU Bangkok

Posted 05/12/2018. A WWARN team recently completed a large systematic literature review to understand whether undernutrition places children at higher, lower, or no differential risk for getting malaria. We raise the concern whether an adapted antimalarial treatment strategy is needed in malnourished children. The results present the risks associated with chronic and severe acute malnutrition and the impact on sub-optimal drug exposure, poor patient outcomes and the potential contribution towards an increased risk of antimalarial drug resistance. Photo credit: Albert González Farran, UNAMID, 2013

The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs

MORU Bangkok

Posted 13/11/2018. Quinoline and related antimalarial drugs are vital tools in the fight against malaria. However, concerns about their possible effects on the heart rhythm may limit their use. Dr Ilsa Haeusler, Dr Xin Hui Chan, and colleagues found that these serious side effects are reassuringly rare in the treatment of malaria

Anaemia and malaria

MORU Bangkok

Posted 06/11/18, review by Professor Nick White. Malaria, a parasitic infection of red blood cells, is a leading cause of anaemia in the tropics. Where malaria transmission is intense patients, typically children, may die from severe anaemia. However when falciparum malaria causes other vital organs to fail, moderate anaemia appears to protect against death.

Field detection devices for screening the quality of medicines

LOMWRU

Posted 23/10/18. A plethora of innovative portable devices to screen for poor quality medicines has become available. In a review of the scientific evidence regarding their performances, Dr Celine Caillet and colleagues show that there is a vitally important lack of independent evaluation of the majority of the 41 devices (most being spectrophotometers) found in our search, particularly in field settings. Intensive research is needed in order to inform national medicines regulatory authorities of the optimal choice of device to combat poor quality medicines.

Valuing the unpaid contribution of community health volunteers to mass drug administration programs

MORU Bangkok

Posted 10/10/2018. Community volunteers are used to deliver a number of healthcare interventions. Although these volunteers are not paid, their time still has an economic value, known as an opportunity cost. Dr Hugo Turner and colleagues found that this economic value is significant for mass drug administration programs: for the African Programme for Onchocerciasis Control alone it would be valued at US$60-90 million.

Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use

MORU Bangkok

Posted 18/09/2018. Let by Professor Yoel Lubell, researchers from MORU and IDDO estimated the economic costs of AMR associated with the consumption of a range of antibiotic classes in high and lower-middle income countries. These estimates are essential for economic evaluations of interventions that affect antibiotic consumption to reflect the full costs and benefits of their use.

Important antimalarial drug DHA-piperaquine safe to use

MORU Bangkok

Posted 04/09/2018. DHA-piperaquine is an important antimalarial recommended by the WHO for the treatment of malaria, and an ideal candidate for mass use in malaria elimination. In a large meta-analysis of ~200,000 subjects, Dr Xin Hui Chan and colleagues find the risk of sudden unexplained death after DHA-piperaquine is extremely low and not higher than baseline, confirming the drug’s safety for the treatment and prevention of malaria.

Addressing challenges faced by insecticide spraying for the control of dengue fever

MORU Bangkok

Posted 24/07/18. A study from Bangkok by Professor Wirichada Pan-Ngum and colleagues shows accessing households for proper spraying was a problem for control dengue outbreaks. In addition, inefficient communications among the sectors from hospital to district offices led to inaccurate or missing patient addresses for spraying. Involving community networks help to improve public engagement with and participation in the programmes.

Risk-based reboot for global lab biosafety

MORU Bangkok

Posted 17/07/2018. This paper by Professor Stuart Blacksell and colleagues describes the first update to the WHO Laboratory Biosafety Manual in 15 years. The need to update international lab biosafety guidance is part of a broader initiative to globalize biosafety, emphasizing principles and approaches that are accessible to countries spanning a broad range of financial, technical and regulatory resources.

Comparison of the Cumulative Efficacy and Safety of Chloroquine, Artesunate, and Chloroquine-Primaquine in Plasmodium vivax Malaria

MORU Bangkok SMRU

Posted 03/07/2018. Chloroquine, the recommended treatment for vivax malaria, delays but does not prevent relapses. Primaquine is the only widely available drug that prevents relapses but it can induce haemolysis in patients with G6PD deficiency. Cindy Chu and colleagues showed that added to chloroquine, primaquine is very effective for relapse prevention, but should be used alongside quantitative G6PD testing.

Small children and pregnant women may be underdosed with widely used antimalarial drug

MORU Bangkok

Posted 27/06/2018. Current recommended treatment regimens for the most widely used medicine for uncomplicated Plasmodium falciparum malaria may be sub-optimal for small children and pregnant women according to a study led by Professor Joel Tarning.

Scrub typhus point-of-care testing

MORU Bangkok

Posted 15/05/2018. Kartika Karaswati, Stuart Blacksell and colleagues reviewed the diagnostic accuracy of the available scrub typhus point-of-care tests, feasible to be used in resource limited settings. Although the available evidence is varied in methodology and quality, POCTs appear to have low false positive rates, thus confidence in interpreting a positive result can be high.

Load More