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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

SMRU

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

LOMWRU MORU Bangkok

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

LOMWRU MORU Bangkok

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

SMRU

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.

Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders’ perspectives in Burkina Faso and Nigeria

MORU Bangkok

Posted 21/09/2022. Phaik Yeong Cheah and colleagues asked malaria stakeholders in Burkina Faso and Nigeria: What are the key ethical considerations to be considered in the deployment of Triple Artemisinin-based Combination Therapies for malaria in Africa when artemisinin combination therapies are effective in most of Africa?

Outdoor residual spraying for malaria vector-control in Kayin (Karen) state, Myanmar: A cluster randomized controlled trial

SMRU

Posted 14/09/2022. Victor Chaumeau and colleagues evaluated the efficacy of outdoor residual spraying for malaria vector control on the Thailand-Myanmar border. Intervention was showed to rapidly interrupt transmission in a setting where the vectors bite mostly outdoors and at a time when people are not protected by mosquito bed nets.

The quality of veterinary medicines and their implications for One Health

MORU Bangkok

Posted 31/08/2022. Substandard and falsified anti-infectives used in human and animals are common, especially in Low- and Middle-Income countries, leading to poor clinical outcomes, adverse drug reactions, economic losses, mistrust in health systems and potentially leading to AMR emergence and spread. One Health research is needed to assess their impact on AMR, by Celine Caillet and colleagues.

A family cluster of cutaneous Leishmania major infection unresponsive to intralesional meglumine antimonial: Case reports

MORU Bangkok

Posted 12/08/2022. This small series describes four family members who contracted cutaneous leishmaniasis due to Leishmania major that did not improve in two patients and worsened in the other two despite 4 weeks of intralesional meglumine antimoniate. All responded to a 4-week course of oral ketoconazole. The paper provides an interesting discussion, by Bob Taylor and colleagues

Perioperative Care Pathways in Low- and Lower-Middle-Income Countries: Systematic Review and Narrative Synthesis

MORU Bangkok

Posted 09/08/2022. Timo Tolppa and CCAA colleagues reviewed the literature on perioperative care pathways in resource-poor settings and found that pathways are increasingly used there with an aim to improve care quality. Patient and clinician beliefs were a major challenge in care pathway implementation, whereas facilitators included context-relevant adaptations, strong evidence-base and teamwork.

Improving the diagnosis of severe malaria in African children using platelet counts and plasma PfHRP2 concentrations

MORU Bangkok

Posted 02/08/2022. Severe malaria is difficult to diagnose in high malaria transmission areas because of the high coincidence of malaria with other febrile illnesses. James Watson and colleagues analysed platelet counts and plasma PfHRP2 concentrations from >2000 severely ill children and show that around a third of children diagnosed with severe malaria have in fact another cause of illness.

Decentralised hepatitis C testing and treatment in rural Cambodia: evaluation of a simplified service model integrated in an existing public health system

MORU Bangkok

Posted 28/07/2022. Meiwen Zhang and Tom Peto start a prevalence survey, including Hepatitis B and Hepatitis C, among the rural population in Bangladesh, Cambodia, and Thailand. In 2021 Meiwen and colleagues published a pilot implementation project on hepatitis C testing and treatment in rural Cambodia.

“Like a wake-up call for humankind”: Views, challenges, and coping strategies related to public health measures during the first COVID-19 lockdown in Thailand

MORU Bangkok

Posted 26/07/2022. In this paper, Phaik Yeong Cheah and colleagues describe the challenges and coping strategies related to public health measures during the first COVID-19 lockdown in Thailand. Major challenges identified included financial hardship, social isolation and loneliness. Coping strategies included turning to religion, practicing acceptance and ‘making merit’ (Tham-bun in Thai).

Impact of delayed processing of positive blood cultures on organism detection: a prospective multi-centre study

COMRU LOMWRU

Posted 19/07/2022. What effect temperature and time have on organism detection from positive blood culture bottles is unknown. Tamalee Roberts, Arjun Chandna and colleagues found that the majority of organisms were recoverable from positive blood culture bottles stored at room temperature. Amies transport swabs also proved effective for transporting blood culture broth and preserving organism viability.

High burden of childhood tuberculosis in migrants: a retrospective cohort study from the Thailand–Myanmar border

SMRU

Posted 14/07/2022. Children bear a substantial burden of TB disease on the Thai-Myanmar border. Treatment success rate exceeded the WHO End TB target of 90%, suggesting that similar vulnerable populations could benefit from the enhanced support of this residential TB program offered by Francois Nosten and colleagues. However better child-friendly diagnostics are needed to improve the detection of TB in children.

Contribution of genetic factors to high rates of neonatal hyperbilirubinaemia on the Thailand-Myanmar border

MORU Bangkok SMRU

Posted 22/06/2022. Mutations on the G6PD and UGT1A1 genes play a large role in neonatal jaundice, including the severe forms, among Karen and Burman neonates. Germana Bancone and colleagues show that improved diagnostics are urgently needed and different screening strategies should be considered in populations with a high prevalence of these traits.

Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): a multicentre prospective study

LOMWRU

Posted 21/06/2022. The South-East Asia Encephalitis Consortium, coordinated by Institut Pasteur-Paris, published in Lancet Global Health, a large prospective study of childhood encephalitis in Cambodia, Laos, Vietnam and Myanmar. The Lao site was coordinated by LOMWRU/Microbiology Laboratory, Mahosot Hospital. This demonstrated the vital importance of prevention, especially vaccination against Japanese encephalitis, and access to rapid, tiered diagnosis and treatment.

Under the Mask: A Film on Tuberculosis at the Thai-Myanmar Border

MORU Bangkok SMRU

Posted 13/05/2022. “Under the Mask” is a 75-min feature film that follows the lives of patients with TB who live on the Thai-Myanmar border. Phaik Yeong Cheah, Michele Vincenti Delmas and colleagues explains the genesis and development of the film, and how it has been used to engage communities at risk of TB.

Should peer reviewers be paid to review academic papers?

MORU Bangkok

Posted 03/05/2022. We’ve all been there! Waiting forever for reviewers comments after submission our paper to a journal. The system is not working. Should we pay reviewers to review a paper? Will it make a difference? Phaik Yeong Cheah and Jan Piasecki give some arguments why we should. What are your thoughts?

Facilitating safe discharge through predicting disease progression in moderate COVID-19: a prospective cohort study to develop and validate a clinical prediction model in resource-limited settings

COMRU

Posted 29/03/2022. In regions with low Covid-19 vaccine coverage, health systems remain vulnerable to surges in infections. Arjun Chandna and colleagues developed three clinical prediction models to help identify patients safe for community-based management. Each model contains three simple clinical parameters (age, sex, SpO2) and one point-of-care biomarker, and could help protect resource-limited health systems.

Triple therapy with artemether–lumefantrine plus amodiaquine versus artemether–lumefantrine alone for artemisinin-resistant, uncomplicated falciparum malaria: an open-label, randomised, multicentre trial

MORU Bangkok

Posted 22/03/2022. The first randomised trial of artemether-lumefantrine plus amodiaquine for uncomplicated falciparum malaria in areas with a high prevalence of artemisinin resistance shows it is a well-tolerated, effective treatment for multidrug-resistant parasites. Coordinated by Tom Peto, James Callery and Rupam Tripura, the triple therapy provides an alternative first-line treatment in Southeast Asia and elsewhere, with an expected longer therapeutic lifetime than current artemisinin combination therapies.

History and evolution of tuberculosis and global health

MORU Bangkok

Posted 15/03/2022. Bipin Adhikari reviews a book titled ‘Phantom Plague: How Tuberculosis Shaped History’ by Vidya Krishnan--a prominent medical science reporter. The book is a compelling journey into a history of medicine, current development of Tuberculosis epidemiology and treatment, and Global Health and is an essential read in Global Health.

The proxy dilemma: Informed consent in paediatric clinical research - a case study of Thailand

MORU Bangkok

Posted 11/03/2022. In paediatric research, a legal representative must provide consent on behalf of the child. Using Thailand as a case study, Sheila Varadan, Phaik Yeong Cheah and colleagues contemplate how international legal frameworks could be leveraged to navigate legal uncertainty in the informed consent process, enabling more children to participate in paediatric clinical research.

Anopheles salivary antigens as serological biomarkers of vector exposure and malaria transmission: A systematic review with multilevel modelling

SMRU

Posted 08/03/2022. In this review, Victor Chaumeau and colleagues assessed the level of association between antibody responses to mosquito salivary antigens and the metrics of malaria transmission across different areas of the globe. They identified knowledge gaps that need to be addressed before these serological markers of exposure to vector bites can be used operationally for malaria elimination.

Community engagement for malaria elimination in the Greater Mekong Sub‑region: a qualitative study among malaria researchers and policymakers

MORU Bangkok

Posted 01/03/2022. Nils Kaehler and colleagues, policymakers and researchers involved in malaria offered insights on strategies for community engagement for malaria elimination in the Greater Mekong Subregion. More than ever, sustaining community engagement and engaging with community-based health workers are critical to ensure that the last remaining malaria cases are not left 'untreated'.

Utility of InTray COLOREX Screen agar and InTray COLOREX ESBL agar for urine culture in the Lao PDR

LOMWRU

Posted 23/02/2022. Simple diagnostics are needed for enhanced antimicrobial resistance surveillance. Tamalee Roberts and colleagues showed how InTray COLOREX Screen chromogenic agar can be used for simple and rapid detection of uropathogens and ESBLs in LMIC settings. Inoculated agar plates also have the potential for easy storage and transport from field sites to central laboratories.

The impact of COVID-19 non-pharmaceutical interventions on the lived experiences of people living in Thailand, Malaysia, Italy and the United Kingdom: A cross-country qualitative study

MORU Bangkok

Posted 10/02/2022. In many countries, strict public health measures characterised the first wave of the pandemic, disrupting and changing everyday lives. But how were these measures individually experienced? This qualitative study by Mira Schneiders and colleagues provides a rich account of the challenges, opportunities and coping strategies of people living through the first COVID lockdown in Thailand, Malaysia, Italy, and the UK.

Transforming Nepal’s primary health care delivery system in global health era: addressing historical and current implementation challenges

MORU Bangkok

Posted 09/02/2022. To understand how complex social and programmatic interventions work, a mix of methods that entailed a blend of literature review, reflections from experiential and disciplinary expertise were utilized. This review by Bipin Adhikari and colleagues highlights the complexity of Nepal’s primary health care system (PHC), how it has evolved over the decades and through the current federalization, and challenges and opportunities to transform the PHC.

Mapping genetic markers of artemisinin resistance in Plasmodium falciparum malaria in Asia: a systematic review and spatiotemporal analysis

MORU Bangkok

Posted 04/02/2022. Current knowledge of P. falciparum artemisinin resistance evolution in Asia is as old as 4yrs ago. For swift policy decisions, rapid sharing of data collected over extended periods in the same areas is highly needed. Frank Kagoro and colleagues found a steady increase in geographic locations and the proportion of artemisinin resistance from 2002 to 2018. Using the latest WHO classification, the authors map all published K13 markers in Asia by province and district.

A case–control study of the causes of acute respiratory infection among hospitalized patients in Northeastern Laos

LOMWRU

Posted 28/01/2022. This case-control study by Koukeo Phommasone and colleagues aimed to determine the causes of acute respiratory infection (ARI) in patients presenting to a hospital in Laos. ARI was commonly attributed to influenza A and B, human metapneumovirus and respiratory syncytial virus. Other organisms were detected at similar frequency in cases and controls.

Clinical impact of vivax malaria: A collection review

LOMWRU

Posted 25/01/2022. This latest addition by Elizabeth Ashley and colleagues to the PLOS Medicine Vivax Malaria Collection describes the clinical impacts of Plasmodium vivax malaria, and incorporates a rapid systematic review of severe disease. Reports of severe vivax malaria are increasing, however the literature is dominated by case reports and case series, impeding accurate estimation of incidence.

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.