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
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.
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.
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.
Posted 02/05/2023. The \u2018Antibiotic footprint\u2019 concept supports a global reduction in antibiotic overuse. In this paper, Direk Limmathurotsakul and colleagues describe \u2018antibiotic footprint calculator\u2019, an open-access, web-based application that lets anyone calculate how different individual decisions can reduce or increase their own personal antibiotic footprint.
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.
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.
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.
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.
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.
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.
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\u2019s causes and reconstruct the origin of the circulating strains.
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.
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.
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.
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.
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.
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.
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?
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.
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
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.
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.
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.
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 \u2018making merit\u2019 (Tham-bun in Thai).
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.
Posted 13/05/2022. \u201cUnder the Mask\u201d 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.
Posted 03/05/2022. We\u2019ve 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?
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.
Posted 15/03/2022. Bipin Adhikari reviews a book titled \u2018Phantom Plague: How Tuberculosis Shaped History\u2019 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.
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.
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'.
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.
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\u2019s 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.
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.
Posted 23/12/2021. Marcus Schultz and colleagues analysed 4 large prospective observational studies conducted in 534 ICUs in 54 countries. Patients in middle\u2013income 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\u2013income countries, and inversely associated with GDP.
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
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.
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.
Posted 01/10/2021. In 2017 hundreds of thousands of \u2018Rohingya\u2019 fled from Myanmar to refugee camps in Cox\u2019s 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
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.
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.
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
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.
Posted 27/07/2021. This qualitative study by Mira Schneiders and colleagues discusses the important nutrition-related roles and responsibilities of grandparents caring for grandchildren in rural Cambodian \u2018skip-generation\u2019 households. Grandparents appear highly motivated to improve grandchildren\u2019s health and nutrition, but lack necessary resources, leading to frequent moral dilemmas and ethical trade-offs. Interventions to improve child health and nutrition should be designed to be inclusive of older caregivers.
Posted 16/07/2021. Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. What prognostic factors are associated with severe metabolic acidosis and uraemia in African children with severe falciparum malaria? Secondary analysis of a randomized trial by Mavuto Mukaka and colleagues
Posted 06/07/2021. Surveillance of Antimicrobial resistance (AMR) is important in generating evidence to support efforts in controlling the infection. Cherry Lim and colleagues discuss the strengths, potential sources of bias, and challenges of routine microbiology data and different surveillance strategies and solutions used in low- and middle-income countries. Areas requiring support and improvement are highlighted.
Posted 16/06/2021. The progress made in treatment of malaria is threatened by the emergence of resistance to current first line treatments artemisinin-based combination therapies (ACTs). There are currently no good alternatives for the treatment of uncomplicated malaria in the African setting in the event of resistance emerging to antimalarials that are in the ACTs. Mainga Hamaluba, Rob van der Pluijm and colleagues demonstrate that triple artemisinin combination therapies (TACTs) can potentially be used safely to prevent, delay or manage uncomplicated malaria in our setting.
Posted 15/06/2021. Plasmodium vivax caused an estimated 14 million malaria cases in 2017. By collating economic and epidemiological data, Angela Devine and colleagues estimated an economic cost of $359 million associated with these episodes. A scenario analysis explored how costs might change with global access to safe radical cure, estimating cost savings of $17-93 million.
Posted 25/05/2021. Seeking treatment including antibiotics without prescription at drug shops is a common practice in Nepal which can contribute to rising antibiotic resistance. This may leave us without effective antibiotics for future infections. In this study, Bipin Adhikari and colleagues explore why people buy antibiotics over the counter in Nepal and implications for its control.
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