MORU Tropical Health Network

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border

Posted 22/10/2024. Severe neonatal hyperbilirubinaemia is often diagnosed late in low-resources settings because of lack of point-of-care tools. In this study, Germana Bancone and SMRU researchers have evaluated the performance of a transcutaneous bilirubinometer for screening of neonates born along the Thai-Myanmar border. The study was supported by a Wellcome Trust iTPA grant.

Artemisinin-resistant malaria

Posted 18/10/2024. Nick White and K. Chotivanich publish a review of mechanisms, genetic associations, phenotyping, epidemiology and current status of artemisinin resistance, and a brief discussion of policies and potential counter-measures.

In-host modeling of dengue virus and non-structural protein 1 and the effects of ivermectin in patients with acute dengue fever

Posted 09/10/2024. Junjie Ding and the MORU Clinical Pharmacology Team developed an in-host dengue kinetic model to quantitatively predict drug effects in dengue fever. This model offers valuable insights to inform dengue drug development, and shows that ivermectin reduces NS1 but not viral load. The results are published in a leading PK/PD modelling journal, CPT:PSP.

Prevalence and associated risk factors of stunting, wasting/thinness, and underweight among primary school children in Kandahar City, Afghanistan: a cross-sectional analytical study

Posted 17/09/2024. Bob Taylor and colleagues investigated 1205 primary school children in Kandahar and found almost 50% were stunted, 25% were underweight and 20% wasted. Risk factors for stunting in 6–9 year old children were poverty, skipping breakfast, and being a girl from a large family with an uneducated mother and an unemployed father.

Anti-infectivity efficacy and pharmacokinetics of WHO recommended single low-dose primaquine in children with acute Plasmodium falciparum in Burkina Faso: study protocol

Posted 11/09/2024. The Groupe de Recherche Action en Santé, a Developing Paediatric Primaquine project partner, will assess, for the first time, the transmission blocking efficacy of allometrically-scaled, single low-dose primaquine, using the WHO-recommended 0.25 mg/kg target dose, in under-5 Burkinabe children with uncomplicated Plasmodium falciparum. The study protocol is now published. By Bob Taylor.

Frequency of antimicrobial-resistant bloodstream infections in 111 hospitals in Thailand, 2022

Posted 10/09/2024. Collaborating with the Ministry of Public Health, Direk Limmathurotsakul and colleagues utilised an automated tool, evaluated and reported the frequency of antimicrobial-resistant (AMR) infection in 111 public hospitals in Thailand in 2022. Our approach and findings highlight health regions and hospitals where actions against AMR infection, including antimicrobial stewardship and infection control, should be prioritised.

Genetic diversity, determinants, and dissemination of Burkholderia pseudomallei lineages implicated in melioidosis in Northeast Thailand

Posted 15/07/2024. A recent study from northeast Thailand identified three major bacterial lineages responsible for melioidosis in the region. Each lineage carries unique gene sets that likely contribute to successful dissemination. These genes are expressed under environmental rather than infectious conditions, with one lineage showing overexpression under nutrient deprivation, highlighting environmental persistence is a prerequisite for infection. By Claire Chewapreecha

Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Posted 17/07/2024. A large multidisciplinary team conducted qualitative research in five ICUs in Bangladesh and India. They found that less restrictive ICU visiting policies improved experiences for patients and families – and the family’s presence at the bedside could improve patient care. Supporting nurses to give routine updates promoted better communication with families. By Rebecca Inglis

A randomised trial of malaria vaccine R21/Matrix-M™ with and without antimalarial drugs in Thai adults

Posted 16/07/2024. Borimas Hanboonkunupakarn and coworkers from MORU and the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand have shown that the co administration of the malaria vaccine R21/matrix M combined with the antimalarials drugs DHA/piperaquine and the single low dose primaquine does not interfere with the immunogenicity of the vaccine or the concentrations of piperaquine.

Embedding community and public voices in co-created solutions to mitigate antimicrobial resistance (AMR) in Thailand using the ‘Responsive Dialogues’ public engagement framework

Posted 11/17/2024. Tackling antimicrobial resistance requires collaboration between communities, stakeholders and researchers. In the ‘AMR Dialogues’ project, Tassawan Poomchaichote, Phaik Yeong Cheah and colleagues conducted a series of conversations, bringing together people from different backgrounds. This paper summarises issues identified across Thailand and highlights four locally actionable ‘building blocks’ of co-created solutions.

Estimated global and regional economic burden of genital herpes simplex virus infection among 15–49 year-olds in 2016

Poster 09/07/2024. Genital herpes infections and their related complications lead to billions of dollars in health care expenditures and productivity losses globally, say researchers who calculated the first-ever global estimates of the economic costs of these conditions. The study calls for greater investment in prevention of herpes transmission, including concerted efforts to develop effective vaccines against this common virus. By Puttarin Kulchaitanaroaj; MAEMOD, MORU.

Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate–pyronaridine to control malaria outbreaks in Cambodia

Posted 25/06/2024. The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, an effective response to malaria outbreaks becomes the vital strategy. Authors report a programmatic response to a 2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia. By Bipin Adhikari.

Bioequivalence of a new coated 15 mg primaquine formulation for malaria elimination

Posted 21/06/2024. A new study by Bob Taylor and colleagues confirms that a 15 mg generic primaquine tablet, made by IPCA in India, is bioequivalent to the reference Sanofi product. The dossier has been submitted to WHO for prequalification. Once prequalified, it will be used to help eliminate malaria.

A youth advisory group on health and health research in rural Cambodia

Posted 19/06/2024. Bipin Adhikari and colleagues reflect on how engagement with a youth advisory group on health and research engagement is carried out in a remote malaria endemic district of Cambodia. Authors discuss the processes, outputs and outcomes of youth group engagement including their relevance to broader goals of community engagement using a theory of change.

Rectal artesunate: lives not saved

Posted 03/06/2024. Childhood deaths from severe malaria can be prevented by giving rectal artesunate suppositories (RAS) but in January 2022, based on preliminary interpretation of a flawed observational study, WHO issued a moratorium on RAS. This has now been partially lifted, but use of RAS has markedly declined and thousands of malaria deaths have not been prevented. By Nick White.

Care seeking for childhood illnesses in rural Mtwara, south-east Tanzania: a mixed methods study

Posted 29/05/2024. In Africa, children < 5 years remain highly vulnerable to infectious diseases. Salum Mshamu and colleagues explored treatment seeking behaviour related to childhood illnesses in rural Mtwara, south-east Tanzania which was a part of community based novel housing intervention. How treatment seeking behaviour was influenced by institutional and community level factors are discussed in the article.

Gender and equity considerations in AMR research: a systematic scoping review

Posted 28/05/2024. Bhensri Naemiratch and colleagues report on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours.

Comparison of lumefantrine, mefloquine, and piperaquine concentrations between capillary plasma and venous plasma samples in pregnant women with uncomplicated falciparum and vivax malaria

Posted 01/05/2024. Makoto Saito and SMRU colleagues compared capillary and venous plasma concentrations of mefloquine, lumefantrine, and piperaquine in pregnant women with malaria. While there was a strong correlation, direct interchangeability was limited. Predictability within a ±10% precision range varied by drug. Caution is needed when converting capillary samples at the individual level.

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

Posted 09/04/2024. Using data collected in the SEACTN Rural Febrile Illness project, Christopher Chew and colleagues evaluate the cost-effectiveness of a putative multiplex rapid diagnostic test able to diagnose enteric fever and dengue, coupled with CRP measurement to guide antibiotic prescribing for respiratory tract infections, in rural Cambodian and Bangladeshi primary care settings.

Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

Posted 05/04/2024. There are complex ethical tensions and competing interests that surround interventions to mitigate antimicrobial resistance (AMR). In this paper, Phaik Yeong Cheah, Bipin Adhikari and colleagues have identified how these are especially reflected in low- and middle-income countries. They highlight that these ethical tensions need to be kept in mind when designing AMR policies.

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