Defining the burden of febrile illness in rural South and Southeast Asia: an open letter to announce the launch of the Rural Febrile Illness project

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Abstract

In rural areas of South and Southeast Asia malaria is declining but febrile illnesses still account for substantial morbidity and mortality. Village health workers (VHWs) are often the first point of contact with the formal health system, and for patients with febrile illnesses they can provide early diagnosis and treatment of malaria. However, for the majority of febrile patients, VHWs lack the training, support and resources to provide further care. Consequently, treatable bacterial illnesses are missed, antibiotics are overused and poorly targeted, and patient attendance wanes along with declining malaria.

This Open Letter announces the start of a new initiative, the Rural Febrile Illness (RFI) project, the first in a series of projects to be implemented as part of the South and Southeast Asian Community-based Trials Network (SEACTN) research programme. This multi-country, multi-site project will begin in Bangladesh, Cambodia, Lao PDR, and Myanmar and will define the epidemiological baseline of febrile illness in five remote and underserved areas of Asia where malaria endemicity is declining and access to health services is limited.

The RFI project aims to determine the incidence, causes and outcomes of febrile illness; understand the opportunities, barriers and appetite for adjustment of the role of VHWs to include management of non-malarial febrile illnesses; and establish a network of community healthcare providers and facilities capable of implementing interventions designed to triage, diagnose and treat patients presenting with febrile illnesses within these communities in the future.

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Most cited references 30

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Spread of artemisinin resistance in Plasmodium falciparum malaria.

Elizabeth A Ashley, Mehul Dhorda, Rick Fairhurst … (2014)

Artemisinin resistance in Plasmodium falciparum has emerged in Southeast Asia and now poses a threat to the control and elimination of malaria. Mapping the geographic extent of resistance is essential for planning containment and elimination strategies. Between May 2011 and April 2013, we enrolled 1241 adults and children with acute, uncomplicated falciparum malaria in an open-label trial at 15 sites in 10 countries (7 in Asia and 3 in Africa). Patients received artesunate, administered orally at a daily dose of either 2 mg per kilogram of body weight per day or 4 mg per kilogram, for 3 days, followed by a standard 3-day course of artemisinin-based combination therapy. Parasite counts in peripheral-blood samples were measured every 6 hours, and the parasite clearance half-lives were determined. The median parasite clearance half-lives ranged from 1.9 hours in the Democratic Republic of Congo to 7.0 hours at the Thailand-Cambodia border. Slowly clearing infections (parasite clearance half-life >5 hours), strongly associated with single point mutations in the "propeller" region of the P. falciparum kelch protein gene on chromosome 13 (kelch13), were detected throughout mainland Southeast Asia from southern Vietnam to central Myanmar. The incidence of pretreatment and post-treatment gametocytemia was higher among patients with slow parasite clearance, suggesting greater potential for transmission. In western Cambodia, where artemisinin-based combination therapies are failing, the 6-day course of antimalarial therapy was associated with a cure rate of 97.7% (95% confidence interval, 90.9 to 99.4) at 42 days. Artemisinin resistance to P. falciparum, which is now prevalent across mainland Southeast Asia, is associated with mutations in kelch13. Prolonged courses of artemisinin-based combination therapies are currently efficacious in areas where standard 3-day treatments are failing. (Funded by the U.K. Department of International Development and others; ClinicalTrials.gov number, NCT01350856.).

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Article: not found

Then and now: use of 16S rDNA gene sequencing for bacterial identification and discovery of novel bacteria in clinical microbiology laboratories.

P Woo, S K P Lau, J. Teng … (2008)

In the last decade, as a result of the widespread use of PCR and DNA sequencing, 16S rDNA sequencing has played a pivotal role in the accurate identification of bacterial isolates and the discovery of novel bacteria in clinical microbiology laboratories. For bacterial identification, 16S rDNA sequencing is particularly important in the case of bacteria with unusual phenotypic profiles, rare bacteria, slow-growing bacteria, uncultivable bacteria and culture-negative infections. Not only has it provided insights into aetiologies of infectious disease, but it also helps clinicians in choosing antibiotics and in determining the duration of treatment and infection control procedures. With the use of 16S rDNA sequencing, 215 novel bacterial species, 29 of which belong to novel genera, have been discovered from human specimens in the past 7 years of the 21st century (2001-2007). One hundred of the 215 novel species, 15 belonging to novel genera, have been found in four or more subjects. The largest number of novel species discovered were of the genera Mycobacterium (n = 12) and Nocardia (n = 6). The oral cavity/dental-related specimens (n = 19) and the gastrointestinal tract (n = 26) were the most important sites for discovery and/or reservoirs of novel species. Among the 100 novel species, Streptococcus sinensis, Laribacter hongkongensis, Clostridium hathewayi and Borrelia spielmanii have been most thoroughly characterized, with the reservoirs and routes of transmission documented, and S. sinensis, L. hongkongensis and C. hathewayi have been found globally. One of the greatest hurdles in putting 16S rDNA sequencing into routine use in clinical microbiology laboratories is automation of the technology. The only step that can be automated at the moment is input of the 16S rDNA sequence of the bacterial isolate for identification into one of the software packages that will generate the result of the identity of the isolate on the basis of its sequence database. However, studies on the accuracy of the software packages have given highly varied results, and interpretation of results remains difficult for most technicians, and even for clinical microbiologists. To fully utilize 16S rDNA sequencing in clinical microbiology, better guidelines are needed for interpretation of the identification results, and additional/supplementary methods are necessary for bacterial species that cannot be identified confidently by 16S rDNA sequencing alone.

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Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability?

Dilpreet Minhas, Leslie A Curry, Lauren Taylor … (2013)

We sought to provide a systematic review of the determinants of success in scaling up and sustaining community health worker (CHW) programs in low- and middle-income countries (LMICs). We searched 11 electronic databases for academic literature published through December 2010 (n = 603 articles). Two independent reviewers applied exclusion criteria to identify articles that provided empirical evidence about the scale-up or sustainability of CHW programs in LMICs, then extracted data from each article by using a standardized form. We analyzed the resulting data for determinants and themes through iterated categorization. The final sample of articles (n = 19) present data on CHW programs in 16 countries. We identified 23 enabling factors and 15 barriers to scale-up and sustainability, which were grouped into 3 thematic categories: program design and management, community fit, and integration with the broader environment. Scaling up and sustaining CHW programs in LMICs requires effective program design and management, including adequate training, supervision, motivation, and funding; acceptability of the program to the communities served; and securing support for the program from political leaders and other health care providers.

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Author and article information

Contributors

Arjun Chandna: Role: ConceptualizationRole: Funding AcquisitionRole: MethodologyRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0003-1313-7922

Nan Shwe Nwe Htun: Role: ConceptualizationRole: MethodologyRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

Thomas J Peto: Role: ConceptualizationRole: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0003-3197-9891

Marco Liverani: Role: ConceptualizationRole: MethodologyRole: Writing – Review & Editing

Tobias Brummaier: Role: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-9739-2084

Koukeo Phommasone: Role: MethodologyRole: Writing – Review & Editing

Sazid Ibna Zaman: Role: MethodologyRole: VisualizationRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0001-8017-8500

Aye Sandar Zaw: Role: MethodologyRole: Writing – Review & Editing

Elizabeth Batty: Role: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0001-8559-452X

Naomi Waithira: Role: Data CurationRole: MethodologyRole: SoftwareRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-2267-9347

Melissa Richard-Greenblatt: Role: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0001-6717-8856

Stuart D Blacksell: Role: MethodologyRole: Writing – Review & Editing

Ladaporn Bodhidatta: Role: MethodologyRole: Writing – Review & Editing

James J Callery: Role: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-3218-2166

Watcharintorn Fagnark: Role: MethodologyRole: Writing – Review & Editing

Shayla Islam: Role: MethodologyRole: Writing – Review & Editing

Sanchai Lertcharoenchoke: Role: MethodologyRole: SoftwareRole: Writing – Review & Editing

Mavuto Mukaka: Role: MethodologyRole: Writing – Review & Editing

Tiengkham Pongvongsa: Role: MethodologyRole: Writing – Review & Editing

William HK Schilling: Role: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-6328-8748

Janjira Thaipadungpanit: Role: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-6184-3381

Rupam Tripura: Role: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-3281-9702

Arjen M Dondorp: Role: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0001-5190-2395

Mayfong Mayxay: Role: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing

Nicholas J White: Role: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-1897-1978

Francois Nosten: Role: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-7951-0745

Frank Smithuis: Role: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing

Elizabeth A Ashley: Role: ConceptualizationRole: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-7620-4822

Richard J Maude: Role: ConceptualizationRole: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-5355-0562

Nicholas PJ Day: Role: ConceptualizationRole: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0003-2309-1171

Yoel Lubell: Role: ConceptualizationRole: Funding AcquisitionRole: MethodologyRole: SupervisionRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-0237-1070

Journal

Journal ID (nlm-ta): Wellcome Open Res

Journal ID (iso-abbrev): Wellcome Open Res

Journal ID (pmc): Wellcome Open Res

Title: Wellcome Open Research

Publisher: F1000 Research Limited (London, UK )

ISSN (Electronic): 2398-502X

Publication date (Electronic): 26 March 2021

Publication date Collection: 2021

Volume: 6

Electronic Location Identifier: 64

Affiliations

[1 ]Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK

[2 ]Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia

[3 ]Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

[4 ]Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK

[5 ]Faculty of Public Health, Mahidol University, Bangkok, Thailand

[6 ]School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan

[7 ]Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand

[8 ]Swiss Tropical and Public Health Institute, Basel, Switzerland

[9 ]University of Basel, Basel, Switzerland

[10 ]Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic

[11 ]Myanmar Oxford Clinical Research Unit, Yangon, Myanmar

[12 ]University of Pennsylvania, Pennsylvania, USA

[13 ]Health Nutrition and Population Programme, BRAC, Dhaka, Bangladesh

[14 ]Savannakhet Provincial Health Department, Savannakhet, Lao People's Democratic Republic

[15 ]Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand

[16 ]Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic

[17 ]Harvard TH Chan School of Public Health, Harvard University, Boston, USA

[18 ]The Open University, Milton Keynes, UK

[1 ]Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA

[1 ]Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA

[1 ]Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya

Author notes

[a ] arjun@ 123456tropmedres.ac

[b ] yoel@ 123456tropmedres.ac

No competing interests were disclosed.

Competing interests: No competing interests were disclosed.

Author information

Arjun Chandna https://orcid.org/0000-0003-1313-7922

Thomas J Peto https://orcid.org/0000-0003-3197-9891

Tobias Brummaier https://orcid.org/0000-0002-9739-2084

Sazid Ibna Zaman https://orcid.org/0000-0001-8017-8500

Elizabeth Batty https://orcid.org/0000-0001-8559-452X

Naomi Waithira https://orcid.org/0000-0002-2267-9347

Melissa Richard-Greenblatt https://orcid.org/0000-0001-6717-8856

James J Callery https://orcid.org/0000-0002-3218-2166

William HK Schilling https://orcid.org/0000-0002-6328-8748

Janjira Thaipadungpanit https://orcid.org/0000-0002-6184-3381

Rupam Tripura https://orcid.org/0000-0002-3281-9702

Arjen M Dondorp https://orcid.org/0000-0001-5190-2395

Nicholas J White https://orcid.org/0000-0002-1897-1978

Francois Nosten https://orcid.org/0000-0002-7951-0745

Elizabeth A Ashley https://orcid.org/0000-0002-7620-4822

Richard J Maude https://orcid.org/0000-0002-5355-0562

Nicholas PJ Day https://orcid.org/0000-0003-2309-1171

Yoel Lubell https://orcid.org/0000-0002-0237-1070

Article

DOI: 10.12688/wellcomeopenres.16393.1

PMC ID: 8080974

PubMed ID: 34017924

SO-VID: 3fd4dd9c-15b3-4be2-a45a-654e50427ac0

License:

This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date accepted : 10 March 2021

Funding

Funded by: Global Fund to Fight AIDS, Tuberculosis and Malaria

Award ID: QSE-M-UNOPS-MORU-20864-007-42

Funded by: Wellcome Trust

Award ID: 215604

This work is supported by Wellcome [219644]. The work in Cambodia is conducted as part of an RAI3E OR project, funded by the Global Fund [QSE-M-UNOPS-MORU-20864-007-42]. This diagnostics component of this partner project in Cambodia is supported by the Wellcome Trust.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Defining the burden of febrile illness in rural South and Southeast Asia: an open letter to announce the launch of the Rural Febrile Illness project

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Abstract

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Most cited references 30

Spread of artemisinin resistance in Plasmodium falciparum malaria.

Then and now: use of 16S rDNA gene sequencing for bacterial identification and discovery of novel bacteria in clinical microbiology laboratories.

Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability?

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