South and Southeast Asian Community-based Trials Network MORU


The South and Southeast Asian Community-based Trials Network is a network of community healthcare providers and health facilities with two key objectives: 1) to capture the key causes of morbidity and mortality in rural, underserved populations in South and Southeast Asia, and 2) to run implementation trials of scalable, high impact interventions.

Introducing the Rural Febrile Illness project

In the past, patients with a fever in much of Asia and Africa were treated with antimalarials, as this was assumed to be the most common of febrile illness. Today, malaria is increasingly rare in Southeast Asia, and knowing how to treat febrile illnesses is more challenging. Febrile-related deaths in LMICs are typically attributed to delayed diagnoses for a broad spectrum of pathogens, limited access to medical care, and insufficient laboratory diagnostic capacities. The first three years of the SEACTN programme will focus on the Rural Febrile Illness project, establishing the epidemiological baseline of febrile illness in understudied regions and communities in South and Southeast Asia. This will allow us to identify cost-effective interventions that expand healthcare capacity and delivery of patient care using pre-existing community networks. This will be achieved by collecting blood samples and clinical data from approximately 100,000 patients presenting to Village Health Workers (VHWs) and health centers in over 750 villages in Bangladesh, Cambodia, Laos, Thailand and Myanmar, and in approximately 10,00 patients presenting at higher level health facilities across the region. Household surveys will explore the health status, risk factors and health seeking behaviors in these communities. Verbal autopsies will be carried out to assess the relative burden of febrile illness as compared with other causes of death in these regions. In parallel, we will carry out stakeholder interviews to better understand the opportunities, barriers, and appetite for adjustment of the role of VHWs to include management of non-malarial febrile illnesses. The network of community healthcare providers and facilities will later be used in implementation studies of interventions designed to triage, diagnose and treat patients presenting with febrile illnesses within these communities.

Incidences, causes, and outcomes of febrile illness in patients presenting to VHWs
Causes and outcomes of febrile illness in patients presenting at health facilities
Latest Updates                                                                                                                                       

“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. Treatable bacterial illnesses are missed, antibiotics are overused and poorly targeted, and patient attendances decline along with declining malaria. 

The Rural Febrile Illness (RFI) project is 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 remote and underserved areas of Asia where malaria endemicity is declining and access to health services is limited.