South and Southeast Asian Community-based Trials Network MORU
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Preparing to launch the Electronic clinical Decision support for Acute fever Management (EDAM) study in Battambang, Cambodia

On 2 and 3 May, the Provincial Health Department in Battambang, Cambodia, hosted a “Train the Trainer” workshop in collaboration with Mahidol Oxford Tropical Medicine Research Unit (MORU) and Action for Health Development (AHEAD) to prepare for the upcoming launch of the Electronic clinical Decision support for Acute fever Management (EDAM) study.

The EDAM study is a cluster-randomised clinical trial that will evaluate the impact of an electronic clinical decision support algorithm (eCDSA) – incorporating pulse oximetry and a rapid C-reactive protein (CRP) test – on antibiotic prescribing rates in primary care. The EDAM algorithm is housed within a user-friendly app and has been co-created with local clinicians. Thirty healthcare centres across three districts will be randomised into the intervention or control arm.

During the workshop on 2 and 3 May, the EDAM study protocol and procedures were presented to senior members of the Provincial Health Department (PHD) and Operation District (OD) Directors, after which a fruitful discussion followed to ensure the optimal planning of the study for the local context in Battambang. Workshop participants also had the chance to test the EDAM app, the structure and content of which has been honed over the past 5 months by Dr Marco Liverani with input from both MORU clinical researchers and Cambodian doctors. Despite 42-degree heat and intermittent air-conditioning, all participants were very engaged and provided invaluable suggestions for improving the study!

The MORU-AHEAD team in Cambodia will continue to work closely with PHD and the OD Directors to plan the main training session on 16 and 17 May 2024 for 90 healthcare workers who will carry out EDAM study procedures. We expect the first participant to be enrolled in the study on 20 May 2024.

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Summary of HHS Publication on SEACTN Household Health Survey in Bangladesh, Cambodia, and Thailand

The data collection for the SEACTN household health survey across Bangladesh, Cambodia, and Chiang Rai (Thailand) is completed. This survey utilized questionnaire interview, physical examinations, and blood tests to evaluate the prevalence of a wide range of non-communicable and communicable diseases in these rural communities. The findings will inform evidence-based healthcare prioritization.

The members of a household from one of the survey villages in Chiang Rai, Thailand, were undergoing the consent process to participate in the survey.
The members of a household from one of the survey villages in Chiang Rai, Thailand, were undergoing the consent process to participate in the survey.

Read article at BMJ

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Progress updates

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

Using data collected in the SEACTN Rural Febrile Illness project, Christopher Chew and colleagues evaluate the cost-effectiveness of a 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.

Dr Chew (extreme left) visiting one of the primary health centres in Bangladesh participating in the study with members of the local site team.

Read article at ScienceDirect

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Progress updates

WP-B Dashboard February updates

We have surpassed 7,000 enrolled participants in Work Package B! Thanks to everyone involved for reaching this milestone.

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BRAC Health Program’s SEACTN team continue their excellent work in Bangladesh

The BRAC Health Program research team has recently wrapped up both WPA and HHS data collection activities in Bangladesh, having recruited over 19000 participants for WPA and 1800 participants for HHS from SEACTN villages in Bandarban and Cox’s Bazar. Having also completed Stakeholder Analysis and being the only site to have implemented all five major components under this initial phase of SEACTN studies, it has been a tremendous achievement for the research staff.

In frame: Dr. Aninda Sen (center), Team Lead for BRAC conducting a monthly update meeting with village health workers in Bandarban

“We have worked diligently in partnership with our friends at MORU in order to establish a capable team of research physicians, clinical staff, interviewers and data managers, which will not only contribute to the ongoing success of SEACTN, but will help answer key questions regarding health priorities in the region and establish local scientific leadership and expertise for future studies on health research in Bangladesh,” said Dr Akramul Islam, Senior Director of BRAC and the local Principal Investigator for SEACTN in Bangladesh.

“We are eagerly looking forward to learning what the data reveals, so that we may work more effectively with our government partners and local stakeholders in order to improve the quality of health among rural populations in Bangladesh,” said Dr Shayla Islam, Associate Director of BRAC and Co-investigator for SEACTN.

The activities of the field research team was also audited during multiple visits by visiting teams from MORU, which greatly added to overall quality of work and towards the development of professional capacity within local staff.

The next challenge for the team is to ship all the biological samples collected and send them to MORU central laboratory for analysis and results dissemination. Very exciting times indeed!

– Text and pictures courtesy of Dr. Aninda Sen.

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WP-A Dashboard November updates

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SEACTN meets to refine stats analysis and plan next phase

On 2-3 Nov, investigators from the South and Southeast Asian Community-based Trials Network (SEACTN) spent two intense but highly productive days in Bangkok refining the statistical analysis plans for the projects in the first phase of SEACTN which ends in 2024, as well as brainstorming for its next phase. Exciting times are ahead, with many high-impact outputs from the first phase expected to be published starting  next year! Special thanks to Watcharintorn Thongpiam, Krongkarn Nareepon, and Sureeporn Thongkuna for coordinating the logistics, ensuring a smooth and efficient meeting!

SEACTN aims to define comprehensively the epidemiology of acute febrile illness in rural South and Southeast Asia, and to serve as a platform for trials of interventions to improve its management.

– Text courtesy of Chris Chew, with thanks to Krongkarn (Fang) Nareepon for photo.

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MORU PLATCOV and SEACTN teams visits LOMWRU

It was good to see lots of MORU colleagues (Maliwan Hongsuwan, Akanittha Poonchai, William Schilling, Ellen Beer, Simon Boyd, Nick White, Phrutsamon Wongnak, Tanatchakorn Asawariworanan, Wanassanan Madmanee, Jindarat Kouhathong, and Kanokon Suwannasin) in Laos 6-8 Aug for a monitoring and training visit related to the PLATCOV (PIs Will Schilling & Nick White) and SEACTN (PI Yoel Lubell) projects. 

The PLATCOV study (Platform trial of antiviral pharmacodynamics in early symptomatic COVID-19) has been running in Mahosot Hospital with the Lung Ward since 2022. Recruitment has been challenging as COVID-19 has transitioned to a predominantly mild illness with few patients presenting to the hospital. We hope to start the AD ASTRA study (NCT05648448) in the coming months, which is a similar study in patients with influenza.

The SEACTN project (Southeast Asia Community Trials Network) is a multicountry study aiming to improve the management of patients with febrile illness living in rural areas in Southeast Asia. LOMWRU have completed Work Package A, recruiting more than 20,000 patients with febrile illness to health centres in collaboration with the Savannakhet Provincial Health Office. Work Package B continues to recruit in Savannakhet Provincial Hospital.

– With thanks to Liz Ashley for text, and Latsaniphone Boutthasavong for the group shot.

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Antibody profiles for determining seroincidence

Following IRB approval, we started collecting dry blood spots in the cause of fever SEACTN-WPB study we are carrying out in Mae Chan and Mae Suai hospitals. The results will help estimate the incidence of febrile illnesses in South and Southeast Asia, a project led by Kristen Aiemjoy. On 20 July, Krista Vaidya, who will carry out a seroincidence project with Kristen in Nepal, visited Mae Chan hospital to see how procedures are being carried out. Thank you, Krista, for the visit and for the many precious tips! Pictured, Benjamas Nuangkanta performs a finger prick to collect blood spots from a SEACTN WPB patients, behind her Nidanuch (Pui) Tasak (left) and Krista Vaidya (right), assist in the procedure. 

– Text and photo courtesy of Carlo Perrone.

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SEACTN-Work Package A team say goodbye to Savannakhet colleagues 

Having overseen recruitment of an astounding 25,000 patients by our partners from Savannakhet Health Centres in Atsaphangthong, Phalanxay and Phin District Health Centres as part of Work Package A of the multi-country SEACTN project (improving management of febrile illnesses in rural areas), as well as conducting more than 1400 verbal autopsies, the LOMWRU Work Package A team packed up to return to Vientiane last week (week of 3 July). We visited the district hospitals with Provincial Health Office Director Dr Tiengkham Pongvongsa (bottom photo, left) who has overseen numerous research projects in Savannakhet Province over the years. Dr Koukeo Phommasone, who has coordinated all the work packages in Laos since the beginning of the project, gave very preliminary results to the heads of the District Health Offices, who eagerly await full results from MORU in Bangkok at a later date. We also caught up with Dr Chanthala Phamisith, Director of Savannakhet Provincial Hospital where Work Package B of SEACTN is being conducted with more than 1000 patients included so far (WP-B team is Dr Xaykhamphet, Dr Khanxayaphone, Dr Sengdavanh and Mr Bank).

The LOMWRU WP-A team are shown above on a previous visit, from left: Mr Souksavanh Simanivong (logistician), Mr Somdy Xayalath (VA project), Dr Nongneth Khambounheuan (Director of Atsaphangthong District Hospital), Dr Souphap Inxyxiengma (Head of Atsaphangthong District Health Office), Dr Xaipasong Xaiyaphet (site coordinator), Dr Khambang Seevanhthong, and Dr Aitlada Soulivong. 

– Text courtesy of Liz Ashley, with thanks to Dr Xaipasong Xaiyaphet for photos.