Author: Chanbroset Prach

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.

As part of the work for the South and South East Asia Community Trials Network (SEACTN), Jaruwan Tubprasert and Akanittha Poonchai visited CCRU to monitor the work package B, which will find out the causes of acute febrile illness and its outcomes in people presenting to hospitals in the region, and the household survey, which will define a picture of the health status of communities in the network. Their precious feedback will help us improve the quality of our work, Thank you Jaruwan and Akanittha!

Together with the monitoring team, Dr Aninda Sen, Dr Sharmin Ahmed and Dr Nawrin Kabir came from BRAC University, Bangladesh to exchange experiences on the project, as they will soon start the household survey and have only recently started with work package B. Meiwen Zhang, Watcharintorn Thongpiam, SEACTN PI Prof Yoel Lubell and Chris Chew completed the visiting party. Together, we visited Chiangrai Prachanukroh and Mae Chan Hospitals together, met local partners and household survey fieldworkers, and discussed issues related to the projects.

Pictured during a lunch break at Mae Chan, clockwise from left: Dr Sharmin Ahmed, Laphaphat Naruesornsiri, Jaruwan Tubprasert, Akanittha Poonchai, Yoel Lubell, Dr Aninda Sen, Carlo Perrone, Chris Chew, Benjamas Nuangkanta, Dr Nawrin Kabir, Nidanuch Tasak and Areerat Thaiprakhong,

We all thank our visitors for their company and help. Unfortunately, the dry-season wildfires have made the air hazardously polluted so outdoor activities had to be kept to a minimum. We hope in future visits to show them Chiangrai’s wonderful outdoors. 

– Thank you, Carlo Perrone, for text and Benjamas Nuangkanta for photo.

Congratulations are in order as our amazing SEACTN-Work package A team, from left, Souksavanh Simanivong (logistician), Dr Aitlada Soulivong, Dr Khambang Seevanhthong and site coordinator Dr Xaipasong Xaiyaphet and the Savannakhet provincial and District health staff led by Dr Tiengkham Pongvongsa (not pictured), enrolled more than their target of 20,000 consultations in health centres in Atsaphangthong, Phalanxay and Phin by end Feb. This is a massive achievement and the Laos site is the first to reach its target. Taking place in Bangladesh, Thailand, Myanmar and Cambodia and Laos, SEACTN (Southeast Asia Community Trials Network) aims to improve the management of febrile illness in rural areas. There are other work packages such as WP-B studying patients presenting to Savannakhet Provincial Hospital with febrile illness, and a verbal autopsy sub-study. Dr Koukeo Phommasone, Deputy Head of Mahosot Hospital Microbiology and Clinician Scientist, manages the Lao SEACTN programme of research, and Prof Yoel Lubell, based in MORU, Bangkok, is overall SEACTN PI.  

– Thank you, Liz Ashley, for text and Dr Xaipasong Xaiyaphet for photo.

The site initiation visit for work package B, a project aiming to find out the causes of febrile illness in healthcare facilities of the South and Southeast Asian Community Trials Network (SEACTN), took place at Mae Chan hospital on November 29^th. The CCRU team was welcomed enthusiastically, we are all very excited to expand our activities at this new site in the beginning of 2023. (Photo: CCRU and Mae Chan Hospital teams discussing the SEACTN WPB project.)

– Thank you, Carlo Perrone, for text, and Benjamas Nuangkanta for photo.

On 24 Oct, Liz Batty, Senior Bioinformatician and co-Head of the Molecular Microbiology group in MORU Microbiology, was awarded U$200,000 by the Chan Zuckerberg Initiative (CZI) with the Bill & Melinda Gates Foundation (BMGF) to use metagenomic sequencing to define the causes of febrile illness in remote and rural areas of South and Southeast Asia. 

Liz’s grant will analyse samples from South and Southeast Asia Community-based Trials Network (SEACTN) work package B (WP-B) sites, in Laos, Thailand and Bangladesh via collaborations with LOMWRU, SMRU, and the Bangladesh Rural Advancement Committee (BRAC]. Led by Prof Yoel Lubell, and supported by the Wellcome Innovations Flagship Programme, SEACTN seeks to ascertain the incidence, causes and outcome of febrile illness in SE Asia.

By enabling scientists to analyse all nucleic acids in a sample, metagenomic next-generation sequencing (mNGS) can be used to detect novel pathogens in outbreaks and investigate diseases with complex etiology, such as encephalitis and antimicrobial resistance. 

“This metagenomic work will help us define the burden of febrile illness by identifying pathogens causing febrile illness that are novel, or missed by traditional diagnostics,” said Liz. “It will improve our understanding of the causes of febrile illness and how we choose target diagnostics for febrile illness.”

Accurately determining which infection is causing fever could have a significant impact on health in South and Southeast Asia, where febrile illness contributes substantially to morbidity and mortality. 

With the decline of malarial illness and mortality in this region, the burden has shifted to non-malarial causes of fever. However, the causes of non-malarial fever remain unknown in many patients – and febrile patients are incorrectly treated as if they had malaria. 

Liz’s grant was part of U$2 million awarded by CZI and BMGF to researchers investigating novel, emerging pathogens with a focus on building metagenomics capacity in high-potential countries that have been historically under-resourced in SE Asia and elsewhere.  

– Text contributions by Liz Batty and John Bleho.