The role of biostatisticians in clinical research is to contribute to trial design, by calculating sample size for example, and to help draw correct conclusions from the data, discriminating important information from noise. They are instrumental in the translation of a practical problem into a statistical model, and the translation of the result into practice.
\n \n\n \n \nInfections such as dengue and Japanese encephalitis are important problems in Laos but confirmed data are lacking, particularly from outside the capital Vientiane. Rapid diagnostic tests that can be kept at tropical room temperature help better diagnosis and treatment, and also inform policy to implement vaccination programmes.
\n \n\n \n \nScrub typhus is an infection caused by Orientia tsutsugamushi, a bacteria transmitted by the bite of an infected chigger mite. Characterised by a variety of symptoms and a high mortality rate, scrub typhus is an underfunded, neglected tropical disease not even listed by the WHO. Better diagnostic tests and optimised treatments are being developed since no vaccine is currently available.
\n \n\n \n \nPrimaquine can be used both to treat vivax malaria and to prevent the transmission of falciparum malaria from human to mosquito. A shorter and age-based primaquine regimen would reduce the burden of vivax malaria. It would also allow primaquine to be used more widely to block the transmission of falciparum malaria.
\n \n\n \n \nVivax malaria used to be considered benign but is now recognised as an important cause of morbidity and mortality. Resistance to chloroquine (given to treat the parasite blood stage) is growing and ACT (artemisinin-based combination therapy) is becoming common treatment for vivax malaria. New drugs and better public health strategies can help elimination targets, anticipated for 2030.
\n \n\n \n \nGenomics is the study of the complete DNA sequence, for example of a particular parasite, allowing us to analyse its evolution and the impact of human interventions. Alongside clinical date, we use genomics to identify mutations that are markers for drug resistance. Mapping out drug resistance then helps inform elimination programmes.
\n \n\n \n \nAlthough malaria is decreasing in Myanmar, resistance to anti-malarials is on the rise in the region and the focus is now to treat people early, particularly in remote communities. MOCRU has set up a network of community health workers, trained and supplied with diagnostics, bednets and treatments, to help improve access to healthcare as well as produce the evidence to encourage policy changes.
\n \n\n \n \nIn the falciparum malaria parasite cycle, the gametocyte stages are responsible for the transmission from person to mosquito, then to other persons. A better understanding of how gametocytes respond to malaria treatments would help us block transmission and ultimately eliminate malaria.
\n \n\n \n \nAnti-malaria drug resistance is spreading throughout Southeast Asia and we need to find new treatments. Our researchers at MORU use a combination of artemisinin and two partner drugs instead of one. If confirmed safe and tolerable, triple artemisinin combination therapies might be a good option to treat multi-drug resistant malaria, as well as slow down the emergence and spread of anti-malarial resistance.
\n \n\n \n \nAlthough malaria has greatly declined in Southeast Asia this century, treating clinical cases won\u2019t be sufficient to eliminate it from the region. Mass drug administration allows to eliminate parasites from asymptomatic carriers, and careful engagement with whole communities is key.
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