Angkor Hospital for Children

The virulence of Plasmodium falciparum is closely linked to P. falciparum erythrocyte membrane protein 1 (PfEMP1), encoded by a diverse var gene family. PfEMP1 mediates parasite immune evasion and vascular adhesion of infected red blood cells, contributing to severe disease. While expression of group A or domain cassettes (DC8 and DC13)-containing var genes have been associated with severe malaria, comparisons between the severe malaria syndromes remain limited. Furthermore, interactions between specific var gene expression and the rosetting phenotype, a known marker of severe malaria, are incompletely understood across severe malaria syndromes. We analyzed parasites and clinical data from 712 Kenyan children with non-severe and severe malaria syndromes collected over 18 years in Kilifi, Kenya. We used RT-qPCR and DBLα-tag sequencing to quantify var gene expression. We show that parasites expressing var genes containing the cys2 MFK+REY−motif or encoding DC8 domains were associated with impaired consciousness (IC), while rosetting was associated with respiratory distress (RD) and severe malarial anaemia (SMA), but not IC. These findings demonstrate that distinct PfEMP1 variants are preferentially expressed in specific severe malaria syndromes, highlighting potential targets for variant-specific future therapeutic and diagnostic strategies.

Innovation competency and entrepreneurial capacity have emerged as essential factors for future healthcare professionals in the context of digital transformation and complex patient demands. While global medical education has incorporated innovation training, research on innovation competency and entrepreneurial capacity among Vietnamese health students and related factors remains limited. This study aims to assess the current level of innovation competency and entrepreneurial capacity among Vietnamese health students and identify factors associated with their development. A cross-sectional study was conducted from May 2025 to July 2025, involving 370 students from various health-related majors across Vietnam. Participants completed an innovation competency scale based on Chell & Athayde’s (2009) five domain model and a validated entrepreneurial capacity questionnaire, developed based on Turker’s (2009) methodological proposal for scale development. The innovation competency scale includes creativity, leadership, energy, self-efficacy, and risk propensity, while the entrepreneurial capacity questionnaire consists of 4 domains of entrepreneurial capacity: management and business competency, entrepreneurial capacity, human resources competency, and interpersonal competency. Data were collected via an online survey and analysed using RStudio software, applying descriptive statistics, t-tests, ANOVA and regression. The mean scores of participants’ innovation competency and entrepreneurial capacity were 137.06/217 (SD = 28.91) and 173.40/280 (SD = 35.20), respectively. Significant differences in innovation competency were observed across gender (p = 0.044), academic year (p < 0.001), major (p = 0.043), and geographic region (p = 0.005). Entrepreneurial capacity differed significantly by gender (p < 0.001) and academic year (p = 0.008). Linear mixed-effects model analysis revealed that participation in entrepreneurship courses, competitions, practice opportunities, and strong educational performance were positively associated with entrepreneurship education performance (p < 0.05). The findings contribute to existing research by offering one of the first integrated assessments of innovation competency and entrepreneurial capacity among health students in Vietnam amidst a rapidly transforming context of healthcare education. Overall, Vietnamese health students showed strong motivation and solid understanding in management and business; however, skills related to opportunity recognition, leadership, risk propensity, and communication remain limited. This suggests that current training emphasizes theory over practice. Educational interventions such as experiential learning, leadership training, and risk management workshops would contribute to innovation and entrepreneurial capacity among Vietnamese health students.

Poorly targeted antibiotic use in primary care is a driver of antimicrobial resistance. Electronic clinical decision support algorithms (eCDSAs) integrating point-of-care tests may improve prescribing. We evaluated the impact of an eCDSA on antibiotic prescriptions among febrile patients attending primary health centres in Cambodia. In this cluster randomised controlled trial, 30 PHCs in Battambang Province were randomised (1:1) to either adopt the eCDSA or routine care. The eCDSA integrated clinical assessment with pulse oximetry and C-reactive protein tests. Patients aged ≥1 year with acute febrile illness were eligible. The primary outcome was the proportion of patients prescribed antibiotics, using an age- and sex-adjusted generalised linear mixed model, incorporating PHC as a random effect. Secondary outcomes included hospital referral rates and self-reported recovery at 7 and 14 days. Between May 2024 and January 2025, 4752 patients were enrolled (2324 intervention; 2428 control). Crude proportions of patients prescribed antibiotics were 56.1% and 60.5% in intervention and control arms, respectively. No difference in prescribing rates between the arms was detected (adjusted odds ratio [aOR] 0.64; 95% CI: 0.20-1.99; P = 0.44). Among patients for whom the eCDSA did not recommend antibiotics, almost half (45.6%) received a prescription. Hospital referral was rare (2.0%) and most patients reported full recovery within 7 days (94.3%). This eCDSA did not reduce antibiotic prescription in this setting. Relatively low adherence to the eCDSA's recommendations suggests that, to support a change in prescribing behaviour, future iterations of this intervention should incorporate enhanced training, greater adaptation to local health sector, and deeper engagement with frontline healthcare workers.

Background: Undernutrition among infants and young children in South Asia remains a major public health concern, contributing to high rates of morbidity and mortality. While quantitative systematic reviews have identified various risk factors for undernutrition, no review has focused on qualitative studies. This study aims to review published literature on family member and healthcare provider perceptions about influences on undernutrition among infants and young children in South Asia. Methods: We searched for qualitative research articles published from 2000 to 2026 in the PubMed, Scopus and CINAHL databases, and used the Critical Appraisal Skills Program (CASP) tool to assess the quality of selected articles. Selected articles were analyzed thematically. The PROSPERO registration number is CRD42022385382. Results: After screening 201 research articles, 19 articles were selected for inclusion in this review. Perceived influences of undernutrition among children were categorized into individual, socio-cultural, economic, environmental and system factors. Interconnected influences included maternal illness, single motherhood, mothers' knowledge and awareness, convenience of providing low-quality ready-made and junk food, spiritual beliefs and superstition, violence against women, financial constraints in a context of rising food prices and seasonal impacts on food production, and physical accessibility of healthcare services. Conclusions: This review emphasizes the complex interplay of influences on undernutrition among young children in South Asia. Potential interventions must be culturally tailored and gender-sensitive, with key strategies including nutrition education, community-based support, maternal health improvements, and policies addressing food insecurity and healthcare accessibility.

Over one billion children globally are exposed to violence each year and 55 million European children experience violence in their lifetime. Parenting interventions are a key strategy to reduce child maltreatment and promote child outcomes. Parenting for Lifelong Health for Young Children (PLH-YC) is an in-person parenting program, tested for use in Romania, Moldova, and North Macedonia. Implementation experiences across these settings highlighted key barriers and facilitators to scale-up, including (a) program factors: program length, session duration, home visits, incentives, online delivery; (b) political factors: political will, decision-maker turnover, international politics; and (c) service environment factors: facilitators, human resources, travel infrastructure, recruitment, referral pathways, and scale-up avenues. Drawing on these lessons, this practice note shares practical recommendations for others working to scale parenting interventions in South-East Europe and similar contexts.

Abstract Snakebite is a neglected public health problem that results in significant morbidity and mortality, necessitating the World Health Organization (WHO) to develop a snakebite roadmap that aimed to halve the burden of snakebite envenoming (SBE) by 2030. This study predicted healthcare workers’ priorities regarding the WHO’s 2030 snakebite strategic key activities for preventing and controlling SBE. This cross-sectional study was conducted in the Kwahu Afram Plains North and South districts of Ghana from August to December 2024 and involved 137 healthcare workers, including physici n assistants, clinical officers, medical doctors, certificate/enrolled/general nurses, pharmacists, dispensing technicians, and community health nurses, using a multistage sampling technique. Maximum difference choice experiments and five machine learning models were used to analyze the data. Healthcare workers prioritized the activity “Making safe, effective antivenoms available, accessible, and affordable to all” as the most crucial key activity, with a utility estimate (UE) of 0.8256 (95% confidence interval (CI): 0.7300 to 0.9213), followed by “Effective first aid care and ambulance transport” (UE = 0.4348, 95% CI: 0.3266, 0.5430), “Coordinated data management and analysis” (UE = 0.3744, 95% CI: 0.2353, 0.5134), and “Promoting advocacy, effective communication, and productive engagement” (UE = 0.3630, 95% CI: 0.2528, 0.4732). The use of choice experiments and ML models has provided insights into healthcare workers’ priorities concerning the WHO’s 2030 key activities for snakebite prevention and control. This innovative approach offers a nuanced understanding of local perspectives on WHO’s key activities, which is essential for combating the burden of SBE in Ghana.

There are limited resources to detect and interpret cluster signals in resource-limited hospitals. The aim was to improve the interpretation of pathogen spatiotemporal clustering detected using the SaTScan algorithm - a method that uses space-time scan statistics to detect cluster signals that occur more often than expected. Analysis of electronic data of inpatients with clinical specimens culture positive for seven antimicrobial-resistant pathogens in two tertiary hospitals in Thailand from January to December 2022 was performed. Space-time uniform scan statistics were applied in SaTScan. Four analyses were performed. Analysis 1 did not include antimicrobial susceptibility test (AST) result profiles. Analyses 2, 3, and 4 included AST results of antibiotics that had ≥70%, ≥80%, and ≥90% of available results among the included patients, respectively. There were 125,848 microbiology data records collected from a 1188-bed hospital and 54,069 records from a 773-bed hospital in 2022. Multiple cluster signals were detected in both hospitals, including clusters of carbapenem-resistant Gram-negative organisms across different wards over different time periods. The number of cluster signals detected decreased with increasing thresholds used to select antibiotics to be included in the analysis. For instance, Analysis 2 detected 33 clusters, which reduced to 4 clusters in Analysis 4 in the 1188-bed hospital data. Similar patterns were also observed in the 773-bed hospital data. The temporal occurrence of detected cluster signals coincided with the period during which AST results were unavailable in Analyses 2 and 3. The findings suggest that SaTScan is applicable to detect potential cluster signals in resource-limited settings, and the interpretation of detected signals could be supported by graphical presentations of temporal changes in the availability of AST data.

ABSTRACT Background COVID-19 is associated with higher rates of gastrointestinal diseases, though the duration of this effect, and the role of vaccination and COVID-19 severity remain uncertain. Objective To investigate the relationship between COVID-19 and gastrointestinal diseases, by vaccination status in hospitalised and non-hospitalised patients. Design With NHS England approval, OpenSAFELY-TPP was used to access linked data from 24 million English adults. We defined three cohorts: “Pre-vaccination” (January 2020-June 2021), “vaccinated” and “unvaccinated” (June-December 2021). We estimated adjusted hazard ratios (aHRs) comparing the incidence of 10 gastrointestinal diseases, including upper and lower gastrointestinal bleeding, after versus before or without a COVID-19 diagnosis overall and by COVID-19 severity. Results COVID-19 diagnosis was associated with elevated incidence of gastrointestinal diseases, particularly after hospitalised disease. In the pre-vaccination cohort (n=18,422,781), the adjusted hazard ratios (aHRs) for upper gastrointestinal bleeding after hospitalised COVID-19 were 20.1 (95% CI 18.4–22.1) in weeks 1–4 and 1.90 (1.63–2.22) in weeks 53–102. The corresponding aHRs after non-hospitalised COVID-19 were 1.92 (1.74–2.11) and 1.34 (1.23– 1.45) respectively. Across time periods, aHRs for gastrointestinal diseases were lower in vaccinated (n=14,948,727) than in unvaccinated (n=3,479,043) individuals. These patterns were similar across gastrointestinal diseases. Conclusion The incidence of gastrointestinal disease is elevated for up to two years among individuals hospitalised following a COVID-19 diagnosis. Increases in incidence are attenuated among vaccinated individuals. Monitoring for gastrointestinal diseases after severe COVID-19 and promotion of vaccination in vulnerable groups are key to reducing long-term burden. KEY MESSAGES What is already known on this topic Acute symptoms of COVID-19 include gastrointestinal problems, and there is existing evidence that those with a COVID-19 diagnosis are more likely to experience long-term gastrointestinal complications, especially if they were hospitalised. Previous studies were either limited in size, lacked representativeness of the population, or had short follow-up (e.g. during hospitalisation). The role of vaccination, COVID-19 severity or peoples’ characteristics (e.g. age or sex) were not considered. What this study adds Based on population-wide data on 18.4 million individuals, rates of 10 gastrointestinal diseases are elevated after COVID-19, compared with rates before or without COVID-19 diagnosis. The elevation in rates of gastrointestinal diseases after COVID-19 diagnosis was less marked in people who were vaccinated before COVID-19 diagnosis. The elevation in rates was markedly higher, and persisted for up to two years, among individuals hospitalised with COVID-19, compared with those who were not hospitalised. How this study might affect research, practice or policy We show for the first time that the incidence of both acute and chronic gastrointestinal diseases remains elevated for up to two years after severe COVID-19 leading to hospitalisation. Our findings highlight the protective role of COVID-19 vaccination in reducing severe COVID-19 and its subsequent long-term gastrointestinal complications, reinforcing the importance of vaccination as a public health measure. Individuals who had severe COVID-19, regardless of vaccination status, should be prioritised for clinical monitoring for gastrointestinal diseases.

Acute febrile illness is a major public health issue in tropical regions, particularly in remote and rural areas where healthcare access is difficult. In these areas, patients often seek care too late or rely on self-medication, leading to increased risks of complications and death. This qualitative study examined challenges and opportunities for managing acute febrile illness in Chattogram Division, Bangladesh. The research involved interviews with 35 stakeholders across the health sector in Bangladesh, including health managers and frontline health workers, and international experts. Findings show that referral barriers, health seeking behaviour and financial considerations influence case management and outcomes in complex ways. Community health workers are vital in managing local health issues, but they have limited ability to address the evolving concerns about febrile illness. Gaps in the referral system and inadequate emergency care resources further complicate the situation. Many episodes of fever remain undifferentiated and are often managed with presumptive antibiotic treatment, which may be inappropriate and contributes to antimicrobial resistance. This study highlights the pressing need for an inte-grated approach to febrile illness management in rural Bangladesh, one that accounts for the changing epidemiology of infectious diseases, health seeking behaviour, and the limitations of the existing healthcare infrastructure. Expanding the ability of community health workers to manage patients with non-malarial febrile illnesses, stronger triage and referral systems, and addressing the financial and logistical barriers to care are critical steps toward improving health outcomes in these regions.