The Lancet. Global health最新文献

{"title":"The importance for tuberculosis of mitigating economic crises.","authors":"Davide Rasella, Otavio T Ranzani","doi":"10.1016/S2214-109X(22)00366-7","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00366-7","url":null,"abstract":"","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1371-e1372"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9423769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40335038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Household contact management for rifampicin-resistant tuberculosis.","authors":"Anja Reuter, Ivy Apolisi, Johnny Daniels, Jennifer Furin, Helen Cox","doi":"10.1016/S2214-109X(22)00362-X","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00362-X","url":null,"abstract":"","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1387"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40363486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the effectiveness and safety of treatment of incomplete second trimester abortion with misoprostol provided by midwives and physicians: a randomised, controlled, equivalence trial in Uganda.","authors":"Susan Atuhairwe,&nbsp;Josaphat Byamugisha,&nbsp;Othman Kakaire,&nbsp;Claudia Hanson,&nbsp;Amanda Cleeve,&nbsp;Marie Klingberg-Allvin,&nbsp;Nazarius Mbona Tumwesigye,&nbsp;Kristina Gemzell-Danielsson","doi":"10.1016/S2214-109X(22)00312-6","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00312-6","url":null,"abstract":"<p><strong>Background: </strong>To address the knowledge gaps in the provision of post-abortion care by midwives for women in the second trimester, we investigated the effectiveness and safety of treatment for incomplete second trimester abortion with misoprostol, comparing care provision by midwives with that provided by physicians in Uganda.</p><p><strong>Methods: </strong>Our multicentre, randomised, controlled, equivalence trial undertaken in 14 health facilities in Uganda recruited women with incomplete abortion of uterine size 13-18 weeks. We randomly assigned (1:1) women to clinical assessment and treatment by either midwife or physician. The randomisation sequence was computer generated, in blocks of four to 12, and stratified for study site. Participants received sublingual misoprostol (400 μg once every 3 h for up to five doses). The study was not concealed from the health-care providers and study participants. Primary outcome was complete abortion within 24 h that did not require surgical evacuation. Analysis was per-protocol and intention to treat; the intention-to-treat population consisted of women who were randomised, received at least one dose of misoprostol, and reported primary outcome data, and the per-protocol population excluded women with unexplained discontinuation of treatment. We used generalised mixed-effects models to obtain the risk difference. The predefined equivalence range was -5% to 5%. The trial was registered at ClinicalTrials.gov, NCT03622073.</p><p><strong>Findings: </strong>Between Aug 14, 2018, and Nov 16, 2021, 1191 eligible women were randomly assigned to each group (593 women to the midwife group and 598 to the physician group). 1164 women were included in the per-protocol analysis, and 530 (92%) of 577 women in the midwife group and 553 (94%) of 587 women in the physician group had a complete abortion within 24 h. The model-based risk difference for the midwife versus physician group was -2·3% (95% CI -4·4 to -0·3), and within our predefined equivalence range (-5% to 5%). Two women in the midwife group received blood transfusion.</p><p><strong>Interpretation: </strong>Clinical assessment and treatment of second trimester incomplete abortion with misoprostol provided by midwives was equally effective and safe as when provided by physicians. In low-income settings, inclusion of midwives in the medical management of uncomplicated second trimester incomplete abortion has potential to increase women's access to safe post-abortion care.</p><p><strong>Funding: </strong>Swedish Research Council and THRiVE-2.</p>","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1505-e1513"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40422024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ShangRing versus Mogen clamp for early infant male circumcision in eastern sub-Saharan Africa: a multicentre, non-inferiority, adaptive, randomised controlled trial.","authors":"Spyridon P Basourakos,&nbsp;Quincy G Nang,&nbsp;Karla V Ballman,&nbsp;Omar Al Hussein Al Awamlh,&nbsp;Nahid Punjani,&nbsp;Kaylee Ho,&nbsp;Mark A Barone,&nbsp;Quentin D Awori,&nbsp;Daniel Ouma,&nbsp;Jairus Oketch,&nbsp;Alice E Christensen,&nbsp;Augustino Hellar,&nbsp;Maende Makokha,&nbsp;Alphonce Isangu,&nbsp;Robert Salim,&nbsp;Jackson Lija,&nbsp;Ronald H Gray,&nbsp;Stephen Kiboneka,&nbsp;Aggrey Anok,&nbsp;Godfrey Kigozi,&nbsp;Regina Nakabuye,&nbsp;Charles Ddamulira,&nbsp;Andrew Mulooki,&nbsp;Silas Odiya,&nbsp;Rose Nazziwa,&nbsp;Marc Goldstein,&nbsp;Philip S Li,&nbsp;Richard K Lee","doi":"10.1016/S2214-109X(22)00326-6","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00326-6","url":null,"abstract":"<p><strong>Background: </strong>Use of medical devices represents a unique opportunity to facilitate scale-up of early infant male circumcision (EIMC) across sub-Saharan Africa. The ShangRing, a circumcision device prequalified by WHO, is approved for use in adults and adolescents and requires topical anaesthesia only. We aimed to investigate the safety and efficacy of the ShangRing versus the Mogen clamp for EIMC in infants across eastern sub-Saharan Africa.</p><p><strong>Methods: </strong>In this multicentre, non-inferiority, open-label, randomised controlled trial, we enrolled healthy male infants (aged <60 days), with a gestational age of at least 37 weeks and a birthweight of at least 2·5 kg, from 11 community and referral centres in Kenya, Tanzania, and Uganda. Infants were randomly assigned (1:1) by a computer-generated text message service to undergo EIMC by either the ShangRing or the Mogen clamp. The primary endpoint was safety, defined as the number and severity of adverse events (AEs), analysed in the intention-to-treat population (all infants who underwent an EIMC procedure) with a non-inferiority margin of 2% for the difference in moderate and severe AEs. This trial is registered with Clinical.</p><p><strong>Trials: </strong>gov, NCT03338699, and is complete.</p><p><strong>Findings: </strong>Between Sept 17, 2018, and Dec 20, 2019, a total of 1420 infants were assessed for eligibility, of whom 1378 (97·0%) were enrolled. 689 (50·0%) infants were randomly assigned to undergo EIMC by ShangRing and 689 (50·0%) by Mogen clamp. 43 (6·2%) adverse events were observed in the ShangRing group and 61 (8·9%) in the Mogen clamp group (p=0·078). The most common treatment-related AE was intraoperative pain (Neonatal Infant Pain Scale score ≥5), with 19 (2·8%) events in the ShangRing and 23 (3·3%) in the Mogel clamp group. Rates of moderate and severe AEs were similar between both groups (29 [4·2%] in the ShangRing group vs 30 [4·4%] in the Mogen clamp group; difference -0·1%; one-sided 95% CI upper limit of 1·7%; p=0·89). No treatment-related deaths were reported.</p><p><strong>Interpretation: </strong>Use of the ShangRing device for EIMC showed safety, achieved high caregiver satisfaction, and did not differ from the Mogen clamp in other key measures. The ShangRing could be used by health systems and international organisations to further scale up EIMC across sub-Saharan Africa.</p><p><strong>Funding: </strong>Bill & Melinda Gates Foundation.</p>","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1514-e1522"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9638032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40364386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the of 10-valent pneumococcal conjugate vaccine in Nepal 4 years after introduction: an observational cohort study.","authors":"Shrijana Shrestha, Meeru Gurung, Puja Amatya, Sanjeev Bijukchhe, Anindya Sekhar Bose, Michael J Carter, Madhav C Gautam, Sunaina Gurung, Jason Hinds, Rama Kandasamy, Sarah Kelly, Bibek Khadka, Pratistha Maskey, Yama F Mujadidi, Peter J O'Reilly, Bhishma Pokhrel, Rahul Pradhan, Ganesh P Shah, Sonu Shrestha, Brian Wahl, Katherine L O'Brien, Maria Deloria Knoll, David R Murdoch, Dominic F Kelly, Stephen Thorson, Merryn Voysey, Andrew J Pollard","doi":"10.1016/S2214-109X(22)00281-9","DOIUrl":"10.1016/S2214-109X(22)00281-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In Nepal, Streptococcus pneumoniae (pneumococcus) is a common cause of bacterial pneumonia in children, and is a major health concern. There are few data on the effect of vaccination on the disease or colonisation with pneumococci in the nasopharynx of children in this setting. The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the routine infant immunisation schedule in Nepal in 2015. We aimed to investigate the effect of the introduction of PCV10 on pneumococcal carriage and disease in children in Nepal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We did an observational cohort study in children in Nepal. The hospital surveillance study took place in Patan Hospital, Kathmandu, and community studies in healthy children took place in Kathmandu and Okhaldhunga district. For the surveillance study, all children admitted to Patan Hospital between March 20, 2014, and Dec 31, 2019, aged between 2 months and 14 years with clinician-suspected pneumonia, were eligible for enrolment. For the community study, healthy children aged 0-8 weeks, 6-23 months, and 24-59 months were recruited from Kathmandu, and healthy children aged 6-23 months were recruited from Okhaldhunga. We assessed the programmatic effect of PCV10 introduction using surveillance for nasopharyngeal colonisation, pneumonia, and invasive bacterial disease from 1·5 years before vaccine introduction and 4·5 years after vaccine introduction. For the surveillance study, nasopharyngeal swabs, blood cultures, and chest radiographs were obtained from children admitted to Patan Hospital with suspected pneumonia or invasive bacterial disease. For the community study, nasopharyngeal swabs were obtained from healthy children in the urban and rural settings. Pneumonia outcomes were analysed using log-binomial models and adjusted prevalence ratios (aPR) comparing each calendar year after the introduction of the vaccine into the national programme with the pre-vaccine period (2014-15), adjusted for calendar month, age, and sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between March 20, 2014, and Dec 31, 2019, we enrolled 2051 children with suspected pneumonia, and 11 354 healthy children (8483 children aged 6-23 months, 761 aged 24-59 months, and 2110 aged 0-8 weeks) to assess nasopharyngeal colonisation. Among clinical pneumonia cases younger than 2 years, vaccine serotype carriage declined 82% (aPR 0·18 [95% CI 0·07-0·50]) by 2019. There was no decrease in vaccine serotype carriage in cases among older unvaccinated age groups. Carriage of the additional serotypes in PCV13 was 2·2 times higher by 2019 (aPR 2·17 [95% CI 1·16-4·05]), due to increases in serotypes 19A and 3. Vaccine serotype carriage in healthy children declined by 75% in those aged 6-23 months (aPR 0·25 [95% CI 0·19-0·33]) but not in those aged 24-59 months (aPR 0·59 [0·29-1·19]). A decrease in overall vaccine serotype carriage of 61% by 2019 (aPR 0·39 [95% CI 0·18-0·85]) was also observed in children youn","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1494-e1504"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40364385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandatory food fortification with folic acid.","authors":"Anita Kar,&nbsp;C S Yajnik,&nbsp;P P Doke,&nbsp;Prajkta Bhide,&nbsp;Amruta Chutke,&nbsp;Bhagyashree Radhakrishnan,&nbsp;Supriya Phadnis","doi":"10.1016/S2214-109X(22)00377-1","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00377-1","url":null,"abstract":"","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1390"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40363489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HPV vaccines: when one plus one equals three.","authors":"Cornelia Liu Trimble,&nbsp;Edward L Trimble","doi":"10.1016/S2214-109X(22)00373-4","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00373-4","url":null,"abstract":"","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1373-e1374"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40363481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal corticosteroids in adequately equipped facilities in low-resource settings.","authors":"Rosemary Townsend,&nbsp;Clara Calvert","doi":"10.1016/S2214-109X(22)00387-4","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00387-4","url":null,"abstract":"","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1379-e1380"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40363484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maps of solid-fuel use and household air pollution.","authors":"Jiajun Luo,&nbsp;Briseis Aschebrook-Kilfoy,&nbsp;Christopher O Olopade","doi":"10.1016/S2214-109X(22)00386-2","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00386-2","url":null,"abstract":"","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1361-e1362"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40363477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal dexamethasone for improving preterm newborn outcomes in low-resource countries: a cost-effectiveness analysis of the WHO ACTION-I trial.","authors":"","doi":"10.1016/S2214-109X(22)00340-0","DOIUrl":"https://doi.org/10.1016/S2214-109X(22)00340-0","url":null,"abstract":"<p><strong>Background: </strong>After considerable debate, there is now unequivocal evidence that use of antenatal corticosteroids improves outcomes in preterm neonates when used in women at risk of early preterm birth in reasonably equipped hospitals in low-resource countries. We aimed to evaluate the cost-effectiveness of dexamethasone administration in the management of preterm birth in a cohort of pregnant women from five low-resource countries.</p><p><strong>Methods: </strong>We performed a cost-effectiveness analysis using data from 2828 women (and 3051 babies) who participated in the WHO ACTION-I trial, a multicentre, randomised, placebo-controlled trial that assessed the safety and efficacy of dexamethasone in pregnant women at risk of early preterm birth in 29 hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan. We used a decision tree model to assess the cost-effectiveness of dexamethasone treatment compared with no intervention from a health-care sector perspective. Outcome data were taken from the primary results of the trial and primary data on cost were collected in 28 hospitals. The primary cost-effectiveness outcome was cost per neonatal death or the cost per disability-adjusted life-years (DALYs) averted, or costs saved per 1000 woman-baby units if the intervention was found to be cost-saving.</p><p><strong>Findings: </strong>Administration of dexamethasone averted 38 neonatal deaths per 1000 woman-baby units and 1132 DALYs per 1000 woman-baby units. Compared with no intervention, use of antenatal corticosteroids was cost-saving in all five countries, ranging from a saving of US$1778 per 1000 woman-baby units (95% uncertainty interval [UI] -13 878 to 9483) in Nigeria, to $20 531 per 1000 woman-baby units (-46 387 to 4897) in Pakistan, to $36 870 per 1000 woman-baby units (-61 569 to -15 672) in Bangladesh, to $38 303 per 1000 woman-baby units (-64 183 to -10 753) in India, and to $53 681 per 1000 woman-baby units (-113 822 to 2394) in Kenya. Findings remained consistent following sensitivity analyses. In all five countries, dexamethasone was more effective and cost less compared with no treatment.</p><p><strong>Interpretation: </strong>Antenatal dexamethasone for early preterm birth was cost-saving when used in hospitals in low-resource countries. Decision makers in low-resource settings can be confident that use of antenatal dexamethasone for early preterm birth is cost-effective, and often cost-saving when used in reasonably equipped hospitals in low-resource countries.</p><p><strong>Funding: </strong>Bill & Melinda Gates Foundation and WHO.</p>","PeriodicalId":153380,"journal":{"name":"The Lancet. Global health","volume":" ","pages":"e1523-e1533"},"PeriodicalIF":34.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40364387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}