Lancet Global Health最新文献

{"title":"Access to antibiotics for pneumonia and sepsis in LMICs.","authors":"Amy Sarah Ginsburg, Ken Duncan, Keith P Klugman, Padmini Srikantiah","doi":"10.1016/S2214-109X(24)00418-2","DOIUrl":"10.1016/S2214-109X(24)00418-2","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1928-e1929"},"PeriodicalIF":19.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening health-care systems to reduce child mortality.","authors":"Abubakar Umar, Catherine E Oldenburg","doi":"10.1016/S2214-109X(24)00447-9","DOIUrl":"10.1016/S2214-109X(24)00447-9","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1919-e1920"},"PeriodicalIF":19.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial.","authors":"Yiying Cai, Suchart Booraphun, Andrew Yunkai Li, Gyan Kayastha, Paul Anantharajah Tambyah, Ben S Cooper, Nicholas Graves, Yin Mo","doi":"10.1016/S2214-109X(24)00327-9","DOIUrl":"10.1016/S2214-109X(24)00327-9","url":null,"abstract":"<p><strong>Background: </strong>The REGARD-VAP trial showed that individualised shortened antibiotic therapy was non-inferior to usual care for mortality and pneumonia recurrence in patients with ventilator-associated pneumonia (VAP). We aimed to assess the cost-effectiveness of an individualised shortened antibiotic therapy approach in this planned economic analysis.</p><p><strong>Methods: </strong>REGARD-VAP was a phase 4, multicentre, open-label, randomised trial to assess a short-course antibiotic treatment strategy for treatment of VAP. In this planned economic analysis, we fitted a decision tree with data from the REGARD-VAP trial to estimate the cost-effectiveness of individualised short-course therapy for VAP, compared to usual care from the health system perspective, in Nepal, Singapore, and Thailand. Incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits with 95% uncertainty intervals (UIs) were reported against relevant willingness-to-pay thresholds. Parameter uncertainties were evaluated using scenario analyses. A value of information analysis was conducted.</p><p><strong>Findings: </strong>Adopting individualised short-course therapy was cost-effective for Nepal (ICER=US$1086; percentage cost-effectiveness=50·3%), Singapore (ICER=-$6069; percentage cost-effectiveness=55·2%), and Thailand (ICER=$263; percentage cost-effectiveness=60·5%). The associated incremental net monetary benefits were $41 (95% UI -2308 to 2390) in Nepal, $5156 (-45 805 to 56 117) in Singapore, and $804 (-6245 to 7852) in Thailand. Value of information analysis showed that reducing uncertainties for mortality probabilities, bed-day costs, and variable costs were valuable for decision making.</p><p><strong>Interpretation: </strong>We found that an individualised short-course antibiotics strategy in patients with VAP is likely to be cost-effective in high-income, middle-income, and low-income settings, although with evident uncertainty. Considered alongside the positive externalities of reduced antimicrobial use, our findings foster confidence in policy makers contemplating adoption of short-course antibiotics.</p><p><strong>Funding: </strong>UK Medical Research Council, Singapore National Medical Research Council, and Wellcome Trust.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e2059-e2067"},"PeriodicalIF":19.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do breastfeeding mothers in DR Congo have access to the mpox vaccine?","authors":"Mija Ververs, Prince Imani-Musimwa, Karleen Gribble, David A Schwartz","doi":"10.1016/S2214-109X(24)00423-6","DOIUrl":"10.1016/S2214-109X(24)00423-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1931"},"PeriodicalIF":19.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling vaccination approaches for mpox containment and mitigation in the Democratic Republic of the Congo.","authors":"Alexandra Savinkina, Jason Kindrachuk, Isaac I Bogoch, Anne W Rimoin, Nicole A Hoff, Souradet Y Shaw, Virginia E Pitzer, Placide Mbala-Kingebeni, Gregg S Gonsalves","doi":"10.1016/S2214-109X(24)00384-X","DOIUrl":"10.1016/S2214-109X(24)00384-X","url":null,"abstract":"<p><strong>Background: </strong>Mpox was first identified in the Democratic Republic of the Congo (DRC) in 1970. In 2023, a historic outbreak of mpox occurred in the country, continuing into 2024. Over 14 000 cases and 600 deaths were reported in 2023 alone, representing a major increase from previous outbreaks. The modified vaccinia Ankara vaccine (brand names JYNNEOS, Imvamune, and Imvanex) was used in the 2022 mpox outbreak in the USA and Europe. However, at the time of the study, vaccination had not been made available in the DRC. We aimed to inform policy and decision makers on the potential benefits of, and resources needed, for mpox vaccination campaigns in the DRC by providing counterfactual scenarios evaluating the short-term effects of various vaccination strategies on mpox cases and deaths, if such a vaccination campaign had been undertaken before the 2023-24 outbreak.</p><p><strong>Methods: </strong>A dynamic transmission model was used to simulate mpox transmission in the DRC, stratified by age (<5, 5-15, and >15 years) and province. The model was used to simulate potential vaccination strategies, varying by age and region (endemic provinces, non-endemic provinces with historic cases, and all provinces) assessing the effect the strategies would have on deaths and cases in an epidemic year similar to 2023. In addition, we estimated the number of vaccine doses needed to implement each strategy.</p><p><strong>Findings: </strong>Without vaccination, our model predicted 14 700 cases and 700 deaths from mpox over 365 days. Vaccinating 80% of all children younger than 5 years in endemic regions led to a 27% overall reduction in cases and a 43% reduction in deaths, requiring 10·5 million vaccine doses. Vaccinating 80% of all children younger than 5 years in all regions led to a 29% reduction in cases and a 43% reduction in deaths, requiring 33·1 million doses. Vaccinating 80% of children aged 15 years or younger in endemic provinces led to a 54% reduction in cases and a 71% reduction in deaths, requiring 26·6 million doses.</p><p><strong>Interpretation: </strong>When resources are limited, vaccinating children aged 15 years or younger, or younger than 5 years, in endemic regions of the DRC would be the most efficient use of vaccines. Further research is needed to explore long-term effects of a one-time or recurrent vaccination campaign.</p><p><strong>Funding: </strong>Canadian Institutes of Health Research, Canadian International Development Research Centre, US Department of Defense (Defense Threat Reduction Agency, Mpox Threat Reduction Network), Global Affairs Canada (Weapons Threat Reduction Program), US Department for Agriculture (Agriculture Research Service, Non-Assistance Cooperative Agreement).</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1936-e1944"},"PeriodicalIF":19.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for more equitable engagement for African researchers.","authors":"Bamba Gaye, Ngoné Gaye, Gurbinder Singh, Naoufel Madani, Roberta Lamptey, Jamal Eddine Kohen, Abdoulaye Samb, Léon Tshilolo, Pasquale Maffia, Ibrahima Socé Fall, Modou Jobe","doi":"10.1016/S2214-109X(24)00427-3","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00427-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a community-based intervention for sexually transmitted infections on population-level prevalence among youth in Zimbabwe (STICH): a cluster-randomised trial.","authors":"Chido Dziva Chikwari, Ethel Dauya, Victoria Simms, Katharina Kranzer, Tsitsi Bandason, Anna Machiha, Owen Mugurungi, Primrose Musiyandaka, Tinashe Mwaturura, Nkazimulo Tshuma, Sarah Bernays, Constancia Mavodza, Mandikudza Tembo, Kevin Martin, Constance R S Mackworth-Young, Joanna Busza, Suzanna C Francis, Richard J Hayes, Rashida A Ferrand","doi":"10.1016/S2214-109X(24)00373-5","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00373-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Young people are at particularly high risk of acquiring sexually transmitted infections (STIs). We conducted a trial to investigate the effect of a community-based intervention that included STI screening among youth on population-level prevalence of STIs in Zimbabwe.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;STICH was a parallel-arm, cluster-randomised controlled trial nested within CHIEDZA, a trial of community-based integrated HIV and sexual and reproductive health services for youth in Zimbabwe. STICH was conducted in Harare and Bulawayo provinces with eight clusters in each province, randomised 1:1 to control (existing health services) or to the intervention: community-based screening and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae (males and females) and Trichomonas vaginalis (females only) offered over 12 months to intervention cluster residents aged 16-24 years who were attending CHIEDZA. Outcomes were ascertained through a population-level survey immediately after the intervention period, which included young people aged 18-24 years who lived in randomly selected households in each of the 16 clusters. The primary outcome was population prevalence of any (one or more) of the three STIs; secondary outcomes were prevalence of each of the three STIs. The STICH trial is registered with ISRCTN registry, ISRCTN15013425, and the CHIEDZA trial is registered with ClinicalTrials.gov, NCT03719521.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;From Oct 6, 2021, to March 8, 2022, 6361 randomly sampled young people were recruited into the outcome survey (median age 20 years [IQR 19-22], 3500 female and 2101 male, 3066 in intervention clusters and 3295 in control clusters). 5601 participants were included in the primary outcome analysis (2756 in intervention clusters and 2845 in control clusters). In the intervention clusters, 612 (22·2%) of 2756 participants reported that they had attended CHIEDZA and 298 (10·8%) had been tested for C trachomatis and N gonorrhoeae. In the control clusters, 113 (4·0%) of 2845 participants had attended CHIEDZA and 40 (1·4%) had been tested for C trachomatis and N gonorrhoeae. In the outcome survey, the cluster-level geometric mean prevalence of the primary outcome (any of C trachomatis, N gonorrhoeae, and T vaginalis) was 19·07% (geometric standard deviation [GSD] 1·20) in the intervention arm versus 19·95% (GSD 1·10) in the control arm (risk ratio [RR] 0·93 [95% CI 0·78-1·10]; p=0·35). There was no difference between arms in geometric mean prevalence of C trachomatis (12·86% [GSD 1·14] in the intervention arm vs 12·94% [GSD 1·15] in the control arm, RR 0·97 [95% CI 0·84-1·11]; p=0·60) or T vaginalis (7·06% [GSD 1·48] vs 6·20% [1·38], RR 1·09 [95% CI 0·74-1·60]; p=0·66). N gonorrhoeae prevalence was significantly lower in the intervention arm, with a 43% risk reduction (geometric mean 1·65% [GSD 1·77] vs 2·87% [1·43], RR 0·57 [95% CI 0·34-0·96]; p=0·036).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimates of resource use in the public-sector health-care system and the effect of strengthening health-care services in Malawi during 2015-19: a modelling study (Thanzi La Onse).","authors":"Timothy B Hallett, Tara D Mangal, Asif U Tamuri, Nimalan Arinaminpathy, Valentina Cambiano, Martin Chalkley, Joseph H Collins, Jonathan Cooper, Matthew S Gillman, Mosè Giordano, Matthew M Graham, William Graham, Iwona Hawryluk, Eva Janoušková, Britta L Jewell, Ines Li Lin, Robert Manning Smith, Gerald Manthalu, Emmanuel Mnjowe, Sakshi Mohan, Margherita Molaro, Wingston Ng'ambi, Dominic Nkhoma, Stefan Piatek, Paul Revill, Alison Rodger, Dimitra Salmanidou, Bingling She, Mikaela Smit, Pakwanja D Twea, Tim Colbourn, Joseph Mfutso-Bengo, Andrew N Phillips","doi":"10.1016/S2214-109X(24)00413-3","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00413-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In all health-care systems, decisions need to be made regarding allocation of available resources. Evidence is needed for these decisions, especially in low-income countries. We aimed to estimate how health-care resources provided by the public sector were used in Malawi during 2015-19 and to estimate the effects of strengthening health-care services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For this modelling study, we used the Thanzi La Onse model, an individual-based simulation model. The scope of the model was health care provided by the public sector in Malawi during 2015-19. Health-care services were delivered during health-care system interaction (HSI) events, which we characterised as occurring at a particular facility level and requiring a particular number of appointments. We developed mechanistic models for the causes of death and disability that were estimated to account for approximately 81% of deaths and approximately 72% of disability-adjusted life-years (DALYs) in Malawi during 2015-19, according to the Global Burden of Disease (GBD) estimates; we computed DALYs incurred in the population as the sum of years of life lost and years lived with disability. The disease models could interact with one another and with the underlying properties of each person. Each person in the Thanzi La Onse model had specific properties (eg, sex, district of residence, wealth percentile, smoking status, and BMI, among others), for which we measured distribution and evolution over time using demographic and health survey data. We also estimated the effect of different types of health-care system improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We estimated that the public-sector health-care system in Malawi averted 41·2 million DALYs (95% UI 38·6-43·8) during 2015-19, approximately half of the 84·3 million DALYs (81·5-86·9) that the population would otherwise have incurred. DALYs averted were heavily skewed to children aged 0-4 years due to services averting DALYs that would be caused by acute lower respiratory tract infection, HIV or AIDS, malaria, or neonatal disorders. DALYs averted among adults were mostly attributed to HIV or AIDS and tuberculosis. Under a scenario whereby each appointment took the time expected and health-care workers did not work for longer than contracted, the health-care system in Malawi during 2015-19 would have averted only 19·1 million DALYs (95% UI 17·1-22·4), suggesting that approximately 21·3 million DALYS (20·0-23·6) of total effect were derived through overwork of health-care workers. If people becoming ill immediately accessed care, all referrals were successfully completed, diagnostic accuracy of health-care workers was as good as possible, and consumables (ie, medicines) were always available, 28·2% (95% UI 25·7-30·9) more DALYS (ie, 12·2 million DALYs [95% UI 10·9-13·8]) could be averted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;The health-care system in Malawi provides substantial health gains wi","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women at the front line of the Marburg virus disease response in Rwanda: balancing clinical care, public health, and family life.","authors":"Tsion Firew, Louise Mwiseneza, Malaika Asabwe, Ineza Nadine Vanessa, Marie Henriette Uwintwari, Françoise Nizeyimana, Doris Lorette Uwamahoro","doi":"10.1016/S2214-109X(24)00470-4","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00470-4","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cause of nodding syndrome remains unknown - Authors' reply.","authors":"Rodney Ogwang, Angela Vincent, Richard Idro","doi":"10.1016/S2214-109X(24)00366-8","DOIUrl":"10.1016/S2214-109X(24)00366-8","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1757"},"PeriodicalIF":19.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}