Lancet Global Health最新文献

{"title":"Melioidosis in Mali: a retrospective observational study.","authors":"Sabine Lichtenegger,Isabel Klugherz,Gabriel E Wagner,Justine Michel,Bastien Mollo,Adama Sanogo,Moussa K Diawara,Soumaila Traore,Hyacinthe G Kodo,Max-Yvon Mbangui,Marie-Hortense Koudika,Youssouf Diam Sidibé,Johanna Dabernig-Heinz,Christian Kohler,Karsten Becker,Karoline Assig,Direk Limmathurotsakul,Matthias Kohl,Carolina Jimenez,Rupa Kanapathipillai,Janet Ousley,Ivo Steinmetz","doi":"10.1016/s2214-109x(25)00317-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00317-1","url":null,"abstract":"BACKGROUNDMelioidosis is a neglected tropical bacterial infection with a high mortality rate caused by the Gram-negative soil bacterium Burkholderia pseudomallei. Although the disease is increasingly recognised in Asian and Pacific regions, the situation in Africa is characterised by a scarcity of data and great uncertainty regarding the disease burden and distribution. Here, we aimed to report cases of melioidosis in children younger than 5 years in Mali, where no confirmed melioidosis had been reported previously.METHODSMédecins Sans Frontières maintains a paediatrics programme in Koutiala, Mali, for children younger than 5 years, including a microbiology laboratory. Between January 2018, and September 2021, biochemical characteristics of bacterial isolates suggested the presence of B pseudomallei in clinical samples from children admitted with severe signs of infection. Isolated strains were characterised by whole genome sequencing. Clinical data on the course and outcome of confirmed melioidosis cases were retrospectively analysed from the hospital records.FINDINGS31 melioidosis cases of children younger than 5 years were confirmed. 15 (48%) cases were in infants aged 12 months or younger. B pseudomallei-positive samples included 28 blood cultures, two pleural fluids, and one pus sample. Of 19 patients with available outcome data, 12 (63%) died. Phylogenetic analysis of the B pseudomallei isolates revealed high genetic diversity suggesting long-standing persistence of the bacterium in this region. We estimated an annual melioidosis incidence of 8·8 per 100 000 (95% CI 5·7-11·9) in the paediatric population and the derived 15·5 per 100 000 (10·0-20·8) for the overall population.INTERPRETATIONThis is, to the best of our knowledge, the first case series reported in Mali and the largest cohort of melioidosis cases ever reported in Africa. Our annual incidence estimates suggest that melioidosis is a significant public health problem in this part of Africa. These findings clearly highlight the need for improved diagnostics and observational studies to learn more about the African melioidosis burden. They also support the inclusion of melioidosis in national health strategies to inform surveillance and empiric treatment protocols. As melioidosis is resistant to common empirical antibiotic regimens, these measures are essential to reduce the high mortality rate.FUNDINGNone.TRANSLATIONFor the French translation of the abstract see Supplementary Materials section.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"45 1","pages":"e1964-e1972"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314611","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":"NCD risk factors in low-income populations in India.","authors":"Rajeev Gupta,Indu Mohan","doi":"10.1016/s2214-109x(25)00357-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00357-2","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"102 1","pages":"e1792-e1793"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314628","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":"Prophylactic strategies for postpartum haemorrhage: unaddressed considerations.","authors":"Hu Li","doi":"10.1016/s2214-109x(25)00411-5","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00411-5","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"112 8 1","pages":"e1814"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314632","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":"Causes, associated exposures, and outcomes of cirrhosis and hepatocellular carcinoma in Malawi: an observational cohort and case-control study.","authors":"Alexander J Stockdale,Benno Kreuels,Isaac T Shawa,Niza M Silungwe,Blessings Mbale,Karen Chetcuti,Elizabeth Joekes,Jane Mallewa,Egbert Tannich,Christina Weiler-Normann,Marc Lütgehetmann,Peter Finch,Elizabeth Waddilove,Marion Delphin,Philippa C Matthews,Emma C Thomson,Anna Maria Geretti,Melita A Gordon","doi":"10.1016/s2214-109x(25)00312-2","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00312-2","url":null,"abstract":"BACKGROUNDAfrican countries have the highest age-standardised mortality from liver disease. We studied patients with cirrhosis and hepatocellular carcinoma in Malawi to ascertain the causes, associated exposures, and outcomes after discharge, and identify opportunities for intervention strategies.METHODSIn this case-control cohort study, we recruited patients aged 16 years or older who met the study definitions for cirrhosis or hepatocellular carcinoma from the Queen Elizabeth Central Hospital in Blantyre, Malawi. In the cirrhosis group, we excluded patients with a liver stiffness greater than 12 kPa if a cause of potential false elevation of liver stiffness was identified and a liver ultrasound did not show signs of cirrhosis; people with extrapulmonary tuberculosis or other non-hepatic causes of ascites; and pregnant people. In the hepatocellular carcinoma group, we excluded those with an extrahepatic malignancy or ultrasound features consistent with liver metastases, pregnant people, and indeterminate lesions as determined by consultant radiologists on serial ultrasounds. Research nurses identified potential participants on medical and surgical wards, the medical outpatient clinic, and endoscopy unit, using systematic case notes review and clinician referral during weekdays. Patients were followed up for 6 months. A community sample was recruited from the catchment area of the hospital to estimate the general population prevalence of diseases and exposures potentially associated with liver disease. For hepatitis B and C, we conducted a serological survey in individuals aged 16 years or older who were randomly selected from a census, and we randomly selected a proportion of individuals who were HBsAg positive or HBsAg negative to estimate the general population prevalence of HIV, alcohol, smoking, diabetes, hepatitis D and E, and autoimmune hepatitis serological markers. We estimated population attributable fractions (PAFs) for cirrhosis and hepatocellular carcinoma using community controls and the serological survey. PAFs were estimated from logistic regression models adjusted for age and sex, using the Bruzzi method with percentile bootstrap confidence intervals.FINDINGSBetween Nov 1, 2017, and April 30, 2019, we prospectively screened 708 patients and enrolled 138 diagnosed with cirrhosis and 78 diagnosed with hepatocellular carcinoma. Patients had a median age of 40 years (IQR 35-51), 134 (62%) were male, and 82 (38%) were female. In those with hepatocellular carcinoma, median tumour size was 13·2cm (10·2-17·3) and median survival was 40 days (95% CI 30-51). The community sample comprised 3258 individuals with hepatitis B and 1661 with hepatitis C identified from the serological survey, and 120 individuals negative for HBsAg and 94 people who were HBsAg positive from the serological survey to estimate the general population prevalence of HIV, alcohol, smoking, diabetes, hepatitis D and E, and autoimmune hepatitis serological markers. At 6 m","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"41 1","pages":"e1924-e1934"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314612","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":"Correction to Lancet Glob Health 2025; 13: e1358-66.","authors":"","doi":"10.1016/s2214-109x(25)00377-8","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00377-8","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"22 1","pages":"e1816"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314617","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":"Switching antibiotic therapy from injectable to oral to optimise the duration of inpatient care for young infants presenting with moderate-mortality-risk signs of possible serious bacterial infection: an open-label, multicountry, randomised controlled trial.","authors":" ","doi":"10.1016/s2214-109x(25)00311-0","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00311-0","url":null,"abstract":"BACKGROUNDIn low-resource settings, challenges in hospitalisation stay for sick young infants younger than 2 months persist. Early discharge of young infants with moderate-mortality-risk possible serious bacterial infection (PSBI) signs might provide a safe and effective alternative. We compared the clinical outcomes of switching parenteral antibiotics to oral antibiotics along with hospital discharge after 48 h of admission with those who continued hospitalisation for 7 days.METHODSAn open-label, multicountry, multicentre, individually randomised controlled trial was done in Bangladesh, Ethiopia, India, Nigeria, Pakistan, and Tanzania. Young infants aged 1-59 days presenting with moderate-mortality-risk PSBI signs were screened and hospitalised for inpatient care with injectable ampicillin and gentamicin. After 48 h of admission, young infants without any PSBI sign, and negative C-reactive protein, were randomly assigned to either the intervention (outpatient) group (discontinuation of injectable antibiotics and hospital discharge after switching to oral amoxicillin twice daily for 5 more days) or the control group (continued inpatient care). Treatment received throughout was documented on days 4 and 8 of initiation, and outcomes on days 4, 8, and 15. The primary outcome of poor clinical outcome was a hierarchical composite indicator that included death (any time after randomisation up to day 15 of initiation of therapy), presence of any sign of critical illness (no movement at all, unable to feed at all, or convulsions), or any sign suggestive of another serious infection, such as meningitis, bone or joint infection (on day 4 or day 8 of initiation of therapy), and presence of any sign of clinical severe infection (CSI) (on day 8 of initiation of therapy). The non-inferiority margin was set at 2%. We did a per-protocol analysis to compare the proportions of primary outcome between the two groups and reported risk differences (RDs) with 95% CI. The study is registered with the ISRCTN registry (ISRCTN16872570).FINDINGSBetween June 24, 2021, and Aug 7, 2024, of 6549 young infants with moderate-mortality-risk PSBI signs who were reassessed after 48 h of admission, 5253 (80·3%) were randomly assigned to the outpatient group (n=2635) or the inpatient care group (n=2618). Treatment adherence was 96·7% (2549 of 2635) in the oral amoxicillin group and 95·7% (2506 of 2618) in the inpatient care group (with at least 80% of the antibiotic dosage received). In the per-protocol analysis, the rate of poor clinical outcome was 4·0% (105 of 2616) in the outpatient group and 3·5% (90 of 2603) in the inpatient care group (RD 0·0056 [95% CI -0·0047 to 0·0158]). The most common reason for poor clinical outcome was any sign of CSI at day 8 (3·4% in the outpatient group and 2·6% in the inpatient care group). Six (0·2%) young infants died in the outpatient group and eight (0·3%) in the inpatient care group. Besides deaths, two young infants developed serious adverse e","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"1 1","pages":"e1903-e1913"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314619","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":"Addressing stigma and violence against women with disabilities globally.","authors":"Katrina Scior,Aseel Hamid,Monjurul Kabir,Nicholas Booth,Simone Boneschi,Aleta Moriarty,Alisa Sivathorn","doi":"10.1016/s2214-109x(25)00364-x","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00364-x","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"1 1","pages":"e1813"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314630","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":"Postpartum haemorrhage: aligning for renewed action.","authors":" The Lancet Global Health","doi":"10.1016/s2214-109x(25)00417-6","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00417-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"352 1","pages":"e1781"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314634","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":"Achieving cervical cancer elimination: an ecological assessment of global determinants using a policy determinant model.","authors":"Amelia Hyatt,Karen Canfell,Rob Moodie,Sanchia Aranda","doi":"10.1016/s2214-109x(25)00310-9","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00310-9","url":null,"abstract":"BACKGROUNDCountries must implement and scale up effective programmes to achieve the WHO 2030 cervical cancer elimination targets; however, systemic challenges exist. This study aimed to determine key economic, political, sociocultural, and health-system determinants associated with achieving target coverage of human papillomavirus vaccination and screening, cancer treatment, and areas of opportunity for policy reform and health system strengthening.METHODSIn this ecological study, we developed a policy determinant model (PDM) to assess key policy determinants of interest using the following conceptual frameworks: social determinants of health, WHO building blocks, and universal health coverage. Core framework domains were operationalised within the PDM through identification of direct or proxy variables located in publicly available global datasets. The PDM was applied with cervical cancer as the disease focus, using an ecological approach. Kendall's and Pearson's correlation coefficients measured the strength of associations between policy indicators and indicators measuring WHO elimination target coverage for vaccination, screening, and treatment.FINDINGSData from 155 countries across 39 policy determinant indicators were analysed. Indicators measuring equity-focused economic, social, and public policies had large positive associations, with higher values reported for country-level screening and treatment coverage, per WHO targets. Assessment of indicators measuring health system performance likewise showed core health system capability and availability to be associated with progress in cervical cancer elimination. National cancer control planning had low or no associations with achieving target coverage, indicating ineffective implementation.INTERPRETATIONSocial, economic, cultural, and environmental policies, in conjunction with health system performance and equitable access to care play integral roles in country capacity to achieve the 2030 elimination targets. In harnessing the cervical cancer elimination agenda, nations have the opportunity to leverage global momentum and funding to drive broader health system strengthening, investment, and policy reform.FUNDINGAustralian National Health and Medical Research Centre.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"6 1","pages":"e1828-e1836"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314610","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":"Screening for asymptomatic tuberculosis among adults with household exposure to pulmonary tuberculosis: a prospective observational cohort study.","authors":"Simon C Mendelsohn,Humphrey Mulenga,Michele Tameris,Tumelo Moloantoa,Stephanus T Malherbe,Austin Katona,Fernanda Maruri,Firdows Noor,Ravindre Panchia,Khuthadzo Hlongwane,Kim Stanley,Yuri F van der Heijden,Katie Hadley,Dominique T Ariefdien,Novel N Chegou,Gerhard Walzl,Thomas J Scriba,Timothy R Sterling,Mark Hatherill, ","doi":"10.1016/s2214-109x(25)00276-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00276-1","url":null,"abstract":"BACKGROUNDMore than half of tuberculosis cases detected by community prevalence surveys are classified as asymptomatic. We evaluated yield of symptom and chest radiograph screening of tuberculosis-exposed household contacts in South Africa.METHODSFor this prospective observational cohort study, adult volunteers (aged ≥18 years) with household exposure within the past 6 months to patients with untreated or partially treated pulmonary tuberculosis, identified through local health services, were enrolled at three sites in South Africa (Worcester and Ravensmead, Western Cape Province, and Soweto, Gauteng Province). Household contacts were excluded if they were unlikely to attend study visits, or had conditions interfering with consent or study participation, including psychiatric illness, substance dependence, or incarceration. Systematic screening of tuberculosis symptoms (any duration), chest radiograph (any abnormality indicative of active tuberculosis), and sputum microscopy, Xpert Ultra, and liquid culture were performed. Serum C-reactive protein (CRP) was measured by multiplex bead array. Prevalent tuberculosis was microbiologically confirmed (Xpert Ultra or culture). Symptomatic and asymptomatic tuberculosis were defined as prevalent tuberculosis with and without reported symptoms compatible with tuberculosis. The primary outcome was the diagnostic yield (sensitivity) of microbiologically confirmed pulmonary tuberculosis.FINDINGSBetween April 22, 2021 and Sept 22, 2022, 979 household contacts were enrolled, 345 (35·2%) male and 634 (64·8%) female, 185 (18·9%) living with HIV and 187 (19·1%) with previous tuberculosis. Prevalent tuberculosis occurred in 51 (5·2%) and was asymptomatic in 42 (82·4%) of 51. Only 13 (31·0%) of 42 asymptomatic people with tuberculosis were sputum-smear positive; eight (61·5%) of these 13 had a low bacillary burden, with smear grades scanty or 1+ (1-99 acid-fast bacilli per 100 fields). CRP did not discriminate healthy household contacts from those with asymptomatic tuberculosis (area under the curve 0·60, 95% CI 0·47-0·73). An abnormal chest radiograph suggestive of tuberculosis was observed in 23 of 41 asymptomatic (sensitivity 56·1%, 95% CI 41·0-70·1) versus eight of nine symptomatic (sensitivity 88·9%, 56·5-98·0) people with tuberculosis. Sensitivity of chest radiograph in combination with symptom screening was 32 (64·0%) of 50 (50·1-75·9) for all prevalent tuberculosis.INTERPRETATIONMore than 80% of confirmed people with tuberculosis among household contacts were asymptomatic; chest radiograph screening missed more than 40% of these. Community prevalence surveys reliant on symptom-based and chest radiograph-based approaches might substantially underestimate the prevalence of asymptomatic tuberculosis in endemic countries.FUNDINGRegional Prospective Observational Research for Tuberculosis South Africa through funding from the US National Institutes of Health, the Civilian Research and Development Foundation, and ","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"43 1","pages":"e1869-e1879"},"PeriodicalIF":34.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314613","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}