Lancet Global Health最新文献

{"title":"The impact of aid sanctions on maternal and child mortality, 1990-2019: a panel analysis.","authors":"Ruth M Gibson, Paul H Wise, Joseph L Dieleman, Yoto V Yotov, Aleksandra Kirilakha, Gary L Darmstadt, Eran Bendavid, Constantinos Syropoulos, Michele Barry, Sebastien Bradley","doi":"10.1016/S2214-109X(25)00058-0","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00058-0","url":null,"abstract":"<p><strong>Background: </strong>Aid sanctions are a type of financial punishment imposed on a country by other countries or international organisations in response to a political coup, armed conflict, or human rights abuses. Humanitarian catastrophes in Burkina Faso, Sudan, and Myanmar have brought aid sanctions to the centre of the foreign affairs strategy debate because of their inadvertent negative effects on human health. Our analysis investigates the effects of aid sanctions from 1990 to 2019 on maternal and child mortality. These questions are particularly relevant in the context of the abrupt shift in US foreign aid policy in 2025, leading to aid prohibitions that might resemble aid sanctions in their effects.</p><p><strong>Methods: </strong>Data were drawn from a broad set of sources, including population health metrics databases, established sanctions databases, and a novel global dataset on aid sanctions created for this study. We assessed the prevalence of the use of aid sanctions worldwide during 1990-2019 and estimated their impact on official development assistance (ODA) and development assistance for health (DAH). We investigated the effect of aid sanctions on infant (age <1 year), children younger than 5 years (hereafter referred to as under-5), maternal (within 42 days of the end of pregnancy), and all-age mortality rates using panel difference-in-differences ordinary least squares estimation. We applied linear regression methods and included country and year fixed effects, country-specific time trends, and multiple control variables. We also conducted a series of sensitivity analyses, including entropy balancing, to confirm the validity of our results.</p><p><strong>Findings: </strong>During our study period, 67 low-income or middle-income countries (LMICs) and sovereign territories (hereafter referred to as countries) were targeted by 88 unique aid sanction episodes. Relative to our control group of 66 never-sanctioned countries, aid sanctions reduced ODA by an estimated US$213·07 million per year (95% CI 502·28 to -76·12) for the average target country and reduced DAH by $16·42 million (32·57 to 0·27)--a 17% reduction in DAH. Aid sanctions resulted in an additional 129·3 infant deaths per 100 000 livebirths (11·7 to 246·9), an additional 47·1 under-5 deaths per 100 000 livebirths (-2·8 to 97·0), and an additional 10·9 (2·2-19·6) maternal deaths per 100 000 livebirths, per year. Relative to mean in-sample mortality rates, aid sanctions thus increased infant, under-5, and maternal mortality rates by 3·1%, 3·6%, and 6·4%, respectively, on an annual basis.</p><p><strong>Interpretation: </strong>Over the period 1990-2019, infant, under-5, and maternal mortality rates among LMICs declined at average annualised rates of 2·6%, 3·2%, and 2·0%, respectively. Aid sanction episodes lasting 5 years-the median duration observed in our sample-would thus negate nearly 30% of the overall improvements in infant and under-5 mortality seen in the","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694190","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":"A roadmap for integrating nutritional assessment, counselling, and support into the care of people with tuberculosis.","authors":"Pranay Sinha, Madhavi Bhargava, Madeline E Carwile, Madolyn R Dauphinais, Phumeza Tisile, Chelsie Cintron, Lindsey M Locks, Janika Hauser, Matt Oliver, Scott K Heysell, Saurabh Mehta, Julia L Finkelstein, Kobto G Koura, J Peter Cegielski, Rein M G J Houben, C Finn McQuaid, Anurag Bhargava","doi":"10.1016/S2214-109X(25)00021-X","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00021-X","url":null,"abstract":"<p><p>Undernutrition-the leading risk factor for tuberculosis worldwide-is associated with impaired immunity, more extensive disease, delayed sputum conversion, and worse treatment outcomes, including mortality. In this Health Policy, we propose a comprehensive roadmap for integrating nutritional assessment, counselling, and support into tuberculosis treatment as part of person-centred care. At treatment initiation, we recommend standard nutritional assessment with anthropometric measurements and haemoglobin estimation, in addition to macronutrient and micronutrient support alongside nutritional counselling. Weight should be monitored during treatment and lack of weight gain at the end of the intensive phase should prompt an investigation of causes, such as food insecurity, poor treatment adherence, malabsorption, uncontrolled diabetes, or drug resistance. At the end of treatment, we recommend reassessing anthropometric measures to assess nutritional recovery. People with tuberculosis who remain underweight should receive close follow-up to detect early relapse. We call for annual reporting of nutritional metrics by WHO, explicit inclusion of nutritional assessment and care in national strategic plans, domestic or international support of nutritional programmes for people with tuberculosis, increased support for operational research initiatives, and integration of nutritional care into the WHO Multisectoral Accountability Framework at national and regional levels.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694188","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":"No health without aid and development.","authors":"Charlotte Hanlon, Martyn Pickersgill, Seth Amanfo, Harry Campbell, Anna Chiumento, Jeff Collin, Michael Eddleston, Liz Grant, Ewen Harrison, Aisha Holloway, Sumeet Jain, Stephen Lawrie, Angus Macbeth, Chelsea Morroni, Lotte Segal, Nadine Seward, Rosie Stenhouse, Robert C Stewart, Harish Nair","doi":"10.1016/S2214-109X(25)00111-1","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00111-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694189","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":"Africa's defining moment: the time to lead the HIV response is now.","authors":"Mumbi Chola, Izukanji Sikazwe, Magda Robalo, Pokuaa Oduro-Bonsrah, Alex Coutinho, Robb Sheneberger, Jekwu Ozoemene, Pierre M'pele, Damaris Nyamweya, Sasha Stevenson, Yvette Raphael, Sesupo Makakole Nene, John Ataguba, Mohamed Chakroun, Michel Sidibe","doi":"10.1016/S2214-109X(25)00102-0","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00102-0","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630963","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":"Urgent and decisive action needed in maternal morbidity and mortality to prevent stagnation in progress.","authors":"Maria Laura Costa, Jose Guilherme Cecatti","doi":"10.1016/S2214-109X(25)00069-5","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00069-5","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597863","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":"Global and regional causes of maternal deaths 2009-20: a WHO systematic analysis.","authors":"Jenny A Cresswell, Monica Alexander, Michael Y C Chong, Heather M Link, Marija Pejchinovska, Ursula Gazeley, Sahar M A Ahmed, Doris Chou, Ann-Beth Moller, Daniel Simpson, Leontine Alkema, Gemma Villanueva, Yanina Sguassero, Özge Tunçalp, Qian Long, Shaoming Xiao, Lale Say","doi":"10.1016/S2214-109X(24)00560-6","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00560-6","url":null,"abstract":"<p><strong>Background: </strong>Maternal mortality is not on track to meet Sustainable Development Goal (SDG) target 3.1 of a global maternal mortality ratio below 70 per 100 000 livebirths by 2030. Updated evidence on causes of death is needed to accelerate progress.</p><p><strong>Methods: </strong>We conducted a multi-strategy systematic review to identify causes of maternal deaths occurring in 2009-20. Data sources included civil registration and vital statistics systems data from the WHO Mortality Database, reports published by Member States, and national and subnational journal articles identified via bibliographic databases. We used a Bayesian hierarchical model to estimate the maternal cause of death distribution by SDG regions and worldwide. Given the paucity of data on maternal suicide and late maternal deaths occurring beyond 42 days postpartum, additional analyses were conducted to estimate the proportion of maternal deaths from suicide and the ratio of maternal to late maternal deaths (all cause).</p><p><strong>Findings: </strong>Globally, the most common cause of maternal death was haemorrhage (27%; 80% uncertainty interval 22-32), followed by indirect obstetric deaths (23%, 18-30), and hypertensive disorders (16%, 14-19). The proportion of haemorrhage deaths varied substantially by region and was highest in sub-Saharan Africa and Western Asia and Northern Africa. The proportion of maternal deaths from hypertensive disorders was highest in Latin America and the Caribbean. Most maternal deaths from haemorrhage and sepsis occurred during the postpartum period. Only 12 countries recorded one or more maternal suicides; of those countries, the proportion of deaths from suicide ranged from below 1% to 26% of maternal deaths. For countries reporting at least one late maternal death (ie, deaths that occur more than 42 days but less than 1 year after the termination of pregnancy), the ratio of late maternal deaths to maternal deaths up to 42 days ranged from <0·01 to 0·07.</p><p><strong>Interpretation: </strong>Haemorrhage remains the leading cause of death, despite the existence of effective clinical interventions, emphasising the need for improved access to quality health care. The timing of most deaths in the postpartum period demands renewed commitment to improving the provision of postpartum care in addition to intrapartum care. Indirect causes of death require health system approaches to integrate obstetric and non-obstetric care.</p><p><strong>Funding: </strong>USAID; US Fund for UNICEF via the Bill & Melinda Gates Foundation; and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP).</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597925","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":"Thank you to The Lancet Global Health's statistical and peer reviewers in 2024.","authors":"Zoë Mullan","doi":"10.1016/S2214-109X(25)00050-6","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00050-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 3","pages":"e407-e413"},"PeriodicalIF":19.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531958","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":"Mpox vaccination strategies in DR Congo.","authors":"Rajesh Kanna Gopal, Pitchaipillai Sankar Ganesh, Naji Naseef Pathoor","doi":"10.1016/S2214-109X(25)00006-3","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00006-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 3","pages":"e415"},"PeriodicalIF":19.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532010","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":"Tuberculosis and people who use drugs: why focus on this overlooked population is important and why adapted interventions are necessary.","authors":"Morgana D'Ottavi, Peter Godfrey-Faussett, Corinne S Merle, Mircea T Sofonea, Didier Laureillard, Peter Vickerman, Jean-Pierre Molès, Frederick L Altice, Philippe Van de Perre, Jack Stone, Nicolas Nagot","doi":"10.1016/S2214-109X(24)00481-9","DOIUrl":"10.1016/S2214-109X(24)00481-9","url":null,"abstract":"<p><p>People who use drugs show a higher incidence and prevalence of tuberculosis than people who do not use drugs in areas where Mycobacterium tuberculosis is endemic. However, this population is largely neglected in national tuberculosis programmes. Strategies for active case finding, screening, and linkage to care designed for the general population are not adapted to the needs of people who use drugs, who are stigmatised and difficult to reach. Moreover, access to care, linkage to care, and treatment adherence are challenging for such a marginalised population. Learning from the HIV field about successful interventions targeting this group, we advocate for the implementation of tuberculosis interventions adapted for people who use drugs, highlighting the key role that community-based approaches could have in both design and implementation. Alongside reducing health inequities by reducing the excess tuberculosis burden among people who use drugs, these targeted interventions can also reduce tuberculosis transmission at the population level.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e593-e598"},"PeriodicalIF":19.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042664","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":"Childhood iron-folic acid supplementation in India for mild-to-moderate anaemia.","authors":"Tinku Thomas, Anura Kurpad","doi":"10.1016/S2214-109X(25)00053-1","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00053-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 3","pages":"e383-e384"},"PeriodicalIF":19.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531984","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}