Lancet Global Health最新文献

{"title":"Correction to Lancet Glob Health 2022; 11: e1623–31","authors":"","doi":"10.1016/j.langlo.2026.104056","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104056","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"24 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148461867","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 2025 small island developing states report of the Lancet Countdown on health and climate change: building resilience in the face of rising heat.","authors":"Georgiana M Gordon-Strachan,Stephanie Y Parker,Heather C Harewood,Kimalie F Parchment,David C Smith,Pablo Mendez-Lazaro,Abdullahi O Abdulkadri,Paul J Beggs,Daniel F Buss,Shouro Dasgupta,Natalie G Guthrie-Dixon,Natalie S Greaves,Harry Kennard,Sandeep B Maharaj,Kwesi G Marshall,Shelly R McFarlane,Kimberley S McKenzie,Maziar Moradi-Lakeh,Madhuvanti Murphy,Michelle A Mycoo,Roannie Ng Shiu,Kelera S Oli,Fereidoon Owfi,Karen A Polson,Mahnaz Rabbaniha,Tim Repke,Elizabeth J Z Robinson,Meisam Tabatabaei,Maria Walawender,Marina Romanello","doi":"10.1016/j.langlo.2026.103961","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.103961","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"39 1","pages":"103961"},"PeriodicalIF":34.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451662","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":"Genetic testing versus clinical screening for relatives of patients with hypertrophic cardiomyopathy in the Brazilian public health system: a cost-utility analysis.","authors":"Andressa Braga,Marisa Santos,Bernardo Tura,Marcelo Correia,Adriana Bastos Carvalho,Tais Hanae Kasai-Brunswick,Raiana Andrade Quintanilha Barbosa,Dilza Campos,Milene Rangel,Carlos Magliano","doi":"10.1016/j.langlo.2026.103979","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.103979","url":null,"abstract":"BACKGROUNDHypertrophic cardiomyopathy (HCM) is an autosomal dominant myocardial disorder affecting 0·2% of the global population and a leading cause of sudden cardiac death in young individuals and athletes. Current guidelines recommend periodic clinical screening of first-degree relatives for early diagnosis and risk stratification. Genetic testing identifies at-risk individuals while exempting genotype-negative relatives from lifelong surveillance. However, it remains unavailable in Brazil's public health system (Sistema Único de Saúde, SUS). This study aimed to evaluate the cost-utility of genetic testing for HCM cascade screening in Brazil.METHODSA cost-utility analysis was conducted from the SUS perspective, using a hybrid decision tree and Markov model to project lifetime costs and health outcomes. Inputs were derived from literature and validated by a multidisciplinary expert panel. Genetic testing costs were micro-costed; other costs were obtained from Brazil's national reimbursement database (SIGTAP). Effectiveness was measured in quality-adjusted life-years (QALYs). Deterministic and probabilistic analyses assessed model robustness.FINDINGSGenetic testing was cost-effective (incremental cost-effectiveness ratio: US$1411 per QALY), yielding an incremental gain of 0·06 QALYs per relative at an additional cost of $87 per relative. Utility values had the greatest influence on cost-utility outcomes. In probabilistic analysis, genetic testing was cost-effective in 99·4% of simulations at the Brazilian willingness-to-pay threshold of $7421 per QALY. In the base-case hypothetical cohort of 1000 relatives (250 probands with four first-degree relatives each), 205 (20·5%) of 1000 relatives were exempted from lifelong surveillance, reducing screening visits by 18·6% per tested individual.INTERPRETATIONGenetic testing is a cost-effective strategy for HCM cascade screening in Brazil's public health system. By exempting genotype-negative relatives from lifelong surveillance, it optimises resource allocation, reduces unnecessary follow-ups and psychological burden, and supports informed family planning. These findings provide an economic evidence base for integrating genetic testing into SUS clinical practice guidelines.FUNDINGPrograma Nacional de Genômica e Saúde de Precisão (Genomas Brasil) of the Brazilian Ministry of Health and Conselho Nacional de Desenvolvimento Científico e Tecnológico.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"273 1","pages":"103979"},"PeriodicalIF":34.3,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416046","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":"In-hospital and post-discharge mortality among infants with respiratory syncytial virus in rural Kenya: a 25-year retrospective cohort study.","authors":"Maureen W Mburu,Esther Nyadzua Katama,Mercy S Safari,Timothy O Makori,Elijah T Gicheru,Martin Mutunga,Clement Lewa,Robinson Cheruiyot,Hillary Wafula,Grace Maina,Caroline Ngetsa,Augustus Kea,Neema Mturi,Mohammed Shebe,John Kalama Fondo,Charles Chesaro,Hiza Dayo,Joyce U Nyiro,Charles N Agoti,Charles J Sande","doi":"10.1016/j.langlo.2026.104003","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104003","url":null,"abstract":"BACKGROUNDRespiratory syncytial virus (RSV) is the leading cause of hospital admission for lower respiratory infection in infants worldwide, with more than 95% of deaths occurring in low-income and middle-income countries. Predictors of adverse outcomes following RSV hospitalisation remain poorly defined. We aimed to identify clinical and anthropometric predictors of mortality among infants admitted with RSV pneumonia and to assess changes in mortality over a 25-year surveillance period.METHODSIn this retrospective cohort study, we analysed 25 years of paediatric surveillance at Kilifi County Hospital, Kilifi, Kenya, spanning 25 successive RSV seasons. Neonates (aged <28 days) and post-neonatal infants (aged 28 days to 12 months) admitted with WHO-defined pneumonia were tested for RSV and demographic, anthropometric, and clinical data were recorded at admission. The primary outcome was in-hospital death among infants admitted with RSV pneumonia. Predictors of mortality were identified using random-forest and multivariable logistic regression, and temporal trends in mortality and anthropometric status were examined.FINDINGSOf 75 482 admissions of infants to Kilifi County Hospital between Jan 1, 2001, and July 13, 2025, 19 299 (25·6%) met WHO pneumonia criteria and 2745 (22·7%) had RSV. Of these infants, 2390 (87·1%) were post-neonatal, of whom 58 (2·4%) died in hospital with 44 (76%) deaths within 7 days of admission. Mortality was independently associated with congenital heart disease (odds ratio 3·51 [95% CI 1·37-8·97]), severe undernutrition (per 1-unit reduction in weight-for-age Z score: 1·59 [1·28-1·99]), and hypoxaemia (per 1% decrease in peripheral oxygen saturation: 1·05 [1·03-1·08]). 38 (70·4%) of 54 infants with RSV who died in hospital had a mid-upper arm circumference below the severe acute malnutrition threshold of 11·5 cm. There was no evidence of a sustained decline in RSV-associated in-hospital mortality or improvement in anthropometric status over the 25-year study period.INTERPRETATIONRSV mortality in Kenyan infants remains high and has not declined over 25 years. Severe undernutrition and congenital heart disease identify infants with RSV who are at the highest risk of in-hospital death. These findings highlight the role of chronic anthropometric deficits in RSV outcomes and support targeted nutritional interventions to reduce mortality.FUNDINGBill & Melinda Gates Foundation and Wellcome.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"35 1","pages":"104003"},"PeriodicalIF":34.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416048","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":"Country ownership without fiscal justice is responsibility without resources.","authors":"Katherine Tumlinson,Madhukar Pai","doi":"10.1016/j.langlo.2026.104013","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104013","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"267 1","pages":"104013"},"PeriodicalIF":34.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393663","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 feasibility of cervical cancer elimination: a multidimensional scenario-based modelling analysis across 175 countries.","authors":"Mauricio A Cuello,Fernán Gomez-Valenzuela,Ignacio Wichmann,Alexander B Olawaiye","doi":"10.1016/j.langlo.2026.104008","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104008","url":null,"abstract":"BACKGROUNDCervical cancer remains a major cause of preventable cancer mortality worldwide. Progress towards elimination remains uneven, with persistent disparities in health system capacity, governance, and education. Existing models often rely on income classifications, overlooking structural determinants critical for success. We aimed to evaluate the global feasibility of cervical cancer elimination under structurally differentiated policy scenarios.METHODSWe developed a multidimensional scenario-based model integrating 270 structural indicators obtained from WHO, IARC, UN, World Bank, and other international databases across 175 countries. Principal component analysis and clustering identified four structural readiness groups beyond income-based typologies. Regression modelling and Monte Carlo simulations (500 iterations per country-scenario trajectory) were used to project age-standardised incidence and mortality rates from 2022 to 2050 under four policy scenarios: Inertia (no structural improvements), Vaccination Focus (increased HPV vaccine uptake), Empowerment (vaccination plus education gains), and Comprehensive Progress (multidimensional structural strengthening). Monte Carlo simulations propagated uncertainty. Time-series projections to 2050 were independently benchmarked using autoregressive integrated moving average models based on historical trends from 2004-2022.FINDINGSStructural readiness was more strongly associated with elimination feasibility than income classification. Of 175 countries, 48 were more likely than not (probability ≥0·50) to meet both WHO elimination targets by 2050 under Comprehensive Progress, compared with 15 under Empowerment, two under Vaccination Focus, and none under Inertia. Across countries, estimated probabilities ranged from near 0·00 in several high-burden settings to 1·00 in some high-readiness countries. Mortality reductions lagged incidence declines across all scenarios.INTERPRETATIONAchieving cervical cancer elimination globally will require strategies addressing systemic barriers beyond vaccination. Integrating education, health infrastructure, and targeted financing is essential, but many countries will remain above elimination thresholds without sustained policy engagement and equitable resource allocation.FUNDINGCenter for Cancer Prevention and Control (CECAN).","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"446 1","pages":"104008"},"PeriodicalIF":34.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372403","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":"PABS and the dangerous temptation of more time.","authors":" The Lancet Global Health","doi":"10.1016/j.langlo.2026.104042","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104042","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"24 1","pages":"104042"},"PeriodicalIF":34.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372405","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":"Phone-based screening versus home-based screening after tuberculosis in India (TB Aftermath): a multicentre, open-label, randomised, controlled, non-inferiority trial.","authors":"Samyra R Cox,Abhay Kadam,Shahanara Valawalkar,Gayatri Lele,Aye Hnin Moe,Vipul Dhamale,Akshay N Gupte,Nishi Suryavanshi,Emily A Kendall,Hojoon Sohn,Christopher J Hoffmann,Arjunlal Kakrani,Ryan Thompson,Nikhil Gupte,Madhu Sudan Barthwal,Jonathan E Golub,Vidya Mave, ","doi":"10.1016/j.langlo.2026.103971","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.103971","url":null,"abstract":"BACKGROUNDTuberculosis survivors and their household contacts are at increased risk for tuberculosis even after treatment completion; however, effective strategies for post-tuberculosis screening remain untested. We aimed to assess whether phone-based screening is non-inferior to home-based screening for tuberculosis after treatment completion in India.METHODSIn this multicentre, open-label, randomised, controlled, non-inferiority trial, we enrolled tuberculosis survivors (aged >18 years) within 60 days of completing treatment for any form of tuberculosis from six public clinics in Maharashtra, India. Household contacts were enumerated at baseline (all ages). Survivors were randomly assigned (1:1) to receive phone-based or home-based symptom screening at 6 months and 12 months. The trial was powered to identify a difference in the tuberculosis detection rate per 100 person-years among survivors and contacts together (primary outcome), comparing screening groups during the 12 months after survivor treatment completion. We conducted an intention-to-treat analysis with a rate difference non-inferiority margin of 1·70 per 100 person-years based on the upper bound of the 95% CI. We adjusted for household-level clustering of tuberculosis by fitting a multilevel Poisson model. We also conducted a subgroup analysis of detection rates among survivors and contacts separately. This study is registered with ClinicalTrials.gov, NCT04333485 and is completed.FINDINGSWe enrolled 1076 tuberculosis survivors (537 in the phone-based screening group and 539 in the home-based screening group) and enumerated 3309 contacts (1638 in the phone-based screening group and 1671 in the home-based screening group) between Jan 21, 2021, and Sept 4, 2023. In the 12-month post-treatment period, tuberculosis was detected in 75 (7%) tuberculosis survivors and 30 (1%) contacts: 41 events in the phone-based screening group (rate 1·19 [95% CI 0·82-1·71]) compared with 64 events in the home-based screening group (1·92 [1·37-2·45]). Non-inferiority was reached (rate difference 0·73 [95% CI 0·05-1·41]). Among tuberculosis survivors, the recurrence detection rate was 4·36 (95% CI 2·87-6·34) in the phone-based screening group compared with 8·00 (5·90-10·60) in the home-based screening group (p=0·01). Among contacts, the tuberculosis detection rate was 0·61 (95% CI 0·32-1·07) in the phone-based screening group compared with 0·70 (0·39-1·20) in the home-based screening group (p=0·70).INTERPRETATIONRisk of tuberculosis remains high for households with a tuberculosis survivor. For detecting tuberculosis among survivors and their household contacts together, phone-based screening was non-inferior to home-based screening. For survivors, the recurrence detection rate was higher in the home-based screening group. Countries with a high burden of recurrence should consider home-based screening among tuberculosis survivors.FUNDINGUS National Institute of Allergy and Infectious Diseases.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"37 1","pages":"103971"},"PeriodicalIF":34.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372402","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, regional, and national impact of the Expanded Programme on Immunization against 14 pathogens from 1974 to 2024: an economic evaluation.","authors":"Xiaozhen Lai, Kaja Abbas, Koen B Pouwels, Mark Jit, Hai Fang","doi":"10.1016/j.langlo.2026.103965","DOIUrl":"10.1016/j.langlo.2026.103965","url":null,"abstract":"<p><strong>Background: </strong>2024 marked the 50th anniversary of the Expanded Programme on Immunization (EPI), launched by WHO. Despite its crucial role in preventing infectious diseases, EPI's 50-year economic impact has not been systematically evaluated. This study aims to estimate the benefit-cost ratios (BCRs) and incremental cost-effectiveness ratios (ICERs) of EPI at global, regional, and national levels.</p><p><strong>Methods: </strong>We conducted an economic evaluation of EPI for 14 globally important pathogens with robust long-term data availability: Corynebacterium diphtheriae (diphtheria), Haemophilus influenzae type b, hepatitis B virus (hepatitis B), Japanese encephalitis virus (Japanese encephalitis), measles virus (measles), Neisseria meningitidis group A (meningitis A), Streptococcus pneumoniae, Bordetella pertussis (pertussis), poliovirus (polio), rotavirus, rubella virus (rubella), Clostridium tetani (tetanus), Mycobacterium tuberculosis (tuberculosis), and yellow fever virus (yellow fever) from Jan 1, 1974, to Dec 31, 2024, across 194 WHO member states. We compared costs (procurement, administration, and family additional costs from time spent synthesised from authoritative global databases and systematic literature reviews) and benefits (primarily averted mortality retrieved from published global burden estimates) between observed EPI implementation and a counterfactual scenario of no vaccination, from which BCRs and ICERs were derived.</p><p><strong>Findings: </strong>From 1974 to 2024, the cost of EPI reached US$937 billion (95% CI 699-1187), offset by $15 050 billion (12 609-17 605) in averted productivity losses due to mortality (aggregate BCR 16·06 [95% CI 10·62-25·20]; ICER cost-saving). Immunisation against all 14 pathogens showed favourable economic outcomes. Measles vaccination produced the highest BCR (73·97 [45·78-124·06]), and the ICERs for all vaccines remained below conventional cost-effectiveness thresholds. EPI against 14 pathogens in aggregate achieved cost savings (BCR>1) in all 194 WHO member states. Economic returns varied across six WHO regions and four World Bank income groups, with the Eastern Mediterranean region (BCR 17·22 [11·22-28·67]) and low-income countries (BCR 23·63 [16·87-34·32]) showing the highest BCRs.</p><p><strong>Interpretation: </strong>The 50-year EPI has proven highly cost-effective at global, regional, and national levels, and remains a worthwhile investment. The EPI delivered impactful life-saving benefits and favourable economic returns, especially in high-burden and low-income settings.</p><p><strong>Funding: </strong>The National Natural Science Foundation of China, the China Postdoctoral Science Foundation, the Vaccine Impact Modelling Consortium, and the Japan Agency for Medical Research and Development.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"103965"},"PeriodicalIF":22.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165371","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":"Elimination in the age of retrenchment: what hepatitis reveals about the future of global health.","authors":"Noah M Trudeau, Catherine Freeland, Kenneth Kabagambe, C Wendy Spearman, Prince Okinedo, Philippa C Matthews","doi":"10.1016/j.langlo.2026.103959","DOIUrl":"10.1016/j.langlo.2026.103959","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"103959"},"PeriodicalIF":22.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876276","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}